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Total Results: 2,792 records

Showing results for "occurred".

181. Final Progress Report: A Novel Debriefing Strategy for Interprofessional Simulation-Based Team Training (pdf file)
     www.ahrq.gov/sites/default/files/2024-01/vanschaik-report.pdf
     January 01, 2024 - On the rare occasions that interprofessional co-facilitation occurred prior to implementation of the … When this occurred, the discussion was brief and limited to generic statements about the importance … Discussions about medical management were less physician focused and more frequently occurred in the … Perspective taking was uncommon, and mostly occurred in the context of physician participants explaining … If so, why do you think they occurred?

182. Antibiotic-Patient-Safety-Facilitator-Guide (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/antibiotic-patient-safety-facilitator-guide.docx
     June 01, 2021 - We’re only going to focus on those that occurred in the long-term care facility. … SAY: A second problem occurred when the daytime health care practitioner prescribed antibiotics. … Science of Safety SAY: Let’s apply the three basic principles of safe design to the problems that occurred

183. Final Progress Report: Quality of bag mask ventilation in critically ill children (pdf file)
     www.ahrq.gov/sites/default/files/2024-05/nishisaki-report.pdf
     January 01, 2024 - Desaturation (SpO2<80%) or adverse TIAEs occurred in 5/20 (25%) of children with high-quality breath … Desaturation (SpO2<80%) or adverse TIAEs occurred in 5/20 (25%) of children with high-quality breath

184. Special Considerations for Measurement of Diagnostic Safety (continued) | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/reports/issue-briefs/state-of-science-2b.html
     June 01, 2020 - events so they can review the medical record to determine if an actual or potential adverse event has occurred … Process breakdown taxonomy, 97 both of which help to identify where in the diagnostic process a problem occurred

185. The New York Model: Root Cause Analysis Driving Patient Safety Initiative to Ensure Correct Surgical and Invasive Procedures (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Faltz_56.pdf
     March 27, 2008 - These errors occurred in a wide variety of locations (Table 3). Table 3. … Of the latter, two of the four cases occurred when the vendor representative handed the wrong component … Presentations included a detailed description of a recent wrong-sided surgical sentinel event that occurred … Of these, two-thirds occurred in settings other than the operating room.

186. | Agency for Healthcare Research and Quality
     www.ahrq.gov/research/publications/search.html?page=10
     March 01, 2016 - experienced by hospital patients in 2011, 2012, 2013, and 2014 relative to the number of HACs that would have occurred

187. | Agency for Healthcare Research and Quality
     www.ahrq.gov/research/publications/search.html?page=12
     February 01, 2015 - experienced by hospital patients in 2011, 2012, and 2013 relative to the number of HACs that would have occurred

188. Leverage Patient Safety Infrastructure | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/resources/simulation-issue-brief3.html
     July 01, 2024 - Simulation That Revealed an Equipment Malfunction A patient safety event occurred when an infusion delivered

189. Federal Interagency Workgroup: Improving Diagnostic Safety and Quality in Healthcare (pdf file)
     www.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.

190. Federal Interagency Workgroup: Improving Diagnostic Safety and Quality in Healthcare (pdf file)
     www.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.

191. Introduction | Agency for Healthcare Research and Quality
     www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-reimagining-healthcare-teams-1.html
     July 01, 2023 - Some of the most significant healthcare AI/ML advancements have occurred in diagnostics.

192. CHIPRA 123: Technical Specifications (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/availability/chipra-0123-technical-specifications.pdf
     June 02, 2025 - CALCULATION Step 1: Identify all deliveries that occurred in medical facilities, using the criteria …                                                                Step 8: Count the number of high risk deliveries that occurred

193. CHIPRA 120 Section 2, Technical Specifications (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/availability/chipra-120-section-2-technical-specs.pdf
     June 02, 2025 - CALCULATION Step 1: Identify all deliveries that occurred in medical facilities, using the criteria … Step 8: Count the number of high risk deliveries that occurred in Class 1 and Class 2 facilities for

194. Technical Specifications: High-Risk Deliveries at Facilities with 24/7 In-House Physician Coverage Dedicated to the Obstetrical Service by an Anesthesiologist Who Is Qualified to Provide Obstetrical Anesthesia (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/availability/chipra-121-technicalspecs.pdf
     June 02, 2025 - CALCULATION Step 1: Identify all deliveries that occurred in medical facilities, using the criteria … Step 8: Count the number of high risk deliveries that occurred in Class 1 and Class 2 facilities for

195. Data Measures Guide (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/vae/datameasures-guide.pdf
     January 01, 2017 - Mobility Intubated: Adverse Event Incidence Rate Numerator Total number of adverse events which occurred … Example In a given time period, say a unit enters the following data: • Adverse events (4) and (7) occurred … of Adverse Events Numerator Total number of adverse events in each of the 25 categories which occurred … NOT Intubated: Adverse Event Incidence Rate Numerator Total number of adverse events which occurred … Total number of patient days with Intub/Trach & Mech Vent marked “N” on which any adverse event(s) occurred

196. Facility Action Plan Template | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/resources/tools/implement/action-plan.html
     March 01, 2017 - has done to communicate and share survey results with staff, and an understanding of what benefits occurred

197. Module 4: Teamwork and Communication: Material Use Guide | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/implementation/long-term-modules/module4/guide.html
     March 01, 2017 - facility leaders and administrators to share information with residents/families when an event has occurred

198. Project Report - Lean Sigma (ppt file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/toolkit/contentcalls/twomorees-slides/Two-More-Es-and-How-to-Spread-Dec-13-2011-508.ppt
     January 01, 2011 - Continued feedback of infection data that the team perceived as valid Improvements in safety culture that occurred

199. Patient and Family Engagement for Perinatal Safety: Facilitator Guide | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/teamwork/pf-engagement-fac-guide.html
     July 01, 2023 - Generally, only findings that are reasonably certain to have occurred and unlikely to change should be … investigate and analyze it (e.g., a root cause analysis may be conducted) to determine whether patient harm occurred

200. Quality Improvement Study Framework (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/sections/implementation/implementation-guide/appendix-k-study-elements.docx
     June 02, 2025 - Include— · Frequency: How often the issue occurred in your study period · Sources: Potential reasons