The goal is to deliver safe, high-quality health care to patients in all clinical settings. You can use the information in this guide to help improve quality of care across settings and at multiple levels.
Resources and links provide information on these topics:
Falls and Injuries
Falls can lead to moderate to severe injuries, such as hip fractures and head trauma, and can even increase the risk of early death. Fortunately, falls are a public health problem that is largely preventable.
 CDC fact sheet on falls among older adults
CDC fact sheet on falls in nursing homes
Fall and Injury Prevention from the Evidence-Based Handbook for Nursesi
 Falls toolkit from the National Center for Patient Safety
The Falls Management Program - tool to improve fall care processes and outcomes
Falls Prevention Literature Review - a resource for the design and implementation of fall prevention programs
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Pressure Ulcers
Each year, more than 2.5 million people in the United States develop pressure ulcers. ii Prevention requires an organizational culture and operational practices that promote teamwork and communication, as well as individual expertise.
AHRQ toolkit to prevent pressure ulcers in hospitals
Preventing and Managing Pressure Ulcers from the Evidence-Based Handbook for Nursesiii
Pressure Ulcer Training from the National Database of Nursing Quality Indicators 
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Ventilator Associated Pneumonia (VAP)
VAP is the leading cause of death amongst hospital-acquired infections. Reducing mortality due to VAP requires an organized process that guarantees early recognition of pneumonia and consistent application of the best evidence-based practices.
Learn strategies to prevent VAP in hospitals
IHI Ventilator Bundle - series of interventions to prevent VAP
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Intravascular Catheter-Related Infections
In the United States, about 15 million central vascular catheter (CVC) days occur in intensive care units (ICUs) each year. iv
CDC guidelines for the prevention of intravascular catheter related infections
IHI Central Line Bundle - a series of interventions to prevent infections related to CVCs
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Urinary Catheter-Related Infections
Urinary tract infections (UTIs) account for about 40% of all hospital acquired infections. More than 80% of those infections are associated with catheters. Nursing staff can be instrumental in preventing urinary catheter-related infections. v
 CDC overview video on catheter associated UTIs
Prevention and management guidelines for catheter associated UTIs
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Preventing Other Healthcare Associated Infections
Healthcare-associated infections (HAIs) lead to 99,000 deaths annually. vi There are more than 75,000 bloodstream infections a year among hospital patients, and as many as 25% of infected patients die . vii Nurses are on the frontlines of preventing these infections, and by implementing certain evidence-based recommendations these infections can be dramatically reduced.
Evidence-based strategies for nurses on controlling the spread of HAIsviii
Nursing infection control checklistix
CDC recommendations to prevent infections
CDC guide to infection prevention for outpatient settings
Various CDC toolkits for preventing healthcare associated infections
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Opportunities for Patient Safety and Quality Improvement
Reducing Medication Errors
Each year, about 7,000 people die because of medication errors in hospitals. x Nurses play a critical role in preventing medication errors and facilitating better medication management.
General information from the FDA regarding medication errors
Study showing the relationship between task interruptions and medication errors by nurses
Learn about the nurse's role in preventing medication errors
Learn about the medication safety in relation to nursing xi
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Handoffs
The transfer of essential information and the responsibility for care of the patient from one health care provider to another is an integral component of communication in health care. Ineffective handoffs can lead to adverse events and patient safety risks.
Recommended strategies to improve the handoff process in the hospital
Toolkit to guide handoff communication in perioperative practice
Learn how to improve communication during handoffs
Learn how nurses can improve the handoff processxii
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Working Conditions and Work Environment for Nurses
Nurse Fatigue and Stress
The increased demands on nurses have set the stage for increased nurse fatigue and stress, compromising patient safety and negatively impacting the health and well-being of nurses.
Learn how working conditions contribute to work stress and burnout among nurses
 Presentation on nurse fatigue and patient safety
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Nursing Turnover
Nursing turnover has been reported to range from 15 percent to 36 percent per year. xiii
High nurse turnover rates negatively affect the ability of hospitals to meet patient needs and provide quality care.
Learn how to decrease nurse turnover rates by creating a safe and high quality work environmentxiv
Tools to calculate total nursing turnover expenses
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Teamwork
Safe health care depends on highly trained individuals with disparate roles and responsibilities acting together in the best interests of the patient.
Study showing the relationship between teamwork among nurses and job satisfaction
Study describing an intervention to enhance nursing staff teamwork and engagement
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Nursing Workload and Patient Safety
Nurses are experiencing higher workloads than ever before. Research has shown that heavy nursing workloads adversely affect patient safety.
Learn about the impact of high nursing workloads on patient safety xv
NEJM study on the association of nurse workload and increased inpatient mortality
Research findings on nurse staffing and quality of care
Evidence-based research on nurse staffing and quality of care
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General Resources on Nursing and Quality of Care
The following general resources provide key information on the role of nurses in improving quality of care.
This 1,400 page Evidence-based handbook provides a comprehensive review of how nurses can improve patient safety and quality
IOM report examining the future of the nursing workforce
Implementation guide for nursing sensitive care measures
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i Patient Safety and Quality: An Evidence-Based Handbook for Nurses. AHRQ Publication No. 08-0043, April 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/nurseshdbk/.
ii Preventing Pressure Ulcers in Hospitals: A Toolkit for Improving Quality of Care. AHRQ Publication No. 11-0053-EF, April 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/ltc/pressureulcertoolkit/.
iii Patient Safety and Quality: An Evidence-Based Handbook for Nurses. AHRQ Publication No. 08-0043, April 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/nurseshdbk/.
iv Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011. CDC Publication, April 2011. Centers for Disease Control and Prevention, Healthcare Infection Control Practices Advisory Committee (HICPAC). http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf.
v Prevention and Management of Catheter-Associated UTIs. Infectious Disease Special Edition, September 2010. http://www.idse.net/download/UTI_IDSE10_WM.pdf.
vi AHRQ's Efforts to Prevent and Reduce Healthcare-Associated Infections. Fact Sheet. AHRQ Publication No. 09-P013, September 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/haiflyer.htm.
vii CDC. Vital Signs: Central Line - Associated Bloodstream Infections-United States 2001, 2008, and 2009. MMWR 2011; 60(08);243-248.
viii Patient Safety and Quality: An Evidence-Based Handbook for Nurses. AHRQ Publication No. 08-0043, April 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/nurseshdbk/.
ix Infection Control Checklist - Nursing Department. Best Practices, October 2000. Texas Health Care Association. http://www.txhca.org/BestPractices/InfectionControl/nursing.pdf.
x Interdisciplinary Nursing Quality Research Initiative. Nurses' Role in Preventing Medication Errors. http://www.inqri.org/uploads/ResearchSynthesisMedicationErrors.pdf.
xi Patient Safety and Quality: An Evidence-Based Handbook for Nurses. AHRQ Publication No. 08-0043, April 2008. Agency for Healthcare Research and Quality, Rockville, MD.
http://www.ahrq.gov/qual/nurseshdbk/.
xii Ibid.
xiii Hayes LJ, O'Brien-Pallas L, Duffield C, et al. Nurse turnover: a literature review. Int J Nurs Stud 2006;43:237-63.
xiv Patient Safety and Quality: An Evidence-Based Handbook for Nurses. AHRQ Publication No. 08-0043, April 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/nurseshdbk/.
xv Ibid.
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