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2921. Quality Indicators Sensitive to Nurse Staffing in Acute Care Settings (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Savitz.pdf
      March 01, 2004 - relationship of nursing with negative—or adverse—patient outcomes, such as medication errors, patient falls … represent an evolution of AHRQ’s interest in quality of care and consist of three indicator sets: prevention … overarching indicators related to medication administration errors, nosocomial infections, patient falls … infection X • Hospital acquired pneumonia X X • Ventilator associated pneumonia X Patient falls

2922. Medication Safety in Nursing Homes: What's Wrong and How to Fix It | PSNet
      psnet.ahrq.gov/perspective/medication-safety-nursing-homes-whats-wrong-and-how-fix-it
      August 01, 2012 - We looked at the outcomes on falls, pressure ulcers, and restraint use. … We found that places with the worst patient safety culture scores had an association with falls and use … case mix adjust in the nursing home environment good enough that you can make sense of differences in falls

2923. AHRQ’s Safety Program for Nursing Homes: On-Time Preventable Hospital and Emergency Department Visits | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/prevhosp/transfer.html
      September 01, 2017 - AHRQ’s Safety Program for Nursing Homes: On-Time Preventable Hospital and Emergency Department Visits Electronic Reports Transfer Risk Report Table 1. Sample High-Risk Transfer Report Facility Name: Unit: Report Date: Resident Name and Advance Directive Status # ED Visits Within: ED Discharg…

2924. PowerPoint Presentation (ppt file)
      www.ahrq.gov/sites/default/files/wysiwyg/nhguide/4_TK2_T4-Common_Suspected_Infections_Tools_to_Improve_Communication_and_Decision_Making.ppt
      May 01, 2014 - anaphylaxis Drug interactions: coumadin, glipizide If on fluoroquinolones  tendon rupture Dehydration  falls … Description of current problem Vital signs Usual cognitive function Recent/current health status (including falls … ) Falls, minor injury: require on-site first aid treatment (dressing, ice pack, pain medication) Falls … This is the point where the form itself is reviewed and discussed Note that falls are included to facilitate

2925. High-Priority Evidence Gaps for Clinical Preventive Services: 13th Annual Report to Congress (pdf file)
      www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/2023-12/2023-annual-report-to-congress.pdf
      January 01, 2023 - Associate Director for Prevention Director, Office of Disease Prevention National Institutes of Health … Syphilis Infection in Pregnant Persons Vitamin D & Calcium Supplementation to Prevent Fractures & Falls … of Lynch Syndrome–Related Cancer Vitamin D & Calcium Supplementation to Prevent Fractures & Falls … Centers for Disease Control and Prevention. About Mental Health. Reviewed April 25, 2023. … Centers for Disease Control and Prevention.

2926. Research Themes and Findings | Digital Healthcare Research
      digital.ahrq.gov/program-overview/research-reports/2022-year-review/research-themes-and-findings
      January 01, 2022 - interoperable CDS to improve care and decision making A Clinical Decision Support Tool for Preventing Falls … Tools like ASPIRE that integrate fall prevention clinical decision support and patient resources may … AcceptabLE cDs (SCALED) Approach of Interoperable Clinical Decision Support for Venous Thromboembolism Prevention

2927. Behavioral Counseling Interventions to Promote a Healthy Diet and Physical Activity for CVD Prevention in Adults Without Known CVD Risk Factors: Updated Evidence Report and Systematic Review for the USPSTF (pdf file)
      www.uspreventiveservicestaskforce.org/home/getfilebytoken/UXw277rnvJ8e_Dfsh4V3K3
      July 26, 2022 - Behavioral Counseling Interventions to Promote a Healthy Diet and Physical Activity for CVD Prevention … groups.29-31,48,56,82 Twelve trials reported the incidence of musculoskeletal injuries, fractures, or falls … physical activity counseling reported generally no differences in rates of musculoskeletal injuries or falls … Preventing weight gain in adults: the Pound of Prevention study. … Prevention of cardiovascular risk factor elevations in healthy premenopausal women.

2928. Final progress Report: Anticholinergics and Cognitive Decline in the Elderly with Depression (pdf file)
      www.ahrq.gov/sites/default/files/2024-01/aparasu-report.pdf
      January 01, 2024 - Around 10-20% of nursing home falls cause serious injuries; 2-6% of the falls result in fractures.17 … Medications are considered as a potentially modifiable risk factor for falls and fractures. … Falls in the nursing home. Annals Intern Med. 1994; 121:442– 51. PMID:8053619. 16. … Medication-related falls in the elderly: causative factors and preventive strategies. … Associations Between Drug Burden Index and Falls in Older People in Residential Aged Care.

2929. Hurried Team Huddle and Poor Communication: Unsafe Practice During Anesthesia for Emergency Cesarean Delivery | PSNet
      psnet.ahrq.gov/web-mm/hurried-team-huddle-and-poor-communication-unsafe-practice-during-anesthesia-emergency
      September 27, 2023 - Centers for Disease Control and Prevention. Published June 2022. … VTE, thrombophilia, antithrombotic therapy, and pregnancy: antithrombotic therapy and prevention of thrombosis … During the COVID-19 Pandemic June 29, 2020 Assessment of a wearable fall prevention … August 9, 2023 Cost of inpatient falls and cost-benefit analysis of implementation of … an evidence-based fall prevention program.

