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3721. Acknowledgments | Agency for Healthcare Research and Quality
      www.ahrq.gov/research/findings/final-reports/ptflow/acknowledgements.html
      July 01, 2018 - The Need to Address Emergency Department Crowding Section 2. … Sharing Results References Appendix A: Guide to Online Resources Successfully Used by Hospitals to … representatives from: Shore Health System, Easton, MD; UMass Memorial Medical Center, Worcester, MA; and Baptist Health … Care, Pensacola, FL. … Return to Contents Proceed to Next Section

3722. The SHARE Approach: Using the Teach-Back Technique (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/sdm/share-approach/share-teachback-guide.pdf
      October 09, 2024 - Patients use their own words to explain what they need to know about their health or what they need … After you offer decision aids to your patients, be sure to follow up at the next visit. … to your patients. … Rockville, MD: Agency for Healthcare Research and Quality; March 2024. … use the teach-back technique with your patients What To Say How To Say It When To Use Teach-Back

3723. Making Effective Changes in Antibiotic Decision Making (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/safety/changes-facilitator-guide.pdf
      November 01, 2019 - These are technical factors (no access to guidelines about indications for vancomycin), health care … This is likely both a health care worker and team factor (provider did not have time or did not want … It is important to avoid assigning blame to individual people but rather to systems or health care worker … roles, as we all make mistakes, and it rare that a health care worker intentionally tries to cause … These practices are offered as helpful options for consideration by health care practitioners, not

3724. Infectious Complications Related to the Catheter Other than CAUTI (September 9, 2014) | Agency for Healthcare Research and Quality
      www.ahrq.gov/hai/cauti-tools/archived-webinars/infectious-complications-transcript.html
      November 01, 2015 - Or a health care worker asking if mode of transmission between patients. … to the healthcare worker organisms will contaminate over the environment and they will pass for months … Antimicrobial resistance is associated with about $20 billion direct healthcare costs per year. … Antimicrobial resistance is associated with $1 billion direct healthcare costs per year. … patient because if there's not such easy access to bathrooms for example in the ED, and samples, etc

3725. An Analysis of Nurses' Cognitive Work: A New Perspective for Understanding Medical Errors (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Potter.pdf
      January 01, 2003 - Research and Quality has made the effects of health care working conditions on patient safety a major … communicate patient information to a health care colleague. … Overall, 34 percent of the observed interruptions were attributed to queries from health care colleagues … Author affiliations PBJC Health Care, St. Louis (PP, LW, JS). … The effect of health care working conditions on patient safety.

3726. CHIPRA Activities | Agency for Healthcare Research and Quality
      www.ahrq.gov/policymakers/chipra/chipra-activities.html
      October 01, 2014 - CHIPRA Activities As a followup to identifying the initial core measure set of children's health … care quality measures, the Children's Health Insurance Program Reauthorization Act (CHIPRA) required … Improve Children's Health Care Quality Measures: Background Report on the 2012 Process . … Subcommittee on Quality Measures for Children's Healthcare (SNAC) to assess submitted measures. … Return to CHIPRA Page

3727. Selected Best Practices and Suggestions for Improvement (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/pdi/d4f_pdi08-postophemorrhage-bestpractices.pdf
      May 16, 2016 - o Establish a policy to empower nurses to rapidly escalate up the chain of authority to reach the responsible … hemorrhage at least annually).8 Additional Resources Systems/Processes • The Merck Manual for Health … Care Professionals: Postoperative Care http://www.merckmanuals.com/professional/special-subjects/care-of-the-surgical … publications/Postoperativecare.pdf • Anticoagulant Toolkit: Reducing Adverse Drug Events, Institute for Healthcare … Relevance of the Agency for Healthcare Research and Quality Patient Safety Indicators for children’

3728. Selected Best Practices and Suggestions for Improvement (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/d4t_combo_pdi08-postophemorrhage-bestpractices.pdf
      May 16, 2016 - o Establish a policy to empower nurses to rapidly escalate up the chain of authority to reach the responsible … hemorrhage at least annually).8 Additional Resources Systems/Processes • The Merck Manual for Health … Care Professionals: Postoperative Care http://www.merckmanuals.com/professional/special-subjects/care-of-the-surgical … publications/Postoperativecare.pdf • Anticoagulant Toolkit: Reducing Adverse Drug Events, Institute for Healthcare … Relevance of the Agency for Healthcare Research and Quality Patient Safety Indicators for children’

3729. Error Producing Conditions in the Intensive Care Unit (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol3/Advances-Drews_15.pdf
      February 26, 2008 - error in health care. … Efforts to improve patient safety in health care should to go beyond an RCA to incorporate a psychologically … factors that contribute to error in the context of health care. … However, it is important to keep in mind that error in health care is an issue that clinicians do not … used in prior non-health care domains—can be used to identify EPCs.

3730. Medical Injury Identification Using Hospital Discharge Data (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Layde.pdf
      January 01, 2003 - that for identifying injury caused by health care interventions.2, 6 The criteria evaluated in this … error reduction.2 Health care facilities in Wisconsin are required to submit inpatient discharge data … A report of the committee on Quality of Health Care in America, Institute of Medicine. … The quality in Australian health care study. Med J Aust 1995;163(9):458–71. 9. … Measuring errors and adverse events in health care. J Gen Intern Med 2003;18:61–7.

