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4001. Puh-Erepguide (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/pruhealing/puh-erepguide.pdf
      February 10, 2014 - AHRQ’s Safety Program for Nursing Homes: On-Time Pressure Ulcer Healing 1 Pressure Ulcer Healing Reports Slide AHRQ’s Safety Program for Nursing Homes: On-Time Pressure Ulcer Healing Facilitator Training Instructor Guide Slide 1: Introduction to Pressure Ulcer Healing Reports SAY: In this sess…

4002. Final Progress Report: Improving Patient Safety by Reducing Medication Errors (pdf file)
      www.ahrq.gov/sites/default/files/2024-03/strom2-report.pdf
      January 01, 2024 - Final Progress Report: Improving Patient Safety by Reducing Medication Errors Improving Patient Safety by Reducing Medication Errors Brian Strom, MD, MPH, Principal Investigator: Director, Administrative Core; Director, Data Collection Core Harold I. Feldman, MD, MSCE: Co-Principal Investigator; Co-Director, Ad…

4003. Strategy 1: Working with Patients & Families as Advisors (Implementation Handbook) (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy1/Strat1_Implement_Hndbook_508_v2.docx
      January 28, 2011 - Step 5: Implement and coordinate advisor activities (on page 22) For the three hospitals that pilot tested

4004. Optimizing Health and Function as We Age: Roundtable Report (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/ncepcr/tools/healthy-aging-roundtable.pdf
      September 08, 2022 - members facilitate “sprint” cycles, which are short, intense experimentation periods where the MVP is tested

4005. Final Progress Report: National Claims-Based Quality Measures for Surgical Site Infections (pdf file)
      www.ahrq.gov/sites/default/files/2025-02/platt-report.pdf
      January 01, 2025 - We tested a broad set of claims codes that are less sensitive to changes in coding practices over time

4006. Final Progress Report: Multicenter Medication Reconciliation Quality Improvement Study (MARQUIS) (pdf file)
      www.ahrq.gov/sites/default/files/2024-01/schnipper-report.pdf
      January 01, 2024 - When tested, hospital-based medication reconciliation interventions have consistently demonstrated reductions

4007. Final Progress Report: Medication List Consistency When Patients Transition from Hospital to Community (pdf file)
      www.ahrq.gov/sites/default/files/2024-01/kennelty-report.pdf
      January 01, 2024 - Finally, the interview protocol was pilot tested on three different community pharmacists.

4008. Final Progress Report: Human Factors and Systems Integration in High Technology Surgery (HF-SIgHTS) (pdf file)
      www.ahrq.gov/sites/default/files/2025-07/catchpole-report.pdf
      January 01, 2025 - . • Despite calls for teamwork, checklist and other intevnetions, few have been tested • Flow disruptions

4009. AHRQ Issue Brief: Understanding the AI Wave: Foundational Knowledge for Improving Diagnosis and Beyond (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/diagnostic/resources/issue-briefs/dxsafety-brief-ai-wave.pdf
      June 01, 2025 - with specific racial groups, reflecting and reinforcing real-world disparities.37 Even when directly tested

4010. Regulation of Health Policy: Patient Safety and the States (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Weinberg.pdf
      March 01, 2004 - State legislation has tested the boundaries between Federal and State legislation with respect to employee

4011. Evaluation and Research on Antimicrobial Stewardship's Effect on Clostridium difficile (ERASE C. difficile) Project: toolkit (pdf file)
      www.ahrq.gov/sites/default/files/publications/files/cdifftoolkit.pdf
      September 01, 2012 - Evaluation and Research on Antimicrobial Stewardship's Effect on Clostridium difficile (ERASE C. difficile) Project: toolkit Evaluation and Research on Antimicrobial Stewardship’s Effect on Clostridium difficile (ERASE C. difficile) Project Toolkit for Reduction of Clostridium difficile Through Antimicrobial…

4012. Final Progress Report: Epidemiology, Exploration, and Evaluation: Addressing potentially dangerous medications in children on Medicaid with a mental health diagnosis (pdf file)
      www.ahrq.gov/sites/default/files/2024-02/kleinman-report.pdf
      January 01, 2024 - Final Progress Report: Epidemiology, Exploration, and Evaluation: Addressing potentially dangerous medications in children on Medicaid with a mental health diagnosis Title of Project Epidemiology, Exploration, and Evaluation: Addressing potentially dangerous medications in children on Medicaid with a mental health…

