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Showing results for "adverse events".
Users also searched for: patient safety indicators

301. AHRQ Safety Program for Perinatal Care: Labor and Delivery Unit Safety
     ahrqpubs.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/strategies/labor-delivery-unit/ldusafety.pptx
     May 01, 2017 - L&D Unit Safety 30 Key Safety Elements: Learn From Defects Debrief and analyze near misses and adverse … events. … Have a process in place to review severe maternal or neonatal morbidity and mortality events. … Factors to consider: Unit and malpractice claims data suggesting adverse events or near misses related

302. AHRQ Safety Program for Perinatal Care: Safe Medication Administration: Oxytocin (doc file)
     ahrqpubs.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/strategies/medication/tool_safe-oxytocin.docx
     May 01, 2017 - parameters for provider notification and expectations for provider response ensures that signs of potential adverse … Defects (CUSP Module) Key Perinatal Safety Elements Examples Debrief and analyze near misses and adverse … events related to oxytocin use … · Unit can decide its approach to debriefing events based on seriousness of event, expertise available … Have a process in place to review severe maternal or neonatal morbidity and mortality events.

303. About Priority Populations | Agency for Healthcare Research and Quality
     ahrqpubs.ahrq.gov/priority-populations/about/index.html
     June 01, 2021 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events

304. Module 1: Preventing Falls in Hospitals—Slide Presentation | Agency for Healthcare Research and Quality
     ahrqpubs.ahrq.gov/patient-safety/settings/hospital/fall-prevention/workshop/module-1/slides.html
     September 01, 2017 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … Patients and Families About AHRQ's Quality & Patient Safety Work Patient Safety News and Events … understanding that even small failures in safety protocols or processes can lead to catastrophic or adverse … events if action is not taken to solve the problem.

305. SDOH Data and Analytics | Agency for Healthcare Research and Quality
     ahrqpubs.ahrq.gov/sdoh/data-analytics.html
     July 01, 2022 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … security, transportation, financial strain, general well-being, social connectedness, physical safety, and adverse

306. AHRQ Safety Program for Perinatal Care: Labor and Delivery Unit Safety Safe Cesarean Section (doc file)
     ahrqpubs.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/strategies/labor-delivery-unit/tool_safe-csection.docx
     May 01, 2017 - Learn From Defects (CUSP Module) Key Perinatal Safety Elements Examples Debrief and analyze adverse … events related to cesarean section … · Unit can decide its approach to debriefing events based on seriousness of event, expertise available … case reviews Have a process in place to review severe maternal or neonatal morbidity and mortality events

307. Nursing Home Workplace Safety Resource List (pdf file)
     ahrqpubs.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/nursing-home/nursing-home-workplace-safety-resources.pdf
     January 01, 2023 - page provides tips to encourage staff members to report conditions that could lead to near-misses or adverse … events.

308. TeamSTEPPS 2.0 Module 3: Communication
     ahrqpubs.ahrq.gov/sites/default/files/wysiwyg/teamstepps/instructor/onlinecourse/tsonlinemodule3.pptx
     December 01, 2005 - * 2010 - 2012: Ineffective communication among top 13 root causes of sentinel events reported ** * ( … JC Root Causes and Percentages for Sentinel Events (All Categories) January 1995−December 2005) ** (JC … As a patient safety officer, I covered all our sentinel events, as well as any other adverse events, … which may not have been sentinel events. … We use it in our adverse event reports.

309. Declines in Hospital-Acquired Conditions from 2014 to 2016 | Agency for Healthcare Research and Quality
     ahrqpubs.ahrq.gov/data/infographics/hac-rates-decline.html
     August 01, 2018 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events

310. Preventing Pressure Injuries in Hospitals
     ahrqpubs.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/pressure_ulcer_prevention/module1/module1_pu-whychange_slides.pptx
     June 16, 2017 - understanding that even small failures in safety protocols or processes can lead to catastrophic or adverse … events if action is not taken to solve the problem. … Memo on never events, July 7, 2008.

311. AHRQ Stats | Agency for Healthcare Research and Quality
     ahrqpubs.ahrq.gov/news/newsroom/ahrq-stats.html
     November 01, 2023 - (Source: Complications, Adverse Drug Events, High Costs, and Disparities in Multisystem Inflammatory … Measures showing the most improvement included reduced adverse events among hospital patients receiving … (Source: Healthcare Cost and Utilization Project Statistical Brief #237: Patient Safety and Adverse … Events, 2011 and 2014 .) … Events, 2011 and 2014 .)

