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101. Preventing Falls and Injury While in the Hospital (pdf file)
     digital.ahrq.gov/sites/default/files/docs/publication/action-fall-prevention-ed-tool.pdf
     June 16, 2021 - Preventing Falls and Injury While in the Hospital Preventing Falls and Injury While in the … factors for falling: R Dizziness or fainting R Seizure disorder R Irregular heartbeats R Low blood pressure … Falls can lead to broken bones and head injuries that can slow your recovery and keep you from returning … R PT recommendations: Keeping you safe if you are forgetful To prevent falls and injuries, your plan … R A low bed helps prevent fall injuries.

102. A Laceration that Needed a Proper Exam, Not an X-Ray | PSNet
     psnet.ahrq.gov/web-mm/laceration-needed-proper-exam-not-x-ray
     November 25, 2020 - In a study of 165 patients undergoing wound exploration after hand laceration, 32% of tendon injuries … Explore wounds for evidence of arterial bleeding, foreign body, tendon injury, and arthrotomy. … A blood pressure cuff applied proximal to the wound is another option. … If a tendon injury cannot be ruled out after wound exploration and functional testing, assume an occult … Medico-legal risks associated to hand and wrist trauma.

103. Impact of AHRQ’s Patient Safety Tools: Challenge Competition | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/about/challenge-competition.html
     February 01, 2024 - Toolkit for Improving Quality of Care to decrease Patient Safety Indicator 03 (PSI-03) (reportable pressure … injuries) by 92% and save an estimated $350,000 in avoidable costs. … Implementation focused on MU Health Care’s 390-bed University Hospital, the only level I trauma center … injury rates and PSI-03 among Vizient peers to the top decile over the course of 2 years. … Injuries by 92%."

104. Surgeon commitment to trauma care decreases missed injuries. | PSNet
     psnet.ahrq.gov/issue/surgeon-commitment-trauma-care-decreases-missed-injuries
     June 15, 2012 - Study Surgeon commitment to trauma care decreases missed injuries. … Surgeon commitment to trauma care decreases missed injuries. … Surgeon commitment to trauma care decreases missed injuries. … March 9, 2009 Interactive effects of nurse-experienced time pressure and burnout on patient … June 25, 2009 Missed injuries in trauma patients: a literature review.

105. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/836976/psn-pdf
     April 27, 2022 - Her wounds led to significant blood loss. … arterial blood pressure.23 Elevated compartment pressure leads initially to venous congestion, then … transferred to the OR for surgical exploration, debridement, and possible closure of her traumatic wounds … Injury. 2017;48:S22–S25. … Injury. 1994;25(6):379–81. [Free full text] 31. Günal I, Köse N, Gürer D.

106. Describe How a Plan or Provider Can Influence a Quality Measure | Agency for Healthcare Research and Quality
     www.ahrq.gov/talkingquality/translate/labels/describe.html
     January 01, 2023 - Massachusetts General Hospital (MGH) URL: https://www.massgeneral.org/quality-and-safety/patient-safety/pressure-injury-prevalence … (To view complete information, go to https://www.massgeneral.org/quality-and-safety/patient-safety/pressure-injury-prevalence … Overall, the rate of patients who have pressure ulcers at MGH is low. … that nurses have the necessary knowledge for skin assessment and intervention they attend a Phase I Wound … Bed surface is a key factor in preventing pressure ulcers.

107. Success in hospital-acquired pressure ulcer prevention: a tale in two data sets. | PSNet
     psnet.ahrq.gov/issue/success-hospital-acquired-pressure-ulcer-prevention-tale-two-data-sets
     May 17, 2018 - Success In Hospital-Acquired Pressure Ulcer Prevention: A Tale In Two Data Sets. … Success In Hospital-Acquired Pressure Ulcer Prevention: A Tale In Two Data Sets. … July 2, 2019 Differences in the reporting of care-related patient injuries to existing … injury incidence. … injury policy.

108. Appendix B. Prioritize Opportunities for Improvement | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/hospital/resource/pressureinjury/guide/apb.html
     October 01, 2017 - Pressure Injury Prevention Program Implementation Guide Appendix B. … Injury Prevention Program Implementation Guide Overview Get Ready Pressure Injury Prevention Program … Firm up your Implementation Team Leader, Core Team, Pressure Injury Team, and pressure injury champions … They might include ideas such as universal pressure injury precautions, pressure injury risk screening … Alternatively, you might decide to group ideas under the major categories in the pressure injury clinical

109. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/46524/psn-pdf
     October 18, 2017 - Pressure Injury Prevention in Hospitals Training Program. … https://psnet.ahrq.gov/issue/pressure-injury-prevention-hospitals-training-program Pressure ulcers are … designed to help hospitals implement practice and process improvements to reduce the occurrence of pressure … https://psnet.ahrq.gov/issue/pressure-injury-prevention-hospitals-training-program https://psnet.ahrq.gov … /issue/preventing-facility-pressure-ulcers-patient-safety-strategy-systematic-review https://psnet.ahrq.gov

110. On-Time Pressure Ulcer Healing: Introduction | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/pruhealing/intro.html
     December 01, 2017 - , and other clinical details known to affect wound healing, such as nutrition, temperature, and ulcer … For example, during wound rounds, the wound nurse may prefer having treatment details for each ulcer … Healing Report ), and the entire team may attend wound rounds with a copy of the Weekly Wound Rounds … Pressure Ulcers At Risk for Delayed Healing Weekly Wound Rounds Report Weekly Pressure … Advisory Panel and Pan Pacific Pressure Injury Alliance.

