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pbrn.ahrq.gov/priority-populations/observances/hispanic-heritage/index.html
October 01, 2021 - built an automated language translation tool to allow clinical evaluations of recorded interviews to occur
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pbrn.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/communication-facilitator-guide.docx
June 01, 2021 - This can occur after someone has had antibiotics and can be devastating in nursing home residents. … 13
Case 3: Communication
SAY:
Let’s walk through a final case of communication errors that can occur … The nurse does not feel comfortable with this plan and knows that serious side effects can occur on antibiotics … Slide 16
Case 3 — DESC Script
SAY:
Conflict can occur in teams, and it is important to know how … to handle such situations when they occur.
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pbrn.ahrq.gov/cpi/about/otherwebsites/qsrs.ahrq.gov/index.html
March 01, 2021 - SHARE:
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About
About AHRQ
AHRQ's 35th Anniversary
Profile
Mission and Budget
AHRQ’s Core Competencies
Health Equity
National Advisory Council for Healthcare Research and Quality
National Actio…
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pbrn.ahrq.gov/hai/cusp/modules/patient-family-engagement/notes.html
September 01, 2013 - Introduction to Adverse Events
Say:
Adverse events occur when a patient is harmed as a result of … Rarely does an adverse event occur as a result of intent.
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pbrn.ahrq.gov/hai/pfp/2015-interim.html
December 01, 2016 - SHARE:
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Healthcare-Associated Infections Program
Combating Antibiotic-Resistant Bacteria
About the CUSP Method
Decolonization – Universal and Targeted
Tools
National Scorecard on Rates of Hospi…
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pbrn.ahrq.gov/patient-safety/news-events/psaw-2022/index.html
July 01, 2022 - Thomas, M.D., M.P.H., " Understanding Where, Why, and How Diagnostic Errors Occur "
AHRQ PSNet Primer
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pbrn.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/pressure_ulcer_prevention/module4/module4_pu-implementation_slides.pptx
November 20, 2014 - Unit staff tell the Wound Care Team about high-risk patients or if skin problems occur. … 19
Practice Insight
Staff Turnover
20
Communication Patterns
Good communication needs to occur
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pbrn.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/candor/module5/mod5-disclosure-checklist.pdf
April 01, 2016 - tool: Use Part I of the checklist to prepare for the initial disclosure conversation, which should
occur
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pbrn.ahrq.gov/news/blog/ahrqviews/eliminate-diagnostic-errors.html
August 01, 2022 - An estimated 250,000 diagnostic errors occur annually in U.S. hospitals.
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pbrn.ahrq.gov/sites/default/files/wysiwyg/teamstepps/instructor/onlinecourse/tsonlinemodule11.pptx
November 02, 2018 - When and where the improvements will occur? … Outcome aims focus on changes that occur because your staff carries out the intervention. … When will the training sessions occur and for how long?
Where will the sessions occur? … When will training occur and how long will the sessions last? … When will training occur and how long will the sessions last?
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pbrn.ahrq.gov/teamstepps-program/curriculum/communication/tools/checkback.html
July 01, 2023 - patient harm are often caused by a provider overlooking messages alerting them to a test result or occur
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pbrn.ahrq.gov/hai/quality/tools/cauti-ltc/modules/implementation/long-term-modules/module4/mod4-facguide.html
March 01, 2017 - Slide 17: For Information Transfer – Handoffs
Say:
Handoffs occur during a change in assignment … A handoff may occur when a resident is first welcomed to the nursing home from the hospital or during … another staff member, even for a short timespan such as a lunch break, a structured communication should occur
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pbrn.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy2/Strat2_Tool_1_Be_Partner_508.docx
February 10, 2011 - Nurse shift changes occur when nurses who are going off duty share information about you with nurses
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pbrn.ahrq.gov/sites/default/files/wysiwyg/professionals/prevention-chronic-care/decision/research-centers/new_model_thinking.pdf
February 01, 2014 - University of North Carolina, Chapel
Hill, is focused on reducing unintended harms to patients that occur
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pbrn.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/fallprevention-training/module5/module5_tools.docx
August 03, 2017 - Ensure timescales for assessing and preventing falls are tailored to when falls are most likely to occur … Observations at the bedside should occur at the time of day when most patients who are well enough would
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pbrn.ahrq.gov/teamstepps-program/curriculum/communication/overview/index.html
June 01, 2023 - This step is particularly crucial for handoffs that occur electronically (e-handoffs).
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pbrn.ahrq.gov/hai/tools/surgery/index.html
December 01, 2017 - address respectively adaptive and technical work, which are both critical elements for improvement to occur
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pbrn.ahrq.gov/teamstepps/readiness/abouttips.html
April 01, 2016 - SHARE:
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TeamSTEPPS®
About TeamSTEPPS®
Readiness Assessment
Curriculum Materials
TeamSTEPPS® 2.0 Online Master Trainer Course
Research/Evidence Base
TeamSTEPPS® Webinars
Tips and…
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pbrn.ahrq.gov/research/findings/making-healthcare-safer/index.html
July 01, 2023 - SHARE:
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Research
Publications & Products
Research Findings & Reports
Grantee Final Reports: Patient Safety
Evidence-based Practice Center Reports
Fact Sheets
National Healthcare Quality & Disparities Rep…
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pbrn.ahrq.gov/teamstepps/instructor/fundamentals/module3/igcommunication.html
March 01, 2019 - which information must be communicated, a leader must be clearly designated, and mutual support must occur … Discuss findings with the group regarding root cause analyses from events that occur in your organization … Shift change—Transitions in care are the most significant time when communication breakdowns occur. … Discussion:
Where might miscommunication occur in this situation?