2930. Improving Patient Safety in Ambulatory Surgery Centers: A Resource List for Users of the AHRQ Ambulatory Surgery Center Survey on Patient Safety Culture. (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/asc/resources/asc-resource_list.pdf
      March 01, 2016 - Checklist for Outpatient Settings: Minimum Expectations for Safe Care Infection Prevention Training … Missed nursing care is linked to patient harm, including falls and infections. … Infection Prevention Training for Ambulatory Surgical Centers https://cne.memberclicks.net/index.php? … Because the Center’s Culture of Safety is based on prevention, not punishment, RCA teams investigate … Also used to systematically assess personnel adherence to correct infection prevention practices.

2931. Collegiality vs. Competence | PSNet
      psnet.ahrq.gov/web-mm/collegiality-vs-competence
      August 28, 2024 - May 22, 2024 Talking about falls: a qualitative exploration of spoken communication of … patients' fall risks in hospitals and implications for multifactorial approaches to fall prevention.

2932. Inpatient Stays and Emergency Department Visits Involving Traumatic Brain Injury, 2017 (pdf file)
      hcup-us.ahrq.gov/reports/statbriefs/sb255-Traumatic-Brain-Injury-Hospitalizations-ED-Visits-2017.pdf
      January 01, 2017 - groups greater than or equal to 10 percent are noted in the text. 1 Centers for Disease Control and Prevention … patients were more likely to involve cerebral hemorrhage, no loss of consciousness, and unintentional falls … four in five stays for patients aged 65 years or older (85.2 percent) were caused by unintentional falls … of injury matrix for causes other than poisoning developed by the Centers for Disease Control and Prevention … vehicle-nontraffic o Pedal cyclist, other o Pedestrian, other 10 Centers for Disease Control and Prevention

2933. 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 … 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 … Clinician's Guide to Prevention and Treatment of Osteoporosis.

2934. Long-Term Drug Therapy and Drug Holidays for Osteoporotic Fracture Prevention (pdf file)
      effectivehealthcare.ahrq.gov/sites/default/files/pdf/research-protocol-osteoporosis_2.pdf
      October 05, 2018 - Long-Term Drug Therapy and Drug Holidays for Osteoporotic Fracture Prevention 1 Evidence-based … Review Protocol Project Title: Long-term Drug Therapy and Drug Holidays for Osteoporotic Fracture Prevention … who had heightened fracture risk because of low bone mass (i.e., osteopenia) or other factors (e.g., falls … Evidence on fracture prevention from long-term RCTs is available only for bisphosphonates, and has … Drugs Used for Osteoporosis Treatment and Prevention Drug class Drug name Delivery route Dosing

2935. Medical error: the second victim. | PSNet
      psnet.ahrq.gov/issue/medical-error-second-victim-0
      February 17, 2017 - Commentary Medical error: the second victim. Citation Text: McCay L, Wu AW. Medical error: the second victim. Br J Hosp Med (Lond). 2012;73(10):C146-148. Copy Citation Format: Google Scholar PubMed BibTeX EndNote X3 XML EndNote 7 XML Endnote tagged PubMedId RIS Do…

2936. Patient Safety Organizations: a new paradigm in quality management and communication systems in healthcare. | PSNet
      psnet.ahrq.gov/issue/patient-safety-organizations-new-paradigm-quality-management-and-communication-systems
      March 10, 2021 - Commentary Patient Safety Organizations: a new paradigm in quality management and communication systems in healthcare. Citation Text: Dotan DB. Patient safety organizations. J Clin Engineer. 2013;34(3):142-146. doi:10.1097/jce.0b013e3181aae4b2. Copy Citation Format: DOI G…

2937. A concept analysis of systems thinking. | PSNet
      psnet.ahrq.gov/issue/concept-analysis-systems-thinking
      August 20, 2018 - November 27, 2013 Fall prevention in hospitals: an integrative review.

2938. Thinking fast and slow in medicine. | PSNet
      psnet.ahrq.gov/issue/thinking-fast-and-slow-medicine
      June 21, 2017 - October 11, 2017 Evaluation of clinical practice guidelines on fall prevention and management

2939. Using medical malpractice closed claims data to reduce surgical risk and improve patient safety. | PSNet
      psnet.ahrq.gov/issue/using-medical-malpractice-closed-claims-data-reduce-surgical-risk-and-improve-patient-safety
      December 01, 2010 - June 3, 2020 Evaluation of clinical practice guidelines on fall prevention and management

2940. Cognitive biases associated with medical decisions: a systematic review. | PSNet
      psnet.ahrq.gov/issue/cognitive-biases-associated-medical-decisions-systematic-review
      March 01, 2023 - October 7, 2020 Evaluation of clinical practice guidelines on fall prevention and management