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441. AHRQ's Safety Program for Nursing Homes: On-Time Pressure Ulcer Prevention | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/pruprev/factraining.html
     December 01, 2014 - home staff generally do a good job of investigating and following up after an adverse event, such as a fall … we be sure to instruct the nursing assistant to stay close by when she was ambulating to prevent a fall

442. SOPS™ Health Information Technology (Health IT) Supplemental Items for Hospitals Webcast Transcript (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/sops/quality-patient-safety/patientsafetyculture/hospital/healthitwebinar/sops-hit-webcast-transcript.pdf
     July 25, 2018 - Next question is: "We are surveying this Fall, and then adopting a new EHR before the next survey cycle … Do you think it would beneficial to add the Health IT supplement this Fall, and then to survey after … So again, there's a user who's surveying this Fall, then adopting a new EHR and could potentially survey … So would you recommend that they administer the survey, the Health IT items, this Fall and then again … But if you're going to do it in the Fall, and you want to administer it now before you've started that

443. Unique Challenges in Approaching Diagnostic Safety in Older Adults | Agency for Healthcare Research and Quality
     www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-older-adults2.html
     September 01, 2024 - State of the Science and Future Directions To Improve Diagnostic Safety in Older Adults Unique Challenges in Approaching Diagnostic Safety in Older Adults Previous Page Next Page Table of Contents State of the Science and Future Directions To Improve Diagnostic Safety in Older Adults Introduction …

444. Section 3: Teaching Introductory Material | Agency for Healthcare Research and Quality
     www.ahrq.gov/teamstepps-program/curriculum/intro/teach.html
     August 01, 2023 - Information about the new version of the app will be available in fall 2023 on the TeamSTEPPS Pocket

445. Module 2: Communicating Change in a Resident's Condition | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/long-term-care/resource/facilities/ltc/mod2.html
     March 01, 2019 - Module 2: Communicating Change in a Resident's Condition Next Page Table of Contents Module 2: Communicating Change in a Resident's Condition Learning and Performance Objectives Session 1 Session 2 Conclusion Additional Tools and Resources Appendix. Example of the SBAR and CUS Tools …

446. Federal Interagency Workgroup on Improving Diagnostic Safety and Quality in Healthcare July 2020 Meeting Summary (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/topics/public-notes-meeting-summary-072320.pdf
     November 06, 2020 - Bioengineering a very strong response, and the hope is that there will be some results or impact made in the fall

447. Enhancing Patient Safety Through Cognition and Communication (M-Safety Lab) | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/resources/learning-lab/enhancing-long-desc.html
     April 01, 2021 - Other detected motions include getting out of bed, which can increase the risk of fall events, and rhythmic

448. CHIPRA 150 Section 6, Antipsychotics Testing Summary (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-150-metabolic-monitoring-testing-summary.pdf
     December 31, 2015 - prescribed a psychotropic medication, the broader class of medications under which antipsychotics fall

449. Indwelling Urinary Catheter Indications Facilitator Notes (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/clabsi-cauti-icu/urinary-catheter-indications-notes.docx
     April 01, 2022 - She has chronic urinary incontinence and is a high fall risk. … The answer is False, because the catheter actually does not decrease fall risk.

450. Interim Update on 2013 Annual Hospital-Acquired Condition Rate and Estimates of Cost Savings and Deaths Averted From 2010 to 2013 | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/pfp/interimhac2013-ap2.html
     December 01, 2014 - Efforts To Improve Patient Safety Result in 1.3 Million Fewer Patient Harms Interim Update on 2013 Annual Hospital-Acquired Condition Rate and Estimates of Cost Savings and Deaths Averted From 2010 to 2013 Previous Page Next Page Table of Contents Efforts To Improve Patient Safety Result in 1.3 Mill…

