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161. Using a Computerized Fall Risk Assessment Process to Tailor Interventions in Acute Care (pdf file)
     www.ahrq.gov/downloads/pub/advances2/vol1/advances-hook_25.pdf
     February 26, 2008 - , impaired physical mobility, accidental injuries, patient safety, safety management, injury control … Minor: Resulted in application of a dressing, ice, cleaning of a wound, limb elevation, or topical … Blood pressure changes on upright tilting predict falls in older people. … Complications of preinjury warfarin use in the trauma patient. J Trauma 2003; 54: 842-847. 36. … Minor head trauma in anticoagulated patients. Acad Emerg Med 1999; 6: 121-124. 38.

162. Using a Computerized Fall Risk Assessment Process to Tailor Interventions in Acute Care (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Hook_25.pdf
     February 26, 2008 - , impaired physical mobility, accidental injuries, patient safety, safety management, injury control … Minor: Resulted in application of a dressing, ice, cleaning of a wound, limb elevation, or topical … Blood pressure changes on upright tilting predict falls in older people. … Complications of preinjury warfarin use in the trauma patient. J Trauma 2003; 54: 842-847. 36. … Minor head trauma in anticoagulated patients. Acad Emerg Med 1999; 6: 121-124. 38.

163. Intramuscular Injections – Best Practices for Safe Vaccine Administration in Nursing Homes (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/nursing-home/materials/intramuscular-injections.pdf
     June 01, 2021 - intramuscular (IM) administration is important to make sure the vaccine does its job and to avoid shoulder injury … and Health Administration (OSHA) regulations do not require you to wear gloves unless you have open wounds … Apply gentle pressure to the injection site for several seconds or longer to minimize bleeding using … For residents who take anticoagulation medications, gentle pressure may need to be applied longer to … pre-filled autoinjector (at least three doses) • H1 antihistamine (e.g., diphenhydramine/Benadryl) • Blood pressure

164. Results | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/pfp/haccost2017-results.html
     November 01, 2017 - literature on excess mortality may be due to the difficulty in finding reliable sources of data on injuries … One study used national representative data (HCUP-NIS) for obstetrical trauma (defined based on AHRQ … only. 54 Further, this study found no increase in mortality for obstetrical trauma. … studies included amniotic fluid embolisms and anesthesia complications; two studies included intracranial injuries … and internal injuries of thorax, abdomen, and pelvis; one study included iatrogenic events.

165. Data Infographics | Agency for Healthcare Research and Quality
     www.ahrq.gov/data/infographics/index.html
     July 01, 2025 - Antidepressant Prescriptions Potentially Preventable Pediatric Hospital Stays Most Common Cause of Injuries … 2017 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 Inpatient … Anemia in Hemodialysis Patients Worse Among Blacks HRSA's Health Center Program Making Progress on Blood Pressure

166. 2013 Annual Hospital-Acquired Condition Rate and Estimates of Cost Savings and Deaths Averted From 2010 to 2013 (pdf file)
     www.ahrq.gov/sites/default/files/publications/files/hacrate2013_0.pdf
     October 01, 2015 - MPSMS (2013) In-Hospital Patient Falls 240,000 7.2 Obstetric Adverse Events PSI (2013) OB Trauma … Fall and injury prevention (Chapter 10). In: Hughes RG, ed. … Preventing falls and eliminating injury at Ascension Health. … The road to zero preventable birth injuries. … Eliminating birth trauma at Ascencion Health.

167. Draft Final Report Estimating the Additional Hospital Inpatient Cost and Mortality Associated with Selected Hospital Acquired Conditions (pdf file)
     www.ahrq.gov/sites/default/files/publications2/files/hac-cost-report2017.pdf
     November 01, 2017 - Pressure Ulcers A new pressure ulcer developed during a stay, or Stage 1 or 2 pressure ulcer(s) present … , Closed"[Mesh] OR "Craniocerebral Trauma"[Mesh] OR "Cerebrovascular Trauma"[Mesh] OR "Cerebrovascular … Tissue Injury” [tiab] OR “Pressure Ulcer” [MeSH] OR “Pressure Ulcer” [tiab] OR “osteomyelitis” [MeSH … Ostomy/wound Mgmt. 2016 Nov;62(11):30. d Weiser TG, Semel ME, Simon AE, et al. … Ostomy Wound Manage. 2016 Nov;62(11):30-8. 65 Mendizabal A, Thibault DP, Willis AW.

