-
psnet.ahrq.gov/node/861288/psn-pdf
January 24, 2024 - care) adversely impacts patient safety, contributing to higher incidence of falls,
medication errors, pressure … injuries, and healthcare-associated infections.
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www.ahrq.gov/sites/default/files/wysiwyg/sops/events/webinar/03-nh_webcast-castle.pdf
January 01, 2006 - Hospitals
►Moving, Transferring, or Lifting Residents
►Medication errors
►Falls
►Pressure ulcers
►Sanitation … Patient Safety Culture in Nursing Homes
• Safety culture influences staff as well as residents
► Overall injury
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psnet.ahrq.gov/issue/mr-safety-week
November 17, 2016 - Root cause analysis to identify contributing factors for the development of hospital acquired pressure … injuries. … August 8, 2018
Preventing accidents and injuries in the MRI suite.
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psnet.ahrq.gov/issue/implementation-centers-medicare-medicaid-services-nonpayment-policy-preventable-hospital
September 16, 2020 - The study looked at four nursing-sensitive adverse outcomes: pressure ulcers, falls with injuries, catheter-associated … hospitals had significantly fewer of these hospital-acquired conditions, except for patient falls with injury
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effectivehealthcare.ahrq.gov/sites/default/files/related_files/ems-blood-transfusion-protocol-amendment.pdf
February 04, 2025 - setting
• Physiological indicators (including but not limited to
the following)
o Systolic blood pressure … o Diastolic blood pressure
o Mean arterial pressure
o Heart rate
o Respiratory rate
o Respiratory … /condition, severity,
blood pressure, other indicators), intervention and comparator details (e.g., … Back to the future: whole blood resuscitation of the
severely injured trauma patient. … Joint Trauma System. The Department of Defense Center of Excellence for Trauma.
-
psnet.ahrq.gov/node/49860/psn-pdf
April 01, 2019 - improved
functional independence at 4 and 12 months.(12-14)
Hip fracture is a common and serious injury … , which in turn increases the risk of delirium, thromboembolism, pneumonia,
pressure ulcers, and significant … Injury. 2018;49:1458-1460. [go to
PubMed]
2. Cummings SR, Black DM, Rubin SM. … J Orthop Trauma.
2006;20:172-180. … J Orthop Trauma. 2014;28:e49-e55.
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psnet.ahrq.gov/issue/supporting-perioperative-safety-during-disaster-through-clinical-crisis-education
July 05, 2017 - August 12, 2020
Learning during crisis: the impact of COVID-19 on hospital-acquired pressure … injury incidence. … January 15, 2025
Identifying resilience: a system safety review of trauma and orthopaedic
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psnet.ahrq.gov/node/852447/psn-pdf
August 16, 2023 - palliative care can include inappropriate pain management, preventable hospital
(re)admissions, falls, and pressure … injuries.
-
psnet.ahrq.gov/node/848036/psn-pdf
April 26, 2023 - Issues identified included medical device-related pressure injuries
and device dislodgement, concerns
-
psnet.ahrq.gov/node/45036/psn-pdf
February 15, 2017 - provide intensive
rehabilitation to patients recovering from hospitalization for an acute illness or injury … Nearly half of the events were considered preventable,
with the most common types of events including pressure
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psnet.ahrq.gov/issue/rates-adverse-events-hospitalized-patients-after-summer-time-resident-changeover-united
June 22, 2022 - room hospital accommodation associated with differences in healthcare-associated infection, falls, pressure … March 23, 2012
Injury and death associated with incidents reported to the Patient Safety … Hospitals
Medicine
Medication Errors/Preventable Adverse Drug Events
Nosocomial Infections
Pressure
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www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-194-section-1-tables-1-5.pdf
June 02, 2025 - thunderclap 339.43
Other complicated 339.44
Other
Post-traumatic headache 339.2x
Acute pain due to trauma … seizure 780.33
Other convulsions 780.39
4
Table 4 [=IMG9]: ICD-9-CM Codes to Identify Head Trauma … 852.x
Other/unspecified intracranial hemorrhage following injury 853.x
Intracranial injury of other … 61106
Twist drill hole for subdural or ventricular puncture; for implanting ventricular catheter or pressure … excision of foreign body from brain 61570
Craniectomy or craniotomy; with treatment of penetrating wound
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psnet.ahrq.gov/issue/effects-computerized-decision-support-system-implementations-patient-outcomes-inpatient-care
November 06, 2019 - effective for managing blood glucose and blood transfusions and for preventing venous thromboembolism , pressure … ulcers , acute kidney injury, and incipient clinical deterioration. … June 28, 2023
Implementation of the World Health Organization Trauma Care Checklist Program
-
psnet.ahrq.gov/issue/getting-rid-never-events-hospitals
April 25, 2016 - Never events are devastating and preventable, and health care organizations are under increasing pressure … September 21, 2005
"Near injury" alters procedures at Virginia Mason.
