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61. References | Agency for Healthcare Research and Quality
    www.qualitymeasures.ahrq.gov/hai/pfp/hacrate2013-refs.html
    October 01, 2015 - Injury From Falls Barrett JA, Bradshaw M, Hutchinson K, et al. … Fall and injury prevention (Chapter 10). In: Hughes RG, ed. … Preventing falls and eliminating injury at Ascension Health. … Eliminating birth trauma at Ascencion Health. Jt Comm J Qual Patient Saf 2007;33:15-24. … Pressure Ulcers Agency for Healthcare Research and Quality.

62. Documentation and Coding for Patient Safety Indicators (pdf file)
    www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/b4_combo_documentationcoding.pdf
    March 15, 2016 - PDI 02 Pressure Ulcer Rate (stage III, IV, Unstageable) Diagnosis and site of pressure ulcer must … PSI 18, PSI 19 OB Trauma – Vaginal Delivery With Instrument OB Trauma – Vaginal Delivery Without … X PDI 11 Postoperative Wound Dehiscence Rate X Depth of the wound dehiscence: external/superficial … X PSI 14 Postoperative Wound Dehiscence X Depth of the wound dehiscence: external/superficial vs … PSI 18 PSI 19 OB Trauma – Vaginal Delivery With Instrument OB Trauma – Vaginal Delivery Without

63. C1 Prioritization Matrix (xls file)
    www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/c2_combo_prioritizationworksheetexample.xlsx
    July 01, 2016 - Patient Safety PSI 03 Pressure Ulcer   1.2 1.3 7 $109,870 $ 769,087 N 6 7 7 Y Y Y Y Y PSI 06 Iatrogenic … 13 Postoperative Sepsis 12.7 11.7 15 $49,215 $ 738,225 N 9 7 3 Y Y Y Y Y PSI 14 Postoperative Wound … Accidental Puncture or Laceration 3.2 3.3 1 $22,629 $ 22,629 Y 4 3 7 Y N Y Y Y Obstetric PSI 17 Birth Trauma-Injury … to Neonate   0.0 0.1 0 $88,000 $ - 0 N 2 3 9 Y Y Y Y Y PSI 18 Obstetric Trauma-Vaginal Delivery … Postoperative Sepsis Rate 0.0 16.2 0 $117,815 $ - 0 N 9 10 10 Y Y Y Y Y PDI 11 Postoperative Wound

64. Selected Best Practices and Suggestions for Improvement (pdf file)
    www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/d4u_combo_pdi09-postoprespfailure-bestpractices.pdf
    May 17, 2016 - o Decreased central nervous system input (head injury, ingestion of central nervous system depressant … o Peripheral nerve/neuromuscular junction (spinal cord injury, organophosphate/carbamate poisoning, … expansion exercises with children, such as incentive spirometry, deep breathing, intermittent positive-pressure … breathing, and continuous positive airway pressure. … Noninvasive positive pressure ventilation for acute respiratory failure in children: a concise review

65. Health Care Facility Design Safety Risk Assessment Toolkit | Agency for Healthcare Research and Quality
    www.qualitymeasures.ahrq.gov/patient-safety/settings/hospital/resource/safety-assess.html
    October 01, 2020 - Resources CANDOR Family-Centered Rounds Toolkit MATCH Toolkit NICU Toolkit Pressure … Injury Preventing Pressure Ulcers in Hospitals Re-Engineered Discharge Toolkit QI … The toolkit: Targets six areas of safety—infections, falls, medication errors, security, injuries of

66. BLADDER SCAN – POLICY #2202 12/11/06 (doc file)
    www.qualitymeasures.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/resources/tools/prevent/clinical-faqs.docx
    March 01, 2017 - . · Assistance in healing of open pressure ulcers, skin grafts, and stage III or IV perineal and sacral … wounds for selected residents with urinary incontinence. · To improve comfort for end-of-life care, … Management of the neurogenic bladder for adults with spinal cord injuries. … resident) · After having contact with body fluids or excretions, mucous membranes, nonintact skin and wound … Examples when a suprapubic catheter is used include— · Urethral injuries or trauma · Urethral obstruction

67. Introduction to Communication and Optimal Resolution (CANDOR): Video | Agency for Healthcare Research and Quality
    www.qualitymeasures.ahrq.gov/patient-safety/settings/hospital/candor/videos/introduction.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

68. Peer Support Interaction—Physician: Video | Agency for Healthcare Research and Quality
    www.qualitymeasures.ahrq.gov/patient-safety/settings/hospital/candor/videos/physicians.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

69. Disclosure Conversation with Family: Video | Agency for Healthcare Research and Quality
    www.qualitymeasures.ahrq.gov/patient-safety/settings/hospital/candor/videos/disclosure.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

70. Accountability—Peer to Peer Coaching: Video | Agency for Healthcare Research and Quality
    www.qualitymeasures.ahrq.gov/patient-safety/settings/hospital/candor/videos/accountability.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

71. Communication and Optimal Resolution (CANDOR): Grand Rounds Presentation Video | Agency for Healthcare Research and Quality
    www.qualitymeasures.ahrq.gov/patient-safety/settings/hospital/candor/videos/grpresentation.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

