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psnet.ahrq.gov/node/45829/psn-pdf
June 27, 2018 - Learning from errors: analysis of medication order
voiding in CPOE systems.
June 27, 2018
Kannampallil TG, Abraham J, Solotskaya A, et al. Learning from errors: analysis of medication order
voiding in CPOE systems. J Am Med Inform Assoc. 2017;24(4):762-768. doi:10.1093/jamia/ocw187.
https://psnet.ahrq.gov/issue/le…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/implementation/educational-bundles/infection-prevention/precautions/ppe-quiz.docx
March 01, 2017 - AHRQ Safety Program for
Long-Term Care: HAIs/CAUTI
Training Module 3 Quiz
Personal Protective Equipment
1. Personal protective equipment (PPE) can reduce contamination of health care personnel hands and clothes.
☐ True
☐ False
2. PPE includes gloves, gowns, masks, and goggles.
☐ True
☐ False
3. Gowns should …
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/implementation/educational-bundles/infection-prevention/precautions/ppe-quiz-key.docx
March 01, 2017 - AHRQ Safety Program for
Long-Term Care: HAIs/CAUTI
Training Module 3 Quiz Answer Key
Personal Protective Equipment
1. Personal protective equipment (PPE) can reduce contamination of health care personnel hands and clothes.
☒ True
☐ False
2. PPE includes gloves, gowns, masks, and goggles.
☒ True
☐ False
3. Go…
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psnet.ahrq.gov/node/45535/psn-pdf
January 23, 2017 - Surgical specimen management: a descriptive study of
648 adverse events and near misses.
January 23, 2017
Steelman VM, Williams TL, Szekendi MK, et al. Surgical specimen management: a descriptive study of 648
adverse events and near misses. Arch Pathol Lab Med. 2016;140(12):1390-1396.
https://psnet.ahrq.gov/issue/…
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psnet.ahrq.gov/node/37803/psn-pdf
January 06, 2017 - Paying the piper: investing in infrastructure for patient
safety.
January 6, 2017
Pronovost P, Rosenstein BJ, Paine LA, et al. Paying the piper: investing in infrastructure for patient safety.
Jt Comm J Qual Patient Saf. 2008;34(6):342-8.
https://psnet.ahrq.gov/issue/paying-piper-investing-infrastructure-patient-…
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psnet.ahrq.gov/node/60523/psn-pdf
May 27, 2020 - "We're not ready, but I don't think you're ever ready."
Clinician perspectives on implementation of crisis
standards of care.
May 27, 2020
Chuang E, Cuartas PA, Powell T, et al. "We're not ready, but I don't think you're ever ready." Clinician
perspectives on implementation of crisis standards of care. AJOB Empir …
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psnet.ahrq.gov/node/41993/psn-pdf
April 21, 2015 - Simulation-based trial of surgical-crisis checklists.
April 21, 2015
Arriaga AF, Bader AM, Wong JM, et al. Simulation-based trial of surgical-crisis checklists. N Engl J Med.
2013;368(3):246-53. doi:10.1056/NEJMsa1204720.
https://psnet.ahrq.gov/issue/simulation-based-trial-surgical-crisis-checklists
Surgical check…
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psnet.ahrq.gov/node/60347/psn-pdf
January 01, 2021 - Patient safety education 20 years after the Institute of
Medicine report: results from a cross-sectional national
survey.
May 20, 2020
Arora S, Tsang F, Kekecs Z, et al. Patient safety education 20 years after the Institute of Medicine report:
results from a cross-sectional national survey. J Patient Saf. 2021;17(…
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psnet.ahrq.gov/node/844043/psn-pdf
February 08, 2023 - In situ simulation: a strategy to restore patient safety in
intensive care units after the COVID-19 pandemic?
February 8, 2023
Gómez-Pérez V, Escrivá Peiró D, Sancho-Cantus D, et al. In Situ Simulation: A Strategy to Restore Patient
Safety in Intensive Care Units after the COVID-19 Pandemic? Systematic Review. Heal…
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psnet.ahrq.gov/node/858163/psn-pdf
December 13, 2023 - Blackbox error management: how do practices deal with
critical incidents in everyday practice? A qualitative
interview study.
