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

281. Resource List - AHRQ Medical Office Survey (pdf file)
     pcmh.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/medical-office/medoffice-resourcelist.pdf
     April 01, 2023 - Staff can use this decision tree when analyzing an error or adverse event in an organization to help … events and close calls. … events, and near-misses. … These organizations consistently minimize adverse events despite carrying out intrinsically complex and … drug events (ADEs).

282. Information Items | Agency for Healthcare Research and Quality
     pcmh.ahrq.gov/teamstepps/readiness/informationitems.html
     April 01, 2016 - Objective information can originate from a variety of sources, including adverse event and near-miss

283. AHRQ Safety Program for Perinatal Care: Labor and Delivery Unit Safety Umbilical Cord Prolapse (doc file)
     pcmh.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/strategies/labor-delivery-unit/tool_cord-prolapse.docx
     May 01, 2017 - Defects (CUSP Module) Key Perinatal Safety Elements Examples Debrief and analyze near misses and adverse … events related to cord prolapse … · A 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

284. Yale Center for Healthcare Innovation, Redesign, and Learning | Agency for Healthcare Research and Quality
     pcmh.ahrq.gov/patient-safety/resources/learning-lab/yale-center-long-desc.html
     June 01, 2020 - Patients and Families About AHRQ's Quality & Patient Safety Work Patient Safety News and Events … Emergency department boarding and adverse hospitalization outcomes among patients admitted to a general

285. Overview of Patient Safety Learning Laboratory (PSLL) Projects | Agency for Healthcare Research and Quality
     pcmh.ahrq.gov/patient-safety/resources/learning-lab/index.html
     February 01, 2024 - outpatient monitoring for high-risk conditions, and (c) enhanced medication comprehension to reduce adverse … drug events. … drug events. … patient safety events. … events, and improve efficiency for ED healthcare providers.

286. Resource List - AHRQ Nursing Home Survey (pdf file)
     pcmh.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/nursing-home/nursinghome-resourcelist.pdf
     April 01, 2023 - These organizations consistently minimize adverse events despite carrying out intrinsically complex and … events and close calls. … events, and near-misses. … • Eliminating Wrong Site Surgery and Procedure Events. • MHS Leadership Engagement. … drug events (ADEs).

287. Strategy 3: Bedside Shift Report (Tool 3)
     pcmh.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy3/strat3_tool_3_pres_video_508.pptx
     July 23, 2010 - For example, one study found that more than 70 percent of adverse events are caused by breakdowns in … As noted above, one study found that more than 70 percent of adverse events are caused by breakdowns … infections, and air embolism, all of which are on CMS’s list of hospital-acquired complications “never events … successful transfer of information between nurses going off duty and nurses coming on duty to prevent adverse … events and medical errors.

288. Enhancing Safety for Patients with Limited English Proficiency Train-the-Trainer Instructor Guide (pdf file)
     pcmh.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/lep/traintrainers/lepigstafftrain.pdf
     November 19, 2008 - The Story of Willie Ramirez SAY: To illustrate why LEP patients are at risk of patient safety events … Language proficiency and adverse events in U.S. hospitals: a pilot study. … inspired by the 2006 book by John Kotter, Our Iceberg Is Melting: Changing and Succeeding Under Adverse … Our iceberg is melting: changing and succeeding under adverse conditions. … identified as a primary contributor to the clinical errors found in malpractice cases and sentinel events

289. AHRQ Views Blog Post: With TeamSTEPPS 3.0, AHRQ Refreshes a Landmark Patient Safety Training Curriculum | Agency for Healthcare Research and Quality
     pcmh.ahrq.gov/news/newsletters/e-newsletter/880.html
     September 01, 2023 - section News Newsroom Blog Newsletter AHRQ News Now Events … of implementation factors related to addressing social determinants to reduce racial disparities in adverse

290. TeamSTEPPS 2.0 Readiness Assessment | Agency for Healthcare Research and Quality
     pcmh.ahrq.gov/teamstepps/readiness/index.html
     August 01, 2015 - Objective information can originate from a variety of sources, including adverse event and near-miss

291. Labor and Delivery Unit Safety: Slide Presentation | Agency for Healthcare Research and Quality
     pcmh.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/strategies/labor-delivery-unit/ldu-safety-slides.html
     July 01, 2023 - Patients and Families About AHRQ's Quality & Patient Safety Work Patient Safety News and Events … Elements Slide 31: 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

