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2361. Exploring nursing-sensitive events in home healthcare: a national multicenter cohort study using a trigger tool. | PSNet
      psnet.ahrq.gov/issue/exploring-nursing-sensitive-events-home-healthcare-national-multicenter-cohort-study-using
      August 05, 2020 - December 1, 2021 View More Related Resources The challenge of risk prevention

2362. Learning from mistakes and near mistakes: using root cause analysis as a risk management tool. | PSNet
      psnet.ahrq.gov/issue/learning-mistakes-and-near-mistakes-using-root-cause-analysis-risk-management-tool
      June 19, 2024 - Innovations Preventing Falls Through Patient and Family Engagement to Create Customized Prevention

2363. Periodic Issue | PSNet
      psnet.ahrq.gov/periodic-issue/periodic-issue-339
      April 27, 2022 - substantial cumulative positive impact on delays in the diagnosis of serious harm resulting from a fall

2364. Exploring the harmful effects of health care. | PSNet
      psnet.ahrq.gov/issue/exploring-harmful-effects-health-care
      January 25, 2023 - October 31, 2012 Fall prevention in hospitals: an integrative review.

2365. In Conversation With...Amy Helwig about Health Plan Patient Safety Initiatives | PSNet
      psnet.ahrq.gov/perspective/conversation-withamy-helwig-about-health-plan-patient-safety-initiatives
      July 10, 2024 - We are interested in whole healthcare, quality of life, patient experience, and prevention of patient … As we all experience healthcare, we consider how we can minimize unplanned care and maximize prevention … Healthcare Effectiveness Data and Information Set (HEDIS) measures that we use, including chronic care prevention

2366. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49820/psn-pdf
      February 01, 2018 - psnet.ahrq.gov/web-mm/returning-home-safely The Case A 72-year-old man was admitted to the hospital after a fall … understand strategies for managing the patient's serious illness at home, alternatives to hospital care, fall … prevention, home-based rehabilitation, and meaningful activities for patients over the long course

2367. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49598/psn-pdf
      February 01, 2010 - medication-reconciliation-pitfalls The Case A 90-year-old woman who lived alone suffered a mechanical fall

2368. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49755/psn-pdf
      February 01, 2016 - Good Night's Sleep Gone Wrong February 1, 2016 Gillis CM, Degrado J, Anger KE. Good Night's Sleep Gone Wrong. PSNet [internet]. 2016. https://psnet.ahrq.gov/web-mm/good-nights-sleep-gone-wrong The Case A 64-year-old woman came to the emergency department complaining of cough and shortness of breath, along with an…

2369. Putting safety on the curriculum. | PSNet
      psnet.ahrq.gov/issue/putting-safety-curriculum
      February 10, 2010 - Newspaper/Magazine Article Putting safety on the curriculum. Citation Text: Ellis O. Putting safety on the curriculum. BMJ (Clinical research ed.). 2009;339:b3725. doi:10.1136/bmj.b3725. Copy Citation Format: DOI Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML E…

2370. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/35572/psn-pdf
      February 03, 2011 - in patient safety programs, drug administration and safety procedures, error reporting processes, prevention … However, the authors point out that the overall findings fall short of the IOM recommendations and necessitate

2371. When illegitimate tasks threaten patient safety culture: a cross-sectional survey in a tertiary hospital. | PSNet
      psnet.ahrq.gov/issue/when-illegitimate-tasks-threaten-patient-safety-culture-cross-sectional-survey-tertiary
      February 19, 2020 - April 27, 2022 Improving hospital safety culture for falls prevention through interdisciplinary

2372. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/44872/psn-pdf
      February 12, 2016 - https://psnet.ahrq.gov/issue/partnership-patients https://psnet.ahrq.gov/issue/preventing-falls-and-fall-related-injuries-health-care-facilities

2373. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/41985/psn-pdf
      October 26, 2016 - The most common adverse events reported were pressure ulcers and fall- related injuries or deaths. … /serious-reportable-events-healthcare-2011-update https://psnet.ahrq.gov/issue/preventing-falls-and-fall-related-injuries-health-care-facilities … https://psnet.ahrq.gov/issue/preventing-falls-and-fall-related-injuries-health-care-facilities

2374. Association of overlapping cardiac surgery with short-term patient outcomes. | PSNet
      psnet.ahrq.gov/issue/association-overlapping-cardiac-surgery-short-term-patient-outcomes
      November 09, 2022 - May 12, 2021 A randomized trial of a multifactorial strategy to prevent serious fall … October 19, 2022 Evaluating the prevalence of four recommended practices for suicide prevention … Shared understanding of resilient practices in the context of inpatient suicide prevention … August 17, 2022 Development and implementation of a suicide prevention checklist to create

2375. Selling soap. | PSNet
      psnet.ahrq.gov/issue/selling-soap
      March 06, 2005 - January 13, 2021 Improving hospital safety culture for falls prevention through interdisciplinary … Innovations Preventing Falls Through Patient and Family Engagement to Create Customized Prevention … Plans May 31, 2023 Impact of patient safety climate on infection prevention

2376. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/73168/psn-pdf
      April 21, 2021 - critical care units in England between 2009 and 2017 and found that a small proportion (2%) involved a fall … Common factors involved in fall incidents included patients attempting tasks without assistance, patient … patient-safety-incidents-describing-patient-falls-critical-care-north-west-england-between https://psnet.ahrq.gov/primer/falls https://psnet.ahrq.gov/web-mm/another-fall

2377. Partnered pharmacist charting on admission in the general medical and emergency short-stay unit—a cluster-randomised controlled trial in patients with complex medication regimens. | PSNet
      psnet.ahrq.gov/issue/partnered-pharmacist-charting-admission-general-medical-and-emergency-short-stay-unit-cluster
      July 06, 2011 - potentially fatal errors associated with high doses of insulin: a successful multifaceted multidisciplinary prevention … May 28, 2015 A randomized trial of a multifactorial strategy to prevent serious fall … : Topics in Medication Safety March 31, 2022 6-PACK programme to decrease fall

2378. The Safety and Quality of Long Term Care | PSNet
      psnet.ahrq.gov/web-mm/safety-and-quality-long-term-care
      January 01, 2016 - She was found to have a left hip fracture as a result of the fall and underwent an uncomplicated surgical … Home Care Contributing to Adverse Events While it is difficult to know whether the patient's initial fall … report might have alerted staff about the resident's increased pressure ulcer risk so that aggressive prevention … In the current case, perhaps frontline caregivers would have spoken up about fall risk or pressure ulcer … Innovations Preventing Falls Through Patient and Family Engagement to Create Customized Prevention

2379. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49609/psn-pdf
      October 01, 2010 - risk in hemodialysis patients is higher than in the general population.(4) Assessment of fall risk, … use of neuropsychiatric medications, and avoiding hypotension in dialysis patients may all reduce fall … mandated by CMS under Medicare's conditions for coverage.(9) Future investigation into the occurrence and prevention … Falls and fall-related injuries in older dialysis patients. … Centers for Disease Control and Prevention (CDC) Sets standards for infection control in dialysis

2380. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/46451/psn-pdf
      September 27, 2017 - bad-hospital-design-making-us-sicker https://psnet.ahrq.gov/issue/guidelines-design-and-construction https://psnet.ahrq.gov/issue/prevention-design-construction-and-renovation-health-care-facilities-patient-safety-and