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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/leveraging-cultural-change-transcript.doc
August 12, 2014 - No matter what process you put in place, it’s communication at the bedside.” … So when you have a culture that there’s dialogue about patients, there’s dialogue at the bedside about … So Nurse ED gives report to Nurse Med on the medical floor and she says, “Patient A is an 87-year-old … When discussing the issue with the front line staff, they report that the chief of surgery has created … And I also came from the trenches, having worked at the bedside for over 20 years, nights and days.
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www.ahrq.gov/hai/cauti-tools/archived-webinars/leveraging-cultural-change-transcript.html
December 01, 2017 - No matter what process you put in place, it's communication at the bedside.” … So when you have a culture that there's dialogue about patients, there's dialogue at the bedside about … So Nurse ED gives report to Nurse Med on the medical floor and she says, “Patient A is an 87-year-old … When discussing the issue with the front line staff, they report that the chief of surgery has created … And I also came from the trenches, having worked at the bedside for over 20 years, nights and days.
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www.ahrq.gov/hai/universal-icu-decolonization/universal-icu-ape.html
September 01, 2013 - Standard skin preps prior to a surgical procedure or for a bedside procedure should be utilized on patients … The cost burden of decolonization is a shift from lab costs (MRSA swab, nurse time, technician time,
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www.ahrq.gov/es/hai/universal-icu-decolonization/universal-icu-ape.html
September 01, 2013 - Standard skin preps prior to a surgical procedure or for a bedside procedure should be utilized on patients … The cost burden of decolonization is a shift from lab costs (MRSA swab, nurse time, technician time,
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/engaging-nurse-physician-patient.pptx
May 28, 2015 - Nurse OR gave report to Nurse ICU.
08/03/12 – Ms. C is stable. … C’s son was at the bedside during visiting hours, he stated he was angry and concerned that his mother … When = Rounding, every shift
Why = Provide the stats, harm, cost
8
Providing the Tools to Succeed … Unit
Saint Joseph Mercy Hospital
Ann Arbor, Michigan
53
Finding the Defects
54
Staff feedback
Shift … Event reporting
Root Cause Analysis, hospital reporting system
Quality and safety measures
Monthly data reports
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www.ahrq.gov/sites/default/files/wysiwyg/research/findings/making-healthcare-safer/mhs3/sepsis-1.pdf
March 01, 2020 - or to emergency medical services
[EMS]) or at regular intervals (e.g., the start of every nursing shift … A Critical Analysis of Existing and Emerging Patient Safety Practices
https://www.hcup-us.ahrq.gov/reports … /statbriefs/sb148.jsp
https://www.hcup-us.ahrq.gov/reports/statbriefs/sb148.jsp
Sepsis Recognition … General methods for this report are described in the
Methods section of the full report. … General methods for this report are described in the Methods
section of the full report.
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www.ahrq.gov/es/patient-safety/settings/hospital/resource/pressureulcer/tool/pu3.html
October 01, 2014 - prevention, it is necessary to recognize at the outset that implementing these best practices at the bedside … In some settings, though, it may be done as frequently as every shift. … Positive reinforcement will help when nursing assistants do find and report new abnormalities. … Having staff who do not feel empowered to report abnormal skin findings: Communication among nursing … Including results as part of patient report or handover.
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www.ahrq.gov/patient-safety/settings/hospital/resource/pressureulcer/tool/pu3.html
October 01, 2014 - prevention, it is necessary to recognize at the outset that implementing these best practices at the bedside … In some settings, though, it may be done as frequently as every shift. … Positive reinforcement will help when nursing assistants do find and report new abnormalities. … Having staff who do not feel empowered to report abnormal skin findings: Communication among nursing … Including results as part of patient report or handover.