292. AHRQ Safety Program for Perinatal Care: Rapid Response for Perinatal Safety: Rapid Response Systems (doc file)
     pcmh.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/strategies/rapid-response/tool_rapidresponse-systems.docx
     May 01, 2017 - Patients on perinatal units can experience cardiopulmonary and metabolic events or deterioration that … Defects (CUSP Module) Key Perinatal Safety Elements Examples Debrief and analyze near misses and adverse … events, regardless of whether a rapid response was activated. … · Unit can decide its approach to debriefing events based on seriousness of event, expertise available … Elements Examples Have a process in place to review severe maternal or neonatal morbidity and mortality events

293. Federal Interagency Workgroup: Improving Diagnostic Safety and Quality in Healthcarae Meeting (pdf file)
     pcmh.ahrq.gov/sites/default/files/wysiwyg/topics/dx-safety-workgroup-meeting-notes-nov2023.pdf
     March 01, 2024 - able to use Measure Dx to guide their efforts to detect, analyze, and learn from diagnostic safety events … IHS • Existing Activities Regarding Diagnostic Safety o Voluntary adverse event report via I-STAR. … optimize this effort, as they are focused on root cause analysis standardization to help in identifying events

294. 2022 National Healthcare Quality and Disparities Report Data Sources (pdf file)
     pcmh.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2022qdr-datasources.pdf
     December 01, 2022 - Standard forms for the data collection and model procedures for the uniform registration of events are … , such as medication prescriptions and laboratory test results that are relevant to patient safety events … Measures and modules included in calculation of adverse event rates Measure Module One or more adverse … outcomes Birth - Maternal Adverse event associated with hypoglycemic agent Medication Adverse event … events Pressure Ulcer Venous thromboembolism/pulmonary embolism (VTE/PE) not related to procedure

295. Building an Ambulatory Patient Safety Learning Laboratory for Diverse Populations (ASCENT) | Agency for Healthcare Research and Quality
     pcmh.ahrq.gov/patient-safety/resources/learning-lab/building-ambulatory-long-desc.html
     April 01, 2021 - Patients and Families About AHRQ's Quality & Patient Safety Work Patient Safety News and Events … outpatient monitoring for high-risk conditions, and (c) enhanced medication comprehension to reduce adverse … drug events.

296. Final report: Realizing Improved Patient Care through Human-centered Design in the OR (pdf file)
     pcmh.ahrq.gov/sites/default/files/2024-01/joseph3-report.pdf
     January 01, 2024 - Scope The incidence of adverse events, such as surgical site infections and surgical errors, is an immense … Previous attempts to reduce adverse events in the OR have focused on enhancing skills and training for … Research in complex settings suggests that adverse events are often caused by a combination of active

297. Diagnostic error in mental health: a review (pdf file)
     pcmh.ahrq.gov/sites/default/files/wysiwyg/topics/dx-safety-mental-health-bmjqs.pdf
     April 15, 2024 - conceptual and operational defini- tions for diagnostic errors are needed to measure and learn from these events … bias Consider how social determinants are related to differential exposure to risk factors (eg, adverse … education and socioeconomic status,76 77 79 80 less reliable access to healthcare,65 66 history of adverse

298. 2023 National Healthcare Quality and Disparities Report Data Sources (pdf file)
     pcmh.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2023qdr-data-sources.pdf
     December 01, 2023 - Standard forms for the data collection and model procedures for the uniform registration of the events … , such as medication prescriptions and laboratory test results that are relevant to patient safety events … Measures and modules included in calculation of adverse event rates Measure Module One or more adverse … outcomes Birth - Maternal Adverse event associated with hypoglycemic agent Medication Adverse event … events Pressure Ulcer Venous thromboembolism/pulmonary embolism (VTE/PE) not related to procedure

299. Mod5-Comm-Assessment (pdf file)
     pcmh.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/candor/module5/mod5-comm-assessment.pdf
     April 01, 2016 - communicators who participate in conversations with patients, families, and caregivers following an adverse … demonstrate all of the skills and competencies should be involved in delivering communication about adverse … events to patients, families, and caregivers. … Future events are simply described. … Conventional Responses can include… ■ Describe Mary’s current condition and the events that led up to

300. Library of PCOR Resources | Agency for Healthcare Research and Quality
     pcmh.ahrq.gov/pcor/library-of-resources/index.html
     April 01, 2021 - database , which contains information on study participants and a summary of study outcomes, including adverse … events.