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preventiveservices.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/index.html
February 01, 2024 - Resources
CANDOR
Family-Centered Rounds Toolkit
MATCH Toolkit
NICU Toolkit
Pressure … Injury
Preventing Pressure Ulcers in Hospitals
Re-Engineered Discharge Toolkit
QI … How do you measure fall and fall-related injury rates?
5.2.
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preventiveservices.ahrq.gov/patient-safety/settings/hospital/engage-tool.html
July 01, 2022 - Resources
CANDOR
Family-Centered Rounds Toolkit
MATCH Toolkit
NICU Toolkit
Pressure … Injury
Preventing Pressure Ulcers in Hospitals
Re-Engineered Discharge Toolkit
QI
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preventiveservices.ahrq.gov/teamstepps/instructor/scenarios/operroom.html
March 01, 2014 - At 2200, two emergency trauma cases arrive. … Comments
This scenario demonstrates how managing resources can prevent inefficiency or potential injury … chronic pain patient jumps from the hospital roof and sustains severe and multiple life-threatening injuries … The trauma surgeons request access to the Operating Room (OR) for immediate laparotomy and other repairs … Comments
This scenario demonstrates how cross-monitoring team members can help prevent error, damage, or injury
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preventiveservices.ahrq.gov/npsd/data/dashboard/index.html
October 01, 2023 - to falls, the presence of fall assistance, presence of fall assistance by patient harm, type of fall injury … Pressure Ulcer Dashboard
Details the documentation of increased risk for pressure ulcer following a … risk assessment; and the timing of the first risk assessment for reported pressure ulcers or sDTIs.
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preventiveservices.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/clinical-pathway.html
January 01, 2013 - Resources
CANDOR
Family-Centered Rounds Toolkit
MATCH Toolkit
NICU Toolkit
Pressure … Injury
Preventing Pressure Ulcers in Hospitals
Re-Engineered Discharge Toolkit
QI
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preventiveservices.ahrq.gov/patient-safety/settings/hospital/surgecapacitytool.html
May 01, 2020 - Resources
CANDOR
Family-Centered Rounds Toolkit
MATCH Toolkit
NICU Toolkit
Pressure … Injury
Preventing Pressure Ulcers in Hospitals
Re-Engineered Discharge Toolkit
QI
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preventiveservices.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/pfp/natlhacratereport-rebaselining2014-2016_0.pdf
January 01, 2016 - patient safety events, including
many types of hospital-acquired infections, adverse drug events, and injuries … Ulcers/Pressure Injuries
Surgical Site Infections
Ventilator-Associated
Pneumonias
(Post-op) Venous … Central Venous Catheters
Falls MPSMS In-Hospital Patient Falls
Obstetric
Adverse
Events
PSI OB Trauma … National number of adverse events captured by PSIs 18 and 19 on obstetric
injury and national number … 8,513 0.29
Falls MPSMS In-Hospital Patient Falls 238,965 8.03
Obstetric
Adverse
Events
PSI OB Trauma
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preventiveservices.ahrq.gov/patient-safety/settings/hospital/red/toolkit/contactsheet2.html
March 01, 2013 - Resources
CANDOR
Family-Centered Rounds Toolkit
MATCH Toolkit
NICU Toolkit
Pressure … Injury
Preventing Pressure Ulcers in Hospitals
Re-Engineered Discharge Toolkit
QI
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preventiveservices.ahrq.gov/hai/pfp/methods.html
December 01, 2017 - Venous Catheters
Falls
MPSMS
In-Hospital Patient Falls
Obstetric Adverse Events
PSI
OB Trauma … Pressure Ulcers
Surgical Site Infections
NHSN
SSIs combined for 17 procedures based on CDC NHSN … The national number of adverse events captured by PSIs 18 and 19 on obstetric injury , and the national … MPSMS
In-Hospital Patient Falls
262,317
32,750,000
8.010
Obstetric Adverse Events
PSI
OB Trauma … Ulcer
MPSMS
Hospital-Acquired Pressure Ulcers
1,317,211
32,750,000
40.220
Surgical Site
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preventiveservices.ahrq.gov/patient-safety/quality-measures/qsrs/index.html
September 01, 2022 - events, including certain hospital-acquired conditions (HACs), such as postsurgical complications and pressure … events, e.g., not just fall rates over a given time, but also the percentage of falls that resulted in injury … and the rates of each specific type of injury.
