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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-Clarke_8.pdf
January 25, 2008 - Fall
E. Error related to procedure, treatment, and/or test
F. … the organizational, technical, patient, and
practitioner causes for any error, plus the indicated prevention … : Selective 8.3
Prevention: Universal 7.6
6
Table 2. … Event type (modified UHC taxonomy) 37.6
Disposition of event 37.6
Procedure error: Procedure 30.0
Fall … We already spend time critiquing causes and prevention during discussions in weekly group
analyses of
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/McPhillips.pdf
January 01, 2004 - he or she meant to prescribe), potentially no error would be detected because this
dose would still fall … Many minimum recommended
adult doses fall well below the minimum recommended weight-based dose for … Implications for prevention. ADE Prevention Study
Group. JAMA 1995;274(1):29–34.
2. … Medication
error prevention by clinical pharmacists in two
children’s hospitals. … The impact of
computerized physician order entry on medication
error prevention.
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www.ahrq.gov/hai/cusp/toolkit/content-calls/small-hospitals.html
April 01, 2013 - re going to listen first to Denise Flook, who is the director of workforce development and infection prevention … I work especially with our patient safety on infection prevention initiatives, and Lorna Martin works … We want to enhance the coordination of care because that’s where a lot of times we fall down. … What is your fall rate or your pressure ulcer rate or whatever? … Or, “We’ve gone 20 days without a patient fall.”
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www.ahrq.gov/hai/cauti-tools/archived-webinars/preventing-cauti-plan-b-transcript.html
December 01, 2017 - We had seven hospitals that were implementing a CAUTI prevention program. … This is actually a CAUTI prevention guide to patient safety. … Do you have a project manager with dedicated time coordinate your CAUTI prevention activities? … prevention on that same unit? … This has to do in applying mindfulness to CAUTI prevention.
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www.ahrq.gov/sites/default/files/2024-01/coburn-report.pdf
January 01, 2024 - The project resulted in an online infection control and prevention training module that is currently … After the completion
of the evaluation this fall, the curriculum will be offered to other state EMS … Project Closeout Reports: Each pilot site project completed a survey in the fall of 2012 to summarize … EMS online training
An online infection control and prevention training curriculum for EMS providers … Manuscript on the EMS intervention and online training tool to be submitted to a peer-reviewed
publication, Fall
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/pruprev/functspecs.pdf
March 22, 2014 - ulcer healing, falls
prevention, and prevention of inappropriate hospitalizations. … Specifications for Each Pressure Ulcer Prevention Report
3.1. … for Nursing Homes: On-Time Pressure Ulcer Prevention
12
3.2.4. … Days Prior value may not be the same as Weight for Week 4 because the 30 Days
Prior value date may fall … 30 Days Prior value may not be the same as Weight for Week
(Week4) because 30 Days Prior value may fall
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/prevhosp/facslides.html
September 01, 2017 - Slide 6: On-Time Reports for Four Adverse Events
Four Reports:
Pressure Ulcer Prevention. … Falls Prevention.
Preventable Hospital and ED Visits. … Large decline in pressure ulcer incidence rate seen in Pressure Ulcer Prevention Program Evaluation. … Prevention Programs: Reviews information on existing prevention programs.
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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.
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www.ahrq.gov/patient-safety/settings/hospital/resource/qitool/casestudy.html
December 01, 2017 - The Healthcare-Acquired Pressure Ulcers and Falls Prevention task forces have achieved similar successes
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www.ahrq.gov/diagnostic-safety/resources/issue-briefs.html
July 01, 2025 - The papers fall under two types—either a "call to action" or a "state of the science."
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/facilities/ltc/gdmodap2b.html
October 01, 2014 - Falls Prevention
Appendix 1-A. Suggested Slides for Module 1
Appendix 1-B.
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/best-practices/ASB-one-page.pdf
November 01, 2019 - Asymptomatic Bacteriuria
Diagnosis
• Asymptomatic bacteriuria (ASB) is a positive urine culture in a patient with no signs or
symptoms of a urinary tract infection (e.g., dysuria, frequency, urgency, fever, flank pain).
• ASB is common and often assocated with pyuria (urine containing ≥10 white blood cells …
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www.ahrq.gov/hai/cauti-tools/archived-webinars/leveraging-cultural-change-slides.html
December 01, 2017 - Leveraging Cultural Change to Reduce Urinary Catheter Use
Linda Greene, RN,MPS,CIC
Manager Infection Prevention … She’s going to fall trying to get up.”
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www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-reimagining-healthcare-teams-6.html
July 01, 2023 - For example, a clinician may recommend a wearable technology to assess a patient’s fall risk. 29 The … be responsible for ensuring the technology is worn, while the AI would provide daily summaries about fall … risk and near falls and notify family members or the clinician if a fall occurs. … In fall 2022, the FDA provided updated guidance on designation of software as a medical device (SaMD)
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www.ahrq.gov/hai/cauti-tools/archived-webinars/preventing-cauti-engaging-clinicians-transcript.html
December 01, 2017 - or VAT prevention. … Third: Do you have an effective nurse champion for your CAUTI prevention activities? … Six: Do you have an effective physician champion for your CAUTI prevention activities? … Seven: Have physicians fully embraced CAUTI prevention activities? … Eight: Has senior leadership fully supported CAUTI prevention activities?
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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/booklets/appendectomy-booklet.pdf
November 01, 2023 - If your blood pressure is low, we may have you wait
so you don’t faint or fall. … Call, Don’t Fall!
Do NOT get up on your own the first time! … You may be lightheaded and could fall.
Press the call button. And a nurse will help you
get up. … Timing of Surgery
Your Wishes
Recovery in the Hospital
Moving Helps You Recover
Call, Don’t Fall
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www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-older-adults1.html
September 01, 2024 - State of the Science and Future Directions To Improve Diagnostic Safety in Older Adults
Introduction
Previous Page Next Page
Table of Contents
State of the Science and Future Directions To Improve Diagnostic Safety in Older Adults
Introduction
Unique Challenges in Approaching Diagnostic Safety i…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/preventing-cauti-plan-b-transcript.doc
November 04, 2014 - We had seven hospitals that were implementing a CAUTI prevention program. … This is actually a CAUTI prevention guide to patient safety. … Do you have a project manager with dedicated time coordinate your CAUTI prevention activities? … prevention on that same unit? … This has to do in applying mindfulness to CAUTI prevention.
-
www.ahrq.gov/news/newsletters/e-newsletter/918.html
June 01, 2024 - AHRQ Commits to Priority Actions for Suicide Prevention . Upcoming AHRQ Webinars . … AHRQ Commits to Priority Actions for Suicide Prevention The Biden-Harris administration's 2024 National … Strategy for Suicide Prevention introduced a comprehensive,10-year plan to tackle suicide across society
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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 … Incidence of adverse drug events and
potential adverse drug events: Implications for prevention.