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Showing results for "occurrence".

21. Final Progress Report: Risk and Recovery in Complex Environments: Labor and Delivery as a Model (pdf file)
    www.ahrq.gov/sites/default/files/2025-05/goldman2-report.pdf
    January 01, 2025 - [3] Pivotal event – A pivotal event is an intermediate event for which occurrence or non- occurrence … If the pivotal event is an event (e.g., maternal hypotension), its occurrence or non-occurrence determines … ‘Y’ or ‘N’ refers to the occurrence or non-occurrence of each particular event, and points to a specific … or non-occurrence, success or failure), then a demand-based model was selected. … /non-occurrence of this event

22. Pressure Ulcers | Agency for Healthcare Research and Quality
    www.ahrq.gov/topics/pressure-ulcers.html
    Pressure Ulcer Prevention This toolkit helps nursing homes with electronic medical records reduce the occurrence

23. Recommended Infection Prevention Components of Quality Assessment and Performance Improvement (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/esrd/recommendedinfectionprev-components.pdf
    June 02, 2025 - Infection occurrence surveillance: Occurrences should be logged for— a. … Sufficient information should be recorded for each occurrence, including patient identification, date

24. Serious Reportable Adverse Events in Health Care (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Kizer2.pdf
    December 01, 2000 - Introduction Lapses in patient safety are a major health care quality problem, and the occurrence … occur, and changing processes of care to reduce the chance of harm, requires reliable data about the occurrence … list of serious reportable events While it is believed that having reliable information about the occurrence … The occurrence of a serious preventable adverse event in health care—e.g., operating on the wrong patient … Event means a discrete, auditable, and clearly defined occurrence.

25. | Agency for Healthcare Research and Quality
    www.ahrq.gov/topics/index.html?page=0
    October 01, 2008 - differences in access to or availability of medical facilities and services and variation in rates of disease occurrence

26. | Agency for Healthcare Research and Quality
    www.ahrq.gov/topics/index.html
    October 01, 2008 - differences in access to or availability of medical facilities and services and variation in rates of disease occurrence

27. Grant Final Report: Toward an Optimal Patient Safety Information System (TOPSIS) (pdf file)
    www.ahrq.gov/sites/default/files/2024-04/koss-report.pdf
    January 01, 2024 - Risk managers were asked how many occurrence reports were entered into their occurrence reporting system … The number of occurrence reports ranges widely. … Risk managers were asked about the dissemination of occurrence reports in their hospital. … Risk managers were asked how many occurrence reports were entered into their occurrence reporting system … The number of occurrence reports ranged widely from 344 to 7,263.

28. Final Progress Report: Improving the safety of pediatric tracheal intubation in ICUs with apneic oxygenation and video laryngoscopes (pdf file)
    www.ahrq.gov/sites/default/files/2025-06/nishisaki3-report.pdf
    January 01, 2025 - Of 7,076 intubations from the apneic oxygenation sites, the use of apneic oxygenation had lower occurrence … Of 5,060 intubations from video laryngoscope sites, the use of video laryngoscope had lower occurrence … After adjusting for patient, provider, and practice factors, the apneic oxygenation and the occurrence … Similarly, the occurrence of hypoxemia was not different between the video laryngoscope versus the direct … Ketamine Use for Tracheal Intubation in Critically Ill Children Is Associated With a Lower Occurrence

29. 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 - Ventilation (BMV) delivered to critically ill children and to evaluate the association of BMV quality on the occurrence … BMV delivered to critically ill children and to evaluate the association of quality of BMV on the occurrence … For our specific aim 2: To evaluate the association of the quality of BMV with the occurrence of adverse … Our primary outcome was the occurrence of adverse TIAEs or severe oxygen desaturation (SpO2<80%) during

30. 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 - The panel analyzed 254 root cause analyses submitted to the New York Patient Occurrence Reporting and … system has gone through several design changes to reach its present form as the New York Patient Occurrence … Exclusions • Occurrence with the administration of anesthesia only (Code as 912). … In 1998, the system was revised to its current form, the New York Patient Occurrence and Tracking System … New York State patient occurrence and tracking system report, 2002-2004.

