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Showing results for "falls".
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  1. Exploring how nursing schools handle student errors and near misses. | PSNet

    psnet.ahrq.gov/issue/exploring-how-nursing-schools-handle-student-errors-and-near-misses
    May 28, 2014 - Study Exploring how nursing schools handle student errors and near misses. Citation Text: Disch J, Barnsteiner J, Connor S, et al. CE: Original Research: Exploring How Nursing Schools Handle Student Errors and Near Misses. Am J Nurs. 2017;117(10):24-31. doi:10.1097/01.NAJ.0000525849.3553…

  2. Quality improvement implementation and hospital performance on patient safety indicators. | PSNet

    psnet.ahrq.gov/issue/quality-improvement-implementation-and-hospital-performance-patient-safety-indicators
    January 12, 2022 - Study Classic Quality improvement implementation and hospital performance on patient safety indicators. Citation Text: Weiner BJ, Alexander JA, Baker LC, et al. Quality improvement implementation and hospital performance on patient safety indicators. Med Care …

  3. Errors prevented by and associated with bar-code medication administration systems. | PSNet

    psnet.ahrq.gov/issue/errors-prevented-and-associated-bar-code-medication-administration-systems
    October 16, 2019 - Study Errors prevented by and associated with bar-code medication administration systems. Citation Text: Cochran GL, Jones KJ, Brockman J, et al. Errors prevented by and associated with bar-code medication administration systems. Jt Comm J Qual Patient Saf. 2007;33(5):293-301, 245. Cop…

  4. Evidence summary and recommendations for improved communication during care transitions. | PSNet

    psnet.ahrq.gov/issue/evidence-summary-and-recommendations-improved-communication-during-care-transitions
    October 19, 2022 - Review Evidence summary and recommendations for improved communication during care transitions. Citation Text: Jackson PD, Biggins MS, Cowan L, et al. Evidence Summary and Recommendations for Improved Communication during Care Transitions. Rehabil Nurs. 2016;41(3):135-48. doi:10.1002/rnj…

  5. Decreased bile duct injury rate during laparoscopic cholecystectomy in the era of the 80-hour resident workweek. | PSNet

    psnet.ahrq.gov/issue/decreased-bile-duct-injury-rate-during-laparoscopic-cholecystectomy-era-80-hour-resident
    March 17, 2021 - Study Decreased bile duct injury rate during laparoscopic cholecystectomy in the era of the 80-hour resident workweek. Citation Text: Yaghoubian A, Saltmarsh G, Rosing DK, et al. Decreased bile duct injury rate during laparoscopic cholecystectomy in the era of the 80-hour resident work…

  6. Toolkits | PSNet

    psnet.ahrq.gov/toolkits
    March 01, 2025 - ) Medical Complications (40) Nosocomial Infections (27) Patient Falls … Falls, wrong surgery and unintended retained foreign bodies were among the most frequently submitted

  7. The Emergency Department & Catheter Insertions | Agency for Healthcare Research and Quality

    www.ahrq.gov/hai/cauti-tools/archived-webinars/ed-catheter-insertions-slides.html
    December 01, 2017 - He gets more restless, gets out of bed, trips on the catheter and falls . … middle, with several issues surrounding it (i.e. immobility, CAUTI, pressure ulcers), that could lead to Falls

  8. Presentation: Program Overview

    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/cusp/build-businesscase-slides.pptx
    January 01, 2017 - Healthcare-Acquired Conditions (HACs) Series 1 VAPs SSIs CLABSI Other HACs Pressure Ulcers Post-op DVTs Falls … 21,000 CLABSI $ 17,000 Other HACs $ 17,000 Pressure Ulcers $ 17,000 Post-op DVTs $ 8,000 Falls

  9. Patient Safety Indicators | PSNet

    psnet.ahrq.gov/primer/patient-safety-indicators
    June 15, 2024 - measure patient safety for post-acute care facilities , including outcome measures focusing on mobility (falls … outcomes such as avoidable deaths due to health care-associated venous thromboembolism, sepsis, or patient falls

  10. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/840175/psn-pdf
    November 16, 2022 - The risk of thrombosis increases exponentially as the INR falls from 2.0 down to 1.0.5 However, patients … If the INR value falls below a value of 1.8, and especially if the INR is <1.5, prompt addition of subcutaneously

  11. Psn-Pdf (pdf file)

    psnet.ahrq.gov/node/847934/psn-pdf
    April 26, 2023 - measure patient safety for post-acute care facilities, including outcome measures focusing on mobility (falls … such as avoidable deaths due to health care-associated venous thromboembolism, sepsis, or patient falls

  12. Human factors in patient safety as an innovation. | PSNet

    psnet.ahrq.gov/issue/human-factors-patient-safety-innovation
    June 09, 2021 - January 20, 2021 Information flow during pediatric trauma care transitions: things falling

  13. Beyond patient safety Flatland. | PSNet

    psnet.ahrq.gov/issue/beyond-patient-safety-flatland
    September 04, 2024 - January 9, 2019 View More Related Resources Falling through the

  14. Medical errors: should you apologize? | PSNet

    psnet.ahrq.gov/issue/medical-errors-should-you-apologize
    August 13, 2010 - July 19, 2010 How to avoid falling victim to a hospital mistake.

  15. Best Practices in the Diagnosis and Treatment of Asymptomatic Bacteriuria and Urinary Tract Infections (pdf file)

    www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/best-practices/ASB-UTI-facilitator-guide.pdf
    November 01, 2019 - of the four moments of antibiotic decision making, management of asymptomatic bacteriuria largely falls … symptoms reviewed earlier may also be associated with delirium, there is no evidence that delirium, falls … symptoms or systemic signs of infection, older patients with bacteriuria experiencing delirium or falls

  16. 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 - patient experience, and prevention of patient safety events and adverse events such as medication issues, falls … Perspective The Ongoing Journey to Prevent Patient Falls … In Conversation with Patricia Dykes about The Ongoing Journey to Prevent Patient Falls

  17. Health Plan Patient Safety Initiatives | PSNet

    psnet.ahrq.gov/perspective/health-plan-patient-safety-initiatives
    July 10, 2024 - patient experience, and prevention of patient safety events and adverse events such as medication issues, falls … Perspective The Ongoing Journey to Prevent Patient Falls … In Conversation with Patricia Dykes about The Ongoing Journey to Prevent Patient Falls

  18. 1 Preventablehospitaledvisits-Overview-Ig (pdf file)

    www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/prevhosp/1_preventablehospitaledvisits-overview-ig.pdf
    June 02, 2025 - , or EMR, data to make staff aware of residents at risk of adverse events such as pressure ulcers, falls … prevent four adverse events: pressure ulcers, pressure ulcers that are not healing appropriately, falls … • Pressure Ulcer Healing, Falls, and Avoidable Hospitalization reports and worksheets have been … is designed to identify residents at risk for the adverse event of interest (e.g., pressure ulcers, falls

  19. 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 - or EMR, data to make staff aware of residents at risk of adverse events such as pressure ulcers and falls … help prevent four adverse events: pressure ulcers, pressure ulcers that are not healing appropriately, falls … Pressure Ulcer Healing, Falls, and Avoidable Hospitalization reports and worksheets have been tested … is designed to identify residents at risk for the adverse event of interest (e.g., pressure ulcers, falls

  20. 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 - briefing or huddle with direct frontline team members regarding a specific safety concern, such as patient falls … But it falls short because it emphasizes the few things that go wrong rather than seeking to understand … In Conversation with Patricia Dykes about The Ongoing Journey to Prevent Patient Falls … Perspective The Ongoing Journey to Prevent Patient Falls
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