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/surgery/modules/onboarding/onboarding_scienceofsafety_facnotes.docx
December 01, 2017 - a surgical site infection, wrong-site surgery, missing equipment, nursing time spent away from the bedside … Residents report receiving inaccurate information during rounds: An electronic progress note system was … forms are readily available so staff members can complete the PSSA whenever they have something to report … important to consider and plan how you will train staff and others who work off hours such as the overnight shift
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www.ahrq.gov/hai/cusp/modules/understand/science-safety-notes.html
July 01, 2018 - This shift of authority led to a significant drop in the number of reported birth complications. … and nurses with a structured approach to review problems that may have occurred during the previous shift … , assess the anticipated workload for the coming shift (such as new patients, patient discharges, and … Executives, physicians, nurse managers, infection preventionists, bedside clinicians, and unit support
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/technical/intro-early-mobility-slides.pptx
January 01, 2017 - Critical Illness3
Data from longitudinal prospective study, pre-baseline information collected by self-report … to sitting
11 percent involved sitting over the edge of the bed
11 percent involved standing at the bedside
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www.ahrq.gov/patient-safety/settings/hospital/resource/pressureinjury/guide/apf.html
October 01, 2017 - Description: The Implementation Team shared details about their initiative via a board report, a presentation … information with your board and other administrative leaders through multiple avenues (e.g., meetings, reports … nurse manager validated orders, and the quality representative checked charts and conducted random bedside … Description: The SWAT has a representative from each unit and shift. … Nurse leaders, the Pressure Injury Prevention Program Lead, and bedside nurses are available to answer
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Wideman.pdf
April 20, 2004 - Administration software
enables users to document electronically the administration of medications at the
bedside … According to a landmark
1999 Institute of Medicine report, between 44,000 and 98,000 Americans die … on the ICU unit to increase nursing staff access to the
BCMA system during those instances when the bedside … , these
individuals were designated BCMA “Super Users” and were made accessible to
staff on every shift … A report of
the Committee on Quality of Health Care in America,
Institute of Medicine.
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www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/reports/issue-briefs/distributed-cognition-er-nurses.pdf
August 01, 2022 - example, nursing work is structured so
that nurses have frequent patient interactions throughout a shift … Another artifact is the paper-based task sheet nurses frequently develop at the beginning of a shift. … Cognition
+
+
4
Nurses’ Role in Diagnosis, Through the Lens of
Distributed Cognition
The landmark report … Finally, dyad combinations are not fixed and may change frequently during an ED shift, with one physician … Impact of altered medica-
tion administration time on interdisciplinary bedside rounds on academic medical
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www.ahrq.gov/sites/default/files/wysiwyg/cahps/surveys-guidance/hospital/compare/WR_751_AHRQ_Quigley_08_26_10.pdf
April 01, 2010 - Those findings were confirmed by patient complaint data, monthly
reports collected from patients through … News
and World Report” annual report on hospitals also indicated a need for improvement. … News and World Report” annual hospital
rankings.
When? … The efforts included: (1) developing bedside descriptors to explain to patients the roles of
attending … The assignment
to each position/shift was determined by seniority.
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/cauti-sustainability-transcript.docx
January 01, 2014 - On the genitourinary shift assessment, the same thing is there and this is required every shift. … We have to report out to infection prevention council.
This is our analysis tools that we have. … From the bedside of the boardroom, it matters. … This is quick screenshot of our shift huddle. This is how we start each shift. … CUSP improvement tools are designed for the bedside caregivers easy for the staff to use.
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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa/170-cusp-science-safety-notes.docx
October 01, 2024 - Preventable Harm
SAY:
Healthcare has focused on safety since the Institute of Medicine released a report … Although significant improvements occurred following that report, there’s still a tremendous need for … According to a World Health Organization report, 1 in 10 patients are harmed when they stay in a hospital … Due to psychological safety, there is no risk when people report their errors and near-misses.
3. … And, when you need to know what is going on at the bedside, ask.
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www.ahrq.gov/diagnostic-safety/research/grants-2022.html
August 01, 2025 - Collaborative Healthcare Patient Safety Organization, Patient Safety Authority) and medical malpractice reports … Impact of clinician training background and stroke location on bedside diagnostic test accuracy in the … Development and external validation of an artificial intelligence model for identifying radiology reports … Period 09/30/22 - 09/29/26 Goals The goal of the Patient-Partnered Diagnostic Center of Excellence is to shift … Develop site-level and groupwide benchmarking reports of error rates, diagnostic processes, and diagnostic
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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa/040-mrsa-surveillance-notes.docx
October 01, 2024 - Staphylococcus aureus, including MRSA, can survive for months on dry surfaces including bed rails and bedside … Most U.S. hospitals report laboratory-identified (LabID) MRSA bacteremia since it is a publicly reported … This shift away from active MRSA surveillance reduces units’ ability to accurately measure the prevalence
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www.ahrq.gov/sites/default/files/publications2/files/distributed-cognition-er-nurses_0.pdf
August 01, 2022 - example, nursing work is structured so
that nurses have frequent patient interactions throughout a shift … Another artifact is the paper-based task sheet nurses frequently develop at the beginning of a shift. … Cognition
+
+
4
Nurses’ Role in Diagnosis, Through the Lens of
Distributed Cognition
The landmark report … Finally, dyad combinations are not fixed and may change frequently during an ED shift, with one physician … Impact of altered medica-
tion administration time on interdisciplinary bedside rounds on academic medical