312. Hospital Survey on Patient Safety Culture: User's Guide (pdf file)
     ahrqpubs.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/hospital/userguide/hospitalusersguide.pdf
     July 01, 2018 - provide an overall grade on patient safety for their work area/unit and to indicate the number of events …  “Patient safety” is defined as the avoidance and prevention of patient injuries or adverse events … Hospital management seems interested in patient safety only after an adverse event happens ......... … Hospital management seems interested in patient safety only after an adverse event happens. … Frequency of Events Reported (Never, Rarely, Sometimes, Most of the time, Always) D1.

313. Module 1: Using the Comprehensive Long-Term Care Safety Modules: Applying Safety Principles: Facilitator Notes | Agency for Healthcare Research and Quality
     ahrqpubs.ahrq.gov/hai/quality/tools/cauti-ltc/modules/implementation/long-term-modules/module1/mod1-facguide.html
     March 01, 2017 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … In addition, the toolkit can enable teams to address root causes of adverse events more effectively. … It investigates events or safety concerns, and determines an appropriate course of action with the employees

314. Health Literacy and Patient and Family Engagement: Strategic Tools to Prevent CAUTI | Agency for Healthcare Research and Quality
     ahrqpubs.ahrq.gov/hai/cauti-tools/archived-webinars/health-literacy-slides.html
     December 01, 2017 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … Percent know correct action for hypoglycemic symptoms 38 53.9 72.6 Slide 8 All Sentinel Events … limited health literacy: Poor compliance with medical management Increased risk of: Poor outcomes/adverse … events Infections/prolonged hospital stays Patient/family anxiety Slide 33 Summary: Health

315. Selected Best Practices and Suggestions for Improvement (pdf file)
     ahrqpubs.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/d4v_combo_pdi10-sepsis-bestpractices.pdf
     May 17, 2016 - Charges and lengths of stay attributable to adverse patient-care events using pediatric-specific quality

316. Strategy 3: Nurse Bedside Shift Report Implementation Handbook (doc file)
     ahrqpubs.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy3/Strat3_Implement_Hndbook_508.docx
     August 01, 2010 - Nurse shift changes require the successful transfer of information between nurses to prevent adverse … events and medical errors. … One study found that more than 70 percent of adverse events are caused by breakdowns in communication … are on the Centers for Medicare and Medicaid Services’ list of hospital-acquired complications “never events … communication during nurse transitions, for example: Reduce the incidence of never events by 5 percent

317. Specific Tools To Support Change (pdf file)
     ahrqpubs.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/g2_combo_specifictoolstosupportchange.pdf
     January 01, 2011 - • Sentinel events: transfusion reaction, wrong blood type, wrong-site surgery, foreign body left … in during procedure, medical equipment- related adverse events, medication errors … • Other care-related adverse events: patient falls, in-hospital hip fracture or fall http://www.oecd.org … Hospital of Philadelphia annually reviews all findings from root cause analyses of serious safety events … This electronic toolbox provides States with tools they can use or modify as they develop or improve adverse

318. Appendix 3: Data Abstraction (xls file)
     ahrqpubs.ahrq.gov/sites/default/files/wysiwyg/research/findings/ta/topicrefinement/ced-appendix3-data-abstraction.xlsx
     June 24, 2022 - utilization; NEST_data • The specific data elements required to assess performance and outcomes (including adverse … events and their timing) in the course of the disease or treatment; NEST_data • The appropriate settings … expectations or preferences will providers and patients be expected to have regarding benefits and adverse … NAM2019 Likelihood that beneficial or adverse effects would be reported or observed? … expectations or preferences will providers and patients be expected to have regarding benefits and adverse

319. Defining Diagnostic Error: A Scoping Review to Assess the Impact of the National Academies’ Report Improving Diagnosis in Health Care (pdf file)
     ahrqpubs.ahrq.gov/sites/default/files/wysiwyg/topics/defining-diagnostic-error-a-scoping-review.pdf
     April 27, 2022 - The remaining 2 studies (Giardina et al29,30) analyzed existing data sets of patient reports of adverse … events and patient complaints, respectively. … Secondary analysis of patient reports of adverse Timeliness, accuracy, communication events ( … The determination of error depends on the temporal or sequential context of events. … Tracking Progress in improving diagnosis: a framework for defining undesirable diagnostic events.

320. Strategy 3: Nurse Bedside Shift Report Implementation Handbook (pdf file)
     ahrqpubs.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy3/Strat3_Implement_Hndbook_508.pdf
     August 01, 2010 - Nurse shift changes require the successful transfer of information between nurses to prevent adverse … events and medical errors. … One study found that more than 70 percent of adverse events are caused by breakdowns in communication … on the Centers for Medicare and Medicaid Services’ list of hospital-acquired complications “never events … communication during nurse transitions, for example: • Reduce the incidence of never events by 5 percent