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www.ahrq.gov/hai/cusp/modules/patient-family-engagement/alt-text-tab.html
September 01, 2013 - Click here to play
Video icon
IDEAL Discharge
Slide 20
What if an Adverse Event Occurs … to help and care for patients without harming them, but adverse events happen
When an adverse even occurs
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/injuries/fallspx/man2.html
December 01, 2017 - FMP Fall Response
The first five steps comprise an immediate response that occurs within the first … Hours
An immediate response should help to reduce fall risk until more comprehensive care planning occurs
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/one-pager-cellulitis.docx
June 01, 2021 - improvement (e.g., reduction of pain, erythema, and local inflammation and resolution of fevers) generally occurs
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www.ahrq.gov/news/newsroom/case-studies/201709.html
June 01, 2017 - Because patient safety culture occurs mainly at the hospital unit level, St.
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/resources/tools/cauti-surveillance/assessment.docx
March 01, 2017 - Definitions:
· Symptomatic CAUTI occurs in a resident while having an indwelling urinary catheter in
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www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/resources/tools/cauti-surveillance/assessment.html
March 01, 2017 - Definitions:
Symptomatic CAUTI occurs in a resident while having an indwelling urinary catheter in
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psnet.ahrq.gov/web-mm/distraction-anesthesiologist-and-lack-resuscitation-drugs-resulting-delayed-treatment
January 29, 2021 - anesthesia, including the postoperative period. 1 It is a potentially life-threatening complication that occurs … to prevent negative pressure pulmonary edema and/or hypoxic cardiac arrest. 6
Laryngospasm usually occurs … sedation and anesthesia must be vigilant and competent to rapidly diagnose and treat laryngospasm, if it occurs … Capillary rupture occurs because of excessive negative pressure created in the lung when the patient
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psnet.ahrq.gov/web-mm/hiding-plain-sight
April 24, 2019 - Background Herpes zoster (or shingles) occurs in approximately 1 million people annually in the United … Or, when HZ occurs fully or partially under the scalp, it can also lead to a missed diagnosis. … Unilateral allergic contact dermatitis, as often occurs with cases of poison ivy, is also in the differential
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effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/white-paper-library-afib.pdf
November 15, 2018 - For other events, it is feasible to identify an event that occurs in a
specified time window after a … AFL/AT of at least 30 seconds’ duration that is
documented by an ECG or device recording system and occurs … Recurrent
AF/AFL/AT that occurs within the post ablation blanking period is not considered a
failure … Progression occurs when patients previously classified as paroxysmal AF are
classified as persistent … Events of
Interest
Periprocedural
bleeding (any
bleeding during
12-month interval
which occurs
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psnet.ahrq.gov/issue/bone-break-hot-debrief-tool-reduce-second-victim-syndrome-nurses
August 02, 2015 - " Second victim syndrome " occurs when an adverse event or error has a negative emotional impact
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psnet.ahrq.gov/issue/impact-initial-hospital-diagnosis-mortality-acute-myocardial-infarction-national-cohort-study
April 19, 2017 - Misdiagnosis or delayed diagnosis of common conditions, such as acute myocardial infarction (AMI), occurs
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psnet.ahrq.gov/issue/predictors-and-triggers-incivility-within-healthcare-teams-systematic-review-literature
July 21, 2011 - Studies generally found that incivility occurs mainly within professional disciplines rather than across
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digital.ahrq.gov/ahrq-funded-projects/evaluation-stage-3-meaningful-use-objectives-analysis-md-and-ar
January 01, 2023 - provider, or care coordinator, with the patient’s consent if required, within 2 hours of when the event occurs
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digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/all-workflow-tools/project
January 01, 2023 - The diagram also includes information about how and why the communication occurs, the specific technology
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psnet.ahrq.gov/issue/why-do-hundreds-us-women-die-annually-childbirth
June 14, 2019 - Resources From the Same Author(s)
Type 1 diabetes defined by severe insulin deficiency occurs
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psnet.ahrq.gov/issue/utilizing-pharmacy-students-transitions-care-services
October 19, 2022 - October 19, 2022
Type 1 diabetes defined by severe insulin deficiency occurs after 30
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psnet.ahrq.gov/issue/standardised-proformas-improve-patient-handover-audit-trauma-handover-practice
October 19, 2022 - April 24, 2018
Type 1 diabetes defined by severe insulin deficiency occurs after 30 years
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psnet.ahrq.gov/issue/infrequent-physician-use-implantable-cardioverter-defibrillators-risks-patient-safety
August 28, 2019 - March 29, 2023
Misdiagnosis of thoracic aortic emergencies occurs frequently among transfers
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psnet.ahrq.gov/issue/whats-sound-managing-alarm-fatigue
April 26, 2023 - July 5, 2017
Misdiagnosis of thoracic aortic emergencies occurs frequently among transfers
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/pruprev/prev-handouts.html
December 01, 2017 - For every meeting that occurs at your facility, indicate how often it occurs, who leads the meeting, … Remember, after a pressure ulcer occurs, it's all well and good to think about what happened, but for … directed at identifying those residents at risk and doing something about it before the pressure ulcer occurs … For every meeting that occurs at your facility, indicate how often it occurs, who leads the meeting,