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preventiveservices.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/resources/tools/cauti-surveillance/review-form.docx
March 01, 2017 - This form is designed to identify contributing factors to and the root cause of a CAUTI that meets the … , if applicable: _________________ Antibiotic(s): __________________ Sensitive: Y – N
Contributing Factors … Using the responses to contributing factors above, what contributed to the resident developing a CAUTI
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preventiveservices.ahrq.gov/news/newsletters/e-newsletter/747.html
January 01, 2021 - Study Shows That Patient-Level Risk Factors Affect Hospital Readmission Rates, Penalties . … Study Shows That Patient-Level Risk Factors Affect Hospital Readmission Rates, Penalties
Medicare’s … framework to improve fairness for safety-net hospitals, but the changes may not sufficiently address risk factors … Their analysis allowed them to determine readmission rates and hospital penalties after adjusting for factors
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preventiveservices.ahrq.gov/hai/cusp/modules/identify/notes.html
December 01, 2012 - Discuss the three greatest risks, and
Rank these risk factors. … Visualize the factors that led to the event.
Step 2. Identify the contributing factors.
Step 3. … Develop interventions for two to five of the most important factors.
Step 2. … look at the technical factors. … by human factors.
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preventiveservices.ahrq.gov/evidencenow/practice-facilitation/lessons/index.html
November 01, 2022 - 05350-7
Lesson: Increasing the impact of practice facilitation programs that target multiple risk factors … longer, more intense intervention and greater attention to external policy and practice contextual factors … A randomized trial of external practice support to improve cardiovascular risk factors in primary care
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preventiveservices.ahrq.gov/patient-safety/settings/hospital/resource/pressureulcer/tool/pu3.html
October 01, 2014 - Some of the factors that make pressure ulcer prevention so difficult include:
It is multidisciplinary … Other risk factors not quantified in the assessment tools must be considered. … Many other factors might be considered as part of clinical judgment. … Several additional specific factors should be considered as part of the risk assessment process. … These scales or tools serve as a standardized way to review some factors that may put a person at risk
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preventiveservices.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/fallprevention-training/module5/module5_slides_fallprev.pptx
December 03, 2012 - Ensure that known risk factors for falls are assessed. … Page 78
‹#›
Care Planning Assessment
All risk factors identified on the fall risk factor assessment … Critical thinking by staff
Tailored approach to each patient, based on the patient’s risk factors
Ensure
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preventiveservices.ahrq.gov/patient-safety/settings/hospital/fall-prevention/workshop/module-5/slides.html
September 01, 2017 - Ensure that known risk factors for falls are assessed. … Slide 41: Care Planning Assessment
All risk factors identified on the fall risk factor assessment … Tailored approach to each patient, based on the patient’s risk factors.
