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Toolkits

Patient safety toolkits provide practical applications of PSNet research and concepts for front line providers to use in their day to day work. These toolkits contain resources necessary to implement patient safety systems and protocols.

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Has your organization developed a Toolkit that provides practical applications of patient safety research and concepts for front line providers to use in their day to day work? Submit your Patient Safety Toolkit for an opportunity to have it published on PSNet.

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Latest Toolkits

Opioid deprescribing toolkit.

Sudden discontinuation of long-term prescription opioid use can lead to adverse outcomes for patients. Based on research and clinician insights, this toolkit aims to guide scalable, effective opioid tapering interventions... Read More

Opioid Taskforce Playbook.

Hospitals play an important role in identifying and preventing the misuse and abuse of prescription opioids. This Opioid Playbook is intended to support healthcare leaders implementing IT-based initiatives to reduce opioid... Read More

Opioid Safety Initiative Toolkit.

Increasing safe opioid prescribing is a patient safety priority. The VA’s Opioid Safety Initiative (OSI) toolkit includes materials and presentations to support clinical decision-making in opioid therapy, including... Read More

Maternal Health Indicators.
Agency for Healthcare Quality and Research. 2024.

Maternal health care faces a variety of patient safety challenges. This set of quality indicators supports the epidemiological or research program use of billing or claims data to measure severe maternal morbidity. The data... Read More

All Toolkits (104)
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Displaying 1 - 20 of 251 Results
Displaying 1 - 20 of 251 Results
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    • Measurement Tool/Indicator
    Maternal Health Indicators.
    Agency for Healthcare Quality and Research. 2024.
    Maternal health care faces a variety of patient safety challenges. This set of quality indicators supports the epidemiological or research program use of billing or claims data to measure severe maternal morbidity. The data can be applied to inform the development of population-level improvement strategies and track trends in severe maternal morbidity.
    Fact Sheet/FAQs
    Advancing Health Care Safety for All.
    Centers for Medicare and Medicaid Services. 2024.
    As one element of a national program to improve care quality, the Centers for Medicare and Medicaid Services (CMS) has developed a three-point plan to guide efforts toward zero preventable harm for the patients they serve. The elements include promoting transparency, supporting safe cultures through partnership, and encouraging improvement through payment reform.
    Book/Report
    Healthcare Simulation Dictionary, Third Edition.
    Lioce L, Lopreiato J, Anderson M, et al, eds and the Terminology and Concepts Working Group. Rockville, MD: Agency for Healthcare Research and Quality; January 2025. AHRQ Publication No. 24-0077.
    The terms in the initial collection have been expanded to reflect changes in the field which now includes artificial intelligence and gamification. This third edition includes a broader set of terms related to patient safety. The document will continue to be refined and expanded over time.
    Multi-use Website
    Core Elements of Hospital Diagnostic Excellence (DxEx).
    Centers for Disease Control and Prevention.
    Diagnostic excellence is an expansion of the diagnostic error reduction movement that encompasses a range of quality and safety activities. This effort highlights six structural elements for driving improvement in diagnostic processes, including leadership commitment and accountability, patient engagement, and multidisciplinary diagnostic teams. Assessment tools and a medical test checklist are available to aid in prioritization of improvement work and in-patient/medical team communication.
    Measurement Tool/Indicator
    Nursing Home Survey on Patient Safety Culture.
    Rockville, MD: Agency for Healthcare Research and Quality; October 2020.
    Challenges to establishing and sustaining a safety culture in a nursing home include insufficient staffing and a tendency to blame individuals for problems. This website hosts the AHRQ Surveys on Patient Safety Culture™ (SOPS®) Nursing Home Survey along with additional materials to assist organizations in using the management tool effectively. It includes a user's guide that explains how to conduct a survey on patient safety in a nursing home and report the results. The resource provides guidance on topics such as data collection, data organization, survey forms, and nursing home staff selection. The 2024 data collection period is now closed.
    Measurement Tool/Indicator
    AHRQ Quality Indicators.
    Agency for Healthcare Research and Quality
    The Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QIs) represent quality measures that make use of a hospital's available administrative data to inform improvement. This Web site provides access to six modules of indicators: prevention, inpatient, pediatric, patient safety, emergency department, and maternal health.
    Toolkit
    Quality Institute Toolkits.
    AAAHC Quality Institute. Deerfield, IL: Accreditation Association for Ambulatory Health Care.
    This collection of toolkits provides resources to support safety in ambulatory care and includes information about allergy documentation, safe injection practices and medication reconciliation.
    Toolkit
    TeamSTEPPS for Diagnosis Improvement.

    Rockville, MD: Agency for Healthcare Research and Quality; June 2024.

    The recognition of diagnosis as a team activity is energizing new diagnostic process initiatives. Building on the established TeamSTEPPS® principles, this new TeamSTEPPS course includes seven training modules, team and knowledge assessment tools, and implementation guidance to develop or enhance communication across the care team to improve the accuracy and timeliness of diagnosis. 
    Toolkit
    AHRQ Health Literacy Universal Precautions Toolkit. 3rd edition.

    Brach C, ed. Rockville, MD: Agency for Healthcare Research and Quality; March 2024. AHRQ Publication No. 15-0023-EF.

