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1701. Appendix C: The Health Care Safety Hotline: Operations Manual (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/hotline/healthcare-safety-hotline-appendixc.pdf
      July 01, 2015 - Services, which are built-in Web services that provide access to features such as forms authentication … The following suggestions are also relevant for all Web forms and are worth considering regardless of … screen readers and also helps regular users who prefer to tab through forms. … We noticed that in some cases, the hotline Web site’s forms would return users to the top of the page … • Input buttons should be used only for submitting forms.

1702. PowerPoint Presentation
      www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/antibiotic-targets-slides.pptx
      June 01, 2021 - Using the Four Moments of Antibiotic Decision Making Form may help identify problems. … identify problems Review data collected on the Four Moments of Antibiotic Stewardship Decision Making Form … Collect and analyze data using the Monthly Data Collection Form Distribute the Antibiotic Side Effects … Staff Safety Assessment  Antibiotic Side Effects One-Pager Four Moments of Antibiotic Decision Making Form … Monthly Data Collection Form Identifying Targets 18 Disclaimer The findings and recommendations

1703. Chapter 5 | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/patients-families/consumer-exp/reporting/chapter5.html
      August 01, 2022 - Reporters will be asked to complete a standardized reporting form. … The form will assure users that confidential information protection is a top priority for the system. … The standardized reporting form will allow both structured and unstructured reporting. … Pilot testing will likely be important for finalizing the reporting form. … A "smart form" would be used for each of these options, allowing submitted information to be entered

1704. 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 - * Evidence-based Communication Between Nurses and Prescribers: Using a Medical Care Referral Form … (MCRF) * Medical Care Referral Form (MCRF) Designed to facilitate evidence-based communication … Ideally, all long-term care facility residents should have a POLST accepted form on the chart and have … The form is on bright pink paper so it can be easily identified in case of an emergency. … A physician, physician assistant, or nurse practitioner must complete the POLST accepted form based on

1705. Tk2 T4 Common Suspected Infections Tools To Improve Communication And Decisionmaking (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/nhguide/TK2_T4_Common_Suspected_Infections_Tools_To_Improve_Communication_and_Decisionmaking.docx
      October 01, 2016 - Nurses and Prescribers SAY: Slide 13 Development and Rationale for Use: Medical Care Referral Form … Slide 14 The Medical Care Referral Form (MCRF) SAY: Slide 15 Medical Care Referral Form (MCRF … Ideally, all long-term care facility residents should have a POLST accepted form on the chart and have … The form is on bright pink paper so it can be easily identified in case of an emergency. … A physician, physician assistant, or nurse practitioner must complete the POLST accepted form based on

1706. AHRQ Safety Program for Perinatal Care: Monitoring for Perinatal Safety: Sensemaking and Learn from Defects
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/teamwork/sensemaking/sensemaking.pptx
      May 01, 2017 - Defects 2 CUSP and Sensemaking Tools1 CUSP Tools Sensemaking Tools Staff Safety Assessment Discovery Form … Safety Issues Worksheet Root Cause Analysis Learn From Defects Form Failure Mode and Effects Analysis … identify defects or failure - Staff Safety Assessment - Status of Safety Issues Worksheet - Discovery Form … Analysis - Probabilistic Risk Assessment Tools to examine defects or failures Learn From Defects Form … Causal Tree Worksheet Coding defects or failures Learn From Defects Form Eindhoven Model 4 AHRQ Safety

1707. IV. References | Agency for Healthcare Research and Quality
      www.ahrq.gov/research/findings/final-reports/crctoolkit/crctoolkit4.html
      April 01, 2018 - Electronic Record Review 4.a-1 Introduction Letter to Patients With Instructions for Completing SEA Form … Spanish) 4.a-2 Screening Eligibility Assessment (SEA) Form  (incl. … Spanish) 5.a-1 Master Patient Database Elements 5.d-1 Chart Audit Review Form 6.a-1 Feedback Form … for Stool Test Positive 6.a-2 Feedback Form for Stool Test Negative 6.b-1 Feedback Form for CDE

