-
www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/resources/tools/implement/facility-action-plan.docx
January 01, 2018 - Steps
How will this happen? … Who will make this happen?
[Be specific for each task.] … What other information do I need to make this happen? … Steps
How will this happen? … What other information do I need to make this happen?
-
www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/medical-office/MO_Items-Composite_Measures.pdf
October 04, 2023 - Sometimes, Most of the time, Always, Does Not Apply or Don’t Know)
How often do the following things happen … This office is good at changing office processes to make sure the same problems don’t happen again. … Mistakes happen more than they should in this office. (negatively worded)
F4. … They overlook patient care mistakes that happen over and over. (negatively worded)
E3. … In your best estimate, how often did the following things happen in your medical office OVER THE PAST
-
www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/hai/tools/clabsi-cauti-icu/action-plan-template.docx
April 01, 2022 - How will this happen? … [Be specific and include important steps to make the idea/activity happen.]
_________________________ … Who will make this happen?
-
www.qualitymeasures.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 - Where will huddle happen? Default: In front of the visual management board
9. … Predict what will happen when the test is carried out (e.g., if we do “x,” “y” will happen)
Measures … When to be done
Where to be done
Predict what will happen … when the test is carried out (i.e., if we do “x,” “y” will happen)
Measures to compare prediction
-
www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/implementation/long-term-modules/module2/defects.docx
March 01, 2017 - the types of systems that contributed to the defect (an event or situation that you do not want to happen … Why did it happen?
-
www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/learning-from-antibiotic-adverse.docx
June 01, 2021 - Events
An antibiotic-associated adverse event is any event or situation that you would not want to happen … (Why did it happen?)
Step 3. … (Why did it happen?)
Factors
Moment 1: Does the resident have symptoms that suggest an infection?
-
www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/sections/sustainability/management/visual/visual-mgmt-pdsa-form.docx
May 01, 2017 - reviewed during huddle; if huddle is not scheduled regularly yet, let all relevant staff know huddle will happen … Predict what will happen when the test is carried out (e.g., if we do “x,” “y” will happen)
Measures … When to be done
Where to be done
Predict what will happen … when the test is carried out (i.e., if we do “x,” “y” will happen)
Measures to compare prediction
-
www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/sustainability/sustainability-assesment-tool.xlsx
March 01, 2017 - Who will make this happen? How do I know to move to next step? … [Be specific and include important steps to make the idea/activity happen.] … I need to make this happen? … Who will make this happen?
[Be specific for each task.] When will this happen? … What other information do I need to make this happen?
-
www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/facilscanform.doc
November 15, 2019 - It is just by chance that more serious mistakes don’t happen around here
(1
(2
(3
(4
(5
11. … My supervisor/manager overlooks patient safety problems that happen over and over
(1
(2
(3
(4
( … 5
SECTION C: Communications
How often do the following things happen in your work area/unit? … We are informed about errors that happen in this unit
(1
(2
(3
(4
(5
4. … (5
SECTION D: Frequency of Events Reported
In your work area/unit, when the following mistakes happen
-
www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/facilscanform.pdf
November 18, 2019 - It is just by chance that more serious mistakes don’t happen around
here .......................... … My supervisor/manager overlooks patient safety problems that happen
over and over .................. … 1 2 3 4 5
3
SECTION C: Communications
How often do the following things happen … We are informed about errors that happen in this unit .............................. 1 2 3 4 5 … SECTION D: Frequency of Events Reported
In your work area/unit, when the following mistakes happen
-
www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/hai/tools/clabsi-cauti-icu/clabsi-learning-from-defects.docx
April 01, 2022 - ) Hemodialysis Other: _____________________
Why did the CLABSI happen
-
www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/medical-office/medical-office-survey-english.pdf
March 01, 2023 - SECTION A: List of Patient Safety and Quality Issues
The following items describe things that can happen … In your best estimate, how often did the following things happen in your medical
office OVER THE PAST … They overlook patient care mistakes that
happen over and over ................................ … Mistakes happen more than they should
in this office .............................................. … This office is good at changing office
processes to make sure the same
problems don’t happen again
-
www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/hai/tools/clabsi-cauti-icu/cauti-learning-from-defects.docx
April 01, 2022 - (Circle): Yes No
Why did the CAUTI happen?
-
www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/sops/quality-patient-safety/patientsafetyculture/hospitalscanform.doc
June 09, 2016 - It is just by chance that more serious mistakes don’t happen around here
(1
(2
(3
(4
(5
11. … My supervisor/manager overlooks patient safety problems that happen over and over
(1
(2
(3
(4
( … 5
SECTION C: Communications
How often do the following things happen in your work area/unit? … We are informed about errors that happen in this unit
(1
(2
(3
(4
(5
4. … SECTION D: Frequency of Events Reported
In your hospital work area/unit, when the following mistakes happen
-
www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/sops/quality-patient-safety/patientsafetyculture/hospitalscanform.pdf
December 22, 2017 - It is just by chance that more serious mistakes don’t happen around
here ......................... … My supervisor/manager overlooks patient safety problems that happen
over and over ................. … 1 2 3 4 5
3
SECTION C: Communications
How often do the following things happen in your … We are informed about errors that happen in this unit .............................. … SECTION D: Frequency of Events Reported
In your hospital work area/unit, when the following mistakes happen
-
www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/hospital/resources/hospscanform.pdf
March 22, 2017 - It is just by chance that more serious mistakes don’t happen around
here ......................... … My supervisor/manager overlooks patient safety problems that happen
over and over ................. … 1 2 3 4 5
3
SECTION C: Communications
How often do the following things happen in your … We are informed about errors that happen in this unit .............................. … SECTION D: Frequency of Events Reported
In your hospital work area/unit, when the following mistakes happen
-
www.qualitymeasures.ahrq.gov/hai/tools/ambulatory-surgery/sections/sustainability/management/huddles-pdsa-form.html
June 01, 2017 - Where will huddle happen? Default: In front of the visual management board
9. … Predict what will happen when the test is carried out (e.g., if we do “x,” “y” will happen)
Measures …
Predict what will happen … when the test is carried out (i.e., if we do “x,” “y” will happen)
Measures to compare prediction
-
www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/hai/tools/clabsi-cauti-icu/clabsi-learning-from-defects.pdf
April 01, 2022 - administration
Total parenteral nutrition (TPN) Hemodialysis Other: _____________________
Why did the CLABSI happen
-
www.qualitymeasures.ahrq.gov/hai/tools/ambulatory-surgery/sections/sustainability/management/pdsa-form.html
June 01, 2017 - reviewed during huddle; if huddle is not scheduled regularly yet, let all relevant staff know huddle will happen … Predict what will happen when the test is carried out (e.g., if we do “x,” “y” will happen)
Measures …
Predict what will happen … when the test is carried out (i.e., if we do “x,” “y” will happen)
Measures to compare prediction
-
www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/nursing-home/sops-nurse-home-items-06-16-21.pdf
January 01, 2000 - Sometimes, Most of the time, Always, Does Not Apply or Don’t Know)
How often do the following things happen … Sometimes, Most of the time, Always, Does Not Apply or Don’t Know)
How often do the following things happen … Sometimes, Most of the time, Always, Does Not Apply or Don’t Know)
How often do the following things happen … This nursing home lets the same mistakes happen again and again. (negatively worded)
D4.