December 13, 2023
Bodek A, Pommée M, Berger A, et al. Blackbox error management: how do practices deal with critical
incidents in everyday practice? A qualitative interview study. BMC Prim …
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psnet.ahrq.gov/node/44904/psn-pdf
June 01, 2016 - Does time pressure have a negative effect on diagnostic
accuracy?
June 1, 2016
ALQahtani DA, Rotgans JI, Mamede S, et al. Does Time Pressure Have a Negative Effect on Diagnostic
Accuracy? Acad Med. 2016;91(5):710-716. doi:10.1097/ACM.0000000000001098.
https://psnet.ahrq.gov/issue/does-time-pressure-have-negative-e…
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www.ahrq.gov/sites/default/files/wysiwyg/cpi/about/organization/orgchart/organizationchart-060225.pdf
June 01, 2025 - AHRQ Organization Chart
Office of Extramural Research,
Education and Priority Populations
Francis D. Chesley, Jr., M.D.
Director
Directs the scientific review process for grants and
contracts, manages Agency research training programs,
evaluates the scientific contribution of proposed and
ongoing research an…
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psnet.ahrq.gov/node/866349/psn-pdf
July 24, 2024 - A multifaceted risk management program to improve the
reporting rate of patient safety incidents in primary care:
a cluster-randomised controlled trial.
July 24, 2024
Chanelière M, Buchet-Poyau K, Keriel-Gascou M, et al. A multifaceted risk management program to
improve the reporting rate of patient safety inciden…
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www.ahrq.gov/evidencenow/projects/heart-health/about/stories/in-action/index.html
March 01, 2021 - EvidenceNOW in Action
EvidenceNOW cooperatives have provided tailored support to small practices in their regions to help them use evidence and data to enhance patient care. For example, external consultants helped practices use their electronic health record data to identify at-risk patients and improve care. …
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www.ahrq.gov/cpi/about/organization/nac/hickman.html
February 01, 2025 - NAC Member Biography: Sharon Weidner Hickman
Sharon Weidner Hickman, M.B.A., CPHQ, CPPS, MCPC, LSSMBB President and Chief Operating Officer Adaptient, LLP Sharon Weidner Hickman, M.B.A., CPHQ, CPPS, MCPC, LSSMBB, is a healthcare executive with a demonstrated track record of achievement in strategic development,…
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www.ahrq.gov/sites/default/files/wysiwyg/cpi/about/organization/orgchart/organizationchart-072825.pdf
July 01, 2025 - AHRQ Organization Chart
Office of Extramural Research,
Education and Priority Populations
Francis D. Chesley, Jr., M.D.
Director
Directs the scientific review process for grants and
contracts, manages Agency research training programs,
evaluates the scientific contribution of proposed and
ongoing research an…
-
psnet.ahrq.gov/node/60342/psn-pdf
May 20, 2020 - Occurrence, prevention, and management of the
psychological effects of emerging virus outbreaks on
healthcare workers: rapid review and meta-analysis.
May 20, 2020
Kisely S, Warren N, McMahon L, et al. Occurrence, prevention, and management of the psychological
effects of emerging virus outbreaks on healthcare wor…
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psnet.ahrq.gov/node/43072/psn-pdf
November 21, 2016 - Physician attitudes toward family-activated medical
emergency teams for hospitalized children.
November 21, 2016
Paciotti B, Roberts KE, Tibbetts KM, et al. Physician attitudes toward family-activated medical emergency
teams for hospitalized children. Jt Comm J Qual Patient Saf. 2014;40(4):187-192.
https://psnet.a…
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psnet.ahrq.gov/node/47500/psn-pdf
October 24, 2018 - Use of a novel, electronic health record–centered,
interprofessional ICU rounding simulation to understand
latent safety issues.
October 24, 2018
Bordley J, Sakata KK, Bierman J, et al. Use of a Novel, Electronic Health Record-Centered,
Interprofessional ICU Rounding Simulation to Understand Latent Safety Issues. …
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psnet.ahrq.gov/node/47286/psn-pdf
July 18, 2018 - ISMP National Vaccine Errors Reporting Program 2017
analysis—part 1 and part 2.
July 18, 2018
ISMP Medication Safety Alert! Acute Care Edition. June 14, 2018,23:1-5. June 28, 2018;23:1-4,6,7.
https://psnet.ahrq.gov/issue/ismp-national-vaccine-errors-reporting-program-2017-analysis-part-1-and-part-
2
Mistakes in t…