    The AHRQ Health Literacy Universal Precautions Toolkit, 3rd edition, can help primary care practices implement improvement actions to reduce the complexity of health care, increase patient understanding of health information, and enhance support for patients of all health literacy levels.
    Measurement Tool/Indicator
    Classic
    Surveys on Patient Safety Culture.
    Rockville MD: Agency for Healthcare Research and Quality; 2020.
    Safety culture has been described as a key to establishing high reliability organizations. The National Quality Forum's Safe Practices for Healthcare and the Leapfrog Group both mandate hospitals to regularly assess their safety culture. This AHRQ Web site provides validated safety culture survey tools (Hospital, Medical Office, Nursing Home, Community Pharmacy, Ambulatory Surgery Center), user guides health care organizations can use to implement the surveys and a bibliography of articles discussing the use of SOPS in the field. Organizations can also use the AHRQ database to compare their Surveys on Patient Safety Culture™ (SOPS®) results. In addition, reports are available that summarize the benchmarking data across cohorts nationwide. An AHRQ WebM&M perspective discussed how to establish a safety culture.
    Measurement Tool/Indicator
    Sentinel Event Data Summary.
    Joint Commission.
    This website provides sentinel event data reported to The Joint Commission, which includes information on sentinel events reported from January through December 2023. Falls, wrong surgery and unintended retained foreign bodies were among the most frequently submitted incidents in this time period. The data and graphs are updated regularly and include a 10 year trend analysis and specific analysis associated with event source by year from 2013 through 2023.
    Multi-use Website
    Diagnostic Safety Supplemental Item Set for Medical Office SOPS.

    Agency for Healthcare Research and Quality. 

    Safe diagnosis in medical offices is challenged by staff workload, communication, and poor information sharing. This Supplemental Item Set for the AHRQ Surveys on Patient Safety Culture™ (SOPS®) Medical Office Survey (MOSOPS) examines elements contributing to time availability, testing and referrals, and provider and staff communication. The Diagnostic Safety Supplemental Item Set 2024 survey results report is now available.
    Fact Sheet/FAQs
    What Do You Do If You Think You Have Been Harmed By Your Healthcare.

    Seattle, WA: Collaborative for Accountability and Improvement; 2023.

    There is a need for patients and families to understand effective routes for action should they experience harm. This FAQ shares steps for patients and families to take to help them get the communication and resolution they need from organizations and clinicians to effectively resolve concerns.
    Fact Sheet/FAQs
    Hand Hygiene in Healthcare Settings.
    Centers for Disease Control and Prevention
    The hand hygiene guidelines represent part of a U.S. Centers for Disease Control and Prevention (CDC) strategy to promote patient safety by reducing infections in health care settings. The site includes fact sheets, a press kit, and other materials to help implement the guidelines.
    Organizational Policy/Guidelines
    Targeted Medication Safety Best Practices for Hospitals.
    Plymouth Meeting, PA: Institute for Safe Medication Practices; 2024.
    This updated report outlines 22 consensus-based best practices to ensure safe medication administration, such as diluted solutions of vincristine in minibags and standardized metrics for patient weight. The set of recommended practices has been reviewed and updated every two years since it was first developed in 2014 to include actions related to eliminating the prescribing of fentanyl patches for acute pain and use of information about medication safety risks from other organizations to motivate improvement efforts. The 2024-2025 edition includes new practices that are associated with tranexamic acid wrong-route errors, transitions of care, and vaccines.
    Fact Sheet/FAQs
    Five Medication Safety Tips for Older Adults.
    FDA Consumer Health Information. Silver Spring, MD: US Food and Drug Administration; February 15, 2024.
    Highlighting how aging affects medication absorption that may lead to complications, this fact sheet offers recommendations for older patients to follow instructions, maintain a medication list, be aware of drug interaction potential, and perform an annual review of medications with clinicians to help them take prescriptions safely.
    Fact Sheet/FAQs
    ISMP's List of High-Alert Medications in Acute Care Settings.
    Horsham, PA; Institute for Safe Medication Practices: 2024.
    This fact sheet lists medications with a high risk of causing significant harm to patients when incorrectly administered. The 2024 publication reflects insights gathered through a survey of current medication use in acute care facilities. The update includes the addition of tranexamic acid injections as a high alert medication based on survey results, error reports and expert review.
    Toolkit
    Rethinking Patient Safety: A Discussion Guide for Patients, Healthcare Providers and Leaders.

    Gilbert R, Asselbergs M, Davis D, et al. Healthcare Excellence Canada; 2023.

    Patient safety requires a systems approach to identify problems and arrive at lasting solutions that reduce harm. This document encourages discussion amongst a broad base of stakeholders to address all forms of harm, such as discrimination, inequality, and psychological stress, in addition to physical injury. The resource insists these components be incorporated in work to close quality and safety gaps across the health care system.
    Toolkit
    Hospital Harm Project.
    Canadian Institute for Health Information, Health Excellence Canada.
    Reducing preventable harm associated with health care is a worldwide goal. This Canadian initiative developed a measure to track unintended harm in acute care hospitals, a toolkit to accompany reduction efforts, and reports that assess the results of improvement efforts and provide data analysis.
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