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www.innovations.ahrq.gov/talkingquality/measures/setting/hospitals/measurement-sets.html
February 01, 2023 - hospitals have safety practices and policies advocated by the National Quality Forum to reduce harm and errors
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www.innovations.ahrq.gov/health-literacy/professional-training/lepguide/chapter3.html
September 01, 2020 - set of team behaviors and structured communication tools to improve patient care and reduce medical errors
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/d4n_combo_iqi-mortalityreview-bestpractices.pdf
May 20, 2016 - care community and the public on the estimation that
between 48,000 and 98,000 deaths from medical errors
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www.innovations.ahrq.gov/hai/cauti-tools/archived-webinars/leveraging-cultural-change-slides.html
December 01, 2017 - Results to Leverage Change
Example- Hospital x Greatest opportunities:
Feedback & Communication About Errors
-
www.innovations.ahrq.gov/research/findings/factsheets/translating/action4/index.html
February 01, 2021 - Reports: Patient Safety
Evidence-based Practice Center Reports
Fact Sheets
Medical Errors
-
www.innovations.ahrq.gov/teamstepps/officebasedcare/module1/office_intro.html
February 01, 2016 - Lessons from the cockpit: how team training can reduce errors on L&D.
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www.innovations.ahrq.gov/patient-safety/settings/ambulatory/tools.html
February 01, 2018 - ambulatory care facilities prepare patients for new and follow-up appointments in order to prevent errors
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www.innovations.ahrq.gov/teamstepps/officebasedcare/module3/office_comm-ig.html
September 01, 2015 - 1995 and 2005, ineffective communication was identified as the root cause for 66 percent of reported errors
-
www.innovations.ahrq.gov/research/findings/evidence-based-reports/search.html
April 01, 2024 - Corporation Report Status: Final
Computerized Clinical Decision Support To Prevent Medication Errors
-
www.innovations.ahrq.gov/news/newsletters/e-newsletter/885.html
October 01, 2023 - Multicomponent pharmacist intervention did not reduce clinically important medication errors for ambulatory
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/officebasedcare/module5/5_ts_office_sitmon.pptx
January 20, 2006 - PowerPoint Presentation
for
Office-Based Care
Situation Monitoring
TEAMSTEPPS 05.2
Mod 1 05.2 Page ‹#›
Page ‹#›
RRS
1
Situation Monitoring
Process of actively scanning behaviors and actions to assess elements of the situation or environment
Enables team members to identify the potential issues or m…
-
www.innovations.ahrq.gov/sites/default/files/wysiwyg/sops/events/webinar/nh-workplace-safety-ginsberg.pdf
January 01, 2015 - New AHRQ SOPS® Workplace Safety Supplemental Item Set for Nursing Homes - Caren Ginsberg, Ph.D.
5
AHRQ’s Surveys on Patient Safety Culture™
(SOPS®) Program
Caren Ginsberg, Ph.D.
Center for Quality Improvement and Patient Safety, AHRQ
6
Agency for Healthcare Research and Quality
• AHRQ is:
► A research and sci…
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/officebasedcare/handouts/knowledge.pdf
December 02, 2015 - Experience preventable errors.
c. Focus attention on the patient.
d. Adapt quickly to changes.
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/chipra_1415-p008-2-ef.pdf
January 01, 2015 - affect parent/caregiver work and school arrangements and expose children to infections
and medical errors
-
www.innovations.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/chipra_14-p008-1-ef.pdf
October 01, 2014 - parent/caregiver work and school arrangements and expose children to risk of
infections and medical errors
-
www.innovations.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/chipra-1416-p006-2-ef.pdf
December 01, 2015 - admission temperature was 29⁰ C or higher (thus, reducing the potential for including potential data errors
-
www.innovations.ahrq.gov/sites/default/files/wysiwyg/teamstepps/officebasedcare/ts-obc-online-module10.pptx
March 07, 2019 - Results
Patient outcome measures
Examples: Complication rates, infection rates, measurable medication errors … Results measures include patient outcome measures—measures such as measurable medication errors—as well … MD or DO—physician assistants, nurse practitioners, or other providers licensed to diagnose medical errors
-
www.innovations.ahrq.gov/sites/default/files/wysiwyg/pqmp/toolkits/translating-cahps-surveys.pdf
January 17, 2017 - approach, for example—include the
following:
• Increased ability to identify and resolve translation errors … (i.e., errors in syntax, grammar, or
meaning)
• Increased ability to identify issues related to variations
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/availability/chipra-133-section-2-tech-specs.pdf
January 01, 2011 - CHIPRA 133: Section 2 Technical Specifications
Section II: Detailed Measure Specifications
Provide sufficient detail to describe how a measure would be calculated from the
recommended data sour…
-
www.innovations.ahrq.gov/sites/default/files/wysiwyg/sops/events/webinar/action-planning-webcast-transcript.pdf
June 01, 2019 - Feedback and Communication About Error is the
extent to which staff are informed about errors.