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121. Module 3: Best Practices in Fall Prevention—Training Guide | Agency for Healthcare Research and Quality
     pbrn.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.

122. AHRQ National Scorecard on Hospital-Acquired Conditions: Updated Baseline Rates and Preliminary Results 2014-2016 (pdf file)
     pbrn.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

123. Gap Analysis Facilitator's Guide | Agency for Healthcare Research and Quality
     pbrn.ahrq.gov/patient-safety/settings/hospital/candor/modules/facguide3.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

124. Module 3: Preparing for Implementation: Gap Analysis | Agency for Healthcare Research and Quality
     pbrn.ahrq.gov/patient-safety/settings/hospital/candor/modules/facguide3/notes.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 … An adverse event is "any injury caused by medical care" and doesn't imply "error," "negligence," or poor

125. Module 5: Situation Monitoring
     pbrn.ahrq.gov/sites/default/files/wysiwyg/teamstepps/diagnosis-improvement/module5-situation-monitoring.pptx
     January 10, 2022 - It also ensures staff are supported in times of stress or production pressures or when the day is just … allows individuals and teams to take steps to interrupt or correct an action or event before harm or injury … risk or unfolding error An opportunity to interrupt or correct an action or event before harm or injury … Are the blood pressure cuffs, otoscope, ophthalmoscopes, and other equipment working properly? … Are things being left undone because of time pressure?

126. Module 1: Preventing Falls in Hospitals (doc file)
     pbrn.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

127. Mod01-Grand-Rounds-Slides (pdf file)
     pbrn.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/candor/grandrounds/mod01-grand-rounds-slides.pdf
     April 01, 2016 - Say: Today’s Presentation Goals are to: ■ Highlight the gap between optimal response to medical injury … the CANDOR process and how this toolkit will help organizations improve their response to medical injury … nursing staff in the room had Michelle connected to a monitor and monitored her heart rate, blood pressure … of ergonomics; as we work more at desks and computers, these areas are redesigned to help prevent injuries … Slide 35 Say: In addition to the organization Medically Induced Trauma Support Services (or MITSS)

128. Care for the Caregiver Program Implementation Guide | Agency for Healthcare Research and Quality
     pbrn.ahrq.gov/patient-safety/settings/hospital/candor/modules/guide6.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 … For additional support in the planning process, Medically Induced Trauma Support Services (MITSS) resources

129. Module 1: An Overview of the CANDOR Process | Agency for Healthcare Research and Quality
     pbrn.ahrq.gov/patient-safety/settings/hospital/candor/modules/notes1.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

130. PowerPoint Presentation
     pbrn.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/candor/module1/grand-rounds-presentation-slides.pptx
     January 01, 2014 - Video: Do Less Harm 2 Presentation Goals Highlight the gap between optimal response to medical injury … Resolution) process and how this toolkit will help organizations improve their response to medical injury … The nursing staff in the room had Michelle connected to a monitor and monitored her heart rate, blood pressure … field of ergonomics; as we work more at desks and computers, these areas are redesigned to help prevent injuries … helps them care for their patients. 36 Module 1 In addition to the organization Medically Induced Trauma

131. Chartbook on Healthy Living: National Healthcare Quality and Disparities Report (pdf file)
     pbrn.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/chartbooks/healthyliving/qdr2015-chartbook-healthyliving.pdf
     January 01, 2020 - , and ■ Birth trauma not elsewhere classified.24  Many of these injuries to neonates may be preventable … .25 Birth trauma—injury to neonate per 1,000 live births, 2004-2013 0.0 0.5 1.0 1.5 2.0 2.5 … Birth trauma—injury to neonate per 1,000 live births, 2004-2013 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 …  Trends: ■ Birth trauma-neonatal injury rates fell from 2.6 per 1,000 live births in 2004 to … Birth Trauma Rate—Injury to Neonate: Technical Specifications.

132. Module 4: How To Implement the Fall Prevention Program in Your Organization—Slide Presentation | Agency for Healthcare Research and Quality
     pbrn.ahrq.gov/patient-safety/settings/hospital/fall-prevention/workshop/module-4/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

133. Re-Engineered Discharge (RED) Toolkit | Agency for Healthcare Research and Quality
     pbrn.ahrq.gov/patient-safety/settings/hospital/red/toolkit/index.html
     April 01, 2023 - Resources CANDOR Family-Centered Rounds Toolkit MATCH Toolkit NICU Toolkit Pressure … Injury Preventing Pressure Ulcers in Hospitals Re-Engineered Discharge Toolkit QI

134. First-of-Its-Kind Study Examines Disparities in Healthcare Costs and Outcomes of Cigarette Smoking in the United States | Agency for Healthcare Research and Quality
     pbrn.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

135. Implementation Guide for the CANDOR Process | Agency for Healthcare Research and Quality
     pbrn.ahrq.gov/patient-safety/settings/hospital/candor/impguide.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 … Medicine (IOM) report, To Err Is Human: Building a Safer Health System , the problems associated with injury

136. TeamSTEPPS Speciality Scenarios - Combat Care (pdf file)
     pbrn.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/instructor/scenarios/CombatCare.pdf
     March 18, 2014 - The right leg is continuing to bleed and now has pressure dressings applied. … They seem overwhelmed by the extent of the patient’s injuries. … Seeing the blood pressure, the nurse asks, “Do you want a code cart in here?” … has an actively hemorrhaging 6-inch laceration on his right lower leg but no other obvious signs of injury … While the physician is reviewing wound care instructions with the mother, the child complains of nausea

137. New Interactive Data Map Shows Extent of Leading Mental Disorders in the United States | Agency for Healthcare Research and Quality
     pbrn.ahrq.gov/news/newsletters/e-newsletter/866.html
     May 01, 2023 - disorders, bipolar and related disorders, suicidal ideation or attempt or intentional self-harm, and trauma … include: Implementing an electronic root cause analysis reporting system to decrease hospital-acquired pressure … injuries.

138. Module 2: Obtaining Organizational Buy-in and Support | Agency for Healthcare Research and Quality
     pbrn.ahrq.gov/patient-safety/settings/hospital/candor/modules/notes2.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

139. Ingestion of Illicit Substances Among Young Children Increased Significantly During COVID-19 Pandemic | Agency for Healthcare Research and Quality
     pbrn.ahrq.gov/news/newsletters/e-newsletter/861.html
     April 01, 2023 - The COVID-19 pandemic has intensified these pressures. … J Trauma Acute Care Surg 2023 Apr;94(5):592-8. Epub 2023 Nov 18. … Renal outcomes following intravenous contrast administration in patients with acute kidney injury: a

140. New Toolkit Can Improve Post-Surgery Complications and Enhance Patient Recovery | Agency for Healthcare Research and Quality
     pbrn.ahrq.gov/news/newsletters/e-newsletter/870.html
     June 01, 2023 - for an estimated 4 million patients who might benefit from “ABCS” interventions ( a spirin, b lood pressure … Walsh has identified factors that contribute to medication errors and injuries in children with chronic … Trauma Case Rep . 2023 Apr;44:100800. Epub 2022 Feb 18.