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6561. Section 6-B, PMCoE PICU Expert Workgroup and Leadership Team Roster (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-199-section-6-b-pmcoe-picu-expert-workgroup.pdf
      September 18, 2014 - Should the measure be a reduction in foley days per patient days? … • Specifications should align with the Solutions for Patient Safety HEN and NDNQI to the extent … • While the ultimate goal should be zero patients with these ulcers, is there some % of patients goal … • Given that HgSS patients are excluded, consider extending to active cancer patients (Additional … Do not exclude cancer patients.

6562. PMCoE PICU Expert Work Group and Leadership Team Roster (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-203-section-6-b-workgroup.pdf
      September 18, 2014 - Should the measure be a reduction in foley days per patient days? … • Specifications should align with the Solutions for Patient Safety HEN and NDNQI to the extent … • While the ultimate goal should be zero patients with these ulcers, is there some % of patients goal … • Given that HgSS patients are excluded, consider extending to active cancer patients (Additional … Do not exclude cancer patients.

6563. Decision Making and Clinical Work of Test Result Followup in Health Information Technology Settings | Digital Healthcare Research
      digital.ahrq.gov/ahrq-funded-projects/decision-making-and-clinical-work-test-result-followup-health-information
      January 01, 2023 - Safety Sociotechnical Aspects A significant number of patients with abnormal test results … ' experiences related to diagnostic errors is essential for progress in patient safety. … Learning from patients' experiences related to diagnostic errors is essential for progress in patient … safety. … Challenges in patient safety improvement research in the era of electronic health records.

6564. Medication Reconciliation Victory After an Avoidable Error | PSNet
      psnet.ahrq.gov/web-mm/medication-reconciliation-victory-after-avoidable-error
      April 01, 2015 - Safety Goals (NPSG) to reduce the impact of medication errors on patient safety.( 4 ) This case identifies … filled by the patient. … [go to PubMed] 4. 2009 Hospitals' National Patient Safety Goals. … Organization (HRO) Principles and Patient Safety February 26, 2025 … Discrepancies between in-home interviews and electronic medical records on regularly used drugs among home care clients

6565. 2023 National Healthcare Quality and Disparities Report (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2023-nhqdr-es-rev.pdf
      January 01, 2023 - Patient safety measures that did not include COVID-19 patients had been improving over the past 5 years … • In 2021, older patients and low-income people were less likely to have audio-plus-video visits … using technology as a factor affecting use of telehealthcare and 64.3% reported limitations in patients … Postoperative Sepsis – Efforts to improve patient safety by avoiding healthcare-associated infections … Experience With Hospital Care Emergency Department Wait Times COVID-19 and Patient Safety Discussion

6566. Chartbook on Healthy Living: Slide Presentation | Agency for Healthcare Research and Quality
      www.ahrq.gov/research/findings/nhqrdr/chartbooks/healthyliving/healthyliving-slides.html
      April 01, 2018 - About 60% of measures of Effective Treatment, Healthy Living, and Patient Safety improved. … Patient Safety: Birth trauma—injury to neonates. … Slide 41 Patient Safety: Birth Trauma Cases included in birth trauma measure: Hemorrhage … AHRQ Quality Indicators™, Version 5.0. Patient Safety Indicators 17. … A case and care management program to reduce use of acute care by clients with substance use disorders

6567. A Painful Dilemma | PSNet
      psnet.ahrq.gov/web-mm/painful-dilemma
      September 01, 2013 - Safety September 1, 2013 Perspective Our Maturing … Understanding of Safety Culture: How to Change It and How It Changes Safety March 1, 2017 … December 6, 2023 Optimizing Pediatric Patient Safety in the Emergency Care Setting. … October 19, 2022 Building comprehensive strategies for obstetric safety: simulation drills … April 1, 2008 WebM&M Cases Environmental Safety

6568. AHRQ Health Information Technology Portfolio's 2010 Annual Report (pdf file)
      digital.ahrq.gov/sites/default/files/docs/page/ahrq2010annualReport.pdf
      October 23, 2012 - • Center for Quality Improvement and Patient Safety (CQuIPS): CQuIPS improves the quality and safety … and impact of medical errors, the root causes of threats to patient safety, and effective ways … Improving Quality and Patient Safety 5. … safety, and patients’ reported experience with care. … Projects focused on shared decisionmaking; patient-clinician communication; providing patients, their

6569. ED-to-Hospital Transitions | Agency for Healthcare Research and Quality
      www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-care-transitions2.html
      June 01, 2023 - Diagnostic Safety Across Transitions of Care Throughout the Healthcare System: Current State and a Call … ED-to-Hospital Transitions Previous Page Next Page Table of Contents Diagnostic Safety … Such issues include narrative uncertainty (i.e., unclear patient history) from patients who are incapacitated … and ruptured aortic aneurysm. 16 In contrast, an admitting hospitalist might ideally view such a patient … Notable examples include DE-PASS: Decisive reason for admission, Evaluation time, Patient summary

6570. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49540/psn-pdf
      August 21, 2007 - The patient was ultimately stabilized and transferred to the cardiac intensive care unit. … crucial need to strictly follow checklist procedures and must be motivated to embrace a culture of safety … Delaying defibrillation to give basic cardiopulmonary resuscitation to patients with out-of-hospital … Indicators/ECG Display    a. Power "on"    b. Self test ok    c. Monitor display functional    d. … Delaying defibrillation to give basic cardiopulmonary resuscitation to patients with out-of-hospital

6571. Statistical Brief #112
      hcup-us.ahrq.gov/reports/statbriefs/sb112.jsp
      May 01, 2011 - Variables for Revisit Analyses American Hospital Association (AHA) Linkage Files AHRQ Quality Indicators … years (28.3 percent were for patients younger than 18 years and 45.3 percent were for patients 18 to … Table 1 shows ED visits related to eye injuries by patient residence. … eye-health-statistics-july-2012-update.pdf (accessed September 15, 2015). 2 National Institute for Occupational Safety … Fact Sheet: Eye Safety at Work is Everyone's Business.

