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Showing results for "event".

101. TeamSTEPPS Pocket Guide (pdf file)
     cahps.ahrq.gov/sites/default/files/wysiwyg/teamstepps-program/teamstepps-pocket-guide.pdf
     May 01, 2023 - .......................11 Effective Team Leadership ..............................12 Effective Team Event … Team Leadership Page 13 Effective Team Event Tools Sharing the Plan y Brief—Short session prior to … I-PASS Team Leadership Multi-Team System forPatient Care Effective Team Leadership Effective Team Event … I-PASS Team Leadership Multi-Team System forPatient Care Effective Team Leadership Effective Team Event

102. AHRQ Safety Program for Perinatal Care: Labor and Delivery Unit Safety Umbilical Cord Prolapse (doc file)
     cahps.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 - facilitating a safe delivery by offering logic and a clear focus during what can often be a chaotic event … · A unit can decide its approach to debriefing events based on seriousness of event, expertise available … · Informal debriefings by clinical team immediately following the event using an approach that does … prolapse diagnosis, awareness and monitoring of time since diagnosis, and discussing next steps in the event

103. AHRQ National Scorecard on Hospital-Acquired Conditions: Updated Baseline Rates and Preliminary Results 2014-2016 (pdf file)
     cahps.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/pfp/natlhacratereport-rebaselining2014-2016_0.pdf
     January 01, 2016 - The use of these five sets of charts also eliminated the need to use 2005-2006 Medicare adverse event … Measures used to estimate the national HAC rate HAC Type Source Measure Adverse Drug Event MPSMS … Associated With Hip Joint Replacements MPSMS Adverse Event Associated With Knee Joint Replacements … for all patients for which the MPSMS data are used, we follow these steps: • Multiply the adverse event … MPSMS Femoral Artery Procedures Puncture for Catheter Angiographic 21,538 0.72 MPSMS Adverse Event

104. The End of the Public Health Emergency Refocuses the Urgency to Improve Healthcare Quality | Agency for Healthcare Research and Quality
     cahps.ahrq.gov/news/blog/ahrqviews/public-health-emergency-refocus.html
     May 01, 2023 - England Journal of Medicine that estimated 1 in 4 people hospitalized are at risk of a patient safety event … Trends in adverse event rates in hospitalized patients. JAMA  2022 Jul 12;328(2):173-83.

105. Methods To Estimate the Baseline 2010 PFP National Hospital-Acquired Condition Rate | Agency for Healthcare Research and Quality
     cahps.ahrq.gov/hai/pfp/methods.html
     December 01, 2017 - Condition Rate Partnership for Patients Hospital-Acquired Conditions Source Measure Adverse Drug Event … population, rather than as a rate for the subpopulation that has the opportunity to experience the adverse event … for each of the 21 HACs for all patients for which the MPSMS data are used, we multiply the adverse event … (rounded)  (updated June 2014) 4,757,000   145 Ideally, we would have estimated the adverse event

106. Federal Interagency Workgroup--Diagnostic Safety: November Meeting Summary (pdf file)
     cahps.ahrq.gov/sites/default/files/wysiwyg/topics/dx-safety-workgroup-meeting-notes-nov2022.pdf
     March 01, 2023 - • Common Formats for Event Reporting – Diagnostic Safety o Released the Common Formats for Event

107. TeamSTEPPS® Instructor Manual: Specialty Scenarios | Agency for Healthcare Research and Quality
     cahps.ahrq.gov/teamstepps/instructor/scenarios/dental.html
     March 01, 2014 - Instructor Comments A call-out is a tactic used to communicate critical information or an emerging event … This communication failure results in an adverse event. … In the event of high workload, team members are expected to prioritize and assist teammates to ensure

108. TeamSTEPPS Fundamentals Course: Module 4. Leading Teams | Agency for Healthcare Research and Quality
     cahps.ahrq.gov/teamstepps/instructor/fundamentals/module4/igleadership.html
     March 01, 2019 - Discussion: What event necessitated the need for the huddle? … Analysis of why the event occurred, what worked, and what did not work. … Debriefs can be a brief (about 3 minutes or less) team event, typically initiated and facilitated by … Held debrief to recap event and share lessons learned. … Use of these tools leads to gaining a shared model or understanding of a situation or event (i.e., shared

109. AHRQ Safety Program for Perinatal Care: Labor and Delivery Unit Safety Shoulder Dystocia (doc file)
     cahps.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/strategies/labor-delivery-unit/tool_shoulder-dystocia.docx
     May 01, 2017 - facilitating a safe delivery by offering logic and a clear focus during what can often be a chaotic event … · A unit can decide its approach to debriefing events based on seriousness of event, expertise available … · Informal debriefings by clinical team immediately following event using an approach that does not … www.safehealthcareforeverywoman.org · Resource name: Process for Reviewing Severe Maternal Morbidity Event

110. CAUTI Sustainability: Embedding CAUTI Policies, Using Data to Monitor Proress and Hardwiring CUSP Principles | Agency for Healthcare Research and Quality
     cahps.ahrq.gov/hai/cauti-tools/archived-webinars/cauti-sustainability-slides.html
     December 01, 2017 - at unexpected events, data results, and outcomes to determine all of the underlying causes of the event … Event Analysis Team notification – Nurse Manager, Medical Director, and Frontline staff notification … – email and huddle Infection Prevention Council report out Slide 66 Event Analysis Tool Image … : Screen shot of a CAUTI Event Analysis form. … Slide 80 Identifying Defects: Defects Can Come From Many Different Sources Staff feedback Event

