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  1. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Mohr.pdf
    February 01, 2004 - Because of the age of pediatric patients, when an error leads to injury it may have an impact on the … No complete loss of consciousness -- mom caught him with no head injury sustained. … post-term newborn infant with mild respiratory distress syndrome requiring continuous positive airway pressure … The occurrence of an error did not imply harm or injury to the patient.
  2. www.ahrq.gov/practiceimprovement/systemdesign/leancasestudies/lean-case2.html
    November 01, 2014 - Participation is required in the following priority areas: falls and fall injuries, pressure ulcers, … For example, in 2008 the national system launched a campaign to have zero preventable injuries or deaths … , the department was working toward certification as an American College of Surgeons (ACS) Level II Trauma … The ED successfully launched a trauma center and identified a new director in early 2010. … Staff perceived a shift of work to other staff because of the pressures of Lean process.
  3. Imp-Handouts (pdf file)

    www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/prevhosp/imp-handouts.pdf
    June 28, 2017 - Report data help identify residents with new ADL decline, fall risk, or fall injury, therefore at risk … Rehab Managers Weekly huddle to review residents at risk for ADL decline or fall or with fall injury … 2 or above pressure ulcers at risk for infection who potentially require hospitalization/ED visit … Reports provide information about current and changing risks for pressure ulcer healing and can aid … Discharge diagnoses were dehydration, fall with injury, cellulitis, and angina.
  4. www.ahrq.gov/research/findings/studies/index.html?page=165
    January 01, 2024 - Keywords: Blood Pressure, Heart Disease and Health, Cardiovascular Conditions, Racial and Ethnic Minorities … This study used data on mass shootings to examine the proximity of adult trauma centers, pediatric trauma … centers (TCs), and non–trauma center hospitals to such events. … Work system barriers and facilitators in inpatient care transitions of pediatric trauma patients. … systems or e-cigarettes) among children and adolescents may help decrease tobacco-related illness and injury
  5. www.ahrq.gov/sites/default/files/wysiwyg/ncepcr/webinars/behavioral-health-primary-care-webinar.pptx
    March 07, 2024 - I would’ve never thought to refer him to it because of the level of his brain injury” Tack, E., Lakhtakia … There are key SSDOH in driving blood pressure disparities for example, like lack of access to healthy
  6. www.ahrq.gov/research/findings/nhqrdr/2014chartbooks/hispanichealth/hisph-slides-pt3.html
    May 01, 2018 - Slide 10 Adults who needed care right away for an illness, injury, or condition in the last 12 months … ) among Hispanics, 2002-2012 Image: Graphs show adults who needed care right away for an illness, injury … Slide 11 Children who needed care right away for an illness, injury, or condition in the last 12 … restrained daily can become weak, lose their ability to go to the bathroom by themselves, and develop pressure … Importance: Many patients who receive home health care are recovering from an injury or illness and
  7. Slide 1 (ppt file)

