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Total Results: 613 records

Showing results for "inadequate".

21. Physician-Reported Adverse Events and Medical Errors in Obstetrics and Gynecology (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-November_45.pdf
    January 01, 2007 - misses were more straightforward, such as incorrect gloves used with a patient allergic to latex and inadequate … Support services were implicated in 17 cases (17 percent), with inadequate supplies being the most common … An inadequate evaluation was performed in the ER prior to transfer, and the patient arrived fully dilated … Process problem: Procedural delay, inadequate evaluation. … Process problem: Insufficient supplies, inadequate communication.

22. Best Practices in Pressure Injury Prevention
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/pressure_ulcer_prevention/module3/module3_pu-bestpractices_slides.pptx
    June 02, 2025 - Barriers to Practice Finding time for skin assessments Determining correct etiology of wounds Using inadequate … Probably Inadequate 3. Adequate 4. Excellent FRICTION & SHEAR 1. Problem 2. Potential Problem 3.

23. The IHA Bundled Episode Payment and Gainsharing Demonstration Project | Agency for Healthcare Research and Quality
    www.ahrq.gov/practiceimprovement/delivery-initiative/abstract-williams.html
    December 01, 2017 - Therefore, few contracts were signed and inadequate volume existed to test hypotheses about the program's

24. NICU Family Information Packet, Appendix B, Breast Milk (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/nicu_toolkit/nicupacket-apb-breastmilk.pdf
    June 02, 2025 - ■ If supplementation is required at discharge due to prematurity, poor growth, inadequate volume

25. Pediatricians Use AHRQ Report to Create New Guidelines on Vitamin D for Infants | Agency for Healthcare Research and Quality
    www.ahrq.gov/news/newsroom/case-studies/coe0702.html
    October 01, 2014 - New Guidelines for Vitamin D Intake , was prompted by reports of rickets in infants attributable to inadequate

26. Early Mobility in the Intensive Care Unit: Facilitator Guide | Agency for Healthcare Research and Quality
    www.ahrq.gov/hai/tools/mvp/modules/technical/early-mobility-icu-fac-guide.html
    February 01, 2017 - Patient-based barriers included dislodgement of devices, worsening gas exchange, unstable hemodynamics, and inadequate … Conclusions—Feasiblity Say: There are significant barriers to overcome with staff, such as insufficient time, inadequate … also patient-based barriers such as oversedation, worsening gas exchange, unstable hemodynamics, and inadequate … Some of these, such as oversedation and inadequate pain control, are addressable through staff education

27. Final Progress Report: Process Reliability and Organizational Learning in Home Health Care (pdf file)
    www.ahrq.gov/sites/default/files/2025-02/silver-report.pdf
    January 01, 2025 - We hypothesize that inadequate care planning has a negative impact on agency functioning and financial … These factors feed into the “inadequate reimbursement for care provided” model element. … We identified the following as causes of inadequate care planning: • Start of care assessment LTA. … Inadequate reimbursement for care provided – Maladaptive organizational responses to this condition are … Beyond the effects of inadequate care planning, his condition is exacerbated by: • Care/visit documentation

28. ASC, Report Output, Report: 'Fault Tree Diagram', Data Source File: 'ASC Fault Tree_with_change' (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/research/findings/final-reports/stpra/stpraapf.pdf
    June 02, 2025 - Page 37 Gate39 Bug in air Q:0.15 Gate105 Improper ventilation system Q:0.05 Gate106 Inadequate … equip in advance of procedure Gate112 When flash sterilization needed, inapprop use Event224 Inadequate … Tree_with_change.RFP Gate112 When flash sterilization needed, inapprop use Q:0 Event228 Inadequate … time Q:0 Event229 Inadequate temp Q:0 Q:0 Event339 Flash area outside OR suite Q:0 … To Page 52 Event230 Inadequate solution Page #: 68 Print Date: 11/9/2011 Print Time:

29. Final Progress Report: Risk-Informed Intervention to Improve Ambulatory Drug Monitoring and Safety (pdf file)
    www.ahrq.gov/sites/default/files/2024-01/field-report.pdf
    January 01, 2024 - found that lack of redundancy and communication problems were the major system factors underlying inadequate … drug events in this setting; 41% of preventable, serious adverse drug events were associated with inadequate … the fault trees and cut sets to understand failures in the medication handling process that lead to inadequate … laboratory monitoring and found that inadequate laboratory monitoring of high-risk medications is the … Inadequate laboratory monitoring of high-risk medications after initial prescription is a medical error