4013. Making Healthcare Safer Practices: 16. Venous Thromboembolism (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/research/findings/making-healthcare-safer/mhs3/venous-thromboembolism-1.pdf
      March 01, 2020 - Making Healthcare Safer Practices: 16. Venous Thromboembolism Venous Thromboembolism 16-1 16. Venous Thromboembolism Eleanor Fitall, M.P.H., and Kendall K. Hall, M.D., M.S. Introduction Background Venous thromboembolism (VTE) is a disorder that includes deep vein thrombosis (DVT) and pulmonary embolism (PE). …

4014. Network of Patient Safety Databases Chartbook, 2019 (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/npsd/data/npsd-chartbook-2019.pdf
      January 01, 2019 - Network of Patient Safety Databases Chartbook, 2019 Network of Patient Safety Databases Chartbook, 2019 This document is in the public domain and may be used and reprinted without permission. Citation of the source is appreciated. Suggested citation: Network of Patient Safety Databases Chartbook, 2019. Rockvi…

4015. Final Progress Report: Implementing a Program of Patient Safety in Small, Rural Hospitals (pdf file)
      www.ahrq.gov/sites/default/files/2024-02/jones-report.pdf
      January 01, 2024 - Final Progress Report: Implementing a Program of Patient Safety in Small, Rural Hospitals Implementing a Program of Patient Safety in Small, Rural Hospitals Principal Investigators Katherine J. Jones, PhD, PT, January 2007 – June 20071 Keith J. Mueller, PhD, July 2005 – December 20061 Team Members Anne Skinn…

4016. Looking for Trouble in All the Right Places: The Legal Implications Associated with “Electronic Signatures” and High-risk Clinical Situations (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Escobar.pdf
      February 01, 2005 - Looking for Trouble in All the Right Places: The Legal Implications Associated with “Electronic Signatures” and High-risk Clinical Situations 51 Looking for Trouble in All the Right Places: The Legal Implications Associated with “Electronic Signatures” and High-risk Clinical Situations Gabriel J. Escobar, Bruc…

4017. Final Progress Report: Factors Associated With Quality of Care Delivered to Children in US EDs (pdf file)
      www.ahrq.gov/sites/default/files/2024-12/marcin-report.pdf
      January 01, 2024 - Final Progress Report: Factors Associated With Quality of Care Delivered to Children in US EDs Factors Associated with Quality of Care Delivered to Children in US EDs PI: James P. Marcin, MD Co-Investigators: Madan Dharmar, MBBS, PhD; Patrick Romano, MD; Nathan Kuppermann, MD, MPH Organization: Regents of the Uni…

4018. Improving Safety Using Teamwork and Patient Safety Norms (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/action-alliance/teamwork-ptsafety-norms-slides.pdf
      June 30, 2025 - Improving Safety Using Teamwork and Patient Safety Norms Creating and Maintaining a Culture of Safety Series (Session 2) Improving Safety Using Teamwork and Patient Safety Norms NATIONAL WEBINAR SERIES March 18, 2025 Housekeeping Instructions • This webinar will be recorded and available for viewing on the NAA…

4019. Module 4: Leadership
      www.ahrq.gov/sites/default/files/wysiwyg/teamstepps-program/dx-improvement/module4-leadership.pptx
      January 05, 2022 - Module 4: Leadership Module 4 Leadership To Improve Diagnosis TeamSTEPPS® for Diagnosis Improvement Welcome to the TeamSTEPPS for Diagnosis Improvement course. This presentation will cover Module 4, Leadership To Improve Diagnosis, that you will review as the course facilitator.    Individuals who plan to take the…

4020. Improving Health Information Technology (IT) Patient Safety: A Resource List for Users of the AHRQ Health Information Technology Supplemental Item Set (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/patient-safety-technology-resources.pdf
      May 01, 2023 - Improving Health Information Technology (IT) Patient Safety: A Resource List for Users of the AHRQ Health Information Technology Supplemental Item Set SOPS Health IT Patient Safety Supplemental Item Set Resource List 1 Improving Health Information Technology (IT) Patient Safety: A Resource List for Users of the A…