3731. Final Progress Report: Off-Label Prescribing: Comparative Evidence, Regulation, and Utilization (pdf file)
      www.ahrq.gov/sites/default/files/2024-01/kesselheim-report.pdf
      January 01, 2024 - Acknowledgement of Agency Support: This K-08 award was provided by the Agency for Healthcare Research … different disease entities, to variations on the approved indication, and to alternatives to the approved … Balancing innovation, access, and profits—market exclusivity for biologics. … Rising health care costs and life-cycle management in the pharmaceutical market. … Practical, legal, and ethical dimensions of expanded access to investigational drugs.

3732. BMI Assessment and Recommended Weight Gain (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/perinatal/chipra-mc4-fullreport.pdf
      July 01, 2016 - health care. … in improving the quality of health care. … care system. … We encourage the use of this measure by physicians, other health care professionals, and health care … Special Health Care Needs Not applicable for this measure. 7.C.

3733. AHRQ’s Safety Program for Nursing Homes: On-Time Preventable Hospital and Emergency Department Visits - Functional Specifications (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/fallsprev/ontimefallspxspecs.pdf
      February 01, 2018 - access data stored in the resident medical record for care planning and decision making. … Physicians, nurse practitioners, and physician assistants may also want to access the reports. … Text Display: “Source: Agency for Healthcare Research and Quality; 2018” in the bottom left margin … Text Display: “Source: Agency for Healthcare Research and Quality; 2017” in the bottom left margin … Text Display: “Source: Agency for Healthcare Research and Quality; 2017” in the bottom left margin

3734. Patient Safety Culture and Medical Liability—Recommendations for Measurement, Analysis, and Interpretation: A Commentary | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/reports/liability/waever.html
      August 01, 2017 - Pronovost Efforts by health care organizations to promote a culture of safety and regularly evaluate … Making health care safer II: an updated critical analysis of the evidence for patient safety practices … Int J Qual Health Care 2010; 22:151–61. 23. Wu AW. Medical error: the second victim. … Health care professionals as second victims after adverse events: a systematic review. … Qual Saf Health Care 2009; 18:325–30. 27. Edrees H, Connors C, Paine L, et al.

3735. Toolbox Contents | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/quality-resources/tools/chtoolbx/toolcon/index.html
      June 01, 2020 - Toolbox Contents Child Health Care Quality Toolbox The Child Health Toolbox contains concepts … , tips, and tools for evaluating the quality of health care for children.   … Top of Page Established Child Health Care Quality Measures Overview: Existing Measurement Sets … Term Consider All Available Measurement Tools Think Fewer Measures Develop a Plan Factors to … Claims Data—Very Carefully Sampling Reliability and Validity Field Testing An Alternative to

3736. Community-Acquired Pneumonia Clinical Decision Support Training - Emergency Department Setting
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cap-toolkit/tool4a_ed-setting.pptx
      January 10, 2017 - Acknowledgements This project was funded under contract/grant number HHSP233201500023I from the Agency for Healthcare … determine the appropriate site of care.” c Outpatient Hospitalization on a medical unit Admission to … add 1 to score if patient is found to be confused Displays patient-specific 30-day mortality and guideline-recommended … more intensive treatment —i.e., hospitalization or, where appropriate and available, intensive in-home health … care services—is usually warranted.” i Moderate recommendation (Even if a majority would follow the

3737. 1 Preventablehospitaledvisits-Overview-Ig (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/prevhosp/1_preventablehospitaledvisits-overview-ig.pdf
      June 02, 2025 - To intervene early? To intervene appropriately? … implement On-Time should have: • EMR vendor willing to provide access to On-Time reports … • Commitment to work with a Facilitator to learn how to use the reports to prevent adverse events … Ask each team member to access the report to ensure that all have “permission” to see the report, and … It was developed with funding from the Agency for Healthcare Research and Quality (AHRQ).

3738. Chapter-6 - Carbapenem-Resistant-Enterobacteriaceae (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/research/findings/making-healthcare-safer/mhs3/carbapenem-resistant-1.pdf
      March 01, 2020 - to reduce CRE-associated transmission and to ensure that healthcare settings remain safe for patients … Many toolkits and guidance documents exist to assist healthcare workers and infection control specialists … healthcare staff to care for patients infected with a particular multi-drug resistant organism (MDRO) … patients, staff, and the healthcare system. 6.1.4 Implementation Fostering a workplace environment … Moderate to low Relevant to discontinuation of CP Making Healthcare Safer III: A Critical Analysis

3739. Understand the Science of Safety | Agency for Healthcare Research and Quality
      www.ahrq.gov/hai/cusp/modules/understand/science-safety-notes.html
      July 01, 2018 - Health Care Defects Slide 5. How Can These Errors Happen? Slide 6. … Yet, despite these advancements, our health care system is still plagued with defects that limit the … Return to Contents   Slide 4: Health Care Defects Say: Examples of the effect of defects and … errors in the U.S. health care system are illustrated on this slide: 7 percent of patients suffer … Return to Contents   Slide 19: Exercise Say: Providers must remember that health care is a

3740. Information to Help Hospitals Get Started (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/howtogetstarted/How_to_Use_Guide_508.pdf
      February 08, 2018 - , Aurora Health Care, and Emory University Hospital … From the Institute for Healthcare Improvement and the National Initiative for Children’s Healthcare … their roles in care • Degree to which staff supported family members throughout the health care experience … Transforming healthcare: a safety imperative. Qual Saf Health Care 2009;18(6):424–8. 2. … Institute for Healthcare Improvement NICHQ.