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Showing results for "how to do a case study".

1661. Lessons Learned from the Evolution of Mandatory Adverse Event Reporting Systems (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Flink.pdf
      April 09, 2004 - model of how using performance data can instill fear and provoke defensive behavior on the part of … reporting process - Determine if incident reporting works with QA - Improve the models of incidents - How … do we weave education into the process - User-friendly system - Shared success - Do not violate legislative … a quarterly basis to discuss issues of significance to NYPORTS. … The Institute of Medicine report on medical errors: could it do harm?

1662. Central Venous Catheter Indications and Alternatives Facilitator Notes (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/clabsi-cauti-icu/urinary-catheter-alternatives-notes.docx
      April 01, 2022 - commonly referred to as a Foley catheter. … . · Collaborate with product representatives who can provide staff with guidance and instruction on how … Two new alternatives, seen on the right in the picture, do not require securement on the shaft of the … indwelling catheters, condom catheters do have some risk, including skin maceration or local tissue … However, instructors often do not focus on the associated risks of these devices.

1663. Standardized Nursing Protocol: Bed Bathing With 2% Chlorhexidine (CHG) No-Rinse Bathing Cloths and Showering With 4% CHG Liquid Soap (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/hai/abate/nursing-protocols/nursing-chg-bed-bathing.pdf
      March 01, 2022 - CHG wipe to a designated body section, use a clean section of the CHG wipe (or a new wipe) to clean … • Allow CHG to air dry naturally – do not wipe off. • CHG cloths have moisturizers. … • Do not place CHG cloths directly on bedding. … Do not flush in toilet. … for how to address patient refusals.

1664. Best Practices in the Diagnosis and Treatment of Asymptomatic Bacteriuria and Urinary Tract Infections (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/best-practices/ASB-UTI-facilitator-guide.pdf
      November 01, 2019 - Slide 1 Objectives: SAY: By the end of this presentation you will be able to— • Explain how … Further, mental status changes alone in the absence of other evidence of UTI do not indicate a UTI. … Most patients with a UTI do not need blood cultures, although they should be obtained in patients with … Empiric therapy for CAUTI depends on how ill the patient appears and is the extent of the infection—limited … treat patients who have UTIs while avoiding antibiotics in those who do not.

1665. Final Progress Report: METs: Preventing Patient Crisies; Protecting Patients in Crisis (pdf file)
      www.ahrq.gov/sites/default/files/2024-11/devita-report.pdf
      January 01, 2024 - The METs, once triggered, respond quickly to attend to patients in a medical crisis. … Emergency Team (MET)—to patients in a medical crisis. … Inadequate knowledge on how to organize and implement a MET response program. … A website was planned to house conference related materials after the event. Results. … Do nurses know when to summon emergency assistance?

1666. CHIPRA Measure 240: Parent Report of Discussion of Weight Concerns for Child (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-240-bmi-parent-full-report.pdf
      February 01, 2020 - Section 2: Detailed Measure Specifications Provide sufficient detail to describe how a measure would … This measure provides a straightforward means to assess how well basic levels of comprehensive care … to assess how well comprehensive care is provided to children in order to assess, prevent, and treat … For example, how might a physician change a visit when a patient records that they are not satisfied … This measure provides a straightforward means to assess how well basic levels of comprehensive care

1667. Surgical Safety: Addressing the JCAHO Goals for Reducing Wrong-site, Wrong-patient, Wrong-procedure Events (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Ludwick.pdf
      June 21, 2004 - Trying to get any group to come to a common agreement on anything can be, and often is, quite exhausting … A new department policy had to be developed. … N/A is appropriate if imaging studies do not exist. … The question then arose as to how to monitor compliance of this initiative across an entire facility … The display serves as a reminder to caregivers and consumers alike that patient safety is a top priority

1668. CHIPRA 230: Documentation of BMI Percentile and Weight Classification for Children (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-230-fullreport.pdf
      July 01, 2019 - These individual values do not qualify as a numerator event. … These individual values do not quality as a numerator event. … Section 2: Detailed Measure Specifications Provide sufficient detail to describe how a measure would … This measure provides a straightforward means to assess how well basic levels of comprehensive care … This measure provides families with a straightforward means to assess how well basic levels of comprehensive

1669. Appendix III (continued) | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/report/apiiii.html
      June 01, 2010 - gauge how well the Bureau is providing services to people with disabilities. … provide information pertaining to how individuals learned of the aging and disability resource center … Do you earn enough money to buy the things you want? … Are you free to take risks when you want to? Do you have control over your own transportation? … Do you get to decide who comes in and out of your home?

1670. Quitting Helps You Heal Faster | Agency for Healthcare Research and Quality
      www.ahrq.gov/prevention/guidelines/tobacco/clinicians/tearsheets/hospital.html
      October 01, 2014 - Quitting Helps You Heal Faster Your Hospital Visit Is a Great Time To Quit Smoking Treating … You will be told NOT to smoke during your hospital stay—now is a great time to quit! … How Do I Quit In the Hospital? … Talk to your doctor or other hospital staff about a plan for quitting. Ask for help right away. … Set a new date to get back on track.

