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Showing results for "event".

41. AHRQ Quality and Safety Review System (QSRS) | Agency for Healthcare Research and Quality
    preventiveservices.ahrq.gov/cpi/about/otherwebsites/qsrs.ahrq.gov/index.html
    March 01, 2021 - Features The QSRS: Offers an expanded array of adverse event measures. … standardized definitions and algorithms, consistent with those used by the AHRQ Common Formats for Event

42. Transitioning to the SOPS™ Hospital Survey Version 2.0: What’s Different and What To Expect, Part II: Appendixes (pdf file)
    preventiveservices.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/hsops2-pt2_transition_apx.pdf
    September 01, 2019 - (F3R) Hospital management seems interested in patient safety only after an adverse event happens. … (C3) We are given feedback about changes put into place based on event reports. … (G1) (No event reports, 1 to 2, 3 to 5, 6 to 10, 11 to 20, 21 event reports or more) 45% 44% 1% … (C3) We are given feedback about changes put into place based on event reports. … (G1) (No event reports, 1 to 2, 3 to 5, 6 to 10, 11 to 20, 21 event reports or more) 45% 44% 1%

43. Major Study Finds Significant National Patient Safety Improvement | Agency for Healthcare Research and Quality
    preventiveservices.ahrq.gov/news/newsroom/press-releases/significant-patient-safety-improvement.html
    July 01, 2022 - Researchers found significant decreases in in-hospital adverse event rates for heart attack, heart failure … In the observed data for 2010 and 2019, adverse event rates fell 36 percent for heart attack patients … After adjustment, the relative risk of experiencing an adverse event diminished for all five patient

44. Hospital Survey on Patient Safety Culture Version 2.0 (doc file)
    preventiveservices.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/SOPS-Hospital-Survey-2.0-English-05.18.21.docx
    June 09, 2016 - Instructions This survey asks for your opinions about patient safety issues, medical error, and event … injuries or adverse events resulting from the processes of healthcare delivery. · A “patient safety event … When an event is reported in this unit, it feels like the person is being written up, not the problem … In this unit, we are informed about changes that are made based on event reports 1 2 3 4 5 9 … Hospital management seems interested in patient safety only after an adverse event happens 1 2 3

45. Puh-Factraining-Guide (pdf file)
    preventiveservices.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/pruhealing/puh-factraining-guide.pdf
    December 15, 2016 -  Nursing home staff generally do a good job of investigating and following up after an adverse event … It is more difficult for staff to identify which residents are at risk for a future adverse event … high risk or had a recent change in risk, would we do things differently to intervene before the event … The questions in each Self-Assessment are tailored to the On-Time adverse event being addressed. … Discussion questions are tailored to the On-Time adverse event being addressed.

46. Hospital Survey on Patient Safety Culture Version 2.0: Composites and Items (pdf file)
    preventiveservices.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/hospitalsurvey2-items.pdf
    August 01, 2019 - When an event is reported in this unit, it feels like the person is being written up, not the problem … In this unit, we are informed about changes that are made based on event reports. … Hospital management seems interested in patient safety only after an adverse event happens.

47. Improving Patient Safety in Hospitals: A Resource List for Users of the AHRQ Hospital Survey on Patient Safety Culture (pdf file)
    preventiveservices.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/hospitalresourcelist.pdf
    January 01, 2019 - • Investigate and analyze an adverse event to learn from it and prevent future adverse events. … /primers/primer/13 This AHRQ primer provides background information on voluntary patient safety event … of event reporting, and how event reports can be used to improve safety. … Staff can use this decision tree when analyzing an error or adverse event in an organization to help … identify how human factors and systemic issues contributed to the event.

48. Communication: Severe Hypertension - PowerPoint Presentation
    preventiveservices.ahrq.gov/sites/default/files/wysiwyg/hai/tools/perinatal-care-2/hypertension_3_communication.pptx
    July 01, 2023 - Please note the technique is the focus, as the event is not a hypertensive event. 10 Assessing the … The event can be real, loosely based on real events, or totally made up. … Please note that the scenario does not relate to a severe hypertensive event. … Sentinel Event Data: Root Causes by Event Type, 2004-2015. 2016. https://hcupdate.files.wordpress.com … /2016/02/2016-02-se-root-causes-by-event-type-2004-2015.pdf.

49. Communication: Severe Hypertension (pdf file)
    preventiveservices.ahrq.gov/sites/default/files/wysiwyg/hai/tools/perinatal-care-2/hypertension_3-communication-speaker-notes.pdf
    July 01, 2023 - Please note the technique is the focus, as the event is not a hypertensive event. 16 Hospital AIM … The event can be real, loosely based on real events, or totally made up. … Please note that the scenario does not relate to a severe hypertensive event. … Sentinel Event Data: Root Causes by Event Type, 2004‐2015. 2016. … https://hcupdate.files.wordpress.com/2016/02/2016‐02‐se‐root‐causes‐ by‐event‐type‐2004‐2015.pdf. 3

50. Federal Interagency Workgroup on Improving Diagnostic Safety and Quality (pdf file)
    preventiveservices.ahrq.gov/sites/default/files/wysiwyg/topics/public-notes-meeting-summary-031121.pdf
    July 22, 2021 - IHS • Enhanced Adverse Event Reporting Capabilities: IHS Safety Tracking and Response (I-STAR) system … Future goal is to align the platform with AHRQ’s Common Formats for Event Reporting.