30. Emergency Departments Don’t Coordinate How They Collect, Use Social Needs Information | Agency for Healthcare Research and Quality
    www.ahrq.gov/news/newsletters/e-newsletter/918.html
    June 01, 2024 - However, children with public insurance had fewer instances of inadequate or insufficient coverage compared … during the pandemic, inconsistent insurance for publicly insured children dropped by 42 percent, while inadequate

31. Facilitator Guide: Build Your SSI Prevention Bundle (doc file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/technical/early-mobility-icu-facguide.docx
    January 01, 2017 - Patient-based barriers included dislodgement of devices, worsening gas exchange, unstable hemodynamics, and inadequate … Feasibility SAY: There are significant barriers to overcome with staff, such as insufficient time, inadequate … also patient-based barriers such as oversedation, worsening gas exchange, unstable hemodynamics, and inadequate … Some of these, such as oversedation and inadequate pain control, are addressable through staff education

32. NICU Family Information Packet, Appendix B, Bronchopulmonary Dysplasia (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/nicu_toolkit/nicupacket-apb-bpd.pdf
    June 02, 2025 - – If inadequate, may be due to insufficient caloric intake or hypoxemia.

33. Appendix Q. Surgeon Focus Group Content Analysis | Agency for Healthcare Research and Quality
    www.ahrq.gov/research/findings/final-reports/ssi/ssiapq.html
    April 01, 2018 - of Surgeon Focus Group Data Models and Metrics Current SSI risk assessment tools are inadequate … consensus among participants was that current models for surgical site infection risk assessment were inadequate

34. Strategies for Improving Patient Experience with Ambulatory Care: Planned Visits (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/cahps/quality-improvement/improvement-guide/6-strategies-for-improving/communication/cahps-strategy-6l.pdf
    August 01, 2017 - chronic illness report that their clinicians do not explain things well, they are often referring to inadequate … uninformed passive patient, interacting with an unprepared practice team, resulting in frustrating, inadequate

35. Transforming the Morbidity and Mortality Conference into an Instrument for Systemwide Improvement (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol2/Advances-Deis_82.pdf
    June 03, 2008 - factors contributing to adverse or “near- miss” outcomes in these cases were communication failures and inadequate … Inadequate or incomplete communication among members of the health care team was the most common contributing … Factors contributing to adverse outcome Factor % Cases Communication: e.g., inadequate handoffs … of key clinical information (i.e., vital signs) between nursing staff and resident physicians and inadequate

36. Results | Agency for Healthcare Research and Quality
    www.ahrq.gov/policymakers/chipra/measure_retirement/measure_retirement4.html
    February 01, 2014 - BMI) assessment for children/adolescents, and measures for which there were validity concerns (e.g., inadequate

37. Views of Emergency Medicine Trainees on Adverse Events and Negligence: Survey Results from an Emergency Medicine Training Program in a Regional Health Care System Following the National Standard of Care (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol2/Advances-Shah_99.pdf
    March 23, 2008 - to negligencea Theme of negligence onlyb (not sustaining an adverse event injury) Examples with inadequate … to negligencea Theme of negligence onlyb (not sustaining an adverse event injury) Examples with inadequate … to negligencea Theme of negligence onlyb (not sustaining an adverse event injury) Examples with inadequate … negligencea Theme of negligence onlyb (not sustaining an adverse event injury) Examples with inadequate … negligencea Theme of negligence onlyb (not sustaining an adverse event injury) Examples with inadequate

38. Next Steps and a Call to Action | Agency for Healthcare Research and Quality
    www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-care-transitions6.html
    June 01, 2023 - communication tools Lack of structured handoffs Patient and family involvement Inadequate

39. Adverse Events | Agency for Healthcare Research and Quality
    www.ahrq.gov/research/findings/evidence-based-reports/adverse-events.html
    April 01, 2018 - adverse events (5.7 percent in studies rated "adequate", compared to 3.9 percent in studies rated "inadequate

40. Chapter 6. Summary | Agency for Healthcare Research and Quality
    www.ahrq.gov/research/findings/final-reports/diabetesnetwork/diabnet6.html
    October 01, 2014 - Recognizing that merely translating an English tool or educational materials into Spanish may be inadequate