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161. Methods To Estimate the Baseline 2010 PFP National Hospital-Acquired Condition Rate (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/pfp/pfphac.pdf
     September 01, 2014 - With Central 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 data … The national number of adverse events captured by PSIs 18 and 19 on obstetric injury, and the national … Ulcers Hospital-Acquired Pressure Ulcers 53.03 62.45 0.85 VAP Ventilator-Associated Pneumonia … Falls MPSMS In-Hospital Patient Falls 262,317 32,750,000 8.010 Obstetric Adverse Events PSI OB Trauma

162. Table 11: Outcome Indicators by Use of Selected Home and Community-Based Services Medicaid State Plan Services, 2005 | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/findings/tab11.html
     February 01, 2023 - Overall Yes 14,177 28,212 18,788 9,372 No 19,380 19,211 19,521 20,716 Pressure … Composite: ACSC Overall 50,783 40,549 9,972 20,001 18,997 10,923 20,108 19,218 Pressure

163. Selected Best Practices and Suggestions for Improvement (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/d4e_combo_psi08-postophipfx-bestpractices.pdf
     May 20, 2016 - In 2008 the Centers for Medicaid & Medicare Services (CMS) identified falls and trauma—including fractures—as … Prevention Protocol Use a standardized fall prevention protocol to help reduce falls and associated injury … /fallspx/fallspxmanual.pdf http://www.ahrq.gov/professionals/systems/long-term-care/resources/injuries … Transforming care at the bedside how-to guide: reducing patient injuries from falls.http://www.ihi.org … High blood pressure and bone-mineral loss in elderly white women: a prospective study.

164. Communication: Severe Hypertension (pdf file)
     www.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

165. 2021 National Healthcare Quality and Disparities Report Appendixes (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2021qdr-appendixes.pdf
     December 01, 2021 - 1,000 elective-surgery admissions of length 4 or HCUP 2018 Reclosure of postoperative abdominal wound … dehiscence per 1,000 2 or more days, adults HCUP 2018 Home health care patients whose surgical wound … 2018 Home health improved care patients whose management of oral medications OASIS 2018 Birth trauma … with pressure ulcer MDS 2018 Low-risk, and left in long-stay nursing the bladder home residents … QUALITY MAP Measure Title Data Source Data Year Home health care patients whose surgical wound

166. Board and Senior Leadership PowerPoint Presentations on the Pediatric Quality Indicators (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/pdi/a2_pdi_boardpresentation.pdf
     October 01, 2015 - October 2015: – Addition of information relevant to ambulatory and managed care encounters – Expanded injury … /TechSpecs/PDI%2002%20Pressure%20Ulcer %20Rate.pdf • Numerator: Discharges with ICD-10-CM code of pressure … • Several exclusions (e.g., length of stay <5 days, principal diagnosis of pressure ulcer). … An Example: Pressure Ulcer (PDI 02) http://www.qualityindicators.ahrq.gov/Downloads/Modules/PDI/V45/ … An Example: Pressure Ulcer (PDI 02)� How can the AHRQ PDIs be used in�quality assessment?

167. Board and Senior Leadership PowerPoint Presentations on the AHRQ Quality Indicators (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/a2_combo_boardpresentation.pdf
     October 01, 2015 - October 2015: – Addition of information relevant to ambulatory and managed care encounters – Expanded injury … • Several exclusions (e.g., length of stay <5 days, principal diagnosis of pressure ulcer). … • Several exclusions (e.g., length of stay <5 days, principal diagnosis of pressure ulcer). … A PSI Example: Pressure Ulcer (PSI 03)� What are the Inpatient Quality Indicators (IQIs)? … An Example: Pressure Ulcer (PDI 02)� How can the AHRQ QIs be used in quality assessment?

168. Chartbook on Healthy Living: National Healthcare Quality and Disparities Report (pdf file)
     www.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 …  Trends: ■ Birth trauma-neonatal injury rates fell from 2.6 per 1,000 live births in 2004 to … ■ Between 2004 and 2013, birth trauma-neonatal injury rates fell for all racial/ethnic groups, … Birth Trauma Rate—Injury to Neonate: Technical Specifications.

169. Background for AHRQ Quality Indicators
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/pdi/a2_pdi_boardpresentation.pptx
     October 01, 2015 - Rate NQI 03 Neonatal Blood Stream Infection Rate PDI 01 Accidental Puncture or Laceration Rate PDI 02 Pressure … PDI 09 Postoperative Respiratory Failure Rate PDI 10 Postoperative Sepsis Rate PDI 11 Postoperative Wound … in October 2015: Addition of information relevant to ambulatory and managed care encounters Expanded injury … Several exclusions (e.g., length of stay <5 days, principal diagnosis of pressure ulcer). … An Example: Pressure Ulcer (PDI 02) Tool A.2 Slide ‹#› Pediatric Toolkit for Using the AHRQ Quality

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

171. AHRQ’s Safety Program for Nursing Homes: On-Time Preventable Hospital and Emergency Department Visits Training | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/prevhosp/ereport-slides.html
     September 01, 2017 - showing 15 active medications during the report week, active high-risk diagnosis of UTI, stage III pressure … DNR,DNH, MOLST, or POLST Order in Place Oxygen Therapy Catheter or Ostomy Present Stage II or > Pressure … Gastrointestinal/ Genitourinary Symptoms Endocrine/ Metabolic/ Nutrition Issues Wound … Genitourinary Endocrine/ Nutritional/ Metabolic Musculoskeletal/ Joint Symptoms Wound … Circulatory Problems Hypertension or Renal Failure Gastroenteritis Angina Pectoris Falls /Trauma

172. Communication: Severe Hypertension - PowerPoint Presentation
     www.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. 