111. Psn-Pdf (pdf file)
     psnet.ahrq.gov/node/866261/psn-pdf
     July 10, 2024 - However, it is associated with several positioning injuries. … In rare circumstances, significant hypoperfusion with ischemic injury to the calf muscles may result … Pressures above 30 mm Hg are worrisome, but the diagnosis can be easily missed if the pressure is measured … Early evaluation and fasciotomy by an orthopedic or trauma surgeon are key to preventing permanent injury … Int Wound J. 2008;5(2):315-328. [Free full text] 6. Matsen FA 3rd.

112. Spotlight Case July 2008 (ppt file)
     psnet.ahrq.gov/sites/default/files/import/webmm.ahrq.gov.230_slideshow.ppt
     December 01, 2010 - injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, … Slough or eschar may be present on some parts of the wound bed. … Suspected deep tissue injury Purple or maroon localized area of discolored intact skin or blood-filled … Ulcers (2) Skin changes can appear days after the tissue injury Pressure ulcers often cause pain initially—may … Guidelines for the prevention of pressure ulcers. Wound Rep Reg. 2008; 16:151-168.

113. Spotlight (pdf file)
     psnet.ahrq.gov/sites/default/files/2022-04/final_spotlight_case_and_commentatry_io_line_extravasation-04.08.2022.pdf
     January 01, 2022 - shock or from traumatic brain injury … , or through skin with overlying infection or burn injury … mean arterial blood pressure … unreliable and rarely used in pediatrics due to differences in normal resting compartment pressures … transferred to the OR for surgical exploration, debridement, and possible closure of her traumatic wounds

114. Organisational strategies to implement hospital pressure ulcer prevention programmes: findings from a national survey. | PSNet
     psnet.ahrq.gov/issue/organisational-strategies-implement-hospital-pressure-ulcer-prevention-programmes-findings
     June 02, 2021 - Study Organisational strategies to implement hospital pressure ulcer prevention programmes … Organisational strategies to implement hospital pressure ulcer prevention programmes: findings from a … Hospital-acquired pressure ulcers are considered a never event and can result in loss of payment … injury incidence. … injury.

115. Self-Assessment Worksheet for Pressure Ulcer Healing | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/pruhealing/saworksheet.html
     December 01, 2017 - the On-Time electronic reports into current workflow to help inform pressure ulcer wound interventions … , and Pan Pacific Pressure Injury Alliance’s Prevention and Treatment of Pressure Ulcers Guidelines … ___ Wound, Ostomy, and Continence Nurses Society (WOCN) Pressure Ulcer Guidelines ___ Other (specify … ___ ___   Selection of dressings based on wound characteristics? … ___ ___   Appropriate use of topical wound agents?

116. Hospital Resources | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/hospital/resource/about.html
     December 01, 2017 - Process Millions of patients visit hospital emergency departments (EDs) each year for a variety of injuries … Pressure Injury Prevention in Hospitals Training Program AHRQ developed the Pressure Injury Prevention … injury prevention program. … Preventing Pressure Ulcers in Hospitals Each year, more than 2.5 million people in the United States … develop pressure ulcers.

117. Appendix A. RACI Chart | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/hospital/resource/pressureinjury/guide/apa.html
     October 01, 2017 - Pressure Injury Prevention Program Implementation Guide Appendix A. … RACI Chart Previous Page Next Page Table of Contents Pressure Injury Prevention Program … Implementation Guide Overview Get Ready Pressure Injury Prevention Program Phases Appendix A

118. Missed Compartment Syndrome after Steep Lithotomy Position for Laparoscopic Gynecological Surgery | PSNet
     psnet.ahrq.gov/web-mm/missed-compartment-syndrome-after-steep-lithotomy-position-laparoscopic-gynecological
     January 29, 2021 - However, it is associated with several positioning injuries. … In rare circumstances, significant hypoperfusion with ischemic injury to the calf muscles may result … Pressures above 30 mm Hg are worrisome, but the diagnosis can be easily missed if the pressure is measured … Early evaluation and fasciotomy by an orthopedic or trauma surgeon are key to preventing permanent injury … Int Wound J . 2008;5(2):315-328. [ Free full text ] Matsen FA 3rd.

119. Under Pressure: Tracheostomy Cuff Over Inflation Leading to Tissue Necrosis and Cuff Rupture | PSNet
     psnet.ahrq.gov/web-mm/under-pressure-tracheostomy-cuff-over-inflation-leading-tissue-necrosis-and-cuff-rupture
     March 15, 2023 - The patient subsequently underwent surgical repair of the tracheal injury. … obstruction (e.g., obstructive sleep apnea; stridor and air hunger due to vocal cord paralysis or neck trauma … intubate, ventilatory support for neuromuscular disease, and as an adjunct to head/neck surgery or trauma … preventable through careful procedural and post-placement care. 6 Patient-related risk factors that affect wound … injuries can occur due to local tissue damage caused by tissue ischemia at high cuff pressures. 15

120. Microsoft PowerPoint - FINAL Spotlight Case_Under Pressure.pptx (pdf file)
     psnet.ahrq.gov/sites/default/files/2023-06/under_pressure.pdf
     January 01, 2023 - obstruction (e.g., obstructive sleep apnea; stridor and air hunger due to vocal cord paralysis or neck trauma … intubate, ventilatory support for neuromuscular disease, and as an adjunct to head/neck surgery or trauma … fistulas.6,7 – With the use of the Seldinger technique, complications from esophageal or carotid injuries … Indications, Complications and Risk Factors of Tracheostomy (4) • Patient-related risk factors that affect wound … blood flow at cuff pressures over 50 cm H20.15 • Stenosis, fistulas, and other tracheal injuries can