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Search results for "Education and Training"

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Grant > Government Resource

Patient Safety Learning Laboratories: Pursuing Safety in Diagnosis and Treatment at the Intersection of Design, Systems Engineering, and Health Services Research (R18).

Rockville, MD: Agency for Healthcare Research and Quality. RFA-HS-19-001.

This funding opportunity will support collaborative learning strategies that enable individuals and organizations to employ rapid prototyping to develop new approaches focused on improving diagnosis and treatment. The application process is now closed.

Book/Report

Toolkit to Promote Safe Surgery.

Rockville, MD: Agency for Healthcare Research and Quality; November 2017.

Preventing surgical complications including surgical site infections are a worldwide target for improvement. This toolkit builds on the success of the Comprehensive Unit-based Safety Program to initiate change. The tools represent practical strategies that helped members of a large-scale collaborative to identify areas of weakness, design improvements, and track the impact of the interventions.

Grant > Government Resource

Improving Patient Safety Through Learning Laboratories.

Rockville, MD: Agency for Healthcare Research and Quality; December 2016.

Collaborative strategies can enable individuals and organizations to learn from each other to support patient safety improvement. This fact sheet summarizes 13 projects launched through Agency for Healthcare Research and Quality funding designed for rapid deployment through team-focused learning laboratories to test and apply systems engineering approaches to improve safety in health care.

Web Resource > Government Resource

AHRQ Impact Case Studies: Patient Safety.

Agency for Healthcare Research and Quality.

AHRQ supports the development and testing of various resources for health care organizations to implement as safety improvement strategies. This collection of case studies highlights AHRQ-funded patient safety tools, including the Comprehensive Unit-based Safety Program, Re-Engineered Discharge Toolkit, and TeamSTEPPS program, to document their successful use in the field.

Audiovisual

Healthcare 411: medication safety toolkit.

Bethesda, MD; Agency for Healthcare Research and Quality. February 25, 2009.

This interview introduces an AHRQ-funded PIPS toolkit to help small and rural hospitals implement medication safety initiatives.

Book/Report

Advances in Patient Safety: New Directions and Alternative Approaches.

  • Classic

Rockville, MD: Agency for Healthcare Research and Quality; July 2008. AHRQ Publication Nos. 080034 (1-4).

The 115 articles freely available in this latest issue of AHRQ's Advances in Patient Safety represent the state of the art in patient safety. Serving as an update and extension to the prior volume, the articles are grouped into four major content areas—assessment, culture and redesign, performance and tools, and technology and medication safety—and are freely available online through the link below.

Audiovisual

Tools, Methods, and Techniques for Improving Patient Safety: Patient Safety Improvement Corps Training DVD.

Rockville, MD: Agency for Healthcare Research and Quality; 2007.

This DVD provides training modules for health care professionals regarding systems-oriented, institutional improvements in patient safety.

Book/Report

Advances in Patient Safety: From Research to Implementation.

  • Classic

Rockville, MD: Agency for Healthcare Research and Quality; February 2005. AHRQ Publication Nos. 050021 (1-4).

With 4 volumes and 140 articles (all of which are freely available through the link below), this expansive collection of literature illustrates the progress made since the 1999 Institute of Medicine's report, To Err is Human: Building a Safer Health System. The efforts represent a successful collaboration between the Agency for Healthcare Research and Quality and the Department of Defense-Health Affairs in meeting the challenge of improving patient safety knowledge, research, and implementation.

Meeting/Conference > Maryland Meeting/Conference

TeamSTEPPS Master Training Course.

Johns Hopkins Armstrong Institute for Patient Safety and Quality. June 25-26, 2019; Constellation Energy Building, Baltimore, MD.

Team training programs seek to improve communication and coordination among team members to reduce the potential for medical error. This workshop will train participants to design, implement, and evaluate team training programs in their organizations based on the TeamSTEPPS model. 

Book/Report

Community Pharmacy Survey on Patient Safety Culture: 2019 User Comparative Database Report.

Famolaro T, Yount ND, Hare R, et al. Rockville, MD: Agency for Healthcare Research and Quality; April 2019. AHRQ Publication No. 19-0033.

The Agency for Healthcare Research and Quality conducts safety culture surveys in a wide variety of clinical settings and makes the results publicly available on a regular basis. This report contains responses to the Community Pharmacy Survey on Patient Safety Culture from 331 participating pharmacies, most of which were chain drugstores or pharmacies within integrated health systems. The areas of strength were similar to the 2015 report, with most community pharmacies scoring well for patient counseling and openness of communication regarding unsafe situations. Inadequate staffing and production pressures were the commonly identified barriers to safety. A PSNet perspective explored safety issues in the community pharmacy setting in detail.

Meeting/Conference > United States Meeting/Conference

TeamSTEPPS Master Training Course.

AHA Team Training. April 1–November 5, 2019.

The TeamSTEPPS program was developed to support effective communication and teamwork in health care. This session will prepare participants to guide their organizations through implementation of the TeamSTEPPS program. Twelve 2-day sessions will be held over the course of 2019.

