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Total Results: 519 records

Showing results for "occurred".

21. Mod01-Grand-Rounds-Slides (pdf file)
    pbrn.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/candor/grandrounds/mod01-grand-rounds-slides.pdf
    April 01, 2016 - An explicit statement that an error occurred. 2. … The Investigation: to determine how the event occurred, and how to mitigate that event or even prevent … This is a cornerstone of the CANDOR process of investigating the root cause of how an error occurred … disclosure is a process, and the first step is to: ■ Let the patient and family know an adverse event occurred … result of the investigation and analysis of Michelle’s case, the following patient safety changes occurred

22. How to Use the CUSP Toolkit | Agency for Healthcare Research and Quality
    pbrn.ahrq.gov/hai/cusp/toolkit/index.html
    July 01, 2018 - the Nationwide Implementation of the Comprehensive Unit-based Safety Program (CUSP) These webinars occurred

23. Reviewing the Team's Performance: Debrief | Agency for Healthcare Research and Quality
    pbrn.ahrq.gov/teamstepps-program/curriculum/team/tools/debrief.html
    December 01, 2023 - Analysis of why the event occurred, what worked, and what did not work.

24. Section 1: Overview of Mutual Support Key Concepts and Tools | Agency for Healthcare Research and Quality
    pbrn.ahrq.gov/teamstepps-program/curriculum/mutual/overview/index.html
    July 01, 2023 - Timely— given soon after the target behavior has occurred.

25. TeamSTEPPS® Instructor Manual: Specialty Scenarios | Agency for Healthcare Research and Quality
    pbrn.ahrq.gov/teamstepps/instructor/scenarios/dental.html
    March 01, 2014 - In this scenario, either of two actions should have occurred. … Had a brief or check-back occurred, they would have shared their individual situation awareness with

26. Mississippi Hospital Reduces Patient Falls by 25 Percent Using AHRQ Program | Agency for Healthcare Research and Quality
    pbrn.ahrq.gov/news/newsroom/case-studies/201801.html
    April 01, 2018 - The majority of falls occurred as patients left their beds to walk to or from the bathrooms, Myers said

27. PowerPoint Presentation
    pbrn.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/candor/module1/grand-rounds-presentation-slides.pptx
    January 01, 2014 - to remember what patients want in our communication with them: An explicit statement that an error occurred … The Investigation: to determine how the event occurred, and how to mitigate that event or even prevent … This is a cornerstone of the CANDOR process of investigating the root cause of how an error occurred, … “Don’t tell me you were sorry that the problem occurred. … disclosure is a process, and the first step is to: Let the patient and family know an adverse event occurred

28. Two Indiana Facilities Use AHRQ Toolkit to Revise Medication Reconciliation | Agency for Healthcare Research and Quality
    pbrn.ahrq.gov/news/newsroom/case-studies/ktcquips91.html
    October 01, 2014 - responsibility for completing medication reconciliation to the ICU charge nurse to eliminate the confusion that occurred

29. Module 5: How To Measure Fall Rates and Fall Prevention Practices (doc file)
    pbrn.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/fallprevention-training/module5/module5_fall-prevention.docx
    June 30, 2017 - When the fall occurred. What the degree of injury was, if any. … First, count the number of falls that occurred during the month from your incident reporting system. … Try to understand why the fall occurred and how such an incident might be prevented in the future. … individual data points are plotted and then connected (as shown by the blue line) to show that they occurred … However, it also shows a breakdown of the fall rate by the different types of falls that occurred—anticipated

30. Module 5: How To Measure Fall Rates and Fall Prevention Practices—Training Guide | Agency for Healthcare Research and Quality
    pbrn.ahrq.gov/patient-safety/settings/hospital/fall-prevention/workshop/module-5/guide.html
    September 01, 2017 - When the fall occurred. What the degree of injury was, if any. … First, count the number of falls that occurred during the month from your incident reporting system. … Try to understand why the fall occurred and how such an incident might be prevented in the future. … individual data points are plotted and then connected (as shown by the blue line) to show that they occurred … However, it also shows a breakdown of the fall rate by the different types of falls that occurred—anticipated

