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ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/toolkit/learndefects.doc
August 08, 2012 - All staff involved in the delivery of care related to a defect should be present when this defect is … For this investigation, put yourself in the place of those involved and in the middle of the event as … Please read each contributing factor and evaluate whether it was involved. … If it was involved, did it negatively contribute (increase harm) or positively contribute (reduce impact … Ask frontline staff involved in the defect whether the interventions reduced the likelihood of recurrence
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ce.effectivehealthcare.ahrq.gov/patient-safety/reports/candor-demo-program/plan-grants/findings.html
August 01, 2022 - None of the discrepancies involved permanent disability or death, but almost half of the discrepancies … involved symptoms or temporary disability, of which 16 percent were judged to require an office visit … Cases involved discharge from one of four hospital sites affiliated with the academic medical center. … Notably, almost half (299 of 632) of reported near misses involved office processes. … In the first part of the study, researchers surveyed patients and medical staff involved in 41 claims
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ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/teamstepps/officebasedcare/ts-obc-online-module11.pptx
March 07, 2019 - There’s a lot involved on the nonclinical side. … And finally, you want to make sure that your key stakeholders are actively involved, and when you find … Who are the people involved? When is the problem occurring? … Who will be involved?
When and where will the improvements occur? … And how will you actually arrange the training session with the people involved?
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ce.effectivehealthcare.ahrq.gov/teamstepps/officebasedcare/impworkbook.html
December 01, 2015 - opportunity for improvement that will be targeted by the TeamSTEPPS Intervention and to identify the involved … Who is involved in the "problem" process? (List by staff positions not individuals' names. … exactly what you hope to achieve with your TeamSTEPPS Intervention—what will be achieved, who will be involved … These are the people involved in the "what you want to achieve" listed above, such as the staff members … good team behavior; increase observed effective team communication among staff)
Who will be involved
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ce.effectivehealthcare.ahrq.gov/patient-safety/reports/liability/neumiller.html
August 01, 2017 - Medication classes most commonly involved in potential ADEs are displayed in Table 1. … Potential ADEs ascribed a significant rating often involved opioids, antihypertensives, anticoagulants … Medications commonly involved in discrepancies assessed to have insignificant consequences involved acetaminophen … Furthermore, our study involved patients discharged from hospital to home care, while the Gandhi study … The involved medicines were anticoagulants or antiplatelets (e.g., enoxaparin, warfarin, dipyridamole
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ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy3/Strat3_Tool_1_BSR_Broch_508.pdf
May 23, 2013 - How can you
get involved? … This brochure explains what nurse bedside
shift report is and how you can get involved. … At [insert hospital
name], we want you to be involved in shift
changes to make sure you get high-quality
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ce.effectivehealthcare.ahrq.gov/teamstepps-program/curriculum/implement/activity/plan.html
February 01, 2024 - process during which the problem, challenge, or opportunity occurs by stating what the process is, who is involved … terms what can be achieved with the TeamSTEPPS intervention: what will be achieved, who will be involved … Tips for Success
Ensure that the people creating the plan will be directly involved in implementing … Getting patients and family caregivers involved to reinforce their inclusion in teams providing them … They may be patient advocates, organization leaders, frontline leaders, staff directly involved in the
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ce.effectivehealthcare.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 - Events
characterized as “none of the above” usually
involved administrative issues with no clinical … Seven events (9 percent) resulted in patient harm
(AEs), while most involved a potential AE
(46 percent … Numerous potential AEs involved lab work delays related to orders not
entered, orders not acknowledged … Eleven cases (11 percent) involved process issues in making a
Diagnosis, and the same number (11 cases … Although only a few minutes per day are involved,
this time has significant value for busy clinicians
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ce.effectivehealthcare.ahrq.gov/questions/resources/articles.html
November 01, 2020 - O'Reilly
[Mentions the AHRQ and Ad Council campaign “Questions Are the Answer: Get More Involved With … Health Care”; quotes AHRQ Directory Carolyn Clancy]
Patients encouraged to ask questions and get more involved … 25, no. 4, pg. 24
[News brief on AHRQ and Ad Council campaign “Questions Are the Answer: Get More Involved … section; Pg. 964
[Brief news item on AHRQ and Ad Council campaign “Questions Are the Answer: Get More Involved
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ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Johnson.pdf
January 01, 2004 - patient safety considerations are incorporated into medical
device purchasing decisions, individuals involved … First, individuals
involved in the purchasing decisions were questioned using a structured interview … All
subjects were involved, albeit to different extents, in the latest purchase of
infusion pumps at … Those directly involved in the decisions at Sites 1 and
2 felt the best decision was made. … This indicated
some awareness of the human factors issues involved with device use safety.