1671. Final Progress Report: Leveraging Existing Assessments of Risk Now (LEARN) Final Report (pdf file)
      www.ahrq.gov/sites/default/files/2025-02/woods2-report.pdf
      January 01, 2025 - it harder to do what cannot be undone; 3) Make it easier to discover and to correct the errors that … do occur; and 4) Change the attitude toward errors. … FMEAs that define how “critical” a failure might be are sometimes referred to as Failure Modes and Effects … (failure events) • How likely is it? (frequency) • What are the consequences? … be ready 1 1 Fax not received in lab 1 1 Labs not received 1 1 Results delayed or do not arrive

1672. Effect of Recent Refresher Training on in Situ Simulated Pediatric Tracheal Intubation Psychomotor Skill Performance (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol3/Advances-Nishisaki_44.pdf
      April 19, 2008 - not know how rapidly pediatric tracheal intubation psychomotor skills decline, how often refresher … A high fidelity simulator was used in a simulated clinical setting to maximize the realism, to accurately … training implementation standpoint, since this will determine how frequently trainees need to take refresher … How would minimum experience standards affect the distribution of out-of-hospital endotracheal intubations … Training in carotid artery stenting: Do carotid simulation systems really help?

1673. Medication Management Transactions and Errors in Family Medicine Offices: A Pilot Study (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol4/Advances-Lynch_37.pdf
      March 21, 2008 - Nurses, medical assistants (MAs), and licensed practical nurses (LPNs) do not help write any prescriptions … At the training session, the study coordinator reviewed the study protocol, including how to complete … In these cases, it was the phone or fax that was responsible for mitigating the error but not how the … to use mitigation transactions as a way to identify errors. … setting speaks to the need for a more comprehensive study to validate this study’s findings and to

1674. Final Progress Report: Watchful Waiting as a Strategy for Reducing Low-value Spinal Imaging (pdf file)
      www.ahrq.gov/sites/default/files/2025-07/fenton2-report.pdf
      January 01, 2025 - clinicians how to recommend and negotiate a watchful waiting strategy when patients request low-value … worsen or do not improve. … Plan should address how the patient should contact the clinician, when they should do so, and what … the clinician is likely to do in response. … Appropriate use of diagnostic imaging in low back pain: a reminder that unnecessary imaging may do as

1675. Improving Patient Safety Using ATHENA-Decision Support System Technology: The Opioid Therapy for Chronic Pain Experience (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol4/Advances-Michel_92.pdf
      April 30, 2008 - red with a pink background to draw the provider’s attention to the area. … The ATHENA-Opioid Therapy team made choices of what information was essential at the first layer, how … member to demonstrate how they would use the system during patient care. … • We acknowledge that the limitations of the patient data do not allow us to reliably make decisions … Instead of presenting a “best guess,” the system presents physicians with detailed instructions on how

1676. Pediatric Diagnostic Safety: State of the Science and Future Directions (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/topics/dxsafety-pediatric-safety.pdf
      September 01, 2023 - The authors are solely responsible for this document’s contents, findings, and conclusions, which do … such as Kawasaki disease, bronchiolitis, autism spectrum disorder, and juvenile idiopathic arthritis do … How do we develop and evaluate performance of diagnostic trigger tools that can be used to identify … how healthcare teams think about diagnosis, such as diagnostic timeouts141; and programs to improve … Overdiagnosis: how our compulsion for diag- nosis may be harming children. Pediatrics.

1677. Standardized Simulated Events for Provocative Testing of Medical Care System Rescue Capabilities (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Blike.pdf
      January 01, 2003 - simply do not exist. … Instead, the literature is replete with descriptions of how sedative medications can be used in a variety … followed and in terms of how well the critical variables were maintained within their desired ranges … how the teams in these settings responded to manage the event. … How to investigate and analyze clinical incidents: clinical risk unit and association of litigation

1678. National Evaluation of the CHIPRA Quality Demonstration Grant Program: Final Project Report (pdf file)
      www.ahrq.gov/sites/default/files/publications/files/chipra-final-report_0.pdf
      February 21, 2016 - determine how to make Format requirements applicable to practice workflow. 2. … • States initially agreed to identify and collect data from comparison groups but then did not do … Nonetheless, our efforts to do so led to three positive developments. … How are CHIPRA demonstration States encouraging health care providers to put quality measures to work … , although some were planning to do so.

1679. 2. Description of the Intervention | Agency for Healthcare Research and Quality
      www.ahrq.gov/research/findings/final-reports/crcscreeningrpt/crcscreen2.html
      April 01, 2018 - to those patients, track whether patients get screened, send reminders to those who do not screen, and … medical school observed that most health care systems do "not have the ability to identify and then … do what and when. … intervention to be used by practices that do not already have an effective means of tracking screening … Learned During our pilot, we learned four key lessons regarding the academic detailing that affected how

1680. Provider-Offered Insurance Products among U.S. Health Systems, 2016 (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/chsp/data/chsp-brief5-insurance-products.pdf
      January 01, 2019 - The relationships between system type and offering an insurance product do not adjust for system size … We constructed a system- level variable equal to one if at least one non-Federal general acute care … Systems with no residents are considered nonteaching systems, systems with a resident-to- bed ratio … inclusion of systems that do not provide comprehensive care in the manner intended by the definition … study the characteristics of high-performing health systems and to understand how health systems use