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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Grayson.pdf
January 01, 2003 - To further increase awareness about the study, posters were distributed to
individual nursing floors … There were enough licensed and unlicensed
personnel on the floor to care for patients.
8. … Did you, or someone else on your floor that you are
aware of, break an accepted policy or protocol? … Participants
worked on a variety of nursing floors, ranging from general medicine to critical
care. … small
Advances in Patient Safety: Vol. 1
60
differences were reported for working on the usual floor
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www.ahrq.gov/news/blog/ahrqviews/aian-trust-responsibility.html
November 01, 2024 - It should represent a floor, not a ceiling, informing the national conversation regarding AI/AN health
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/fallpxtoolkit/fallpxtool2d.docx
January 28, 2013 - 2D: Assessing Current Fall Prevention Policies and Practices
Background: The purpose of this self-assessment tool is to identify what processes of care your hospital has in place and what areas need improvement.
Reference: Adapted from AHRQ publication on the Falls Management Program for nursing homes. www.ahrq.gov/res…
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www.ahrq.gov/teamstepps/rrs/instructor_slides/rrsinstructmod.html
October 01, 2014 - Activators can be floor staff, a patient, a family member, specialists, or anyone else sensing acute … The patient or a family member may also serve as a kind of activator when they alert floor staff about … Team members from the nursing staff or floor staff are trained to monitor for fluctuations in any one … on another floor. … The team arrived on the floor but had to wait to be directed to the appropriate room.
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol3/Advances-Lavelle_33.pdf
March 12, 2008 - protocols
in spiral ACLS resource book
Wheelchairs unavailable (missing, locked up, on a
different floor … )
• Minimum of 1 wheelchair per floor
• 3-4 wheelchairs in reception area including
an extra-wide … , returns immediately to ground floor
to await ambulance crew, accompanies EMS to
patient floor, holds … elevator for EMS return with
patient to ground floor
Staff unable to find patient location in new … building Identify floor, corridor, and room number during overhead page
Staff unaware of standing
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/modules/spread/spread.pptx
April 15, 2012 - With the Next Unit
12
Account for Variability
13
Goal: Decrease CAUTI rates on all floors
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/injuries/fallspx/manapb3.html
February 01, 2023 - Determine if the resident stumbles, trips, has difficulty finding objects or detecting changes in floor
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www.ahrq.gov/news/newsroom/case-studies/cdom0801.html
October 01, 2014 - for low blood pressure; protective aids such as hip, elbow, or knee pads; beds that are low to the floor
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/impl-guide/implementation-guide-appendix-k.pdf
October 05, 2015 - the bag at
a level below the
patient’s bladder
The bag should never come into contact
with the floor
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/integrating-teamwork-tools-cusp-efforts.ppt
October 01, 2015 - Additionally, the patient makes several attempts to climb out of the bed, and is found on the floor at
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/fallspx/implmatls.html
November 01, 2017 - Environmental factors (e.g., glare, poor lighting, uneven surfaces, new environment, patterned carpet … or floor)
|__|
|__|
Situational factors (e.g., recent transfer, time of day, responding to … |__|
Range of motion evaluation
|__|
|__|
Vital signs
|__|
|__|
Surface (floor … /ground) that the resident was found on (e.g., wet floor, uneven terrain)
|__|
|__|
Description
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www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/workshop/module-4/guide.html
October 01, 2017 - This last point is crucial, because once patients are off the unit floor, other hospital Team members … A 9-week preceptorship with floor nurses to build skills.
9 months of support, which includes a … Floor mats.
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/fallprevention-training/module4/module4_fall-prevention.docx
September 20, 2017 - This last point is crucial, because once patients are off the unit floor, other hospital Team members … orientation to the hospital and its fall and other prevention programs
A 9-week preceptorship with floor … these items should be stored on or near the unit for easy availability:
Assistive devices
Low beds
Floor
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/fallspx/packet.html
November 01, 2017 - walker, crutch, O 2 ) – improper use
X
X
Equipment failure, bed, chair, floor
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/rrs/rrsinstructmod.ppt
January 01, 2008 - Activators can be floor staff, a patient, a family member, specialists, or anyone else sensing acute … The patient or a family member may also serve as a kind of activator when they alert floor staff about … Team members from the nursing staff or floor staff are trained to monitor for fluctuations in any one … on another floor. … The team arrived on the floor but had to wait to be directed to the appropriate room.
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/rrs/instructor_slides/rrsinstructmod.pdf
January 01, 2008 - Activators can be floor
staff, a patient, a family member, specialists, or anyone else
sensing acute … The patient or a family member
may also serve as a kind of activator when they alert floor
staff about … Team members
from the nursing staff or floor staff are trained to monitor for
fluctuations in any … on another floor. … The team arrived on the floor but had to wait to be
directed to the appropriate room.
-
www.ahrq.gov/patient-safety/settings/long-term-care/resource/injuries/fallspx/slides.html
December 01, 2017 - Extrinsic Fall Risk Factors
Environment
Clutter
Inadequate lighting, glare
Uneven or wet floors
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www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/workshop/module-5/slides.html
September 01, 2017 - Slide 5: 2012 NDNQI Definition of a Fall
A patient fall is an unplanned descent to the floor with … included whether they result from physiological reasons (fainting) or environmental reasons (slippery floor
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www.ahrq.gov/sites/default/files/wysiwyg/teamstepps/longtermcare/module9/ts2-0ltc_module9_coaching_scenarios.pdf
April 24, 2017 - Scenario 1
You are assigned to coach day shift staff on a 60 bed long-
term care floor on teamwork
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www.ahrq.gov/news/newsroom/case-studies/ktcquips73.html
October 01, 2014 - The revised protocol was pilot tested on the medical floor, with hospitalists consistently ordering VTE