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ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy3/Strat3_Tool_1_BSR_Broch_508.docx
February 24, 2011 - How can you
get involved? … This brochure explains what nurse bedside shift report is and how you can get involved. … At [insert hospital name], we want you to be involved in shift changes to make sure you get high-quality
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ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/primary-care/tpc/impact-profile-pa.pdf
April 01, 2015 - The Pennsylvania Spreading Primary Care Enhanced Delivery
Infrastructure (PA SPREAD) initiative involved … Stage one
involved convening stakeholders; stage two involved providing direct services to practices … via practice
coaches; and stage three involved providing shared services through the general contractor … A second important component of the spread activities in the partner States involved bringing together
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ce.effectivehealthcare.ahrq.gov/prevention/resources/chronic-care/ccrm-atlas-suppl/ccrm-apptabA-10.html
October 01, 2013 - clinician-patient
Instrument:
Wrap-Around Observation Manual – Second Version
Purpose:
For families involved … resource/intervention (e.g., A.A, vocational rehab, Teammates) to the parent or asks if the parent is involved … “Yes” if the team mentions or asks if the parent is involved in resources/interventions. … “Yes” if the team asks about or mentions resources/interventions and the parent is already involved or
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ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/nhguide/5_TK2_P1T3-Checklist_for_Discussion_with_Local_Hospitals_Providers_ERs_Phase_1.doc
May 01, 2014 - residents will go to the Emergency Department, it is reasonable to reach out also to hospital staff involved … This department is often involved in developing antibiograms for the hospital.
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ce.effectivehealthcare.ahrq.gov/npsd/data/dashboard/blood.html
October 01, 2023 - This dashboard details the type of blood product involved, type of blood product by residual harm to
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ce.effectivehealthcare.ahrq.gov/cahps/surveys-guidance/ich/develop-ich-survey/index.html
June 01, 2019 - The development of this CAHPS survey involved several steps, including a review of existing surveys, … Specifically, researchers involved in the pilot did the following:
Evaluated the psychometric properties
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ce.effectivehealthcare.ahrq.gov/research/findings/final-reports/ptflow/section5.html
July 01, 2018 - The most time-consuming strategies were those that involved extensive staff training, large implementation … Since the strategy at Hahnemann largely involved the acquisition of new resources (e.g., hiring new staff … Conversely, Thomas Jefferson used a Lean approach, which involved participation from multiple team members … Many of these interventions involved a simple process change, a change in policy, or a shift in staff … Only three strategies involved sizable expenditures, ranging from $32,850 to $490,000.
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ce.effectivehealthcare.ahrq.gov/patient-safety/reports/candor-demo-program/plan-grants/appa.html
August 01, 2022 - Lastly, the grantee reports, “All complaints involved some additional patient care and most complaints … Of the 566 potential ADEs, none involved permanent disability or death, but almost half (278) involved … Cases involved discharge from one of four hospital sites affiliated with the academic medical center. … Notably, almost half (299 of 632) of reported near misses involved office processes, including filing … Unlike in other States, the majority of cases involved vaginal delivery rather than cesarean section,
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ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/officebasedcare/impworkbook.pdf
December 11, 2015 - opportunity for improvement that will be
targeted by the TeamSTEPPS Intervention and to identify the involved … Who is involved in the “problem” process? (List by staff positions not individuals’ names. … number of staff receiving team training; increase in use of a
specific tool)
Who will be involved … These are the people involved in the “what you want to achieve”
listed above, such as the staff members … health care quality measure; decreased rates of adverse events or near-misses)
Who will be involved
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ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/nhguide/5_TK2_P1T3-Checklist_for_Discussion_with_Local_Hospitals_Providers_ERs_Phase_1.pdf
May 01, 2014 - residents will go to the Emergency
Department, it is reasonable to reach out also to hospital staff involved … This
department is often involved in developing antibiograms
for the hospital.