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41. NPSD Data Spotlight - Patient Safety and COVID-19: A Qualitative Analysis of Concerns During the Public Health Emergency (pdf file)
    healthcare411.ahrq.gov/sites/default/files/wysiwyg/npsd/data/spotlights/spotlight-ptsafety-and-covid-19.pdf
    November 01, 2021 - ulcer o Most advanced stage of pressure ulcer o Stage on admission o Admission skin inspection documented … o Pressure ulcer prevention intervention in place o Secondary patient morbidity • Surgery or anesthesia … