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2661. Mod4-System-Focused-Event-Guide (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/candor/module4/mod4-system-focused-event-guide.pdf
      April 01, 2016 - Stakeholder: typically managers and people who work in the process, the upstream and downstream departments

2662. Title Page (pdf file)
      digital.ahrq.gov/sites/default/files/docs/publication/uc1hs016160-sakuda-final-report-2009.pdf
      January 01, 2009 - implementation, • A detailed HMVR decommission plan executed at project close-out, • Committed Holomua stakeholder

2663. CDS Connect Work Group Agenda - December 2021 (pdf file)
      cds.ahrq.gov/sites/default/files/workgroups/38971/CDS_Connect_WG_December_2021_Summary.pdf
      January 01, 2021 - CDS Connect Work Group Agenda - December 2021 Clinical Decision Support (CDS) Connect Work Group (WG) Meeting Summary December 16, 2021 3:00 – 4:00 pm ET Attendees: 39 people, including 5 phone dial-ins Organization Attendees AHRQ Sponsors Chris Dymek, Edward Lomotan, Mario Teran, James Swiger (4) …

2664. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49814/psn-pdf
      December 01, 2017 - Miscommunication in the OR Leads to Anticoagulation Mishap December 1, 2017 Solsky I, Haynes AB. Miscommunication in the OR Leads to Anticoagulation Mishap. PSNet [internet]. 2017. https://psnet.ahrq.gov/web-mm/miscommunication-or-leads-anticoagulation-mishap The Case A 63-year-old man with a history of coronary…

2665. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49487/psn-pdf
      August 21, 2005 - Surprise Wire August 21, 2005 Pearl JM, Donaldson NE. Surprise Wire. PSNet [internet]. 2005. https://psnet.ahrq.gov/web-mm/surprise-wire The Case A 39-year-old man with a history of liver disease presented to the emergency department (ED) with gastrointestinal bleeding and altered mental status. Due to his clinic…

2666. Module-3-Slides (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/takeheart/training/module-3-slides.pdf
      February 09, 2022 - Understanding Your Workflow Processes to Prepare for Systems Change S te v e n Ke tey i a n , P h D M c Ke n z i e Pe c k m a n , M S , AC S M - C E P Module 3 Today’s Training Session 2 PURPOSE Training sessions guided by the Million Hearts®/AACVPR Cardiac Rehabilitation Change Package (CRCP), locate…

2667. Antibiotic Stewardship Program (ASP) Development
      www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/program-dev-slides.pptx
      June 01, 2021 - Antibiotic Stewardship Program (ASP) Development Developing an Antibiotic Stewardship Program Long-Term Care AHRQ Safety Program for Improving Antibiotic Use AHRQ Pub. No. 17(21)-0029 June 2021 Developing a Program 1 Objectives Name the goals of antibiotic stewardship and why it is important in long-term care (LT…

2668. Strategies and Approaches for Tracking Improvements in Patient Safety | PSNet
      psnet.ahrq.gov/primer/strategies-and-approaches-tracking-improvements-patient-safety
      June 15, 2024 - Strategies and Approaches for Tracking Improvements in Patient Safety Citation Text: Shaikh U. Strategies and Approaches for Tracking Improvements in Patient Safety . PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2021. Copy Citat…

2669. Module 8: Organizational Learning and Sustainability | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/settings/hospital/candor/modules/notes8.html
      August 01, 2022 - Module 8: Organizational Learning and Sustainability AHRQ Communication and Optimal Resolution Toolkit Facilitator Notes Say: Module 8, the last module in the CANDOR Toolkit, provides an overview of organizational learning and how an organization can develop a sustainability plan to assure the CANDO…

2670. Module 3: Preparing for Implementation: Gap Analysis | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/settings/hospital/candor/modules/facguide3/notes.html
      August 01, 2022 - Module 3: Preparing for Implementation: Gap Analysis AHRQ Communication and Optimal Resolution Toolkit Facilitator Notes Say: Module 3 of the CANDOR Toolkit describes the critical steps to prepare an organization for successful implementation of the CANDOR process. The module also includes tools a…

2671. Selected Best Practices and Suggestions for Improvement (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/pdi/d4h_pdi10-sepsis-bestpractices.pdf
      May 17, 2016 - Selected Best Practices and Suggestions for Improvement Pediatric Toolkit for Using the AHRQ Quality Indicators How To Improve Hospital Quality and Safety 1 Tool D.4h Selected Best Practices and Suggestions for Improvement PDI 10: Postoperative Sepsis Why focus on postoperative sepsis in children? • Posto…

2672. Selected Best Practices and Suggestions for Improvement (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/d4v_combo_pdi10-sepsis-bestpractices.pdf
      May 17, 2016 - Selected Best Practices and Suggestions for Improvement Toolkit for Using the AHRQ Quality Indicators How To Improve Hospital Quality and Safety 1 Tool D.4v Selected Best Practices and Suggestions for Improvement PDI 10: Postoperative Sepsis Why focus on postoperative sepsis in children? • Postoperative s…

2673. Learning From Defects
      www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-2/024-ss-cusp-learning-from-defects.pptx
      April 01, 2025 - Learning From Defects Learning From Defects Surgical Services For: Cardiac, Hip and Knee Joint Replacement, and Spinal Fusion Surgeries AHRQ Pub. No. 25-0029 April 2025 AHRQ Safety Program for MRSA Prevention: Targeting SSI AHRQ Safety Program for MRSA Prevention | Surgical Services Learning From Defects 1 Educat…

2674. Selected Best Practices and Suggestions for Improvement (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/d4i_combo_psi12-dvt-bestpractices.pdf
      May 20, 2016 - Selected Best Practices and Suggestions for Improvement Toolkit for Using the AHRQ Quality Indicators How To Improve Hospital Quality and Safety Tool D.4i 1 Selected Best Practices and Suggestions for Improvement PSI 12: Perioperative Pulmonary Embolism (PE) or Deep Vein Thrombosis (DVT) Why Focus on DVT/PE…

2675. Series Overview | Agency for Healthcare Research and Quality
      www.ahrq.gov/research/findings/evidence-based-reports/er208-overview.html
      October 01, 2014 - Series Overview Closing the Quality Gap: Revisiting the State of the Science Overview of new series of evidence reports on quality improvement strategies. Contents Background Topic Selection and Scope Development Principles Key Questions Organizing Framework References     Background …

2676. Staff Roles and Training forYour Pressure Ulcer Prevention Program (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/pressure_ulcer_prevention/webinars/webinar3_pu_staffroles.pdf
      January 01, 2014 - Staff Roles and Training forYour Pressure Ulcer Prevention Program Staff Roles and Training for Your Pressure Ulcer Prevention Program Presented by Elizabeth A. Ayello Ph.D., RN, ACNS-BC, CWON, ETN, MAPWCA, FAAN Excelsior College School of Nursing Welcome! Thank you for joining this webinar about staff role…

2677. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/838221/psn-pdf
      September 28, 2022 - If you do the stakeholder interviews, you'd understand the community assets, right?

2678. 124-Cusp-Science-Safety-Fg (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-2/124-cusp-science-safety-fg.docx
      April 01, 2025 - Including members from different roles and all relevant stakeholder groups leads to a better understanding

2679. 170-Cusp-Science-Safety-Notes (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa/170-cusp-science-safety-notes.docx
      October 01, 2024 - Including members from different roles and all relevant stakeholder groups leads to a better understanding

2680. Measuring Patient Safety | PSNet
      psnet.ahrq.gov/perspective/measuring-patient-safety
      December 14, 2022 - We are seeking stakeholder comments and holding a series of stakeholder listening sessions.