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www.ahrq.gov/teamstepps-program/curriculum/team/implement/teach-coach.html
February 01, 2024 - If the exercise falls before a break, introduce the exercise and hand out the self-assessment forms before … If the exercise does not fall around a break, introduce the exercise, hand out the self-assessment forms … (PDF, 161 KB), and give participants time to complete the forms. … Explain that each will use the coaching self-assessment form (PDF, 161 KB) to map the competencies … The self-assessment form is for themselves and won't be shared with anyone else unless they choose to
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/surgery/tools/surgical-complication-prevention/bim.docx
December 01, 2017 - This document summarizes the five-step process and provides more detailed explanations and sample forms … Use the BIM Team Information Form to gather contact information for subgroup members. … List the team member names and responsibilities on the BIM Team Information Form. … BIM Team Information Form
Compose a diverse subgroup from the safety program team. … Use the BIM Team Information Form below to gather contact information for subgroup members.
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www.ahrq.gov/sites/default/files/2024-11/williams-galimbertti-report.pdf
January 01, 2024 - The conference site was highly regarded by participants
in the evaluation form.
c. … Data Collection: An evaluation form was included in the binder
containing all conference materials … Most respondents to the evaluation form did not answer if
they would do something differently. … Page does not require timed responses
Navigation links Passed Navigation links are not repetitive
Forms … Rule Name Status Description
Tagged form fields Passed All form fields are tagged
Field descriptions
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www.ahrq.gov/patient-safety/reports/hotline/implement3.html
May 01, 2016 - During the first year of the implementation phase (2013–2104), changes in the patient event reporting form … Key recommendations from the TEP for the reporting form and Web site included:
Be clearer on the … Those discussions brought forward another set of recommendations for the reporting form and Web site, … patients known to have been injured, conducting discharge followup calls using the event reporting form … functionality of the Web site, including text revisions to the introductory pages of the reporting form
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www.ahrq.gov/sites/default/files/wysiwyg/evidencenow/tools-and-materials/qica-scoring.pdf
January 01, 2018 - Page does not require timed responses
Navigation links Passed Navigation links are not repetitive
Forms … Rule Name Status Description
Tagged form fields Passed All form fields are tagged
Field descriptions … Passed All form fields have description
Alternate Text
Rule Name Status Description
Figures alternate
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www.ahrq.gov/sites/default/files/wysiwyg/evidencenow/heart-health/smoking-detail-aid.pdf
January 01, 2015 - Page does not require timed responses
Navigation links Passed Navigation links are not repetitive
Forms … Rule Name Status Description
Tagged form fields Passed All form fields are tagged
Field descriptions … Passed All form fields have description
Alternate Text
Rule Name Status Description
Figures alternate
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www.ahrq.gov/sites/default/files/wysiwyg/news/events/ahrq-research-summit/brady-summit2016-plenary.pdf
September 28, 2016 - Page does not require timed responses
Navigation links Passed Navigation links are not repetitive
Forms … Rule Name Status Description
Tagged form fields Passed All form fields are tagged
Field descriptions … Passed All form fields have description
Alternate Text
Rule Name Status Description
Figures alternate
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www.ahrq.gov/sites/default/files/wysiwyg/news/events/ahrq-research-summit/adelman-summit2016.pdf
January 01, 2016 - Page does not require timed responses
Navigation links Passed Navigation links are not repetitive
Forms … Rule Name Status Description
Tagged form fields Passed All form fields are tagged
Field descriptions … Passed All form fields have description
Alternate Text
Rule Name Status Description
Figures alternate
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www.ahrq.gov/sites/default/files/wysiwyg/news/events/ahrq-research-summit/schiff-summit2016.pdf
January 01, 2013 - Page does not require timed responses
Navigation links Passed Navigation links are not repetitive
Forms … Rule Name Status Description
Tagged form fields Passed All form fields are tagged
Field descriptions … Passed All form fields have description
Alternate Text
Rule Name Status Description
Figures alternate
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/sections/sustainability/management/huddles/example-pdsa-form.docx
May 01, 2017 - Practices for Sustainability
Module 2: Daily Huddles
Sample “Plan-Do-Study-Act”[footnoteRef:1] Form … In the “act” step, you integrate your learning into a next test or into daily practice. ]
Use this form … No. 16(17)-0019-4-EF
May 2017
AHRQ Safety Program for Ambulatory Surgery Sample PDSA Form |8
Management
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/modules/assemble/assembleteam.pptx
January 01, 2006 - List team member names and contact information on the Background Quality Improvement Team Information Form … and post the form in a central location
Use the 4 Es to ensure team engagement:
Engage them in the … information*
27
As seen in TeamSTEPPS®
CUSP Tools
Background Quality Improvement Team Information Form
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/changing-system-facilitator-guide.docx
June 01, 2021 - This form is available in the toolkit.
Slide 12
What Happened? … Based on this, you can form an intervention. … Each team should complete a Staff Safety Assessment form. … Hang on to the completed forms as they may help your team identify another intervention down the road … Ask them to complete 5–10 forms each month.
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www.ahrq.gov/antibiotic-use/acute-care/safety/changes.html
November 01, 2019 - Slides (PPTX)
Facilitator Guide (PDF)
Learning from Antibiotic–Associated Adverse Events Form
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www.ahrq.gov/antibiotic-use/long-term-care/improve/track-measure.html
April 01, 2023 - Become familiar with forms for monthly data collection. … Tracking and Measuring Antibiotic Use - Facilitator Guide (DOCX, 2 MB)
Monthly Data Collection Form
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www.ahrq.gov/pqmp/measures/sexual-activity.html
August 01, 2021 - KB)
NCINQ Sexual Activity Status Specifications-Prov (PDF, 72 KB)
NCINQ Sexual Activity Status Form
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www.ahrq.gov/hai/cusp/toolkit/observing-rounds.html
December 01, 2012 - How to use this tool: Complete the form while observing patient care rounds. … You may use this form for one patient or the entire unit.
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www.ahrq.gov/prevention/resources/chronic-care/clinical-community-relationships-measures-atlas/ccrm-atlas5.html
March 01, 2013 - 7
Information about area (community) resources is offered by clinician (Wrap-Around Observation Form … care includes at least one public and/or private community service/resource (Wrap-Around Observation Form
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www.ahrq.gov/sites/default/files/wysiwyg/research/publications/pubcomguide/location-release.docx
July 01, 2024 - AHRQ Publishing and Communications Guidelines
Location Release Form for Video Shoots
Instructions
This … Location Release Form must be completed by the location’s administrative authority (herein called “Administrator
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www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/teamwork/culture-checkup-tool.html
July 01, 2023 - Assign someone to complete the Culture Item Discussion Form (next page) to document issues that surface … Culture Item Discussion Form
Statement to be discussed:
Unit Safety Assessment
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www.ahrq.gov/antibiotic-use/acute-care/safety/communication.html
November 01, 2019 - Decision Making framework
Slides (PPTX)
Facilitator Guide (PDF)
Team Antibiotic Review Form