168. Draft Final Report Estimating the Additional Hospital Inpatient Cost and Mortality Associated with Selected Hospital Acquired Conditions (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/pfp/hac-cost-report2017.pdf
     November 01, 2017 - Pressure Ulcers A new pressure ulcer developed during a stay, or Stage 1 or 2 pressure ulcer(s) present … , Closed"[Mesh] OR "Craniocerebral Trauma"[Mesh] OR "Cerebrovascular Trauma"[Mesh] OR "Cerebrovascular … Tissue Injury” [tiab] OR “Pressure Ulcer” [MeSH] OR “Pressure Ulcer” [tiab] OR “osteomyelitis” [MeSH … Ostomy/wound Mgmt. 2016 Nov;62(11):30. d Weiser TG, Semel ME, Simon AE, et al. … Ostomy Wound Manage. 2016 Nov;62(11):30-8. 65 Mendizabal A, Thibault DP, Willis AW.

169. Presentation: Program Overview
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/technical/early-mobility-icu-slides.pptx
     January 01, 2017 - Patients Adverse Events4 9 patients had 14 adverse events (<1% of activities) Falls to knees without injury … (5) Systolic blood pressure <90 mmHg (4) Oxygen saturation <80% (3) Nasal feeding tube removal (1) … Systolic blood pressure >200 mmHg (1) No extubations No patients required added therapy or increased … sessions (i.e., 6 per 1,000 PT treatment) 80% of events were transient physiological (heart rate, blood pressure … Safety Program for Mechanically Ventilated Patients 5-Year Sustainability of Time to PT Postacute Lung Injury

170. Beyond Nursing Quality Measurement: The Nation’s First Regional Nursing Virtual Dashboard (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Aydin_2.pdf
     January 01, 2021 - Patient outcome variables Patient falls and injury falls • Patient falls/1,000 patient days. … • Injury falls/1,000 patient days. … • Percent of patients with suspected deep tissue injury. 3 Table 1. … • Percent of patients with hospital-acquired suspected deep tissue injury. … ulcers stages III and IV, as well as fall and injury fall incidence and rates.

171. Electronic Reports | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/pruhealing/ereports.html
     December 01, 2017 - This report is helpful for nursing home staff and wound nurses to promote early identification of pressure … These details are available at the time the pressure ulcer is being assessed during wound rounds or during … Information that displays on the Weekly Pressure Ulcer Treatment Summary Report, the Weekly Wound Rounds … Uses DON or ADON, Nurse Manager, Wound Nurse, QI Director Root Cause Analysis for New Pressure … Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance

172. Overuse of Computed Tomography Scans for the Evaluation of Children with Atraumatic Headache: Technical Specifications (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-0206-technicalspecs.pdf
     May 01, 2016 - Exclusions • Denominator/Numerator Exclusions o Trauma-related headache or pain (Table … IMG3) on the day of or within 7 days prior to imaging o Head trauma or suspected abuse/neglect (Table … 339.43 Other complicated 339.44 OTHER Post- traumatic headache 339.2x Acute pain due to trauma … excision of foreign body from brain 61570 Craniectomy or craniotomy; with treatment of penetrating wound … 852.x Other/unspecified intracranial hemorrhage following injury 853.x Intracranial injury of other