1708. 116-Evaluating-Cleaning-Data-Collection-Tool (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-2/116-evaluating-cleaning-data-collection-tool.docx
      April 01, 2025 - Evaluating Environmental Cleaning With Fluorescent Gel: Data Collection Instructions and Form Surgical … check mark under the “Day 1” column of the Environmental Cleaning With Fluorescent Gel: Data Collection Form … NR, or N/A on the “Day 2” column of the Environmental Cleaning with Fluorescent Gel: Data Collection Form … surface is no longer in the patient room) ENVIRONMENTAL CLEANING WITH FLUORESCENT GEL: DATA COLLECTION FORM … Safety Program for MRSA Prevention ENVIRONMENTAL CLEANING WITH FLUORESCENT GEL: DATA COLLECTION FORM

1709. Integrating Primary Care Practices and Community-based Resources to Manage Obesity | Agency for Healthcare Research and Quality
      www.ahrq.gov/ncepcr/tools/obesity/index.html
      May 01, 2014 - Chart Audit Form and Instructions Tool 3. Clinical Care Observation Guide Tool 4.  … Sample Community Inventory Form Tool 9. Sample Prescription Pad Tool 10.  … Chart Audit Form and Instructions Tool 3. Clinical Care Observation Guide Tool 4.  … Sample Community Inventory Form Tool 9. Sample Prescription Pad Tool 10. 

1710. 6-Gap-Analysis-Goal (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/surgery/6-gap-analysis-goal.docx
      June 01, 2023 - AHRQ Safety Program for Improving Surgical Care and Recovery Gap Analysis and Goal-Setting Form Creating … The main purpose of this form is for your institution to see where you are starting from and plan ahead … Review the data collected in the Gap Analysis and Goal-Setting Form with your team. … AHRQ Safety Program for Improving Surgical Care and Recovery Gap Analysis and Goal-Setting Form … AHRQ Safety Program for Improving Surgical Care and Recovery Gap Analysis and Goal-Setting Form

1711. 4 Tk1 T2-Clinician Letter Final 0 (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/nhguide/4_TK1_T2-Clinician_letter_Final_0.pdf
      October 01, 2016 - the Suspected Urinary Tract Infection (UTI) Situation, Background, Assessment, and Request (SBAR) form … The Suspected UTI SBAR form is intended to enhance communication and provide guidance regarding managing … infection within the 3 months following their course of antibiotics.8 Embedded in the Suspected UTI SBAR form … Stewardship Guide Determine Whether To Treat Toolkit 1/Tool 2 3 In preparation for implementing the form … , please find enclosed a copy of the Suspected UTI SBAR form.

1712. Four Kentucky Hospitals Use AHRQ Toolkit to Improve Medication Reconciliation | Agency for Healthcare Research and Quality
      www.ahrq.gov/news/newsroom/case-studies/ktcquips79.html
      October 01, 2014 - Regional Medical Center in Hazard, Kentucky, was using a "One Source of Truth" medication reconciliation form … medication list in the admission history and the medications listed on the medication reconciliation form … medical record system in April 2010 that includes a "One Source of Truth" medication reconciliation form

1713. 027-Evaluating-Cleaning-Data-Collection (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa/027-evaluating-cleaning-data-collection.docx
      October 01, 2024 - Evaluating Environmental Cleaning With Fluorescent Gel: Data Collection Instructions and Form ICU & … checkmark under the “Day 1” column of the Environmental Cleaning With Fluorescent Gel: Data Collection Form … NR, or N/A on the “Day 2” column of the Environmental Cleaning With Fluorescent Gel: Data Collection Form … surface is no longer in the patient room) ENVIRONMENTAL CLEANING WITH FLUORESCENT GEL: DATA COLLECTION FORM

