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41. Tennessee Hospital Association Uses AHRQ Tools To Boost Patient Safety, Saving $17 Million | Agency for Healthcare Research and Quality
    preventiveservices.ahrq.gov/news/newsroom/case-studies/201702.html
    March 01, 2017 - Injuries from falls and immobility. Obstetrical adverse events. Pressure ulcers. … Improvements in 2014 resulted in an estimated 45 percent reduction in pressure ulcers, 24 percent reduction

42. Long-term Care Resources | Agency for Healthcare Research and Quality
    preventiveservices.ahrq.gov/patient-safety/settings/long-term-care/resource/index.html
    November 01, 2021 - Effectiveness Reviews Facilities Home and Community Resources Findings Report Injuries … Nursing Homes: On-Time Prevention End of Life Care Home and Community-based Services Falls and Injury … Long-Term Care Facilities Multiple Chronic Conditions Omissions of Care in Nursing Homes Pressure

43. AHRQ's Quality & Patient Safety Programs by Setting: Long-Term Care | Agency for Healthcare Research and Quality
    preventiveservices.ahrq.gov/patient-safety/settings/long-term-care/index.html
    September 01, 2021 - Effectiveness Reviews Facilities Home and Community Resources Findings Report Injuries … Safety Program for Nursing Homes: On-Time Pressure Ulcer Prevention is a team training curriculum to … help nursing homes with electronic medical records reduce the occurrence of pressure ulcers.

44. Communication: Severe Hypertension (pdf file)
    preventiveservices.ahrq.gov/sites/default/files/wysiwyg/hai/tools/perinatal-care-2/hypertension_3-communication-speaker-notes.pdf
    July 01, 2023 - patient's family members. 4 Hospital AIM Team Leads SPPC‐II Maternal and Perinatal Deaths and Injuries … communication breakdowns are identified as the primary root cause of maternal and perinatal deaths and injuries … Other root causes for maternal and perinatal deaths and injuries are— • Assessment (i.e., the adequacy … Severe‐range blood pressure was sustained for nearly an hour. Ms. … Untitled Communication Severe Hypertension Communication is… Maternal and Perinatal Deaths and Injuries

45. Module 1: Preventing Falls in Hospitals—Training Guide | Agency for Healthcare Research and Quality
    preventiveservices.ahrq.gov/patient-safety/settings/hospital/fall-prevention/workshop/module-1/guide.html
    September 01, 2017 - Resources CANDOR Family-Centered Rounds Toolkit MATCH Toolkit NICU Toolkit Pressure … Injury Preventing Pressure Ulcers in Hospitals Re-Engineered Discharge Toolkit QI … Between 30 and 51 percent of falls in hospitals result in an injury ranging from bruises to severe wounds … The cost of serious fall-related injuries at three Midwestern hospitals. … Thus, the CAUTI, SSI, and Pressure Injury committees used the AHRQ assessment tools, and a speak-up campaign

46. Fall Prevention Toolkit (doc file)
    preventiveservices.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/fallprevention-training/module1/module1_tools.docx
    March 01, 2013 - bodies have definitions (e.g., the NQF defines a fall as “an unplanned descent to the floor without injury … study by van Gaal and colleagues evaluated a program that targeted three patient safety practices (pressure … and found an overall positive effect on the development of any adverse event, a composite measure of pressure … out specific fall assessments or interventions, and investigations such as lying and standing blood pressure … Violence and Injury Prevention: Falls. 2012.

47. Preventing Falls in Hospitals (Slide Presentation) | Agency for Healthcare Research and Quality
    preventiveservices.ahrq.gov/patient-safety/settings/hospital/fall-prevention/webinar/slides.html
    June 01, 2018 - Resources CANDOR Family-Centered Rounds Toolkit MATCH Toolkit NICU Toolkit Pressure … Injury Preventing Pressure Ulcers in Hospitals Re-Engineered Discharge Toolkit QI … Healthcare Research & Quality Toolkit: https://www.ahrq.gov/professionals/systems/long-term-care/resources/injuries … Slide 28 Challenge Unable to sustain falls prevention Graph with on falls and falls with injury … Falls and falls with injury decreased from 2008 to 2009 but increased in 2010 and 2011.