31. Final Progress Report: Addressing Preventable Medication Use Variance in Mississippi (pdf file)
    www.ahrq.gov/sites/default/files/2024-01/brown-report.pdf
    January 01, 2024 - J., Hope, C. (2005) "The impact of a Web-based Reporting System on Variations in Medication Error Occurrence … Reports: Comparing Web-based Occurrence Reports to Paper Occurrence Reports." … "The Use of Web-based Occurrence Reports in Documenting Medication Errors: Part 1." … "The Use of Web-based Occurrence Reports in Documenting Medication Errors: Part 2." … "Evaluating a Web-based System of Medication Error Reporting of Occurrence Reports: Beyond the Numbers

32. Chapter 2. ST-PRA Development | Agency for Healthcare Research and Quality
    www.ahrq.gov/research/findings/final-reports/stpra/stpra2.html
    April 01, 2018 - prioritization of risk reduction interventions based on sequences that have the highest probability of occurrence … element of the ST-PRA models: A review and comparison of policies and procedures related to the occurrence … Using these inputs enabled us to identify the multiple connections associated with the occurrence of … This process leads to a probability of occurrence of the top-level event, along with the major risk points … Cut sets are a unique combination of events leading to the occurrence of a top level event (an SSI).

33. NCEPCR Webinar: Research on Person-Centered Care | Agency for Healthcare Research and Quality
    www.ahrq.gov/ncepcr/about/pcr-webinar-series/person-centered-care.html
    July 01, 2024 - (Mayo Rochester), SDMo – a Measure of the Occurrence of SDM in the Care of Patients with Chronic Conditions

34. Appendix A. Literature Review | Agency for Healthcare Research and Quality
    www.ahrq.gov/research/findings/final-reports/stpra/stpraapa.html
    April 01, 2018 - surgical wound class, identification of positive intraoperative wound cultures, duration of surgery, occurrence … Factors associated with the occurrence of positive intraoperative cultures: surgical wound class (35% … Confirmed an association between the duration of the surgical procedure and the occurrence of infection … finding of our study was that the CD4+ cell count and the HIV viral load were not associated to SSI occurrence … There was a direct association between the occurrence of wound infections and high ASA classification

35. Evaluation Issues | Agency for Healthcare Research and Quality
    www.ahrq.gov/patient-safety/settings/hospital/candor/demo-program/grants/issues.html
    August 01, 2022 - Others implemented patient safety interventions that plausibly might reduce the occurrence of adverse … problem of the malpractice “claims tail” (i.e., that malpractice claims frequently take years from the occurrence

36. Pakyz, Amy | Agency for Healthcare Research and Quality
    www.ahrq.gov/funding/training-grants/grants/active/kawards/Kawdsumpaky.html
    October 01, 2014 - patterns, infection prevention and control, and pharmacy policies predict C. difficile infection (CDI) occurrence

37. Appendix C. Case Study and Program Examples | Agency for Healthcare Research and Quality
    www.ahrq.gov/patient-safety/settings/long-term-care/resource/injuries/fallspx/manapc.html
    December 01, 2017 - Sample of initial nurses note using SOAP and occurrence based documentation methods 4/1/04 11 pm … determined based on further assessment and interdisciplinary evaluation. 4/01/04 11 pm Example 2-Occurrence … Sample of documentation q shift X 72 hours or until stable using both SOAP and occurrence based documentation … determined based on further assessment and interdisciplinary evaluation. 4/2/04 11pm Example 2—Occurrence

38. Executive Summary | Agency for Healthcare Research and Quality
    www.ahrq.gov/research/findings/final-reports/stpra/stprasumm.html
    April 01, 2013 - This process resulted in a probability of occurrence of the top-level event, along with the major risk … effectively] ranked as the most critical unique event, with the highest independent contribution to the occurrence

39. AHRQ’s Safety Program for Nursing Homes: On-Time Pressure Ulcer Prevention | Agency for Healthcare Research and Quality
    www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/pruprev/index.html
    May 01, 2016 - On-Time Pressure Ulcer Prevention to help nursing homes with electronic medical records reduce the occurrence

40. Voluntary Adverse Event Reporting in Rural Hospitals (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Schade_63.pdf
    January 01, 2007 - Methods As a part of this project, we licensed a Web-based medical error reporting system (the Occurrence … In that scheme, events were classified by affected party, occurrence type, and outcome. … We created groups of similar events by occurrence type, such that each group would be expected to include … hospital report: Acute care Definitiona Your hospital All participating hospitals Indicator Occurrence … 8 0.91 1.17 0 – 1.37 1.37 Laboratory specimen- related occurrences Specimen Any specimen-related occurrence