6572. Final Progress Report: Proactive Risk Assessment of Primary Care of the Elderly (pdf file)
      www.ahrq.gov/sites/default/files/2024-12/karsh-report.pdf
      January 01, 2024 - situation and prioritize patient safety efforts. … Identify patient care hazards for elderly patients. 2. … Work system design for patient safety: the SEIPS model. … Sensemaking of Patient Safety Risks and Hazards. … Patient safety efforts should focus on medical errors.

6573. Spotlight (pdf file)
      psnet.ahrq.gov/sites/default/files/2022-01/final_spotlight_stacked_opioid_administration_01.03.2022.pdf
      January 01, 2022 - SAFETY EVENTS INVOLVING OPIOID DOSE STACKING Two cases involving patients who experienced adverse … SAFETY: ADVANCED PATIENT MONITORING STRATEGIES 23 Advanced Patient Monitoring Strategies (1) … A systematic approach to improving patient safety A Systematic Approach to Improving Patient Safety … (1) A Systematic Approach to Improving Patient Safety (1) improving patient safety: Standardized sedation … safety: �Advanced Patient monitoring Strategies Advanced Patient Monitoring Strategies (1) improving

6574. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49407/psn-pdf
      July 01, 2003 - The patient was discharged to a skilled nursing facility (SNF) for physical therapy on low- molecular-weight … Although hemorrhage can occur in any patient receiving warfarin, the risk is magnified when the anticoagulant … monitoring of oral anticoagulants in dedicated thrombosis clinics, using intelligent computer programs or patient … The use of published standard dosing algorithms may increase the safety of initial warfarin dosing. … Conservative treatment of overanticoagulated patients.

6575. PREGNANCY, INCLUDING PRETERM BIRTH #12 (pdf file)
      effectivehealthcare.ahrq.gov/sites/default/files/12_pregnancy_potential_high_impact_2012-12-11.pdf
      January 01, 2012 - milk from a source other than her own, only milk from a source that has been screened to ensure its safety … intervention. 15-21 All experts saw a significant unmet need for more innovative ways to supply VLBW patients … All experts agreed that donor human milk has the potential to significantly improve patient health … Overall, experts agreed that although more safety and efficacy studies must be performed to determine … Food and Drug Administration Center for Food Safety and Applied Nutrition; 2010 Dec 6. 6 p.

6576. Early Mobility in the Intensive Care Unit: Slide Presentation | Agency for Healthcare Research and Quality
      www.ahrq.gov/hai/tools/mvp/modules/technical/early-mobility-icu-slides.html
      February 01, 2017 - Ventilated Patients Slide 1: AHRQ Safety Program for Mechanically Ventilated Patients Early Mobility … Safety of physical therapy interventions in critically ill patients: a single-center prospective evaluation … Safety of physical therapy interventions in critically ill patients: a single-center prospective evaluation … Inadequate patient comfort, pain control. 7. Zanni JM, Korupolu R, Fan E, et al. … Safety of physical therapy interventions in critically ill patients: a single-center prospective evaluation

6577. Evidence Summary: Prevention of Dental Caries in Children Younger Than 5 Years: Screening and Interventions | United States Preventive Services Taskforce
      www.uspreventiveservicestaskforce.org/uspstf/document/final-evidence-summary/prevention-of-dental-caries-in-children-younger-than-age-5-years-screening-and-interventions1
      December 07, 2021 - Data Extraction and Quality Assessment One investigator abstracted details about the study design, patient … Oral health prevention and toddler well-child care: routine integration in a safety net system. … the key questions that the review will address to allow the USPSTF to evaluate the effectiveness and safety … the key questions that the review will address to allow the USPSTF to evaluate the effectiveness and safety

6578. High-Risk Deliveries at Facilities with 24/7 In-House Blood Banking/Transfusion Services - Report (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/availability/chipra-0122-fullreport.pdf
      September 01, 2019 - • Fiscal burden of measure focus (e.g., clinical condition) on patients, families, public and private … Measure Topic – patient safety: Yes. k. Measure Topic – family experience with care: No. l. … Their significance raises them to concerns about patient safety. … In this regard they address four (Timeliness, Equity, Safety, and Patient- Centeredness) of six characteristics … These are important measures regarding quality and patient safety.

6579. Build a Business Case for Quality Improvement: Facilitator Guide | Agency for Healthcare Research and Quality
      www.ahrq.gov/hai/tools/mvp/modules/cusp/build-business-case-fac-guide.html
      February 01, 2017 - Evidence-based care practices improve patient outcomes and reduce complications by getting patients off … Slide 10: AHRQ Safety Program Goals Say: The goals of this safety program are simple, although … Second, we need to improve the teamwork and safety culture in our ICUs. … By getting patients off of the ventilator faster, you will reduce the risk of patient harms associated … By improving teamwork and safety culture, you can realize the first goal and reduce risk of patient harms

6580. In Conversation with…Gerald B. Hickson, MD | PSNet
      psnet.ahrq.gov/perspective/conversation-withgerald-b-hickson-md
      December 01, 2009 - We certainly agree that improving system design and process flow will enhance patient safety, but our … The long road to patient safety: a status report on patient safety systems. … Understanding Patient Safety. New York, NY: McGraw-Hill Professional; 2008. 5. Rosenstein AH. … A survey of the impact of disruptive behaviors and communication defects on patient safety. … safety by shifting power from health professionals to patients.