-
hcup-us.ahrq.gov/reports/race/50_state_r_e_rpt.jsp
July 01, 2016 - and Illnesses, Census of Fetal Occupational Injuries, Current Population Survey), DPH Infectious Diseases … Physical Activity, Mental Health, Tobacco Use, High Blood Pressure, Obesity, Stroke, Heart Disease … Asthma, Cancer, Cardiovascular Disease, Diabetes, Obesity, HIV/AIDS, Infant Mortality, Unintentional Injuries … Vehicle Deaths, Deaths of Children 1-17, Deaths of teens 15-17, Tobacco Use, General Nutrition, Blood Pressure … include "ABC's of Heart Attack", "Heart Disease Prevention", "Preventing and Controlling High Blood Pressure
-
psnet.ahrq.gov/issue/exploring-stakeholder-perceptions-around-implementation-operating-room-black-box-patient
November 04, 2020 - mostly supportive of the OR Black Box, but several potential barriers were identified, such as time pressures … WebM&M Cases
Fecal Contamination of the Peritoneum from Laparoscopic Trocar Injury … August 8, 2012
Role of intraoperative cholangiography in avoiding bile duct injury. … March 31, 2010
Laparoscopic bile duct injury: understanding the psychology and heuristics
-
psnet.ahrq.gov/perspective/conversation-paul-h-oneill-mpa
January 01, 2017 - their workforce, I announced we should be an injury-free workplace. … And over the 13 years I was there we got close to achieving zero injuries. … safety, namely to identify as quickly as possible anything gone wrong—including medication errors, pressure … are probably no better than average at all the other things they do, like central line infections and pressure … Were there time pressures in the OR to proceed with no help?
-
hcup-us.ahrq.gov/datainnovations/clinicaldata/ExampleofUsingPOA-CMSHACsusingall-payerdata.jsp
August 01, 2011 - Falls and trauma: private insurance: 0.37; Medicaid: 0.41. … Stage 3 and 4 pressure ulcers: private insurance: 0.32; Medicaid: 1.25. … Falls and trauma: 45-64 year olds: 2.12; 65-84 year olds: 4.35; 85 years and older: 5.80. … Ulcers are:
707.23, pressure ulcer, stage III
707.24, pressure ulcer, stage IV
The ICD-9- … 830-839.99, dislocation
850-854.99, intracranial injury
925-929.99, crushing injury
940-949.99
-
psnet.ahrq.gov/issue/obstetric-quality-and-safety
February 25, 2009 - November 10, 2010
Learning during crisis: the impact of COVID-19 on hospital-acquired pressure … injury incidence.
-
psnet.ahrq.gov/node/866729/psn-pdf
September 18, 2024 - compared with privately insured patients, Medicaid patients experienced significantly
higher rates of pressure … injuries, catheter-related infections, and six-out-of-seven surgery-related safety
indicators.