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preventiveservices.ahrq.gov/patient-safety/settings/hospital/resource/qitool/pediatric.html
December 01, 2017 - Resources
CANDOR
Family-Centered Rounds Toolkit
MATCH Toolkit
NICU Toolkit
Pressure … Injury
Preventing Pressure Ulcers in Hospitals
Re-Engineered Discharge Toolkit
QI … Introduction PDF [ - 38.47 KB] PDI01 Accidental Puncture or Laceration PDF [ - 62.74 KB] PDI02 Pressure … Respiratory Failure PDF [ - 65.96 KB] PDI10 Postoperative Sepsis PDF [ - 112.29 KB] PDI11 Postoperative Wound
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preventiveservices.ahrq.gov/patient-safety/settings/hospital/candor/modules.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
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preventiveservices.ahrq.gov/news/newsletters/e-newsletter/893.html
December 01, 2023 - The winners of the competition are:
University of Missouri Health Care utilized AHRQ’s Preventing Pressure … Ulcers in Hospitals: A Toolkit for Improving Quality of Care to decrease reportable pressure injuries
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preventiveservices.ahrq.gov/patient-safety/settings/hospital/resource/qitool/webinar080116/index.html
December 01, 2017 - Injury
Preventing Pressure Ulcers in Hospitals
Re-Engineered Discharge Toolkit
QI … Pulmonary Embolism or Deep Vein Thrombosis Rate *
PSI 13: Postoperative Sepsis *
PSI 14: Postoperative Wound … PSI 15: Unrecognized Abdominopelvic Accidental Puncture or Laceration *
PSI 18-‐19: Obstetric Trauma … PDI 09: Postoperative Respiratory Failure
PDI 10: Postoperative Sepsis
PDI 11: Postoperative Wound … Pressure Ulcer Risk Assessment at Admission and Daily: Evaluate all patients for pressure ulcers and
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preventiveservices.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/morse-fall-scale.html
July 01, 2023 - Resources
CANDOR
Family-Centered Rounds Toolkit
MATCH Toolkit
NICU Toolkit
Pressure … Injury
Preventing Pressure Ulcers in Hospitals
Re-Engineered Discharge Toolkit
QI
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preventiveservices.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/fallprevention-training/module1/module1_fall-prevention.docx
March 01, 2013 - In one study, a fall with serious injury added 6.3 days to the hospital stay. … The average operational cost for a fall with injury is about $14,000. … 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
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preventiveservices.ahrq.gov/patient-safety/settings/hospital/fall-prevention/workshop/module-3/guide.html
September 01, 2017 - Injury
Preventing Pressure Ulcers in Hospitals
Re-Engineered Discharge Toolkit
QI … Post-Fall Huddles: Reducing Preventable Falls and Fall-Related Injuries —AHRQ Fall Prevention Program … The patient should be carefully and systematically assessed for injuries. … The post-fall clinical review focuses on immediate risk of injury or complications. … RCA is often used for a fall with injury.
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preventiveservices.ahrq.gov/patient-safety/settings/hospital/fall-prevention/workshop/module-3/slides.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 … number of medications that could cause sedation, confusion, impaired balance, or orthostatic blood pressure … Carefully assess patients for any injuries in a systematic way.
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preventiveservices.ahrq.gov/patient-safety/settings/hospital/fall-prevention/workshop/module-1/slides.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 … Medicare won’t pay for increased costs due to injury from inpatient falls. … Falls harm patients.
30% to 51% of falls result in injury.
Many falls are preventable.
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preventiveservices.ahrq.gov/patient-safety/settings/hospital/candor/acknowledgements.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 … Sources include:
George Mason University
Harvard School of Public Health
Medically Induced Trauma