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psnet.ahrq.gov/issue/challenges-implementing-centers-disease-control-and-prevention-opioid-guideline-consensus
January 25, 2017 - Commentary
Challenges with implementing the Centers for Disease Control and Prevention opioid guideline: a consensus panel report.
Citation Text:
Kroenke K, Alford DP, Argoff C, et al. Challenges with Implementing the Centers for Disease Control and Prevention Opioid Guideline: A Consens…
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psnet.ahrq.gov/issue/relationship-between-nursing-home-staffing-and-resident-safety-outcomes-systematic-review
April 20, 2022 - Review
The relationship between nursing home staffing and resident safety outcomes: a systematic review of reviews.
Citation Text:
Blatter C, Osińska M, Simon M, et al. The relationship between nursing home staffing and resident safety outcomes: a systematic review of reviews. Int J Nurs…
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psnet.ahrq.gov/issue/measuring-administrators-and-direct-care-workers-perceptions-safety-culture-assisted-living
June 02, 2010 - Study
Measuring administrators' and direct care workers' perceptions of the safety culture in assisted living facilities.
Citation Text:
Castle NG, Wagner LM, Sonon K, et al. Measuring administrators' and direct care workers' perceptions of the safety culture in assisted living facilitie…
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psnet.ahrq.gov/issue/association-overlapping-surgery-patient-outcomes-large-series-neurosurgical-cases
November 16, 2022 - Study
Association of overlapping surgery with patient outcomes in a large series of neurosurgical cases.
Citation Text:
Howard BM, Holland CM, Mehta C, et al. Association of Overlapping Surgery With Patient Outcomes in a Large Series of Neurosurgical Cases. JAMA Surg. 2018;153(4):313-321…
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psnet.ahrq.gov/issue/bone-break-hot-debrief-tool-reduce-second-victim-syndrome-nurses
August 02, 2015 - Study
BONE break: a hot debrief tool to reduce second victim syndrome for nurses.
Citation Text:
Hess A, Flicek T, Watral AT, et al. BONE break: a hot debrief tool to reduce second victim syndrome for nurses. Jt Comm J Qual Patient Saf. 2024;50(9):673-677. doi:10.1016/j.jcjq.2024.05.005.…
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psnet.ahrq.gov/issue/exploring-physician-perspectives-residency-holdover-handoffs-qualitative-study-understand
April 27, 2015 - Study
Exploring physician perspectives of residency holdover handoffs: a qualitative study to understand an increasingly important type of handoff.
Citation Text:
Duong JA, Jensen TP, Morduchowicz S, et al. Exploring Physician Perspectives of Residency Holdover Handoffs: A Qualitative St…
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psnet.ahrq.gov/issue/older-adult-misuse-over-counter-medications-effectiveness-novel-pharmacy-based-intervention
March 23, 2022 - Study
Older adult misuse of over-the-counter medications: effectiveness of a novel pharmacy-based intervention to improve patient safety.
Citation Text:
Gilson AM, Chladek JS, Stone JA, et al. Older adult misuse of over-the-counter medications: effectiveness of a novel pharmacy-based int…
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www.ahrq.gov/nursing-home/resources/transfer-tips.html
February 01, 2021 - Tips for Transfer
Resource: Tips for Transfer (PDF, 245 KB)
This form is to be completed by nursing home staff prior to transferring a resident to the hospital. The completed form should travel with the resident to provide ED staff with essential information.
