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3201. A Stroke of Error | PSNet
      psnet.ahrq.gov/web-mm/stroke-error
      February 01, 2016 - year-old man with a history of untreated hypertension presented to the emergency department (ED) after a fall

3202. Final Progress Report: Proactive Risk Assessment of Primary Care of the Elderly (pdf file)
      www.ahrq.gov/sites/default/files/2024-12/karsh-report.pdf
      January 01, 2024 - . - Med causes fall, breaks shoulder that results in frozen shoulder with moderate pain requiring daily

3203. Draft Research Plan: Cognitive Impairment in Older Adults: Screening | United States Preventive Services Taskforce
      www.uspreventiveservicestaskforce.org/uspstf/document/draft-research-plan/cognitive-impairment-older-adults
      March 06, 2025 - foods or fluids or nutrition therapy (e.g., meal replacement therapy) Interventions aimed at primary prevention

3204. PowerPoint Presentation
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/prevhosp/ontime-preventablehospitaledvisits-overview.pptx
      May 01, 2017 - 2017 On-Time Overview 5 5 On-Time Reports for Four Adverse Events Four Reports Pressure Ulcer Prevention … Pressure Ulcer Healing Falls Prevention Preventable Hospital and ED Visits May 2017 On-Time Overview … feasibility and ease of use Large decline in pressure ulcer incidence rate seen in Pressure Ulcer Prevention … Screening: Explores what processes the facility uses to screen residents at risk for adverse events Prevention … Programs: Reviews information on existing prevention programs Communication: Reviews existing team

3205. Pitfalls in Diagnosing Necrotizing Fasciitis | PSNet
      psnet.ahrq.gov/web-mm/pitfalls-diagnosing-necrotizing-fasciitis
      March 24, 2021 - Although the ED physicians felt he had simple bruising from the fall, they noted that he was in severe … soft tissue infections (as in this case, where it appeared the patient had simple bruising after his fall … Necrotizing fasciitis caused by Vibrio vulnificus : epidemiology, clinical findings, treatment and prevention

3206. Screening for Cognitive Impairment in Older Adults: US Preventive Services Task Force Recommendation Statement (pdf file)
      www.uspreventiveservicestaskforce.org/home/getfilebytoken/h5Tt4jScmQJeHeztmo93hu
      February 25, 2020 - Some of the suggested stud- ies investigated the prevention of cognitive impairment by control- ling … Systematic review: factors associated with risk for and possible prevention of cognitive decline in later … Designing prevention programmes to reduce incidence of dementia: prospective cohort study of modifiable … Dementia prevention, intervention, and care. … Statin use for the primary prevention of cardiovascular disease in adults: US Preventive Services Task

3207. Archived: Osteoporosis: Screening 2011 | United States Preventive Services Taskforce
      www.uspreventiveservicestaskforce.org/uspstf/recommendation/osteoporosis-screening-2011
      January 15, 2011 - Other Approaches to Prevention The USPSTF has updated its evidence review on falls prevention in older … have additional risk factors for fractures, such as poor bone quality and an increased tendency to fall … Drug therapies for osteoporosis can be for primary prevention (prevention of an osteoporotic fracture … in patients with low BMD who have no previous fractures) or secondary prevention (prevention of an osteoporotic … There are no primary prevention trials of bisphosphonates in men and only 2 secondary prevention trials

3208. Patient Safety During Hospital Discharge | PSNet
      psnet.ahrq.gov/perspective/patient-safety-during-hospital-discharge
      April 01, 2018 - health care system more positive and focused not only on acute management but also on recovery and prevention … We need to be able to use digital to make sure that people don't fall off during the time in between … Innovations Preventing Falls Through Patient and Family Engagement to Create Customized Prevention

3209. Module-3-Implementation-Guide (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/takeheart/training/module-3-implementation-guide.pdf
      June 02, 2025 - diagrams are a useful way to identify major causes of process failures as well as specific failures that fall … Centers for Disease Control and Prevention. … Centers for Disease Control and Prevention: Million Hearts. … Centers for Disease Control and Prevention. “Million Hearts: Tools and Protocols.”

3210. Mismanagement of Delirium | PSNet
      psnet.ahrq.gov/web-mm/mismanagement-delirium
      February 13, 2014 - The care of a person with dementia should be focused on prevention of delirium (for example, promotion … Delirium in elderly adults: diagnosis, prevention and treatment. Nat Rev Neurol. 2009;5:210-220.