1714. Toolkit Implementation Guide for Acute Care Antibiotic Stewardship Programs (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/improve/acute_care_implementation_guide.pdf
      November 01, 2019 - portion of patients receiving antibiotics; this can be guided by use of the Team Antibiotic Review Form … includes information about initiating an antibiotic time out and use of the Team Antibiotic Review Form … Two forms are provided to assist with these discussions between ASPs and frontline staff: o “Identifying … Antibiotic-Associated Adverse Events Form” is brief and can be used at meetings or left on units for … o “Learning From Antibiotic-Associated Adverse Events Form” is similar to a root cause analysis form

1715. Management Practices for Sustainability Module 4: Observation and Integration | Agency for Healthcare Research and Quality
      www.ahrq.gov/hai/tools/ambulatory-surgery/sections/sustainability/management/observation-slides.html
      June 01, 2017 - Slide 4: Example of a Data Sheet Used To Guide an Observation Image: Example of Observation Form … - This table shows a sample form for frontline managers to observe the surgical checkout, highlighting … Cycle Question Preparation 1 Can you use a surgical safety checklist form … The surgical safety checklist observation form is a natural addition to your visual management board.

1716. 4 Tk1 T2-Clinician Letter Final 0 (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/nhguide/4_TK1_T2-Clinician_letter_Final_0.docx
      October 01, 2016 - , the Suspected Urinary Tract Infection (UTI) Situation, Background, Assessment, and Request (SBAR) form … The Suspected UTI SBAR form is intended to enhance communication and provide guidance regarding managing … Embedded in the Suspected UTI SBAR form is our new protocol for initiating antibiotics for UTIs. … Stewardship Guide Determine Whether To Treat Toolkit 1/Tool 2 2 In preparation for implementing the form … , please find enclosed a copy of the Suspected UTI SBAR form.

1717. I. Introduction | Agency for Healthcare Research and Quality
      www.ahrq.gov/research/findings/final-reports/crctoolkit/crctoolkit1.html
      April 01, 2018 - Electronic Record Review 4.a-1 Introduction Letter to Patients With Instructions for Completing SEA Form … Spanish) 4.a-2 Screening Eligibility Assessment (SEA) Form  (incl. … Spanish) 5.a-1 Master Patient Database Elements 5.d-1 Chart Audit Review Form 6.a-1 Feedback Form … for Stool Test Positive 6.a-2 Feedback Form for Stool Test Negative 6.b-1 Feedback Form for CDE

1718. 7. Tools and Resources | Agency for Healthcare Research and Quality
      www.ahrq.gov/es/patient-safety/settings/hospital/resource/pressureulcer/tool/pu7.html
      October 01, 2014 - Ulcer Prevention 1B: Stakeholder Analysis 1C: Leadership Support Assessment 1D: Business Case Form … An example is shown in the form below. A blank form follows. … Instructions: Complete the form with all the required information. … Use: Use this list to form your implementation team. … What forms do we use? How does our physical environment support or hinder this process?

1719. 7. Tools and Resources | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/settings/hospital/resource/pressureulcer/tool/pu7.html
      October 01, 2014 - Ulcer Prevention 1B: Stakeholder Analysis 1C: Leadership Support Assessment 1D: Business Case Form … An example is shown in the form below. A blank form follows. … Instructions: Complete the form with all the required information. … Use: Use this list to form your implementation team. … What forms do we use? How does our physical environment support or hinder this process?

1720. Tool 5. BMI Protocol Template | Agency for Healthcare Research and Quality
      www.ahrq.gov/ncepcr/tools/obesity/obpcp-tool5.html
      May 01, 2014 - Chart Audit Form and Instructions Tool 3. Clinical Care Observation Guide Tool 4.  … Sample Community Inventory Form Tool 9. Sample Prescription Pad Tool 10.  … clinicians for patients with a BMI > 25 or BMI >30 by starting a community-based resource referral form