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  1. www.ahrq.gov/patient-safety/reports/liability/mincer.html
    August 01, 2017 - Assessment and on-the-fly coaching, which were designed to occur between visits, were often rushed or
  2. www.ahrq.gov/patients-consumers/diagnosis-treatment/treatments/btpills/stayactive-tr.html
    September 01, 2015 - Blood clots are the clumps that occur when the blood hardens and changes from a liquid to a solid.
  3. www.ahrq.gov/patient-safety/resources/learning-lab/improving-safety-diagnosis-long-desc.html
    February 01, 2024 - Improving the Safety of Diagnosis and Therapy in the Inpatient Setting Principal Investigators: Anuj K. Dalal, M.D., and David Bates, M.D., MSc., Brigham & Women’s Hospital, Boston, MA AHRQ Grant No.: HS26613 Project Period:  09/01/18-06/30/22 Description: The overall goal of this learning lab was to i…
  4. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/sections/implementation/training-tools/pf-engagement/pf-engagement-slide-set.pptx
    May 01, 2017 - Safety Program for Ambulatory Surgery 8 Patients and their family members expect the following to occur … Organizations should be prepared to respond and communicate proactively when adverse events occur.
  5. www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/d4f_combo_psi09-postophemorrhage-bestpractices.pdf
    May 20, 2016 - Education should occur upon hire, annually, and when this protocol is added to job responsibilities.
  6. www.ahrq.gov/prevention/guidelines/tobacco/clinicians/update/correctadd.html
    October 01, 2014 - Additional postings may occur yearly or as needed.
  7. www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/fallspx/implmatls.html
    November 01, 2017 - Monthly After about 6 months, the Facilitator's role is to check in to identify obstacles that could occur … The expectation is that reports will be used on a weekly basis except for meetings that occur less frequently
  8. www.ahrq.gov/patient-safety/patients-families/consumer-exp/reporting/summary.html
    August 01, 2022 - indicated that the consumer perspective may be particularly important for patient safety events that occur
  9. www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-patients-source-understanding-dx-error-vol2-3.html
    June 01, 2023 - Patient Experience as a Source for Understanding the Origins, Impact, and Remediation of Diagnostic Errors Eliciting Patients’ Diagnostic Experiences Using Rigorous Methods Previous Page Next Page Table of Contents Patient Experience as a Source for Understanding the Origins, Impact, and Remediation…
  10. www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/pruhealing/saworksheet.html
    December 01, 2017 - Self-Assessment Worksheet for Pressure Ulcer Healing AHRQ’s Safety Program for Nursing Homes: On-Time Pressure Ulcer Healing This self-assessment tool is an important first step in implementing the On-Time electronic reports into current workflow to help inform pressure ulcer wound interventions and improve …
  11. www.ahrq.gov/evidencenow/projects/urinary/optima-interview.html
    November 01, 2024 - lets the provider know that the patient is experiencing bothersome UI, prompting a conversation to occur
  12. www.ahrq.gov/sites/default/files/wysiwyg/npsd/data/npsd-falls-chartbook-2023.pdf
    January 01, 2023 - similar commonly used interventions: either individual preventive measures or combinations that co-occur … similar commonly used interventions: either individual preventive measures or combinations that co-occur … similar commonly used interventions: either individual preventive measures or combinations that co-occur … Frequent patterns of interventions occur in groups with different outcomes: injury and harm vs. no … similar commonly used interventions: either individual actions or a combination of actions that co-occur
  13. www.ahrq.gov/patient-safety/resources/learning-lab/neonatal-interfacility-transfers-long-desc.html
    January 01, 2025 - transport monitoring and communication tool. 1 Findings from this work revealed that adverse events occur
  14. www.ahrq.gov/ncepcr/reports/2024-annual-report/recent-grants-primary-care-workforce.html
    May 01, 2024 - disproportionally takes place in hospitals rather than in the community settings where primary care services mainly occur
  15. www.ahrq.gov/funding/training-grants/index.html
    December 01, 2022 - Research Training and Education Sign up: Research Training and Education Email updates AHRQ's Research Training Opportunities The Agency for Healthcare Research and Quality (AHRQ) provides a variety of funding opportunities designed to support and enhance the education and career development of health…
  16. www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/b3b_combo_resultspresentation.pdf
    April 02, 2025 - However, Pressure Ulcers (PSI 03) occur at higher rates than the national average – this may be an area
  17. www.ahrq.gov/sites/default/files/wysiwyg/sops/quality-patient-safety/patientsafetyculture/pharmsops-composites.pdf
    April 02, 2025 - When patient safety issues occur in this pharmacy, staff discuss them. B15.
  18. www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/implementation/long-term-modules/module6/mod6-facguide.html
    March 01, 2017 - Backsliding can occur as a result of factors such as staffing conditions, administrators' loss of interest … needed to maintain improvements after the project ends allows you to be better prepared if changes occur
  19. www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/situ/simulation-fac-guide.html
    July 01, 2023 - Establishing a Program of In Situ Simulations: Facilitator Guide AHRQ Safety Program for Perinatal Care Slide 1: Establishing a Program of In Situ Simulations Say: Establishing a Program of In Situ Simulations is a pillar of the AHRQ Safety Program for Perinatal Care. This module introduces in situ simu…
  20. www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/strategies/medication/safe-medication-fac-guide.html
    July 01, 2023 - change in patient condition, errors in dosing, etc.) will be caught by a check or team alert when they occur … misses and adverse events related to oxytocin use Having a process in place to review inductions that occur

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