72. Planning for Meetings with Family: Video | Agency for Healthcare Research and Quality
    www.qualitymeasures.ahrq.gov/patient-safety/settings/hospital/candor/videos/meeting.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

73. Table 17D: Intellectual/Developmental Disabilities Subpopulation | Agency for Healthcare Research and Quality
    www.qualitymeasures.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/findings/tab17d.html
    February 01, 2023 - Effectiveness Reviews Facilities Home and Community Resources Findings Report Injuries … 3,252 3,815 3,120 Composite: ACSC Overall 6,079 4,558 5,662 5,312 6,245 5,000 Pressure … Injurious Falls 81 60 90 55 92 60 Outcome Indicator Prevalence of High Blood Pressure … Conditions 3,481 3,208 3,831 3,228 Composite: ACSC Overall 5,719 5,011 6,399 5,136 Pressure

74. Table 17A: National HCBS Population | Agency for Healthcare Research and Quality
    www.qualitymeasures.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/findings/tab17.html
    February 01, 2023 - Effectiveness Reviews Facilities Home and Community Resources Findings Report Injuries … 6,749 9,215 6,184 Composite: ACSC Overall 22,374 14,832 21,534 17,751 23,720 16,492 Pressure … Injurious Falls 316 271 324 280 375 250 Outcome Indicator Prevalence of High Blood Pressure … Conditions 7,298 7,429 9,114 6,570 Composite: ACSC Overall 19,447 18,724 23,221 17,538 Pressure

75. Table 17B: Dually Eligible HCBS Participants | Agency for Healthcare Research and Quality
    www.qualitymeasures.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/findings/tab17b.html
    February 01, 2023 - Effectiveness Reviews Facilities Home and Community Resources Findings Report Injuries … 10,530 7,005 Composite: ACSC Overall 24,760 16,334 23,622 19,729 26,330 18,086 Pressure … Injurious Falls 397 350 396 366 462 324 Outcome Indicator Prevalence of High Blood Pressure … Conditions 8,314 8,522 10,408 7,479 Composite: ACSC Overall 21,408 21,005 25,803 19,316 Pressure

76. Table 17E: Serious Mental Illness Subpopulation | Agency for Healthcare Research and Quality
    www.qualitymeasures.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/findings/tab17e.html
    February 01, 2023 - Effectiveness Reviews Facilities Home and Community Resources Findings Report Injuries … 6,781 8,838 5,914 Composite: ACSC Overall 20,734 15,368 19,563 17,756 23,009 16,087 Pressure … Injurious Falls 253 224 263 220 323 194 Outcome Indicator Prevalence of High Blood Pressure … Conditions 6,956 7,098 7,925 6,580 Composite: ACSC Overall 19,175 17,427 20,509 17,826 Pressure

77. Table 17G: HCBS Population Age 65 | Agency for Healthcare Research and Quality
    www.qualitymeasures.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/findings/tab17g.html
    February 01, 2023 - Effectiveness Reviews Facilities Home and Community Resources Findings Report Injuries … 13,941 8,615 Composite: ACSC Overall 31,820 19,437 32,312 23,141 34,235 21,902 Pressure … Injurious Falls 568 461 588 484 677 430 Outcome Indicator Prevalence of High Blood Pressure … 10,221 11,658 13,626 9,337 Composite: ACSC Overall 25,759 28,549 32,778 23,897 Pressure

78. Table 17F: HCBS Population Ages 18-64 Without Intellectual/Developmental Disabilities or Serious Mental Illness | Agency for Healthcare Research and Quality
    www.qualitymeasures.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/findings/tab17f.html
    February 01, 2023 - Effectiveness Reviews Facilities Home and Community Resources Findings Report Injuries … 5,449 7,139 5,429 Composite: ACSC Overall 23,940 16,507 25,790 18,529 23,803 18,978 Pressure … Injurious Falls 147 123 175 119 170 116 Outcome Indicator Prevalence of High Blood Pressure … Conditions 6,119 6,072 7,171 5,539 Composite: ACSC Overall 21,607 19,235 23,468 19,546 Pressure

79. Table 17C: Medicaid-Only HCBS Participants | Agency for Healthcare Research and Quality
    www.qualitymeasures.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/findings/tab17c.html
    February 01, 2023 - Effectiveness Reviews Facilities Home and Community Resources Findings Report Injuries … 4,111 5,049 3,932 Composite: ACSC Overall 15,281 10,642 14,988 12,306 15,447 12,117 Pressure … Injurious Falls 76 51 101 45 98 47 Outcome Indicator Prevalence of High Blood Pressure … Conditions 4,416 4,102 5,111 4,002 Composite: ACSC Overall 13,885 11,778 15,231 12,519 Pressure

80. Table 6: Categories of Medication Error Classification | Agency for Healthcare Research and Quality
    www.qualitymeasures.ahrq.gov/patient-safety/settings/hospital/match/table-6.html
    August 01, 2012 - Resources CANDOR Family-Centered Rounds Toolkit MATCH Toolkit NICU Toolkit Pressure … Injury Preventing Pressure Ulcers in Hospitals Re-Engineered Discharge Toolkit QI … ordered for patient instead of extended-release E Error that could have caused temporary harm Blood pressure