    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/preventing-cauti-engaging-clinicians-051413.ppt
    January 01, 2013 - Reduce antibiotic use Reduce potential of increased resistance and Clostridium difficile disease Reduce trauma … (mechanical complications): Metal and urethral injury Hematuria Hospitalists Geriatricians Infectious … Inappropriate urinary catheter use may negatively affect the surgeon’s profile Risk of infection and trauma … They may lead to urinary tract infections and cause mechanical trauma to the urethra and bladder. … They also immobilize patients—increasing the likelihood of pressure ulcers, falls and prolonged inpatient
  8. www.ahrq.gov/research/findings/studies/index.html?page=70
    January 01, 2024 - Keywords: Blood Pressure, Prevention, Evidence-Based Practice, Cardiovascular Conditions Barreto … describe the development and feasibility of a multidisciplinary approach to caring for acute kidney injury … This study investigated whether pre-dialysis systolic blood pressure (preSBP) and interdialytic weight
  9. www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Reiling.pdf
    January 01, 2004 - Unfortunately, a small portion of errors do result in an “adverse event”—an injury caused by medical … For example, a 1991 Harvard Medical Practice Study reported that 69 percent of injuries suffered by … hospitalized patients in New York State in 1984 were the result of errors, and nearly 14 percent of these injuries … It may elevate blood pressure, increase pain, alter quality of sleep, and reduce overall perceived
  10. www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/chartbooks/patientsafety/2018qdr-patsaf-chartbook.pptx
    October 01, 2019 - events include postoperative infection (acute or early deep), dehiscence, necrosis, hematoma, nerve injury … events include postoperative infection (acute or early deep), dehiscence, necrosis, hematoma, nerve injury … from the date of the index admission; or mechanical complications, periprosthetic joint infection, or wound … from the date of the index admission; or mechanical complications, periprosthetic joint infection, or wound … treatment with mortality in the United States: a secondary analysis of the Global Burden of Diseases, Injuries
  11. www.ahrq.gov/workingforquality/events/webinar-federal-agency-alignment-to-the-six-priorities.html
    November 01, 2016 - We work to prevent the leading cause of illness, injury, disability, and death. … We've displayed performance on the ABCs, which are appropriate aspirin use, blood pressure control, control … tobacco and got preventive care, we still have to address modifiable risk factors, including blood pressure … their profit according to the extent to which they're able to assist their members in controlling blood pressure
  12. www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-0197-fullreport.pdf
    November 01, 2019 - These complications include compromised airway, hypoxia leading to central nervous system injury, and … moderate and deep sedation carry risk of airway compromise, hypoxia resulting in central nervous system injury … These risks include dental trauma; airway edema (swelling of the windpipe); vocal cord spasm or injury … ; regurgitation of stomach contents with subsequent aspiration (inhalation) pneumonia; injury to arteries … , veins, or nerves; alterations in blood pressure; and/or irregular heart rhythms (Society for Pediatric
  13. www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2022qdr-appendix-combined.pdf
    October 25, 2022 - HCUP 2019 Home health care patients whose management of oral medications improved OASIS 2020 Birth traumapressure ulcer MDS 2019 Low-risk, long-stay nursing home residents with a catheter inserted and left … MDS 2019 Short-stay nursing home patients with pressure ulcers that are new or worsened MDS 2018 … HCUP 2019 Home health care patients whose management of oral medications improved OASIS 2020 Birth trauma … MDS 2019 Short-stay nursing home patients with pressure ulcers that are new or worsened MDS 2018
  14. www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2023-NHQDR-appendixes-ACDE.pdf
    January 01, 2023 - 1,000 elective-surgery admissions, age 18 and over HCUP 2020 Reclosure of postoperative abdominal wound … 2020 Home health care patients whose management of oral medications improved OASIS 2021 Birth trauma … stages 2-4 pressure ulcer or unstageable pressure ulcer MDS 2021 Low-risk, long-stay nursing home … 2020 Home health care patients whose management of oral medications improved OASIS 2021 Birth trauma … stages 2-4 pressure ulcer or unstageable pressure ulcer MDS 2021 Low-risk, long-stay nursing home
  15. www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2023-NHQDR-appendixes-ACDE-rev.pdf
    January 01, 2023 - 1,000 elective-surgery admissions, age 18 and over HCUP 2020 Reclosure of postoperative abdominal wound … 2020 Home health care patients whose management of oral medications improved OASIS 2021 Birth trauma … stages 2-4 pressure ulcer or unstageable pressure ulcer MDS 2021 Low-risk, long-stay nursing home … 2020 Home health care patients whose management of oral medications improved OASIS 2021 Birth trauma … stages 2-4 pressure ulcer or unstageable pressure ulcer MDS 2021 Low-risk, long-stay nursing home
  16. www.ahrq.gov/sites/default/files/wysiwyg/health-literacy/3rd-edition-toolkit/health-literacy-education-presentation-tool-3a.pdf
    January 01, 2019 - Afra wound up with chlamydia, which damaged her fallopian tubes and resulted in her not being able to … • Ed wound up in the hospital from taking both medicines. 16 Presenter Notes Presentation Notes … Ed wound up in the hospital from taking both medicines. … Technical Terms Say Not Pain killer Analgesic Swelling Inflammation Feverish Febrile High blood pressure … Hypertension Wound Lesion Injury Insult Presenter Notes Presentation Notes We’ve been trained in
  17. www.ahrq.gov/research/findings/nhqrdr/2014chartbooks/womenhealth/womenh-slides.html
    March 01, 2020 - Importance: About 70 million American adults (29%) have high blood pressure ( Nwankwo, et al., 2013 … High blood pressure costs the Nation $46 billion each year. … mostly attributable to sudden unexpected infant death (SUID), congenital anomalies, infection, and injury … Web-based Injury Statistics Query and Reporting System (WISQARS) [Online] (2013). … http://www.cdc.gov/injury/wisqars/index.html . Accessed September 1, 2015.
  18. www.ahrq.gov/sites/default/files/wysiwyg/npsd/npsd-portfolios-summary-profile-2014.pdf
    January 01, 2014 - The term safety refers to reducing risk from harm and injury, whereas the term quality suggests striving … Information Form, and Summary of Initial Report Form) and then applying Common Formats for falls, pressure
  19. www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/prescribers-facilitator-guide.docx
    June 01, 2021 - unanticipated event in a health care setting resulting in death or serious physical or psychological injury … Half of the respondents in that study reported feeling pressure to give a medication for which they questioned
  20. www.ahrq.gov/sites/default/files/2024-07/congdon-magilvy-report.pdf
    January 01, 2024 - homes include indicators of physical care, such as rate of restraint use (physical and chemical), pressure … sore prevalence, urinary tract infections, pain, injuries, hospitalizations, functional decline; staffing … follows: .626 for urinary tract infections, .528 for weight loss, .853 for tube feeding, .570 for pressure … indicated that NHs with higher total hours of care had higher rates of urinary tract infections and pressure

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