Source: Probari - for the IN DOH
Topic(s):…
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www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/availability/chipra-0122-technical-specs.pdf
June 02, 2025 - The percent of all residents in poverty by county or county
equivalent are available from the US Department
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/pruprev/functspecs.html
December 01, 2017 - AHRQ's Safety Program for Nursing Homes: On-Time Pressure Ulcer Prevention
Functional Specifications
1.0. Functional Specs for Pressure Ulcer Prevention
2.0. Pressure Ulcer Prevention Reports
3.0. Specifications for Each Pressure Ulcer Prevention Report
3.1. Nutrition Risk Reports: High Risk and …
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www.ahrq.gov/teamstepps-program/curriculum/mutual/tools/desc.html
July 01, 2023 - Tool: DESC
The DESC script is a constructive approach to managing and resolving conflict. While used to address both informational and interpersonal conflict, it is most effective with the latter. It is especially appropriate for major conflicts such as hostile or harassing behaviors that are putting the well-b…
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www.ahrq.gov/hai/cauti-tools/archived-webinars/reducing-urinary-catheter-use-ed-slides.html
December 01, 2017 - Reducing Unnecessary Urinary Catheter Use in the Emergency Department
Slide Presentation
Slide 1
Reducing Unnecessary Urinary Catheter Use in the Emergency Department
Margarita E. Pena, MD, FACEP
Medical Director, Clinical Decision Unit
St. John Hospital and Medical Center
Detroit, MI
Image: Photo…
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digital.ahrq.gov/sites/default/files/docs/publication/uc1hs016143-shank-final-report-2009.pdf
January 01, 2009 - The 90,410 Panhandle residents are especially isolated. … It is not uncommon for
residents to have to drive for several hours to obtain health care or even to … Panhandle residents are
poorer than those living in other parts of Nebraska and the nation. … The Panhandle’s residents are
also less likely to have access to insurance. … rural areas,
the age distribution is also undergoing dramatic reshaping: Over 21% of the Panhandle’s
residents
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www.ahrq.gov/sites/default/files/2025-07/weinger3-report.pdf
January 01, 2025 - Sixty board-certified anesthesiologists (BCAs) and 42 anesthesia residents managed four
standardized … Overall, senior residents received the highest scores followed
closely by BCAs with junior residents … Junior anesthesia residents
needed to have more than 6 months (but <1.5 years) of clinical anesthesia … On each study day (Figure 1), 2-4 BCAs and/or anesthesia residents participated in the 4 simulated
crises … Senior residents
took their ABA exams shortly after participating in IMPACTS while fellows and junior
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www.ahrq.gov/sites/default/files/2024-01/scott-cawiezell-report.pdf
January 01, 2024 - Final Report Fall 2007
Nursing Home Medication Safety 2
Structured Abstract
Purpose: Nursing home residents … Scope: There are 1.6 million US nursing home residents at high risk for adverse effects from
medication … Nursing home residents have more illnesses and take
more medications; thus, they have more risk for … minor discrepancies in medication administration may negatively affect outcomes of
frail nursing home residents … The crushing of these medications
resulted in residents getting time-released medications in bolus doses
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psnet.ahrq.gov/node/36377/psn-pdf
October 28, 2010 - Healthcare: The Problems Are Organizational Not Clinical.
October 28, 2010
J Org Behavior. 2006;27(7):809-1029.
https://psnet.ahrq.gov/issue/healthcare-problems-are-organizational-not-clinical
This special issue looks at the organizational challenges to high quality and safe health care such as how
errors are hand…
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hcup-us.ahrq.gov/reports/statbriefs/sb78.pdf
August 01, 2009 - four categories:
– Large central metropolitan includes metropolitan areas with 1 million or more residents … – Large fringe metropolitan includes counties of metropolitan areas with 1 million or more
residents … includes micropolitan and nonmetropolitan counties, i.e., counties
with no town greater than 50,000 residents
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/fallsprev/ontimefallpxoverviewmaterialspacket.pdf
June 02, 2025 - Abt Single-Sided Body Template
On-Time Falls Prevention: Overview Materials Packet
Samples of four types of reports are provided here:
• On-Time Falls High-Risk Report.
• Quarterly Summary of Falls Risk Factors by Unit or Facility.
• Monthly Contextual Factors Report.
• Postfall Assessment Summary Report.
…
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psnet.ahrq.gov/web-mm/other-hand
December 12, 2012 - On the Other Hand
Citation Text:
Henneman EA. On the Other Hand. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2007.
Copy Citation
Format:
Google Scholar BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS …
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hcup-us.ahrq.gov/db/nation/nis/DataElements_NIS_2004_Hospital.pdf
January 01, 2004 - was expanded to include hospitals with a ratio of .25 or higher of full-
time equivalent interns and residents … member of the Council of Teaching Hospitals (COTH) or has a
ratio of full-time equivalent interns and residents … member of the Council of
Teaching Hospitals (COTH) or has a ratio of full-time equivalent interns and
residents … member of the Council of Teaching Hospitals (COTH) or has a
ratio of full-time equivalent interns and residents … NIS, teaching status
is stored in the variable H_TCH and does not include the ratio of interns and residents