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preventiveservices.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/fallprevention-training/module5/module5_fall-prevention.docx
June 30, 2017 - For example, you may consider adding specific fields for contributing factors to falls (such as high-risk … Instructor’s Note: The hospital may have agreed to use another scale or a simple checklist of risk factors … Slide 41
SAY: For risk factor assessment to make a difference, all risk factors identified on the risk … on the part of staff and a tailored approach to each patient based on the individual patient’s risk factors
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preventiveservices.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/fallprevention-training/module5/module5_tools.docx
August 03, 2017 - Include in Incident Reports
Examples of Information
Reason To Collect This Information
Reporting factors … Environmental factors
Buzzer/bell available within reach before fall
Highlight whether there is an … Patient factors
Mental state
Identify those patients most vulnerable to falls because of sedation,
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preventiveservices.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/fallprevention-training/module2/module2_tools.docx
November 16, 2011 - *
Staff nurses
3G – STRATIFY Scale for Identifying Fall Risk Factors*
Staff nurses
3I – Medication … If a process does not exist (for example, there is no process to assess fall risk factors upon admission … All patients should be assessed for fall risk factors at admission, at a change in status, after a fall … Risk factors for falls include:
Parkinson’s disease
Incontinence
Previous history of falls
Delirium
11 … Education programs for staff should include the importance of fall prevention, risk factors for falls
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preventiveservices.ahrq.gov/hai/cusp/videos/index.html
September 01, 2019 - Identifying Contributing Factors What Will You Do to Reduce the Risk of Recurrence? … Nurse Manager as a Mentor and Coach Encourage Professional Development of Staff Work Alignment Spread Factors
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preventiveservices.ahrq.gov/challenges/past/sdoh/index.html
July 01, 2022 - Further, there are multiple social factors that contribute to poor quality care and increased healthcare … leveraging technology and providing innovative tools to help organizations improve their understanding of factors … Users can identify social and economic factors associated with increased mortality trends at the county
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preventiveservices.ahrq.gov/sites/default/files/wysiwyg/topics/DxSafety-March2019-MeetingNotes.pdf
March 08, 2019 - • Contributions of human factors to errors that have led to harm. … • AHRQ is interested in multidisciplinary research on the topic (with a
heavy emphasis on human factors
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preventiveservices.ahrq.gov/npsd/data/dashboard/index.html
October 01, 2023 - and unsafe conditions, then further examines incidents and near misses along with their contributing factors … analyses by age, deeper explorations of common activities prior to fall, and enhanced analyses of risk factors … It also features new incident-specific near misses-specific analyses that examine their contributing factors
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preventiveservices.ahrq.gov/evidencenow/projects/heart-health/research-results/research/collection.html
March 01, 2021 - Southwest cooperative conducted interviews with practices to understand the internal and external factors … Internal factors included: practice structure, staffing, priorities, change processes, and methods of … External factors included: concurrent/competing QI projects and health IT infrastructure. … practices’ motivations and expectations, cooperative organization, and technological and/or geographic factors
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preventiveservices.ahrq.gov/patient-safety/settings/hospital/candor/modules/notes4.html
August 01, 2022 - Continuous organizational learning as a result of identification of contributing factors that might help … 30-45 business days after the event, the investigation should allow for the determination of causal factors … By focusing on system processes and factors that facilitated the event, adjustments can be made to minimize … Continuous organizational learning—this allows for identification of contributing factors that led to … Create solutions—once contributing factors and unrelated hazards are identified, sustainable and effective
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preventiveservices.ahrq.gov/sites/default/files/wysiwyg/patient-safety/settings/mcc-summit/mcc-summit-vick-wolff.pdf
November 01, 2020 - utm_content=creditCopyText
#2: Infrastructure
9
• How do system-level and community-level structural factors … • How do system- and community-level factors interfere with or
support engagement, and how do we design
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preventiveservices.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/implementation.html
January 01, 2013 - fall risk:
Developing mechanisms for the emergency department to communicate a patient's risk factors … Are data already in the system that can be used as part of a new process to assess fall risk factors? … the most logical place in the record to collect/organize/assess information about patient fall risk factors … Fall risk factor report that summarizes which patients on the unit have specific risk factors. … Strategies for dealing with such reluctance will depend on a number of factors, including the stage of
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preventiveservices.ahrq.gov/patient-safety/settings/hospital/fall-prevention/workshop/module-5/guide.html
September 01, 2017 - For example, you may consider adding specific fields for contributing factors to falls (such as high-risk … Instructor’s Note: The hospital may have agreed to use another scale or a simple checklist of risk factors … Slide 41
Say: For risk factor assessment to make a difference, all risk factors identified … on the part of staff and a tailored approach to each patient based on the individual patient’s risk factors
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preventiveservices.ahrq.gov/sops/bibliography/index.html
January 01, 2024 - Factors determining safety culture in hospitals: A scoping review. … Testing the association between the enabling and enacting factors of patient safety culture and patient … Association of implementation and social network factors with patient safety culture in medical homes