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Showing results for "occur".

401. Using Six Sigma® Methodology to Improve Handoff Communication in High-Risk Patients (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol3/Advances-Mistry_114.pdf
     May 05, 2008 - Building a Safer Health System, the Institute of Medicine (IOM) estimated that up to 98,000 deaths occur … Research suggests that communication failures frequently occur during the operative procedure, with … We hypothesized that: (1) communication errors commonly occur during the postoperative handoff process

402. NICU Family Information Packet, Appendix B, Neurodevelopment (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/nicu_toolkit/nicupacket-apb-neurodevt.pdf
     June 02, 2025 - visual-motor integration and neuromotor and cognitive functions; problems with behavior and temperament may occur

403. Improving Diagnosis in the Context of Rurality | Agency for Healthcare Research and Quality
     www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-rural-healthcare2.html
     October 01, 2024 - that 33 percent  of diagnostic errors result in patient injury, 22 and 57 percent of these failures occur

404. Strategy 3: Nurse Bedside Shift Report (Tool 1) (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy3/Strat3_Tool_1_BSR_Broch_508.docx
     June 02, 2025 - Nurse shift changes occur when nurses who are going off duty share information about your care with nurses

405. Recommendations and Areas for Future Research | Agency for Healthcare Research and Quality
     www.ahrq.gov/diagnostic-safety/resources/issue-briefs/distributed-cognition-er-nurses4.html
     August 01, 2022 - diagnostic process and a patient’s journey through the ED and may help prevent the anchoring bias that can occur … documented but solutions to the problem are sparse. 44-46 For example, communication breakdowns can occur

406. Implementation Quick Start Guide: Warm Handoff Plus (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/warm-handoff-quick-start-final508.pdf
     June 02, 2025 - Evaluate implementation success � How often does the intended Warm Handoff Plus occur?

407. Introducing TeamSTEPPS Introduction
     www.ahrq.gov/sites/default/files/wysiwyg/teamstepps-program/curriculum/teamstepps-introduction-slides.pptx
     June 02, 2025 - Describe the impact of errors and why they occur. Describe the TeamSTEPPS framework.

408. Asthma 1 Measure Calculation Steps (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/pqmp/toolkits/flow-diagrams.pdf
     June 02, 2025 - This means, for a given member-month, a comorbidity may occur in the future (but only within the same

409. The Contribution of Diagnostic Error to Maternal Mortality and Severe Maternal Morbidity | Agency for Healthcare Research and Quality
     www.ahrq.gov/diagnostic-safety/resources/issue-briefs/maternal-mortality-2.html
     September 01, 2021 - Communication breakdowns can occur between patients and providers and within the healthcare team in an

410. Session 2 | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/long-term-care/resource/facilities/ltc/mod3sess2.html
     October 01, 2014 - However, what we can do is eliminate needless falls and limit the injuries from falls that do occur. … vests, pelvic restraints, and lap trays on geri-chairs all contribute to falls and to injuries that occur

411. Best Practices in the Diagnosis and Treatment of Community-Associated Lower Respiratory Tract Conditions (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/best-practices/respiratory-facilitator-guide.pdf
     November 01, 2019 - Best Practices in the Diagnosis and Treatment of Community-Associated Lower Respiratory Tract Conditions AHRQ Safety Program for Improving Antibiotic Use 1 AHRQ Pub. No. 17(20)-0028-EF November 2019 Best Practices in the Diagnosis and Treatment of Community-Associated Lower Respiratory T…

412. NICU Family Information Packet, Appendix B, Growth (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/nicu_toolkit/nicupacket-apb-growth.pdf
     June 02, 2025 - NICU Family Information Packet, Appendix B, Growth Growth General Growth ■ Use growth charts made specifically for premature infants. ■ After infant reaches term corrected gestational age, a standard growth chart may be used. ■ Use corrected postmenstrual age until 2 years of age. ■ Interpretations of catch-u…

413. HAC National Scorecard 2014-16 | Agency for Healthcare Research and Quality
     www.ahrq.gov/data/infographics/hac-scorecard-2014-16.html
     November 01, 2019 - HAC National Scorecard 2014-16 Between 2014-2016, 350,000 fewer hospital-acquired conditions (HACs) occurred, an 8% decrease that saved $2.9 billion and averted 8,000 inpatient deaths. Learn more in the AHRQ report, " National Scorecard on Rates of Hospital-Acquired Conditions ." HAC National Scorecard 2014…

414. Final Progress Report: Real-time assessment of risk factors for medication errors (pdf file)
     www.ahrq.gov/sites/default/files/2024-01/dresselhaus-report.pdf
     January 01, 2024 - nonpreventable adverse drug reactions (due to the inherent properties of the agent), medication errors may occur … Although most of the adverse drug events that occur during the study period will be linked to a specific … provider and captured in the day, hour, and sometimes minute they occur, some will not, making it more

415. Two-Day Training Content | Agency for Healthcare Research and Quality
     www.ahrq.gov/teamstepps-program/curriculum/team/teach/two-day.html
     February 01, 2024 - Use their responses to reinforce the message that teamwork cannot occur in the absence of a clearly defined … Some team meetings may occur in person with the patient and team members, while others may include a … Where did the breakdowns occur between the components of this multi-team system? … Explain that information updates within the team should occur as often as needed.

416. Final Progress Report: Profiling the Needs of Dying Children (pdf file)
     www.ahrq.gov/sites/default/files/2024-10/feudtner-report.pdf
     January 01, 2024 - epidemiological transition’ in pediatric mortality – from mostly accidental and sudden death to deaths that occur … genetic, neuromuscular, and metabolic conditions, and other forms of cancer were all more likely to occur

417. Final Report: Modeling Risk and Reducing Liability through Better Communication and Teamwork (pdf file)
     www.ahrq.gov/sites/default/files/2024-01/baker-report.pdf
     January 01, 2024 - team members, and how to communicate with patients/ families about the risks and mistakes that can occur … members to be effective team members, what this training should consist of, when this training should occur

418. Nursing Practice Guide (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/hai/abate/nursing-protocols/nursing-practice-guide.docx
     March 01, 2022 - Nursing Practice Guide Section 9-5 – Decolonization of Non-ICU Patients With Devices Nursing Practice Guide Use this guide to help ensure that all nursing practice processes and leadership support are in place to actively support the decolonization intervention. Engagement and Collaboration CHG Bath Documentation N…

419. Facilitator Guide: Build Your SSI Prevention Bundle (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/vae/objective-outcome-tool.docx
     January 01, 2017 - Facilitator Guide: Build Your SSI Prevention Bundle Hospital ___________ Unit___________ Month ___________ Please record the following occurrences for all patients in your unit within the selected month. ________ Total number of patients on mechanical ventilation ________ Total number of episodes of mechani…

420. Nursing Practice Guide (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/hai/abate/nursing-protocols/nursing-practice-guide.pdf
     March 01, 2022 - Nursing Practice Guide AHRQ Pub. No. 20(22)-0036 March 2022 Section 9-5 – Decolonization of Non-ICU Patients With Devices Nursing Practice Guide Use this guide to help ensure that all nursing practice processes and leadership support are in place to actively support the decolonization intervention. CHG = c…