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patientregistry.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/staff-safety-assessment.docx
June 01, 2021 - AHRQ Safety Program for Improving Antibiotic Use
Staff Safety Assessment
PURPOSE OF THIS FORM: … All health care providers are encouraged to complete this form. … Consider asking all staff members to complete this form at least semiannually.
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patientregistry.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/d4_combo_bestpracticescover.pdf
June 05, 2016 - The best practices forms are not meant to replace validated guidelines. … Which QIs have best practices forms? … Best practices forms have been developed for all PSIs
and PDIs for which there was sufficient evidence … Best practices forms exist for the following 14 PSIs:
• PSI 03 Pressure Ulcer Rate
• PSI 05 Retained … to be captured by one best
practices form.
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patientregistry.ahrq.gov/hai/tools/surgery/modules/implementation/audit-briefing-slides.html
December 01, 2017 - Grant Application, Review & Award Process
Grant Application Basics
Application Forms … What forms and structures should be in place? … Image: Logistics section of briefing form:
Who initiated briefing?
Surgery attending. … INTRAOP
Back of the form .
Operating room nurse coordinates. … INTRAOP
Back of the form .
Operating room nurse coordinates.
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patientregistry.ahrq.gov/funding/grant-mgmt/recognition_ahrq-funded_study.html
November 01, 2021 - Grant Application, Review & Award Process
Grant Application Basics
Application Forms … Please use this PDF form [153.4 KB] to submit the information below. … Contact journalpublishing@ahrq.hhs.gov with any questions or assistance with this form. … The fillable PDF form linked above contains the following fields to submit information. … This page cannot submit information, and is intended only to identify the information requested in the form
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patientregistry.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/instructor/contents.pdf
March 21, 2014 - Management: How to
Achieve a Culture of Safety
Module 9: Coaching Workshop
• Coaching Feedback Form … • Coaching Scenarios
• Coaching Self-Assessment Form
Module 10: Measurement
• Evaluating TeamSTEPPS … Workshop
• TeamSTEPPS Implementation Guide
Module 12: Practice Teaching Session
• Teaching Feedback Form … Planning Workshop
Module 12: Practice Teaching Session
TAB F MEASURES
Sample Course Evaluation Form
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patientregistry.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/medication-mgmt-sample-process.pdf
January 12, 2017 - Using the Medication List form, go through the prescription medications one by one:
a. … Check whether the medication is expired and note that on the Medication List form.
d. … Indicate on the Medication List form whether the patient is taking the
medication as prescribed. … 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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patientregistry.ahrq.gov/teamstepps/instructor/fundamentals/module9/coachscenarios.html
March 01, 2014 - Grant Application, Review & Award Process
Grant Application Basics
Application Forms … Mark your observations on the coaching feedback form. … Mark your observations on the coaching feedback form. … Mark your observations on the coaching feedback form. … Mark your observations on the coaching feedback form.
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patientregistry.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/instructor/fundamentals/module9/coachscenarios.pdf
March 20, 2014 - Mark
your observations on the coaching feedback form. … Mark
your observations on the coaching feedback form. … Mark
your observations on the coaching feedback form. … Mark
your observations on the coaching feedback form. … Mark
your observations on the coaching feedback form.
