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301. Resident Physicians as Champions in Preventing Device-Associated Infections (pdf file)
     www.ahrq.gov/sites/default/files/publications/files/resphys-champions.pdf
     September 01, 2015 - Assistance with healing of perineal and sacral wounds in incontinent patients. … Required immobilization for trauma or surgery. … Examples include an unstable thoracic or lumbar spine, multiple traumatic injuries such as pelvic fractures … For example, wound care nurses and physical therapists would discourage UC use to reduce the risk for … Many clinical sites (sputum, urine, wounds, or ulcers) are not sterile.

302. Resident Physicians as Champions in Preventing Device-Associated Infections (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/guides/resphys-champions.pdf
     September 01, 2015 - Assistance with healing of perineal and sacral wounds in incontinent patients. … Required immobilization for trauma or surgery. … Examples include an unstable thoracic or lumbar spine, multiple traumatic injuries such as pelvic fractures … For example, wound care nurses and physical therapists would discourage UC use to reduce the risk for … Many clinical sites (sputum, urine, wounds, or ulcers) are not sterile.

303. Acute Care Learning From Defects
     www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/safety/changes-slides.pptx
     November 01, 2019 - associated with biliary duct obstruction from a gallstone Temperature of 101° F, pulse of 100, and blood pressure … Acute kidney injury and unnecessary lab tests and imaging could have been avoided 3 Piperacillin/tazobactam … Care Learning From Antibiotic-Associated Adverse Events Adverse event: Patient develops acute kidney injury

304. Chapter 4 | Agency for Healthcare Research and Quality
     www.ahrq.gov/prevention/resources/vision/resources/vision4.html
     October 01, 2002 - a limitation in life activities may stem from one or more of genetic conditions, acquired diseases, traumas … health care and health information, and have more exposure to interpersonal violence and intentional injury … therapies. 104 The study included 85 patients with various nervous, circulatory, musculoskeletal, and injury … and other care for people with disabilities is of increasing concern given ongoing cost-containment pressures

305. Final Progress Report: Evaluate the Effects of the Massachusetts Reporting System (pdf file)
     www.ahrq.gov/sites/default/files/2024-11/ridley-report.pdf
     January 01, 2024 - high-injury-severity incidents conformed to the 2006 NQF standard. … Stage 3 or 4 pressure ulcers acquired after admission to a healthcare facility 0.0 G. … Ninety-eight percent of hospitals’ policies recommend disclosure in case of serious injuries believed … , organ injury, pneumonia, pneumothorax, pressure sore, sepsis, shock, urinary tract infection, postoperative … wound infection, and other.

306. 2018 National Healthcare Quality and Disparities Report: Appendix A (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2018qdr-appa5.pdf
     January 01, 2018 - per 1,000 vaginal deliveries without instrument assistance -54.51 -35.20 HCUP 2016 Obstetric trauma … - injury to neonate per 1,000 selected live births 8.00 1.46 HCUP 2016 Accidental puncture or laceration … 18 and over or obstetric admissions 75.00 4.24 HCUP 2016 Reclosure of postoperative abdominal wound … People Relative Difference Z Score Data Source Data Year Reclosure of postoperative abdominal wound … - injury to neonate per 1,000 selected live births 3.3 0.50 HCUP 2016 Adults who had a doctor’s office

307. Appendix A, Pt. 2 | Agency for Healthcare Research and Quality
     www.ahrq.gov/research/findings/final-reports/stpra/stpraapa2.html
     April 01, 2018 - Other risk factors were male sex (OR 2.01, 95% CL 0.44-10.45), injury-operation interval less than … The incidence increased from 13.2% in clean wounds to 70.0% in dirty wounds. … for specific operation Intraoperative recommendations Ventilation Maintain positive-pressure … Risks include effusions (12% or procedures), deep vein thrombosis (1.8%-46%), nerve injuries, and arterial … injury or aneurysm formation.

308. AHRQ’s Safety Program for Nursing Homes: On-Time Falls Prevention | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/fallspx/factraining.html
     November 01, 2017 - Facilitator Training This version of On-Time introduction is for training Facilitators who have not had pressure … It is more difficult for staff to identify which residents are at risk for a fall or pressure ulcer or … electronic reports with input from relevant staff (e.g., nursing assistants, director of nursing [DON], wound … weekly basis and encourage multidisciplinary input (e.g., certified nursing assistants [CNAs], DON, wound … On-Time pressure ulcer prevention reports were integrated into day-to-day workflow.

309. A Unit Guide To Infection Prevention for Long-Term Care Staff | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/resources/guides/infection-prevent.html
     March 01, 2017 - Infections cause pain, injury, disability, and sometimes even death, and can be very expensive to treat … signs, such as— Increased temperature Changes in respiration or pulse rate Changes in blood pressure … resident, if needed, that the law requires the use of safety lancets and needles to prevent needle stick injuries … Make sure that wounds are covered. Contain any urine, stool, or wound drainage. … An LTC facility must have negative pressure rooms and a respiratory fit-test program in order to safely

310. Hypertension Screening for Children Who Are Overweight or Obese: Report (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-0232-fullreport.pdf
     February 01, 2020 - percentile (2) documentation of diastolic blood pressure percentile, (3) classification of blood pressure … Markers of vascular injury can be detected in very young children, demonstrating that the path to cardiovascular … , systolic blood pressure value, diastolic blood pressure value, and both height and weight (necessary … blood pressure, diastolic blood pressure, height, and weight) was 100 percent, with a Kappa statistic … Systolic or diastolic blood pressure values. 30 7.