31. Federal Interagency Workgroup on Improving Diagnostic Safety and Quality in Health Care November Meeting Summary (pdf file)
    pbrn.ahrq.gov/sites/default/files/wysiwyg/topics/fed-IWG-dxsafety-Nov19mtg.pdf
    November 15, 2019 - Workgroup Summary: The latest workgroup meeting occurred virtually on November 15, 2019, from 10 a.m

32. Describe How a Plan or Provider Can Influence a Quality Measure | Agency for Healthcare Research and Quality
    pbrn.ahrq.gov/talkingquality/translate/labels/describe.html
    January 01, 2023 - would almost always be placed by a doctor, so the nurse should not be held accountable if an infection occurred

33. AHRQ News Now | Agency for Healthcare Research and Quality
    pbrn.ahrq.gov/news/newsletters/e-newsletter/index.html
    April 30, 2024 - of Digital Healthcare Technologies Advance Equity April 9, 2024 Surge in Drug Shortages Occurred

34. Federal Interagency Workgroup: Improving Diagnostic Safety and Quality in Healthcare (pdf file)
    pbrn.ahrq.gov/sites/default/files/wysiwyg/topics/public-notes-meeting-summary-111921.pdf
    March 11, 2022 - Workgroup Summary: The latest Workgroup meeting occurred virtually on November 19, 2021, from 1 p.m.

35. Federal Interagency Workgroup: Improving Diagnostic Safety and Quality in Healthcare (pdf file)
    pbrn.ahrq.gov/sites/default/files/wysiwyg/topics/diagnostic-safety-workgroup-march-2022-meeting-notes.pdf
    January 01, 2022 - Workgroup Summary: The latest Workgroup meeting occurred virtually on March 11, 2022, from 11 a.m.

36. 2013 Annual Hospital-Acquired Condition Rate and Estimates of Cost Savings and Deaths Averted From 2010 to 2013 (pdf file)
    pbrn.ahrq.gov/sites/default/files/publications/files/hacrate2013_0.pdf
    October 01, 2015 - hospital patients over the 3 years (2011, 2012, 2013) relative to the number of HACs that would have occurred … precise causes of the decline in patient harm are not fully understood, the increase in safety has occurred … Costs included the initial hospital stay and costs of other inpatient sites of care that occurred within … in 2013 than would have occurred if the rate of HACs had remained steady at the 2010 level (Exhibit … The majority of deaths averted occurred as a result of reductions in the rates of pressure ulcers 14

37. CAHPS Adult Hospital Survey | Agency for Healthcare Research and Quality
    pbrn.ahrq.gov/cahps/surveys-guidance/hospital/about/adult_hp_survey.html
    November 01, 2023 - CMS implemented the HCAHPS survey in October 2006, and the first public reporting of HCAHPS results occurred

38. Albuquerque Police Department Uses AHRQ Resources for Crisis Intervention Team Training | Agency for Healthcare Research and Quality
    pbrn.ahrq.gov/news/newsroom/case-studies/201708.html
    May 01, 2017 - Of 2,064 crisis intervention-related incidents that occurred from January through November 2016 in the

39. Five Nebraska Hospitals Use AHRQ Toolkit to Improve Medication Reconciliation Across Care Settings | Agency for Healthcare Research and Quality
    pbrn.ahrq.gov/news/newsroom/case-studies/ktcquips82.html
    October 01, 2014 - By creating a flowchart of the medication reconciliation process that occurred from hospital discharge

40. No‐Cost Extensions (NCEs) | Agency for Healthcare Research and Quality
    pbrn.ahrq.gov/funding/grant-mgmt/nces.html
    November 01, 2020 - extension can only be considered by AHRQ if the grantee can demonstrate that unusual circumstances occurred