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psnet.ahrq.gov/node/850916/psn-pdf
June 21, 2023 - Seven themes were identified, highlighting concerns
regarding bias, algorithm transparency, lack of standardization
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psnet.ahrq.gov/node/42818/psn-pdf
October 31, 2014 - Even
though this study demonstrated significant room for note standardization and improvement, it found
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psnet.ahrq.gov/node/42038/psn-pdf
June 03, 2013 - training for integrated
multidisciplinary OR teams and found that current simulation studies lack standardization
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psnet.ahrq.gov/node/47787/psn-pdf
February 20, 2019 - Investigators identified a set of specific, evidence-based safety practices including standardization
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psnet.ahrq.gov/node/41325/psn-pdf
October 06, 2016 - Some hospitals did achieve higher reliability, and the authors cite standardization of processes as
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psnet.ahrq.gov/node/38673/psn-pdf
April 30, 2014 - analyzing and improving safety and cites the seminal Keystone ICU study as an
example of the role of standardization
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psnet.ahrq.gov/node/42113/psn-pdf
March 20, 2013 - interventions to prevent pressure ulcers and emphasizes the importance of leadership,
simplification and standardization
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psnet.ahrq.gov/node/40636/psn-pdf
November 21, 2011 - Root cause analyses of errors revealed that lack of standardization and human factors
issues were major
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www.ahrq.gov/sites/default/files/2025-02/woods-report.pdf
January 01, 2025 - The establishment of designed
communication systems (e.g., ways of communicating, standards for information
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psnet.ahrq.gov/node/844787/psn-pdf
September 11, 2019 - triad-xii-are-patients-aware-and-agree-dnr-or-polst-orders-their-medical-records
https://psnet.ahrq.gov/issue/identification-inpatient-dnr-status-safety-hazard-begging-standardization
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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-2/077-contact-precautions-one-pager.docx
April 01, 2025 - Methicillin-resistant Staphylococcus aureus (MRSA) Transmission Pathways
MRSA can spread through either direct contact (from person to person) or indirect contact (by touching something in the environment that was previously contaminated by someone else).
The use of transmission-based precautions, specifically contact …
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psnet.ahrq.gov/node/44376/psn-pdf
October 08, 2016 - Avoidability of hospital deaths and association with
hospital-wide mortality ratios: retrospective case record
review and regression analysis.
October 8, 2016
Hogan H, Zipfel R, Neuburger J, et al. Avoidability of hospital deaths and association with hospital-wide
mortality ratios: retrospective case record review…
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meps.ahrq.gov/data_files/publications/rf4/rf4.shtml
January 01, 1998 - Estimates for sample sizes of less than 50
do not meet standards of reliability or precision
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digital.ahrq.gov/ahrq-funded-projects/colorado-associated-community-health-information-exchange-cachie/annual-summary/2010
January 01, 2010 - Colorado Associated Community Health Information Exchange (CACHIE) - 2010
Project Name
Colorado Associated Community Health Information Exchange (CACHIE)
Principal Investigator
Davidson, Arthur
Organization
Denver Health and Hospital Authority
Funding Mechanism
RFA:…
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psnet.ahrq.gov/web-mm/pocket-syringe-swap
July 01, 2006 - They include standardization of drug concentrations, barcode identification of medications, computerized … Standardization and simplification of anesthesia medication regimens may contribute to improvements in
-
psnet.ahrq.gov/web-mm/dilute-or-not-dilute-drug-errors-and-consequences-operating-room
July 28, 2021 - These strategies include pharmacy assistance, use of technological solutions, and standardization. 5 … Standardization of drug concentrations can also be effective in reducing dilution errors. 1 , 5 , 9
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/sections/sustainability/management/visual/visual-mgmt-facnotes.docx
May 01, 2017 - Module 5: Script and Slides
AHRQ Safety Program for Ambulatory Surgery
Management Practices for Sustainability
Module 5: Visual Management
AHRQ Safety Program for Reducing CAUTI in Hospitals
Facilitator Notes
SLIDE 1
Title: Management Practices for Sustainability; Module 5: Visual Management
SAY:
As mentioned in…
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www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/teamwork/understand-sci-fac-guide.html
July 01, 2023 - Understand the Science of Safety for Perinatal Safety: Facilitator Guide
AHRQ Safety Program for Perinatal Care
Slide 1: Understand the Science of Safety for Perinatal Safety
Say:
The Understand the Science of Safety module of the AHRQ Safety Program for Perinatal Care discusses the importance of unders…
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psnet.ahrq.gov/node/37447/psn-pdf
January 09, 2008 - No pay for "never event" errors becoming standard.
January 9, 2008
O'Reilly KB. American Medical News. January 7, 2008.
https://psnet.ahrq.gov/issue/no-pay-never-event-errors-becoming-standard
This article discusses the evolving payer trend to withhold hospital reimbursement related to never events.
https://psnet.…
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psnet.ahrq.gov/node/37165/psn-pdf
May 02, 2018 - Lack of standard dosing methods contributes to IV errors.
May 2, 2018
ISMP Medication Safety Alert! Acute care edition. August 23, 2007,
https://psnet.ahrq.gov/issue/lack-standard-dosing-methods-contributes-iv-errors
This article discusses the myriad dosing methods that can lead to errors in administering intraveno…