48. Hospitals and Health Systems | Agency for Healthcare Research and Quality
    preventiveservices.ahrq.gov/patient-safety/settings/hospital/resource/index.html
    August 01, 2022 - Resources CANDOR Family-Centered Rounds Toolkit MATCH Toolkit NICU Toolkit Pressure … Injury Preventing Pressure Ulcers in Hospitals Re-Engineered Discharge Toolkit QI … Patients with Limited English Proficiency NICU Toolkit Preventing Falls in Hospitals Preventing Pressure

49. Fall TIPS: A Patient-Centered Fall Prevention Toolkit | Agency for Healthcare Research and Quality
    preventiveservices.ahrq.gov/patient-safety/settings/hospital/fall-tips/index.html
    February 01, 2021 - Resources CANDOR Family-Centered Rounds Toolkit MATCH Toolkit NICU Toolkit Pressure … Injury Preventing Pressure Ulcers in Hospitals Re-Engineered Discharge Toolkit QI … Background Falls are the most common cause of preventable injury.

50. Data Infographics | Agency for Healthcare Research and Quality
    preventiveservices.ahrq.gov/data/infographics/index.html
    March 01, 2024 - Antidepressant Prescriptions Potentially Preventable Pediatric Hospital Stays Most Common Cause of Injuries … People Who Spent the Most for Healthcare in 2017 Causes of Hospital Stays for Traumatic Brain Injury … in 2017 High Healthcare Spending in 2017 Sports-Related Traumatic Brain Injuries Among Children … Hemodialysis Patients Worse Among Blacks HRSA's Health Center Program Making Progress on Blood Pressure

51. Puh-Implementation-Handouts (doc file)
    preventiveservices.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/pruhealing/puh-implementation-handouts.docx
    July 01, 2016 - We record onset day, stage, and surface area of each pressure ulcer during wound rounds. … ulcer healing and you will be able to identify wounds suspected of infection. … Injury Alliance’s Prevention and Treatment of Pressure Ulcers Guidelines c. … Wound, Ostomy, and Continence Nurses Society (WOCN) Pressure Ulcer Guidelines d. … Ulcer Report Pressure Ulcers At Risk for Delayed Healing Weekly Wound Rounds Report Weekly Pressure

52. 3. Which fall prevention practices do you want to use? | Agency for Healthcare Research and Quality
    preventiveservices.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/practices.html
    January 01, 2013 - Injury Preventing Pressure Ulcers in Hospitals Re-Engineered Discharge Toolkit QI … This assessment should include checking for a history of osteoporosis, including prior low-trauma fractures … Some may even sustain an injury. … In cases of falls with significant trauma, the patient may need to be taken to surgery. … Prevention of falls and fall injuries in the older adult.

53. Puh-Implementation-Handouts (pdf file)
    preventiveservices.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/pruhealing/puh-implementation-handouts.pdf
    July 01, 2016 - We record onset day, stage, and surface area of each pressure ulcer during wound rounds. … ulcer healing and you will be able to identify wounds suspected of infection. … Pressure Injury Alliance’s Prevention and Treatment of Pressure Ulcers Guidelines c.  Wound, Ostomy … X X X X Wound rounds Multidisciplinary team weekly review of residents with pressure ulcers. … Rounds Report and Pressure Ulcers at Risk for Delayed Healing with wound rounds.

54. Puh-Erepguide (pdf file)
    preventiveservices.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/pruhealing/puh-erepguide.pdf
    February 10, 2014 - Healing  Weekly Wound Rounds Report  Weekly Pressure Ulcer Treatment Summary Report  Pressure … home chains, and wound centers. … Injury Alliance. … The wound nurse, wound physician, and other disciplines attending wound rounds can see quickly which … Treatments  Wound Cleanser.