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patientregistry.ahrq.gov/cahps/cahps-database/research-datasets/index.html
January 01, 2024 - Grant Application, Review & Award Process
Grant Application Basics
Application Forms … from the CAHPS Databases, please submit the following:
CAHPS De-Identified Data Research Abstract Form … (PDF, 230 KB)—Please complete and submit this form to outline the proposed use of the data. … Sample CAHPS De-Identified Research Abstract Form (PDF, 247 KB)—Shows the form completed with sample … westat.com (Subject line: CAHPS De-Identified Data Request)
Timeline
All completed research abstract forms
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patientregistry.ahrq.gov/sites/default/files/wysiwyg/patient-safety/patient-prep-card.pdf
November 30, 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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patientregistry.ahrq.gov/antibiotic-use/long-term-care/safety/index.html
January 01, 2024 - Grant Application, Review & Award Process
Grant Application Basics
Application Forms … Antibiotic Use Commitment Poster (DOCX, 870 KB)
Staff Safety Assessment Form (DOCX, 330 KB)
Implementation … Guide (PDF, 402 KB)
Learning From Antibiotic–Associated Adverse Events Form (DOCX, 227 KB)
Gap … Analysis Tool (DOCX, 382 KB)
The Four Moments of Antibiotic Decision Making Form and Guide
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patientregistry.ahrq.gov/teamstepps/instructor/contents.html
July 01, 2015 - Grant Application, Review & Award Process
Grant Application Basics
Application Forms … Change Management: How to Achieve a Culture of Safety
Module 9: Coaching Workshop
Coaching Feedback Form … Coaching Scenarios
Coaching Self-Assessment Form
Module 10: Measurement
Evaluating TeamSTEPPS … Workshop
TeamSTEPPS Implementation Guide
Module 12: Practice Teaching Session
Teaching Feedback Form … Planning Workshop
Module 12: Practice Teaching Session
Tab F: Measures
Sample Course Evaluation Form
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patientregistry.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/medmanage_medlist.pdf
November 30, 2017 - Page does not require timed responses
Navigation links Passed Navigation links are not repetitive
Forms … Rule Name Status Description
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Field descriptions … Passed All form fields have description
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Rule Name Status Description
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patientregistry.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/medmanage-ptreminder-postcard.pdf
December 01, 2017 - Page does not require timed responses
Navigation links Passed Navigation links are not repetitive
Forms … Rule Name Status Description
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Field descriptions … Passed All form fields have description
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patientregistry.ahrq.gov/antibiotic-use/acute-care/improve/index.html
June 01, 2021 - Grant Application, Review & Award Process
Grant Application Basics
Application Forms … Stewardship
Bedside Nurse
Collaborate With Microbiology Lab
Team Antibiotic Review Form … All ASPs should be making daily interventions to improve antibiotic use; the Team Antibiotic Review Form … AHRQ Safety Program for Acute Care (PDF, 328 KB)
Gap Analysis Tool (DOCX)
Team Antibiotic Review Form
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patientregistry.ahrq.gov/funding/grant-mgmt/noncomp.html
November 01, 2015 - Grant Application, Review & Award Process
Grant Application Basics
Application Forms … Contents
Forms Application Contents Date of Submission Where to Send the Application Inquiries
Forms … /2590/2590.htm , including:
Budget, as described in Section 2.2, including separate budget pages (form … Budget justification, as appropriate, on form page 3 (see item 2 below). … Progress report summary (form page 5).
Checklist (form page 6).
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patientregistry.ahrq.gov/teamstepps/longtermcare/index.html
May 01, 2019 - Grant Application, Review & Award Process
Grant Application Basics
Application Forms … Coaching Self-Assessment Form (PDF; 4 pages; 287.6 KB). … Coaching Feedback Form (PDF; 1 page; 121.6 KB). … Coaching Self-Assessment Form (PDF; 4 pages; 287.6 KB). … Coaching Feedback Form (PDF; 1 page; 121.6 KB).
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patientregistry.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/teach-back-tips-jobaid-final508.pdf
April 04, 2018 - Page does not require timed responses
Navigation links Passed Navigation links are not repetitive
Forms … Rule Name Status Description
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Rule Name Status Description
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patientregistry.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/medicinelist-patient-flier-final508.pdf
April 12, 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
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Rule Name Status Description
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patientregistry.ahrq.gov/teamstepps/instructor/fundamentals/module12/igpracticeteach.html
March 01, 2014 - Grant Application, Review & Award Process
Grant Application Basics
Application Forms … Subsections:
Practice Teaching Session
Module Time: 4 hours
Materials:
Teaching Feedback Form … feedback from me (and/or any other Master Trainers present for the session) on the Teaching Feedback Form … After Module 1 is complete, have participants complete the Teaching Feedback Form. … Time: 4 hours
Materials:
Teaching Feedback Form
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