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www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/strategies/medication/safe-medication-fac-guide.html
July 01, 2023 - Bedside staff, providers, and lab personnel should agree on one unit for reporting and communicating … This may include bedside review by nursing team of pump settings, mainline intravenous fluids, and written … patients and families regarding the frequency of nursing assessment and monitoring, signs and symptoms to report
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psnet.ahrq.gov/web-mm/errors-sepsis-management
November 03, 2015 - She died on hospital day 4 with her family at her bedside. … They also help the primary bedside nurse and rapid response nurse implement the orders within 1-hour … to complete a checklist at least once a shift. … Readers should not interpret any statement in this report as an official position of AHRQ or of the U.S … authors has any affiliation or financial involvement that conflicts with the material presented in this report
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/situ/simulation_postop-csection.docx
May 01, 2017 - This can be done using a verbal report and handoff from one nurse to another nurse during change of shift … Dad is at the bedside with the baby.” … Dad is at the bedside with the baby.”
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.338_slideshow.ppt
January 01, 2015 - The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal … The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal … 18757666
8
Remote Monitoring of FHR
Traditionally, FHR monitors have been located at the patient's bedside … The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal … that it facilitates monitoring of all patients at once
Previously, a nurse or physician had to visit bedside
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psnet.ahrq.gov/web-mm/preventing-picc-complications-whose-line-it
October 01, 2017 - internationally, per year.( 1,2 ) This rapid growth in PICC utilization has been fueled by ease of bedside … increase placement success, obviate the need for fluoroscopic guidance, and can be done safely at the bedside … throughout; and (v) daily evaluation for catheter necessity with prompt removal.( 10 ) In a recent report … Readers should not interpret any statement in this report as an official position of AHRQ or of the U.S … December 18, 2014
Transfer of accountability: transforming shift handover to enhance
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol3/Advances-Woods_78.pdf
July 23, 2008 - Detailed review of a few text reports to formulate meaning.
3. … Review of additional reports to develop preliminary categories.
4. … enabled care conferences 1
Rounds: Structured, scheduled,
interdisciplinary rounds at the patient’s
bedside … suggested Type Examples of interventions
Auto-faxing
medical
information
“When we sign off, the report … In addition,
when rounds take place at the patient’s bedside, senior clinicians could easily verify
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psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.236_slideshow.ppt
March 01, 2011 - communicated the minimal intake of fluids and poor urine output to the day nurse at the 7:00 AM change of shift … for their children and ask questions on their behalf
Yet parents or guardians may need to leave the bedside … Tools to assist in managing children, such as computerized bedside management systems (that can both
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/frontline-cases-studies.pdf
May 01, 2015 - This change also automated data outputs and reports. … For
example, the team conducts each shift report in front of the patient and concludes the report … new behaviors by initiating huddles and
debriefs during and after a cesarean section and requesting reports … Under the pro-
tocol change, the bedside nurse notifies the rapid response nurse and attending physician … The bedside nurse
now focuses on providing immediate care to the patient and providing a report of the
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www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/teamwork/pf-engagement-slides.html
July 01, 2023 - Conducting change-of-shift report at the bedside so patients and families can participate. … Report to the appropriate parties.
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psnet.ahrq.gov/node/50931/psn-pdf
February 26, 2020 - safety besides correct
diagnosis (e.g., sepsis bundles, or prophylaxis against venous thromboembolism), shift-based … Successful implementation of standardized multidisciplinary
bedside rounds, including daily goals, in … Readers should not interpret any statement in this report as an official position of AHRQ or
of the … authors has any affiliation or financial
involvement that conflicts with the material presented in this report
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psnet.ahrq.gov/node/49565/psn-pdf
July 01, 2008 - The LPN on the night shift
mistakenly hooked up the total nutrient fluid prepared for the central line … Recognizing the mistake, the LPN returned to the patient's bedside to correct the error, disconnected … The Commentary
We interpret reports of medical error through the prism of our own underlying assumptions … Final Report to Agency for Healthcare Research and Quality; 2007.
6. … Readers should not interpret any statement in this report as an official position of AHRQ or
of the
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psnet.ahrq.gov/web-mm/right-place-right-drug-wrong-strength
March 26, 2015 - Studies of ADC-related errors report on diverse patient populations with various control factors and … and barcode-assisted medication administration (BCMA) can provide yet another check at the patient bedside … These actions remove some of the possible errors that can occur in the process of bedside decision-making … Share and provide feedback on medication incident reports and experiences. … Readers should not interpret any statement in this report as an official position of AHRQ or of the U.S
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psnet.ahrq.gov/web-mm/complications-ecmo-during-transport
January 27, 2021 - It is feasible for use at bedside, with ambulating patients, and for mobile ECMO. … is also used as part of the patient survey the ECMO specialist nurse performs when beginning every shift … SBAR improves communication and safety climate and decreases incident reports due to communication errors … Readers should not interpret any statement in this report as an official position of AHRQ or of the U.S … authors has any affiliation or financial involvement that conflicts with the material presented in this report
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psnet.ahrq.gov/node/49826/psn-pdf
April 01, 2018 - Checking it twice: an evaluation of
checklists for detecting medication errors at the bedside using … Readers should not interpret any statement in this report as an official position of AHRQ or
of the … authors has any affiliation or financial
involvement that conflicts with the material presented in this report
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/strategies/safe-electronic/e-fetal-monitoring_facguide.docx
May 01, 2017 - Slide 11
SAY:
Clinician pocket cards and bedside reference aids that define and describe the 2008 … policy for certain EFM findings if the maternity care provider is not immediately available at the bedside
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www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/strategies/safe-electronic-fac-guide.html
July 01, 2023 - Slide 12: Key Safety Elements: Create Independent Checks
Say:
Clinician pocket cards and bedside … policy for certain EFM findings if the maternity care provider is not immediately available at the bedside
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www.ahrq.gov/hai/cauti-tools/archived-webinars/engaging-nurse-physician-patient-slides.html
August 01, 2018 - 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 … Root Cause Analysis, hospital reporting system
Quality and safety measures:
Monthly data reports … Slide 60
Image: Sample Post Fall Huddle report. … Slide 61
Image: Sample Post Fall Huddle report continued.
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psnet.ahrq.gov/primer/medication-administration-errors
December 15, 2024 - Background Medication errors have been a key target for improving safety since Bates and colleagues' reports … documentation, and use of standardized administration practices such as dual nurse verification at the bedside … Readers should not interpret any statement in this report as an official position of AHRQ or of the U.S … in Medication Safety December 15, 2024
Editor's Picks
An analysis of incident reports … March 15, 2017
Shift-to-shift handoff effects on patient safety and outcomes: a systematic
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www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/strategies/safe-electronic-tool.html
July 01, 2023 - Clinician pocket cards and bedside reference aids that describe the 2008 NICHD nomenclature and three-tier … This may include bedside review by nursing team of patient’s recent EFM strip, interpretation, and any … The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal … The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal … The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal
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www.ahrq.gov/sites/default/files/2024-04/dykes-report.pdf
January 01, 2024 - Final Progress Report: Generalizability and Spread of an Evidenced-based Fall Prevention Toolkit: Fall … TIPS audit tool is composed of three questions: 1) Is the patient’s Fall TIPS
poster hanging at the bedside … Based
on published literature and ranking of injurious fall incident reports (n=85) from Brigham and … therapists, pharmacists, and para-professionals) varied by position, education, years of experience, shift … implemented was as follows: 75% for question 1 (is the Fall TIPS poster updated and hanging at the
bedside