Journal Article > Commentary

Pursuing patient safety at the intersection of design, systems engineering, and health care delivery research: an ongoing assessment.

Henriksen K, Rodrick D, Grace EN, Shofer M, Brady PJ. J Patient Saf. 2019 Feb 9; [Epub ahead of print].

Applying systems engineering strategies from problem analysis through postimplementation evaluation can lead to solutions grounded in actual practice and learning for individuals, teams, and organizations. This commentary discusses the Agency for Healthcare Research and Quality patient safety learning laboratories initiative. The authors, who serve as program officers and oversee the grants, review lessons learned through experiences of grantees.

Journal Article > Study

Impact of the Agency for Healthcare Research and Quality's Safety Program for Perinatal Care.

Kahwati LC, Sorensen AV, Teixeira-Poit S, et al. Jt Comm J Qual Patient Saf. 2019 Jan 10; [Epub ahead of print].

Labor and delivery is an inherently high-risk care setting. The Agency for Healthcare Research and Quality adapted its Comprehensive Unit-based Safety Program, a best practice toolkit incorporating teamwork, human factors engineering principles, and simulation training, for labor and delivery. In this pre–post evaluation study, staff reported improved safety culture and teamwork. Obstetric trauma and primary cesarean delivery rates declined after the intervention, but neonatal birth trauma rates increased. The authors note that incomplete implementation and lack of sustained program participation observed in the study should be addressed in order to improve obstetric and neonatal care safety. A recent Annual Perspective emphasizes the rising rate of severe maternal morbidity and summarizes national initiatives to improve safety in maternity care.

Tools/Toolkit > Government Resource

Reducing Diagnostic Errors in Primary Care Pediatrics (Project RedDE!) Toolkit.

Itasca, IL: American Academy of Pediatrics; 2018.

Diagnostic error prevention in primary care is a persistent challenge. This AHRQ-funded toolkit provides guidance for ambulatory care organizations that seek to improve the reliability of diagnosis in children. The material focuses on tactics to enhance how practices recognize, track, and follow up on adolescent depression, pediatric elevated blood pressure, and actionable laboratory results.

Audiovisual > Audiovisual Presentation

Health IT Patient Safety Supplemental Items for Hospitals.

Agency for Healthcare Research and Quality. July 25, 2018. 

Tracking the intersection of organizational culture with health information technology use can inform patient safety improvement efforts. This webinar introduced supplemental items to the AHRQ Hospital Survey on Patient Safety Culture and discussed the results of a pilot project integrating the items into assessment efforts. Featured speakers included Dr. Jeff Brady and Dr. Tejal Gandhi.

Journal Article > Study

Opportunities to improve informed consent with AHRQ training modules.

Shoemaker SJ, Brach C, Edwards A, Chitavi SO, Thomas R, Wasserman M. Jt Comm J Qual Patient Saf. 2018;44:343-352.

The process of informed consent is designed to ensure that patients fully understand risks, benefits, and alternatives when receiving certain treatments. In this mixed-methods study, researchers examined the impact of two Agency for Healthcare Research and Quality informed consent training modules across four hospitals.

Tools/Toolkit > Government Resource

SOPS Health Information Technology Patient Safety Supplemental Items for the Hospital Survey.

Rockville, MD: Agency for Healthcare Research and Quality; March 2018.

Organizational culture can affect the use of tools and processes implemented to improve safety. This release of supplemental items to be used in conjunction with the AHRQ Hospital Survey on Patient Safety Culture can help organizations explore how culture affects the use of health information technology. Included with the data set is a report of initial results regarding its use in the field.

Journal Article > Commentary

Learning collaboratives: insights and a new taxonomy from AHRQ's two decades of experience.

Nix M, McNamara P, Genevro J, et al. Health Aff (Millwood). 2018;37:205-212.

Learning collaboratives are multimodal interventions that are often used to implement evidence-based practices. This perspective from AHRQ scientists proposes a taxonomy to describe collaboratives' distinct elements: innovation, or the type of positive change; communication among members; duration and sustainability; and social systems, or the organization and culture of the collaborative. The authors suggest that efforts to evaluate learning collaboratives or quality improvement interventions employ this taxonomy.

Journal Article > Study

Advancing perinatal patient safety through application of safety science principles using health IT.

Webb J, Sorensen A, Sommerness S, Lasater B, Mistry K, Kahwati L. BMC Med Inform Decis Mak. 2017;17:176.

AHRQ's Safety Program for Perinatal Care used a multifaceted approach based on the comprehensive unit-based safety program to improve safety culture and perinatal outcomes at 46 hospitals. In this study, investigators conducted structured interviews to evaluate how participating hospitals used health information technology to enable implementation of the program. A variety of uses for health IT were described, including integration of checklists and standardized handoff tools into the electronic health record.

Tools/Toolkit > Government Resource

TeamSTEPPS 2.0 for Long-Term Care.

Rockville, MD: Agency for Healthcare Research and Quality; November 2017.

This toolkit provides resources to help implement TeamSTEPPS in long-term care, including an instructor guide and training videos. Version 2.0 adds guidance on use of measures to assess initiatives and an updated evidence review.

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