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921. 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.

922. 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

923. 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

924. 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

925. 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.

926. Tobacco Use and Help with Quitting Among Adolescents | Agency for Healthcare Research and Quality
     www.ahrq.gov/pqmp/measures/tobacco-use.html
     August 01, 2021 - , 82 KB) NCINQ Tobacco Use and Help Specifications—Pop (PDF, 88 KB) NCINQ Tobacco Use and Help Form … (PDF, 697 KB) NCINQ Tobacco Use and Help Form—References (PDF, 18 KB) Materials Written Statement

927. 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

928. 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.

929. 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

930. 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.

931. 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

932. 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

933. Staff Safety Assessment | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/implementation/long-term-modules/module2/safety-assessment.html
     March 01, 2017 - This form can be filled out by anyone who works here at any time. … At a minimum, everyone should complete this form twice a year.  

934. 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?

935. 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?

936. AHRQ Safety Program for Perinatal Care: Labor and Delivery Unit Safety Issues Worksheet for Senior Executive Partnership (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/teamwork/supporting/worksheet.docx
     May 01, 2017 - Health care providers and senior leader(s) How to complete this form: Provide as much detail as possible … When to complete this form: It should be completed at least semiannually.

937. 48. What's New in 2008? 2000 Recommendations Changed for 2008 (Continued) | Agency for Healthcare Research and Quality
     www.ahrq.gov/prevention/guidelines/tobacco/clinicians/presentations/2008update-full/slide48.html
     October 01, 2014 - Medications: 2000 Guideline: Recommendation: Combining the nicotine patch with a self-administered form … replacement therapy (either the nicotine gum or nicotine nasal spray) is more efficacious than a single form

938. Tools for Reducing Central Line-Associated Blood Stream Infections (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/hai/clabsi-tools/clabsi-tools-revised.pdf
     January 01, 2013 - Central Line Maintenance Audit Form Appendix 7. CLABSI Event Report Template Appendix 8. … Alternatively, if you have existing reporting mechanisms on your unit (nurse-to-nurse report forms, … charge nurse report forms, for example) add the question of whether or not any catheters or tubes can … Audit Form (Appendix 6) as a checklist for rounding and as a reminder of best practices for central … Seven questions on the audit form address line placement and maintenance, including the need for the

939. 2.a-1 Preintervention Survey of Clinicians and Practice Staff | Agency for Healthcare Research and Quality
     www.ahrq.gov/research/findings/final-reports/crctoolkit/crctool2a-1.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

940. Chapter 4: Building the Community Foundation | Agency for Healthcare Research and Quality
     www.ahrq.gov/ncepcr/tools/obesity/obpcp4.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.  … This process used four key steps and resulted in the creation of a community resource inventory form. … An example of a completed inventory form appears in Tool 8 . … Use or modify the attached form to collect common information from all the resources.