451. Final Progress Report: Staff Nurse Fatigue and Patient Safety (pdf file)
     www.ahrq.gov/sites/default/files/2024-09/rogers-report.pdf
     January 01, 2024 - only were more likely to report struggling to stay awake, they also were 2.4 times more likely to fall

452. Slide 1 (ppt file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/health-literacy-pfe-070913.ppt
     July 01, 2013 - to have an indwelling urinary catheter because they are afraid of soiling linens or incontinence or fall

453. Presentation: Program Overview
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/technical/early-mobility-icu-slides.pptx
     January 01, 2017 - (8 per 10,000 PT treatment) Dislodgement of orogastric tube (2) Dislodgement of arterial line (1) Fall

454. Examples of Physician Quality Measures for Consumers | Agency for Healthcare Research and Quality
     www.ahrq.gov/talkingquality/measures/setting/physician/examples.html
     September 01, 2019 - Examples of Physician Quality Measures for Consumers Following are a few examples of physician quality measures that research evidence and practical experience suggest are appropriate for reporting to consumers. The list is categorized by the Institute of Medicine’s domains for a quality health care system; for…

455. Behavioral Health AI Free Text Analysis - NPSD Data Spotlight (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/npsd/data/spotlights/npsd-spotlight_behavioral-health.pdf
     September 01, 2025 - commonFormatsOverview Behavioral Health AI Free-Text Analysis | Page 3 Device or Medical/Surgical Supply; (5) Fall

456. AHRQ-Funded Patient Safety Project Highlights (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/highlights/ps-project-highlights-hit-hie-rev-0724update.pdf
     July 01, 2024 - ■ An AHRQ Patient Safety Learning Labiv (PSLL) developed an electronic Fall TIPS Tool to help patients … Key Findings/Impact: Investigators found that implementing the Fall TIPS toolkit reduced patient fall … into both the electronic and print versions, because patients are more likely to believe they need a fall … reporter.nih.gov/search/0zBFxPu410GfTZDt4AZLvQ/projects https://www.ahrq.gov/patient-safety/settings/hospital/fall-tips

457. AHRQ-Funded Patient Safety Project Highlights: Improving Healthcare Safety by Enhancing Health Information Technology and Health Information Exchange (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/highlights/ps-project-highlights-hit-hie-2025.pdf
     January 01, 2025 - ■ An AHRQ Patient Safety Learning Labiiiii (PSLL) developed an electronic Fall TIPS Tool to help patients … Key Findings/Impact: Investigators found that implementing the Fall TIPS toolkit reduced patient fall … into both the electronic and print versions, because patients are more likely to believe they need a fall … sites/default/files/2024-07/bates3-report.pdf https://www.ahrq.gov/patient-safety/settings/hospital/fall-tips … /index.html https://www.ahrq.gov/patient-safety/settings/hospital/fall-tips/index.html https://www.ahrq.gov

458. Table 13C: Medicaid-Only HCBS Participants | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/findings/tab13c.html
     December 01, 2012 - Assessing the Health and Welfare of the HCBS Population Table 13C: Medicaid-Only HCBS Participants Previous Page Next Page Table of Contents Assessing the Health and Welfare of the HCBS Population Introduction HCBS Population Availability and Use of State Medicaid HCBS Outcome Indicators for…

459. Table 13F: HCBS Population Ages 18-64 Without I/DD or SMI | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/findings/tab13f.html
     December 01, 2012 - Assessing the Health and Welfare of the HCBS Population Table 13F: HCBS Population Ages 18-64 Without I/DD or SMI Previous Page Next Page Table of Contents Assessing the Health and Welfare of the HCBS Population Introduction HCBS Population Availability and Use of State Medicaid HCBS Outcome…

460. Teaching Implementation Coaching for Culture Change | Agency for Healthcare Research and Quality
     www.ahrq.gov/teamstepps-program/curriculum/team/implement/teach-coach.html
     February 01, 2024 - If the exercise does not fall around a break, introduce the exercise, hand out the self-assessment forms