173. Chapter 4. Long Term Management | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/long-term-care/resource/injuries/fallspx/man4.html
     December 01, 2017 - If there is a drop of 20 mm Hg or more in the resident's systolic pressure 1 minute after standing, the … Use of pressure, position, seat belt or other alarm. … Room sensors to detect resident movement; position or pressure alarms on the bed, chair or wheelchair … Trying to climb over bedrails may well result in a serious fall related injury. … For residents who are in danger of head injury, a helmet can provide protection.

174. Chapter 2. Fall Response | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/long-term-care/resource/injuries/fallspx/man2.html
     December 01, 2017 - the nurse after a resident falls should include a review of the resident systems and description of injuries … Postural blood pressure and apical heart rate. Finger stick glucose (for diabetics). … The presence or absence of a resultant injury is not a factor in the definition of a fall. … A fall without injury is still a fall.

175. Case Scenarios: Handling Challenging Communications | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/hospital/candor/modules/guide5/scenarios.html
     August 01, 2022 - Eventually the team is able to re-establish Mary's normal heart rate, blood pressure, and adequate blood … During the resuscitation efforts, information obtained from the devices monitoring Mary's EKG, blood pressure … Over the next few days, it is clear that he has suffered a significant brain injury due to the lack of

176. References | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/pfp/haccost2017-ref.html
     May 01, 2023 - Costs of venous thromboembolism, catheter-associated urinary tract infection, and pressure ulcer. … The costs of medical falls by component of cost, timing, and injury severity. … Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization … Ostomy Wound Manage . 2016 Nov;62(11):30-8. 65. Mendizabal A, Thibault DP, Willis AW. … Marginal hospital cost of surgery-related hospital-acquired pressure ulcers.

177. AHRQ Stats | Agency for Healthcare Research and Quality
     www.ahrq.gov/news/newsroom/ahrq-stats.html
     January 01, 2025 - , by Cause of Injury, 2017 .) … Trauma During Childbirth The rate of obstetric trauma during childbirth involving instruments such as … Decreasing Pressure Ulcers Among Hospital Patients The average rate of hospital-associated pressure ulcers … Pressure Ulcer Rates of Hospital Patients About 1.2 million cases of hospital-acquired pressure ulcers … highest average expenses per person were for the treatment of heart conditions ($3,794 per person), trauma-related

178. Chartbook on Black Health Care: Slide Presentation | Agency for Healthcare Research and Quality
     www.ahrq.gov/research/findings/nhqrdr/chartbooks/blackhealth/qdr-blackhealth-slides.html
     November 01, 2020 - Infant mortality per 1,000 live births (more than 2,499 grams) Worse No Change Birth trauma—injury … Slide 75 Birth trauma—injury to neonate per 1,000 live births, by race/ethnicity, 2004-2013 Image … : Chart shows birth trauma—injury to neonate per 1,000 live births, by race/ethnicity, 2004-2013: … Trends: From 2004 to 2013, birth trauma-neonatal injury rates fell from 2.6 per 1,000 live births … Between 2004 and 2012, birth trauma-neonatal injury rates fell for all racial/ethnic groups.

179. NPSD Data Spotlight: Patterns of Fall Interventions (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/npsd/data/spotlights/spotlight-patterns-fall-interventions.pdf
     September 01, 2023 - COMMON INTERVENTION(S) IN PLACE FOR PATIENTS WITH DIFFERENT DEMOGRAPHICS OR RISKS OF FALLS OR INJURIES … /Surgical Supply, Fall, Healthcare-Associated Infection, Medication or Other Substance, Perinatal, Pressure … health considerations.1–4 Falls result in significant physical and economic burden, ranging from injuries … Incidence of and county variation in fall injuries in US residents aged 65 years or older, 2016-2019 … Trends in fatal and nonfatal injuries among older Americans, 2004– 2017. Am. J. Prev.

180. On-Time Preventable Hospital and Emergency Department Visits (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/prevhosp/2-preventablehospitalandedvisits-samplerpts_3.pdf
     November 30, 2013 - • Current clinical conditions contributing to transfer risk: use of oxygen, catheter or ostomy, any pressure … and skin, injury (fall related or not fall related), musculoskeletal, abnormal labs or anemia, fever … or skin issues • Fall-related injury • Non-fall-related injury • Abnormal labs • Fever/possible infection … disease • Asthma • Circulatory problems • Hypertension • Gastroenteritis • Angina pectoris • Falls/trauma … obstructive pulmonary disease, asthma, circulatory problems, hypertension, gastroenteritis, angina, falls/trauma