173. Eliminating Preventable Harms During Pediatric Intubation | Agency for Healthcare Research and Quality
     www.ahrq.gov/funding/grantee-profiles/grtprofile-nishisaki.html
     July 01, 2025 - Advanced Education and Innovation, Children’s Hospital of Philadelphia Chair, Pediatric Acute Lung Injury … experiencing respiratory failure, which is caused by various conditions, including pneumonia, asthma attacks, injuries … in five children who undergo the procedure face complications, including breathing issues, low blood pressure … Nishisaki also serves as Chair of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network

174. AHRQ Patient Safety Tools and Resources (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/resources/resources/PS-tools-2024.pdf
     January 01, 2024 - Web: ahrq.gov/goinghomeguide/ Pressure Ulcers Preventing Pressure Ulcers: A Toolkit for Improving … Web: ahrq.gov/pressureulcertoolkit The Pressure Injury Prevention in Hospitals Training Program supports … the training of hospital staff on how to implement AHRQ’s Preventing Pressure Ulcers in Hospitals … injury prevention. … approaches to design that target six areas of safety: infections, falls, medication errors, security, injuries

175. AHRQ Safety Program for Perinatal Care: Labor and Delivery Unit Safety Shoulder Dystocia (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/strategies/labor-delivery-unit/tool_shoulder-dystocia.docx
     May 01, 2017 - Effects of shoulder dystocia training on the incidence of brachial plexus injury. … Shoulder dystocia and injuries: prevention and management. … McRoberts maneuver used concurrently with suprapubic pressure [Call time] (hh:mm:ss) ____:____:____ … The ideal approach is for the clinician to put pressure in the antecubital fossa of the posterior arm … This procedure is considered a heroic measure due to the significant risk of brachial plexus injury associated

176. On-Time Pressure Ulcer Healing: Introduction to Pressure Ulcer Healing Reports Facilitator Training Instructor's Guide | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/pruhealing/erepguide.html
     December 01, 2016 - Pressure Ulcers at Risk for Delayed Healing. Weekly Wound Rounds Report. … home chains, and wound centers. … Injury Alliance. … The wound nurse, wound physician, and other disciplines attending wound rounds can see quickly which … If the pressure ulcer shows signs of delayed healing, as recorded on the wound assessment based on the

177. Outcome Indicators for the HCBS Population | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/findings/find4.html
     December 01, 2012 - All but two of the indicators (Pressure Ulcer and Injurious Falls) build on existing AHRQ Prevention … Pressure Ulcer. Injurious Falls.

178. Putoolssect7 (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/pressureulcertoolkit/putoolssect7.docx
     February 16, 2011 - Pressure ulcers are sterile wounds. 36. … Pressure ulcers are sterile wounds. False 36. … If a skin disruption is found, the type of skin injury will need to be identified. … For example is it a skin tear, a pressure ulcer, or moisture-associated skin damage or injury? … unit staff for pressure ulcer practice Certified Wound Care Nurse · Assesses wounds, does complex

179. 2013 Annual Hospital-Acquired Condition Rate and Estimates of Cost Savings and Deaths Averted From 2010 to 2013 | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/pfp/hacrate2013.html
     January 01, 2018 - 2 In 2010 an HHS Office of the Inspector General (OIG) team identified the rate of harm—that is, injuries … The estimate for deaths associated with pressure ulcers was based primarily on the paper by Zhan and … Zhan and Miller estimated that excess mortality due to pressure ulcers was 72 deaths per 1,000 pressure … This estimate is based on analysis of data from HCUP identifying injuries in 7.45 million hospital discharge … For example, pressure ulcers had a high baseline prevalence, and excess mortality attributed to pressure

180. Reducing Unecessary Urinary catheter Use in the Emergency Department: How to Implement the Process (ppt file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/ed-catheter-insertions-091013.ppt
     January 01, 2010 - Smith (2) Because of his immobility, he develops a pressure ulcer on his sacrum. … Few days later, he develops fever and his blood pressure drops. … Incontinent with open sacral/perineal wounds Consult with wound care End of life/hospice Be sure it … Trauma) Admitting service (e.g. … Protocolized care for trauma Incontinence without open sacral or perineal wounds Pre-operative