55. Platelet-Rich Plasma for Wound Care in the Medicare Population: Disposition of Comments (pdf file)
    preventiveservices.ahrq.gov/sites/default/files/wysiwyg/research/findings/ta/comments/prp-wound-care-comments.pdf
    September 01, 2020 - For diabetic foot ulcers, this involves restoring perfusion, offloading pressure, wound debridement … For pressure ulcers, management of pressure, friction, shear and moisture in addition to good wound … We excluded wounds of other etiologies, including traumatic wounds, peripheral arterial disease (PAD … ) related wounds in nondiabetics (i.e., diabetic wounds are to be included regardless of the presence … Our members report that they also use PRP for athletic overuse injuries.

56. Estimating the Additional Hospital Inpatient Cost and Mortality Associated With Selected Hospital-Acquired Conditions | Agency for Healthcare Research and Quality
    preventiveservices.ahrq.gov/hai/pfp/haccost2017.html
    November 01, 2017 - Comparison to 2010 AHRQ estimates Summary Despite advancements in infection control and injury prevention … can stem from diagnostic or treatment errors (e.g., failure to follow antibiotic protocols); medical injuries … Beginning in 2008, CMS identified the HACs (e.g., CAUTI, falls and trauma, surgical site infection) for … Falls Fall during an inpatient admission, with or without injury, whether or not fall was assisted. … Pressure Ulcers A new pressure ulcer developed during a stay, or Stage 1 or 2 pressure ulcer(s) present

57. Implementation Guide for the CANDOR Process: Appendix C | Agency for Healthcare Research and Quality
    preventiveservices.ahrq.gov/patient-safety/settings/hospital/candor/impguide/apc.html
    August 01, 2022 - Resources CANDOR Family-Centered Rounds Toolkit MATCH Toolkit NICU Toolkit Pressure … Injury Preventing Pressure Ulcers in Hospitals Re-Engineered Discharge Toolkit QI

58. Communication: Severe Hypertension - PowerPoint Presentation
    preventiveservices.ahrq.gov/sites/default/files/wysiwyg/hai/tools/perinatal-care-2/hypertension_3_communication.pptx
    July 01, 2023 - interruption to a doctor who is with a patient's family members. 2 Maternal and Perinatal Deaths and Injuries … communication breakdowns are identified as the primary root cause of maternal and perinatal deaths and injuries … Other root causes for maternal and perinatal deaths and injuries are— Assessment (i.e., the adequacy, … Smith so you can treat her severe blood pressure and draw labs.  … Smith, you do not have severe-range blood pressure at this time. 

59. Home Mechanical Ventilators: Protocol Appendix A (pdf file)
    preventiveservices.ahrq.gov/sites/default/files/wysiwyg/research/findings/ta/topicrefinement/hmv-protocol-appendixa.pdf
    October 11, 2017 - or NPPV or "Positive Airway Pressure*" or "positive end- expiratory pressure*").ti. 25411 3 1 or … 5811 14 *Obesity/ 256788 15 *Respiratory Insufficiency/ 25610 16 *Scoliosis/ 20526 17 *Spinal Cord Injuries … ventilation" or "non-invasive positive pressure ventilation" or NPPV or "Positive Airway Pressure*" … ventilation" or "non-invasive positive pressure ventilation" or NPPV or "Positive Airway Pressure*" … ventilation" or "non-invasive positive pressure ventilation" or NPPV or "Positive Airway Pressure*"

60. Toolkit for Using the AHRQ Quality Indicators | Agency for Healthcare Research and Quality
    preventiveservices.ahrq.gov/patient-safety/settings/hospital/resource/qitool/index.html
    March 01, 2017 - Injury Preventing Pressure Ulcers in Hospitals Re-Engineered Discharge Toolkit QI … detailed information on best practices for selected indicators Introduction PDF [248.26 KB] PSI03 Pressure … Pulmonary Embolism or DVT PDF [136.84 KB] PSI13 Postoperative Sepsis PDF [78.65 KB] PSI14 Postoperative Wound … Dehiscence PDF [137.17 KB] PSI15 Accidental Puncture or Laceration PDF [115.46 KB] PSI18-19 Obstetric Trauma … Respiratory Failure PDF [270.5 KB] PDI10 Postoperative Sepsis PDF [286.81 KB] PDI11 Postoperative Wound