111. TeamSTEPPS Video Debrief Guide: Huddle in Emergency Department (pdf file)
     cahps.ahrq.gov/sites/default/files/wysiwyg/teamstepps-program/video/huddle-emergency-dept-guide.pdf
     August 31, 2023 - Lessons Learned A huddle helps teams improve performance and enhance safety when preparing for an event

112. Resource List - AHRQ Ambulatory Surgery Center Survey (pdf file)
     cahps.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/asc/asc-resource-list.pdf
     April 01, 2023 - Staff can use this decision tree when analyzing an error or adverse event in an organization to help … identify how human factors and systems issues contributed to the event. … Staff can use this decision tree when analyzing an error or adverse event in an organization to help … identify how human factors and systems issues contributed to the event. … Leadership Response to a Sentinel Event: Respectful, Effective Crisis Management 5.

113. Tools for Reducing Central Line-Associated Blood Stream Infections (pdf file)
     cahps.ahrq.gov/sites/default/files/wysiwyg/hai/clabsi-tools/clabsi-tools-revised.pdf
     January 01, 2013 - CLABSI Event Report Template Appendix 8. CLABSI Investigation Nurse Letter Appendix 9. … Use the Event Report Template and Nurse Letter If a CLABSI occurs on your unit, your team should … The CLABSI Event Report Template (Appendix 7) catalogs defects that contribute to a CLABSI. … Central Line-Associated Bloodstream Infection (CLABSI) Event. … device policies Empower nurses to stop procedures Use the Central Line Maintenance Audit Form Use the Event

114. Seeking the Right Balance: Addressing Behaviors That Undermine a Culture of Safety (pdf file)
     cahps.ahrq.gov/sites/default/files/wysiwyg/teamstepps/webinars/2015-materials/teamstepps-monthly-webinar-sept2015.pdf
     January 01, 2015 - Case: “Whistling a Tune” The following event was reported to you (an authority figure) through your … electronic event reporting system. … Behaviors that Undermine Safety Culture Slide 15 What % of the time would someone report the event … to a responsible party or through an established event reporting system?

115. TeamSTEPPS for Code Blue Teams: Piloting SBAR & CUS for Interprofessional Team Education
     cahps.ahrq.gov/sites/default/files/wysiwyg/teamstepps/webinars/2015-materials/teamstepps-monthly-webinar-april2015.pptx
     January 01, 2015 - about issues related to teamwork and communication Quality improvement committee reviews Data from event … Progress 2012 – Began collecting data on teamwork and communication using 5 questions included on our event … TeamSTEPPS for Code Blue Teams Slide ‹#› Measuring Progress Limitations Not a validated questionnaire Event

116. Events | Agency for Healthcare Research and Quality
     cahps.ahrq.gov/news/events/index.html
     November 01, 2022 - Skip to main content An official website of the Department of Health and Human Services Careers Contact Us Español FAQs Search all AHRQ sites Search small Search Menu …

117. In Pandemic’s Wake, We Must Recommit to Patient and Workforce Safety | Agency for Healthcare Research and Quality
     cahps.ahrq.gov/news/blog/ahrqviews/patient-workforce-safety.html
     March 01, 2023 - The event was attended by 800 people online and 200 in person—in my view a strong signal of consensus … I was glad for AHRQ to take the lead in organizing the November 14 event.

118. Improving Patient Safety Systems for Limited English Proficiency Patients
     cahps.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/lep/hospitalguide/lephospitalguide.pptx
     January 01, 2011 - most frequent root cause of serious patient safety events reported to the Joint Commission's Sentinel Event … particularly frontline staff and interpreters, on the full spectrum of what constitutes a patient safety event … English-Speaking and LEP Patients 46.1 40.1 24.4 10.8 22.3 26.1 5.8 19.4 0.9 3.2 0.1 0 0.4 0.5 Sheet1 Adverse Event

119. Module 3: Best Practices in Fall Prevention—Slide Presentation | Agency for Healthcare Research and Quality
     cahps.ahrq.gov/patient-safety/settings/hospital/fall-prevention/workshop/module-3/slides.html
     September 01, 2017 - Components A brief staff gathering, interdisciplinary when possible, that immediately follows a fall event … Convenes within 15 minutes of the fall event. … Led by clinician(s) responsible for patient/resident during the fall event. … Slide 46: Root Cause Analysis After an injurious fall, collect data to reconstruct the event and

120. Best Practices in Fall Prevention
     cahps.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/fallprevention-training/module3/module3_slides_best-practices.pptx
     June 16, 2017 - Components A brief staff gathering, interdisciplinary when possible, that immediately follows a fall event … Convenes within 15 minutes of the fall event Led by clinician(s) responsible for patient/resident during … the fall event Involves the patient/resident whenever possible in the environment where the patient/ … Review Tool 3N ‹#› Root Cause Analysis After an injurious fall, collect data to reconstruct the event