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  1. www.talkingquality.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/hospital/hospwebinar/just-culture-webcast-transcript-508-compliant.pdf
    June 01, 2017 - Well, we define it as the extent to which staff feel that their mistakes and event reports are not held … And these three items are staff feel like their mistakes are held against them; when an event is reported … suggested topics that we might search for policies related to, like corrective action, our sentinel event … policy, our adverse event reporting policy, our patient safety plan that was approved by the Health … Just Culture is also intended to improve event reporting.
  2. www.talkingquality.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/duration/chipra-157-section-2-specs.pdf
    June 30, 2009 - enrollment period Anchor date: Date of enrollment Benefits: Medical, pharmacy, dental, long term care Event
  3. www.talkingquality.ahrq.gov/news/newsroom/press-releases/national-advisory-meeting-july-14.html
    July 01, 2021 - Closed captioning will be provided during this event.
  4. www.talkingquality.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-201-asthma-section-2-tech-specs.pdf
    March 12, 2019 - Event/Diagnosis Diagnosis of asthma in the year prior to the measurement year (see Table 1).
  5. www.talkingquality.ahrq.gov/hai/cusp/modules/patient-family-engagement/index.html
    July 01, 2018 - How to communicate an adverse event to patients and family members.
  6. www.talkingquality.ahrq.gov/news/newsroom/press-releases/nac-meeting-july12.html
    July 01, 2023 - Closed captioning will be provided during this event.
  7. www.talkingquality.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/sections/sustainability/management/visual/visual-mgmt-facnotes.docx
    May 01, 2017 - The top center has key measures including number of procedures since last harm event and near miss. … To start with, you can track key outcome measures, including days since last harm event and days since
  8. www.talkingquality.ahrq.gov/teamstepps/instructor/essentials/implguide.html
    November 01, 2018 - the need for a TeamSTEPPS Intervention could originate from a variety of sources, including adverse event … Available organizational data, (e.g., adverse event and near miss reports, AHRQ Patient Safety Culture … Action Plan required by the Joint Commission when the Action Plan is generated in response to a sentinel event
  9. www.talkingquality.ahrq.gov/news/newsroom/press-releases/nac-meeting-members.html
    July 01, 2022 - Closed captioning will be provided during this event.
  10. www.talkingquality.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/officebasedcare/module4/4_ts_office_leading-ig.pptx
    January 20, 2006 - It occurs after an event or shift and is designed to improve teamwork skills. … Debriefs should be the subject of a brief (about 3 minutes or less) team event typically initiated and
  11. www.talkingquality.ahrq.gov/sites/default/files/wysiwyg/teamstepps/officebasedcare/ts-obc-online-module3.pptx
    January 01, 2008 - December 2005) 2010 - 2013: Communication among top 3 root causes of sentinel events reported (JC Sentinel Event … Data (Root Causes by Event Type) 2004-2012) http://www.jointcommission.org/sentinel_event.aspx … According to sentinel event data compiled by the Joint Commission between 1995 and 2005, ineffective
  12. www.talkingquality.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-139-section-2.pdf
    January 01, 2014 - Event … measurement year"***/ /*Need to include TCD's that may have been performed during visits for a non-SCD event
  13. www.talkingquality.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-0198-technicalspecs.pdf
    October 16, 2019 - Event/Diagnosis CT imaging study of the head (IMG1) for generalized seizure or convulsions (IMG2) occurring
  14. www.talkingquality.ahrq.gov/hai/tools/ambulatory-surgery/sections/sustainability/management/problem-solving-fac-notes.html
    June 01, 2017 - and issues require immediate management attention, such as urgent and important issues like a harm event … If an event occurs during care provision that a staff member is concerned about, this simple protocol
  15. www.talkingquality.ahrq.gov/sites/default/files/wysiwyg/sops/events/webinar/hickner-development-medical-office-sops.pdf
    January 01, 2011 - Frequency of event reporting 4. Handoffs & transitions 5.
  16. www.talkingquality.ahrq.gov/teamstepps/officebasedcare/hybridcourse.html
    November 01, 2018 - Invite the office champions to a one-day in-person learning event using the classroom slides for the
  17. www.talkingquality.ahrq.gov/data/infographics/adverse-drug-events.html
    August 01, 2018 - 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 …
  18. www.talkingquality.ahrq.gov/health-literacy/professional-training/lepguide/app-f.html
    September 01, 2020 - most frequent root cause of serious patient safety events reported to the Joint Commission's Sentinel Event … particularly frontline and interpreters, on the full spectrum of what constitutes a patient safety event
  19. www.talkingquality.ahrq.gov/policymakers/chipra/cpcf-form15.html
    December 01, 2013 - DENOMINATOR The number or population representing the total universe in which an event might happen: … Aggregation Workgroup, 2012 4 NUMERATOR A subset of those in the denominator who have experienced the event
  20. www.talkingquality.ahrq.gov/patient-safety/reports/liability/neumiller.html
    August 01, 2017 - In the event of physician co-investigator review, the physician independently reviewed disputed cases … Discrepancies To Contribute to an ADE and Increased Health Care Needs Note: ADE, adverse drug event

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