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www.cpsi.ahrq.gov/sites/default/files/wysiwyg/teamstepps/longtermcare/module11/ts2-0ltc_module11_slides_implementation.pptx
February 03, 2006 - Key Actions:
Review unit/department/work area performance and safety data
Incident reports
AHRQ Nursing
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www.cpsi.ahrq.gov/sites/default/files/wysiwyg/teamstepps/longtermcare/module3/ts2-0ltc_module3_comm_evbase.pdf
August 20, 2013 - Communication failures in patient sign-out and suggestions for
improvement: a critical incident analysis
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www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/nicu_toolkit/nicupacket-apb-formula.pdf
December 13, 2013 - NICU Family Information Packet, Appendix B, Formula Feedings
Formula Feedings
We recommend breastfeeding for all infants when possible. However, when breastfeeding is
unavailable or undesired, the following formula recommendations apply.
Benefits
■ Premature transitional formulas have higher contents of protein,…
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www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Wakefield2.pdf
January 01, 2003 - involve four basic steps: (1) error recognition; (2) assessment
of the need to report the error; (3) incident … the clinician must also assess the effort and potential personal cost
associated with completing an incident … Almost universally, managers
proclaim that data gathered through incident reporting systems are not … Reporting effort
• Filling out an incident report for a medication
error takes too much time.
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www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/fallprevention-training/module3/module3_tools.docx
January 01, 2012 - Important Communications
In the medical record, document the incident, outcome, and initial and ongoing … Notify the treating medical provider at the time of the incident, and schedule an interdisciplinary review … At handover, inform all clinical team members about the incident, any changes to the care plan, and possible … the capture of fall events in hospitals: combining a service for evaluating inpatient falls with an incident
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www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/vae/vae-tool.docx
January 01, 2017 - Facilitator Guide: Build Your SSI Prevention Bundle
AHRQ Safety Program for
Mechanically Ventilated Patients
Ventilator-Associated Event Data Collection Tool
Date __________ Month __________ Hospital __________ Unit __________
Use this tool to track your progress i…
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www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/nicu_toolkit/nicupacket-apb-nephro.pdf
December 13, 2013 - NICU Family Information Packet, Appendix B, Nephrocalcinosis
Nephrocalcinosis
Characteristics
■ Renal lithiasis in which calcium deposits form in the renal parenchyma and result in reduced
kidney function and hematuria.
■ Seen with renal ultrasound, or occasionally on plain radiographs of the kidneys.
■ Resul…
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www.cpsi.ahrq.gov/news/blog/ahrqviews/focus-diagnostic-safety.html
March 01, 2023 - Skip to main content
An official website of the Department of Health and Human Services
Careers
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www.cpsi.ahrq.gov/ncepcr/funding/index.html
April 01, 2024 - Skip to main content
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www.cpsi.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/nursing-home/SOPS-Nursing-Home-DB-Part-I-2023.pdf
January 01, 2023 - Surveys on Patient Safety Culture (SOPS) Nursing Home Survey: 2023 User Database Report Part I
SURVEYS ON PATIENT
SAFETY CULTURE
Nursing Home Survey:
2023 User Database Report
Surveys on
Patient Safety
Culture™
PATIENT
SAFETY
[This page intentionally left blank]
Surveys on Patient Safety CultureTM (SOPS®)…
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www.cpsi.ahrq.gov/patient-safety/settings/hospital/candor/modules/guide4/apd.html
August 01, 2022 - EQUIPMENT DEVICE FAILURE
If applicable, was this incident reported to the FDA?
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www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/vae/monitoring-vae-slides.pptx
January 01, 2017 - Monitoring Ventilator-Associated Events Module 2
Monitoring Ventilator-Associated Events
AHRQ Safety Program for Mechanically Ventilated Patients
AHRQ Pub. No. 16(17)-0018-26-EF
January 2017
Monitoring VAEs ‹#›
AHRQ Safety Program for Mechanically Ventilated Patients
1
Learning Objectives
After this sessio…
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www.cpsi.ahrq.gov/sites/default/files/wysiwyg/teamstepps/longtermcare/module11/ts2-0ltc_module11_slides_implementation.pdf
June 09, 2017 - LTC 2.0 Page 8
Key Actions:
■ Review unit/department/work
area performance and safety
data
■ Incident
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www.cpsi.ahrq.gov/news/newsletters/e-newsletter/877.html
August 01, 2023 - Comparing rates of adverse events detected in incident reporting and the Global Trigger Tool: a systematic
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www.cpsi.ahrq.gov/hai/cauti-tools/ena-slides/preface.html
October 01, 2015 - Skip to main content
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www.cpsi.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/asc/Part-I-SOPS-ASC-DatabaseReport.pdf
December 01, 2021 - When something happens that could harm the patient, but
does not, how often is it documented in an
incident … When something
happens that could harm
the patient, but does not,
how often is it
documented in an incident … respondents who indicated
that near-miss incidents were “Always” or “Most of the time” documented in an incident … respondents who indicated that near-miss incidents were “Always” or “Most of the time”
documented in an incident … respondents who indicated that near-miss incidents were “Always” or “Most of the time”
documented in an incident
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www.cpsi.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/asc/part-i-asc_database_report-rev091721.pdf
January 01, 2020 - When something happens that could
harm the patient, but does not, how often
is it documented in an incident … When something happens that could harm the patient, but does
not, how often is it documented in an incident … respondents who indicated that near-miss incidents were “Always” or “Most of the time”
documented in an incident … respondents who indicated that near-miss incidents were “Always” or “Most of the time”
documented in an incident … respondents who indicated that near-miss incidents were “Always” or “Most of the time”
documented in an incident
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www.cpsi.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/nicu_toolkit/nicupacket-apb-bpd.pdf
December 13, 2013 - NICU Family Information Packet, Appendix B, Bronchopulmonary Dysplasia
Bronchopulmonary Dysplasia
Characteristics
■ Need for supplemental oxygen at 36 weeks postmenstrual age, with radiographic changes on
chest x-ray (bilateral, diffuse hazy lungs; interstitial thickening; increased lung inflation).
■ Symptoms: …
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www.cpsi.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/facilscanform.pdf
November 18, 2019 - • An “event” is defined as any type of error, mistake, incident, accident, or deviation,
regardless
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www.cpsi.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/facilscanform.doc
November 15, 2019 - .
· An “event” is defined as any type of error, mistake, incident, accident, or deviation, regardless