51. Communication: Obstetric Hemorrhage (pdf file)
    preventiveservices.ahrq.gov/sites/default/files/wysiwyg/hai/tools/perinatal-care-2/hemorrhage_3-communication-speaker-notes.pdf
    July 01, 2023 - In the event of a hemorrhage, it’s recommended to always call‐out when blood loss exceeds 1,000 mL. … Please note the technique is the focus, as the event is not an obstetric hemorrhage event. 16 Hospital … Please be aware that the scenario is unrelated to an obstetric hemorrhage event. … The event can be real, loosely based on real events, or totally made up. … Sentinel Event Data: Root Causes by Event Type, 2004‐2015. 2016.

52. Communication: Obstetric Hemorrhage - PowerPoint Presentation
    preventiveservices.ahrq.gov/sites/default/files/wysiwyg/hai/tools/perinatal-care-2/hemorrhage_3_communication.pptx
    July 01, 2023 - Please note the technique is the focus, as the event is not an obstetric hemorrhage event. 10 Assessing … Please be aware that the scenario is unrelated to an obstetric hemorrhage event. … The event can be real, loosely based on real events, or totally made up. … Sentinel Event Data: Root Causes by Event Type, 2004-2015. 2016. https://hcupdate.files.wordpress.com … /2016/02/2016-02-se-root-causes-by-event-type-2004-2015.pdf.

53. Ventilator-Associated Events and Outcome Measures Module | Agency for Healthcare Research and Quality
    preventiveservices.ahrq.gov/hai/tools/mvp/vae.html
    December 01, 2017 - Tools To Support Monitoring VAEs and Outcome Measures Ventilator-Associated Event Data Collection Tool … - HTML Version of Slide Presentation ; Facilitator Guide - Word , 3 MB) Ventilator-Associated Event

54. Assessment (doc file)
    preventiveservices.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/resources/tools/cauti-surveillance/assessment.docx
    March 01, 2017 - while having an indwelling urinary catheter in place or removed within the 2 calendar days prior to the event … References: Adapted from Centers for Disease Control and Prevention (CDC), Urinary Tract Infection (UTI) Event

55. Reviewing the Team's Performance: Debrief | Agency for Healthcare Research and Quality
    preventiveservices.ahrq.gov/teamstepps-program/curriculum/team/tools/debrief.html
    December 01, 2023 - Analysis of why the event occurred, what worked, and what did not work. … Debriefs can be a short (about 3 minutes or less) team event, typically initiated and facilitated by

56. NPSD Chartbooks | Agency for Healthcare Research and Quality
    preventiveservices.ahrq.gov/npsd/data/chartbook/index.html
    September 01, 2023 - provide an overview of the patient safety data captured in the NPSD through the AHRQ Common Formats for Event … They examine data for topics that cut across the multiple modules in the AHRQ Common Formats for Event

57. PowerPoint Presentation
    preventiveservices.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/pruhealing/puh-factraining-slides.pptx
    November 01, 2016 - Specifications and EMR Vendors Functional specifications are available for On-Time reports for each adverse event … Investigate the root cause when an adverse event occurs. … The questions in each Self-Assessment worksheet are tailored to the On-Time adverse event being addressed … discussion to help the Change Team decide how to use the On-Time reports to help prevent the adverse event

58. Cholesterol Management Evidence and Resources | Agency for Healthcare Research and Quality
    preventiveservices.ahrq.gov/evidencenow/projects/heart-health/evidence/cholesterol.html
    March 01, 2021 - CVD) in adults aged 40 to 75 years, with at least one CVD risk factor and an increased risk of a CVD event … The USPSTF recommended discussing statin use in similar patients with more moderate risk of a CVD event … cardiovascular disease (CVD) and for those who have one or more CVD risk factors with a calculated 10-year CVD event

59. Resource List - AHRQ Hospital Survey (pdf file)
    preventiveservices.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/hospital-v2-resourcelist.pdf
    April 01, 2023 - of event reporting, and ways event reports can be used to improve safety. … • Investigate and analyze an adverse event to learn from it and prevent future adverse events. … Staff can use this decision tree when analyzing an error or adverse event in an organization to help … identify how human factors and systemic issues contributed to the event. … Leadership Response to a Sentinel Event: Respectful, Effective Crisis Management 3.

60. Generic Dashboard | Agency for Healthcare Research and Quality
    preventiveservices.ahrq.gov/npsd/data/dashboard/generic.html
    September 01, 2023 - This dashboard includes information for event and report types organized by year (annual trends), examines