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www.ahrq.gov/sites/default/files/wysiwyg/nhguide/3_TK2_T2-Antibiotic_Use_Tracking_Sheet_Final.doc
October 01, 2016 - Met
HAI/CAI/NHAI/Other Nosocomial*
Lab Results
(organism identified)
X ray
Other Contributing Factors … Met
HAI/CAI/NHAI/
Other Nosocomial*
Lab Results
(organism identified)
X Ray
Other Contributing Factors
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www.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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www.ahrq.gov/es/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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www.ahrq.gov/talkingquality/measures/types.html
July 01, 2015 - seem to represent the “gold standard” in measuring quality, but an outcome is the result of numerous factors … differing characteristics within a population, such as patient health status—can help account for these factors
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/injuries/fallspx/man5.html
December 01, 2017 - can be easily accomplished by naming a specific room or bathroom, wheelchair, or resident with risk factors … Intrinsic Fall Risk Factors
Slide 5. Intrinsic Fall Risk Factors (continued)
Slide 6. … Intrinsic Fall Risk Factors (continued)
Slide 7. Extrinsic Fall Risk Factors
Slide 8. … Extrinsic Fall Risk Factors (continued)
Slide 9. … Extrinsic Fall Risk Factors (continued)
Slide 10. Physical Restraints
Slide 11.
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www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-203-section-2-tech-specs.pdf
December 14, 2011 - Accurate assessment, documentation, prevention, and treatment are all key factors to effective pressure … Pressure ulcers in pediatric intensive care: Incidence and associated
factors. … Increased risk factors for developing pressure ulcers in infants and children include the following: … Risk factors associated with pressure
ulcers in the pediatric intensive care unit. … Although there is no agreement on which risk factors contribute to pressure ulcer development in neonates
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www.ahrq.gov/research/findings/final-reports/ssi/ssiref.html
April 01, 2018 - Initial Risk Factors
Appendix J. Additional Risk Factors
Appendix K. … Final Risk Factors
Appendix L. … Final data sheet submitted by each site that included the list of potential SSI risk factors and other … Focus Group Risk Factors
Appendix Q. Surgeon Focus Group Content Analysis
Appendix R. … Risk factors for mediastinitis after cardiac surgery. Ann Thorac Surg.
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www.ahrq.gov/ncepcr/tools/obesity/obpcp1.html
May 01, 2014 - Assessing Clinic Readiness for Change and Leadership Support
Below are some common factors that may … Clinics should understand, evaluate, and address these factors to help move the process forward. … Multiple Contributing Factors (It's Outside Our Scope of Practice). … These factors do contribute to the obesity epidemic. But, don't throw up your hands and surrender. … These factors contribute to the overall spirit of the organization.
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Scanlon_62.pdf
March 25, 2008 - Understanding adverse events: Human
factors. Qual Health Care 1995; 4: 80-89.
14. … Hum Factors
2007; 49: 257-276.
31. DeJoy DM. … Human
factors in manufacturing. In: Salvendy G, ed. … Handbook of human factors and ergonomics, 2nd ed. … Paper presented at the
Human Factors and Ergonomics Annual Meeting.
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www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/implementation/education-bundles/infection-prevention/environment-and-equipment/environ-equip-slides.html
March 01, 2017 - Risk factors
Use of common measuring device between residents with indwelling urinary catheters. … Nursing home facility risk factors for infection and hospitalization: importance of registered nurse … turnover, administration, and social factors. … Nursing home facility risk factors for infection and hospitalization: importance of registered nurse … turnover, administration, and social factors.
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/envscan-exec-summary.pdf
March 01, 2017 - Results and Discussion of Findings
Patient safety in primary care is influenced by patient-related factors … , provider-related factors,
and health system or practice-related factors. … Although the team identified policy-related factors,
they are beyond the scope of this project. … Factors influencing patient safety within primary care seldom occur in isolation but are part of a … Patient and carer identified factors which contribute to safety incidents in
primary care: a qualitative
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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/clabsi-cauti-icu/cusp-icu-notes.docx
April 01, 2022 - Safety culture does not exist in a vacuum; it is being shaped while also shaping other factors. … There are many factors at play, and these tools take a deep dive into the circumstances that lead to … Infections are typically considered to be “multimodal” harms, which means that several factors add up … and work environment factors including managerial support, staffing, supplies, equipment availability … and maintenance; team factors such as communication abilities; or task factors like the clarity of structure
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www.ahrq.gov/sites/default/files/wysiwyg/chsp/CHSP-accomplishments-report-2021.pdf
January 01, 2021 - The goal was to
understand the factors that affect health systems’ use of patient-centered outcomes … • Develop measures of integration and identify how environmental factors influence the
adoption of … • Identify factors that influence the successful deployment of effective biomedical
innovations, factors … The first two
projects focused on understanding internal and external factors that drive the use of … Understanding systems’ patient factors, patient engagement, and PCOR; and
6.
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www.ahrq.gov/patient-safety/settings/hospital/resource/pressureinjury/workshop/slides3.html
October 01, 2017 - How to conduct a standardized assessment of pressure injury risk factors. … How to incorporate risk factors into care planning. … Meant to be used in conjunction with a review of other risk factors and clinical judgment. … More factors to consider. … Practices
Need to be customized:
Each patient has a different set of pressure injury risk factors
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/assess-adapt-060314.pptx
March 01, 2009 - Teams make wise decisions when there is diverse and independent input
15
Understanding System Factors … 16
Adapted from Vincent
Regional
Clinic
Work Environment
Team Factors
Individual Provider
Task … Factors
Patient Characteristics
Corporate
16
17
System Failures Leading to Error
(Reason, 1990 … Second order problem solving
Fixing the immediate problem
Fixing the system factors that allowed the … Communication failure: basic components, contributing factors, and the call for structure.
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Marken.pdf
January 01, 2004 - Theories of human
error attribute errors to factors such as poor system design, but these theories do … Factors related to errors
in medication prescribing. JAMA 1997 277(4):312–17.
8. Galt KA. … Medication errors and
human factors. In: McCabe PT, editor; Contemporary
Ergonomics 2003. … To err is human factors. Technol Rev 1982
Feb/Mar:23-29.
17. Freud S. … Human Factors in Aviation.
New York: Academic Press; 1988.
21. Rubin J.
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www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-0232-table2.pdf
January 01, 2011 - Genetic, metabolic, and hormonal factors such
as insulin resistance, increased serum
aldosterone levels … Risk factors and risk behaviors accelerate the
development of atherosclerosis, and risk
reduction delays … Overweight and obesity, nutrition/diet,
physical inactivity, and blood pressure are all
factors to
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www.ahrq.gov/downloads/pub/prevent/pdfser/chdser.pdf
December 08, 2003 - Some of these treatments are directed at traditional risk factors (e.g.,
statins for hyperlipidemia … The presence or absence of CHD risk factors affected the cost-effectiveness ratios. … or more
CHD risk factors, it was $20,504. … The Italian RIFLE Pooling Project
(Risk Factors and Life Expectancy). … Exercise-enhanced assessment of risk factors for coronary heart
disease in healthy men.
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/fallspx/strat.html
October 01, 2017 - Weekly Falls Risk or Safety Meetings
Quarterly Summary of Falls Risk Factors by Unit or … Weekly Falls Risk or Safety Meetings
Monthly Contextual Factors by Unit or Facility
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/injuries/fallspx/manapb17.html
December 01, 2017 - These reasons are called fall risk factors. Many of these we can change. … Fall Risk Factors We Can Change
Residents' Living Space and Personal Safety
Clutter, uneven floors