3211. Facilitator Guide: Build Your SSI Prevention Bundle (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/cusp/build-businesscase-facguide.docx
      January 01, 2017 - Facilitator Guide: Build Your SSI Prevention Bundle Slide Title and Commentary Slide Number and Slide

3212. AHRQ-Funded Patient Safety (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/highlights/ps-project-highlights-hit-hie.pdf
      June 01, 2023 - ■ 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 … prevention plan and then follow that plan if they know their risks of harm for falling. … kYnT0DsXhE2-YQlbhGpyMg/project-details/9348608 https://www.ahrq.gov/patient-safety/settings/hospital/fall-tips

3213. In Conversation with Chalapathy Venkatesan and Kathy Helak about Application of Safety-II Principles | PSNet
      psnet.ahrq.gov/perspective/conversation-chalapathy-venkatesan-and-kathy-helak-about-application-safety-ii
      August 28, 2024 - For example, most people don't fall or get a wrong site surgery.

3214. Application of Safety-II Principles | PSNet
      psnet.ahrq.gov/perspective/application-safety-ii-principles
      August 28, 2024 - For example, most people don't fall or get a wrong site surgery.

3215. Final Progress Report: Addressing Preventable Medication Use Variance in Mississippi (pdf file)
      www.ahrq.gov/sites/default/files/2024-01/brown-report.pdf
      January 01, 2024 - recommendations as outlined by the National Coordination Council for Medication Error Reporting and Prevention … (Fall) 2;5:1-12 Rudman, W.J., Brown, C.A., Bailey, J., Hope, C. (2005) "The impact of a Web-based Reporting … Academic Exchange Quarterly (Fall) 8,3. Rudman, W.J., Brown. … Domestic Violence and Healthcare: Policies and Prevention Vol. 35 #2.

3216. Clinical-Care-Rapid-Review-Appendix-C (xls file)
      effectivehealthcare.ahrq.gov/sites/default/files/related_files/clinical-care-rapid-review-appendix-c.xlsx
      January 01, 2018 - Unclear Cause of harm: Surgical/procedural complication Medical management Diagnostic error/delay Fall … In addition, for events that fall under the "CARe Insurer Case Protocol", which outlines steps for insurer … In addition, for events that fall under the "CARe Insurer Case Protocol", lessons learned from the insurer … In addition, for events that fall under the "CARe Insurer Case Protocol", which outlines steps for insurer … For events that fall under the "CARe Insurer Case Protocol", if legal standard of care was violated,

3217. Behavioral Counseling in Primary Care to Promote Physical Activity - Recommendations and Rationale (pdf file)
      www.uspreventiveservicestaskforce.org/home/getfilebytoken/ngSKuH6MP9L_BSuX-Pp2K6
      January 01, 2010 - They may include muscle and fall-related injuries or cardiovascular events.6 It is unclear whether more … Washington, DC: Office of Disease Prevention and Health Promotion; 1996. 2. … Department of Health and Human Services, Centers for Disease Control and Prevention. … National Center for Chronic Disease Prevention and Health Promotion; 1996. … Lieu, MD, MPH (Associate Professor, Department of Ambulatory Care and Prevention, Harvard Pilgrim Health

3218. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33742/psn-pdf
      December 01, 2012 - Delirium often sets off a spiral where someone is very confused and a fall risk, so they get assigned … RW: Can you talk a little bit about what you've learned about prevention strategies? … of those markers could be adapted to be very helpful for appropriate process measures for delirium prevention … SI: The highest bar would be the presence of HELP (Hospital Elder Life Program) or some delirium prevention … If we had a delirium prevention program in every hospital and staff that were trained to recognize delirium

3219. Archived: Osteoporosis: Screening, 2002 | United States Preventive Services Taskforce
      www.uspreventiveservicestaskforce.org/uspstf/recommendation/osteoporosis-screening-2002
      September 17, 2002 - Patients who receive a diagnosis of osteoporosis fall outside the context of screening but may require … Washington, DC: Office of Disease Prevention and Health Promotion; 1996. 2. … Prevention of bone loss with alendronate in postmenopausal women under 60 years of age. … Alendronate Osteoporosis Prevention Study Group. Ann Intern Med 1998:253-61. 24. … Physician's guide to prevention and treatment of osteoporosis. Washington, DC: NOF; 1999.

3220. Literature Collection | The Academy
      integrationacademy.ahrq.gov/products/literature-collection/about
      September 01, 2024 - Among the aspects of substance use disorder examined in this literature are prevention, screening, treatment