311. Nursing Intervention to Remove Non-necessary Urinary Catheters
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/building-team-040814.pptx
     January 01, 2013 - remove the catheter shortly after the surgery is completed 27 Assist Healing of Perineal and Sacral Wounds … end-of-life: depends on what the patient perceives as more comfortable 29 Required Immobilization for Trauma … or Surgery Examples include: Unstable thoracic or lumbar spine Multiple traumatic injuries, such … unit (e.g., congestive heart failure receiving diuretics ) Incontinence without sacral or perineal pressure … ICU, or different non-ICU) Partnering with other stakeholders (case managers, physical therapists, wound

312. 162-Example-Completed-Learning-Defects-Tool (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa/162-example-completed-learning-defects-tool.docx
     October 01, 2024 - Current: He was found unconscious at home after a suspected syncopal episode with injury to his chest … First vitals included a blood pressure of 75/40, temperature of 38.5°C, heart rate of 110 beats per minute … His blood pressure continued to remain low, and it was decided to place a central line and begin a vasopressor

313. 2018 National Healthcare Quality and Disparities Report: Appendix A (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2018qdr-appa4.pdf
     January 01, 2018 - - injury to neonate per 1,000 selected live births 4.5 0.67 HCUP 2016 Adults age 40 and over with … - injury to neonate per 1,000 selected live births 7.4 1.33 HCUP 2016 Adults with chronic joint symptoms … health only per 100,000 population 46.1 5.39 HCUP_NEDS 2016 Reclosure of postoperative abdominal wound … - injury to neonate per 1,000 selected live births 6.7 1.24 HCUP 2016 Children 41-80 lb for whom a … sores or irritation in the calendar year 36.3 2.34 MEPS 2016 Reclosure of postoperative abdominal wound

314. Role of the External Coach in Advancing Research Translation in Hospital-Based Performance Improvement (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol2/Advances-Donaldson_87.pdf
     April 23, 2008 - Patient Falls Project aimed to reduce the incidence of patient falls and the severity of fall-related injury … Throughout this phase, coaches sought to understand site priorities (goals/ strategic plans) and pressures … • Implement individualized interventions to prevent falls/reduce injury. … improvements Monitor organizational change over time; analyze falls risk assessment, incidence, and injury … Changes may be explained by the “pressure” of the intervention (continuous reminders; ongoing scheduled

315. Final Topic Refinement Document - Therapeutic Options for Obesity in the Medicare Population (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/research/findings/ta/topicrefinement/obesity_topic-refinement.pdf
     May 22, 2014 - Adverse effects of interventions ● Activity-related injury ● Adverse effects of medication ( diarrhea … Respiratory disease (i.e., asthma, COPD) ● Sleep apnea o BMI o Adverse effects ● Activity-related injuries … Question 1b CMS Intermediate outcomes We are excluding all intermediate outcomes (adherence, blood pressure … outcomes CMS Intermediate outcomes We are excluding all intermediate outcomes (adherence, blood pressure … skinfold thickness and waist circumference; excluding all intermediate outcomes (adherence, blood pressure

316. Quantitative and Qualitative Analysis of Medication Errors: The New York Experience (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Duthie.pdf
     January 01, 2004 - mandatory error reporting programs gather data on errors associated with fatal outcomes or serious injuries … of administration were trapped prior to completion.10 The population above age 65 sustained more injuries … The most significant potential for injury occurred in the transition of a patient across and between … Inaccurate or incomplete data about medication regimens, when undetected, caused patient injuries. … Time pressures—due to limited CT scanner availability; the critical nature of the patient’s condition

317. Table 7: Health and Welfare of the Home and Community-Based Services Population as Measured by 13 Outcome Indicators, 2005 | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/findings/tab7.html
     December 01, 2012 - 5,672 13,799 7,174   Max 38,852 29,161 10,824 48,675 50,219 49,623 36,143 Pressure

318. Resources by Safety Topic | Agency for Healthcare Research and Quality
     www.ahrq.gov/action-alliance/resources/type-harm.html
     September 01, 2025 - Falls Healthcare-Associated Infections Maternal Safety Medication Safety Never Events Opioid Safety Pressure … Center for Disease Control and Prevention (CDC) Stopping Elderly Accidents, Deaths & Injuries (STEADI … Back to Contents Pressure Ulcers AHRQ Preventing Pressure Ulcers in Hospitals: A Toolkit for Improving … Quality of Care This resource assists hospital staff in implementing effective pressure ulcer prevention

319. AHRQ Views: Celebrating the 40th Anniversary of the U.S. Preventive Services Task Force | Agency for Healthcare Research and Quality
     www.ahrq.gov/news/newsletters/e-newsletter/920.html
     July 01, 2024 - 36 states from AHRQ’s Healthcare Cost and Utilization Project focusing on adverse outcomes such as pressure … Epidemiology and clinical outcomes of community-acquired acute kidney injury in the emergency department

320. AHRQ’s Safety Program for Nursing Homes: On-Time Falls Prevention - Facilitator Training: Overview of On-Time (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/fallsprev/ontimefallpxoverview-ig.pdf
     June 02, 2025 - of On-Time This version of On-Time introduction is for training Facilitators who have not had pressure …  It is more difficult for staff to identify which residents are at risk for a fall or pressure … electronic reports with input from relevant staff (e.g., nursing assistants, director of nursing [DON], wound … weekly basis and encourage multidisciplinary input (e.g., certified nursing assistants [CNAs], DON, wound … when On-Time pressure ulcer prevention reports were integrated into day-to-day workflow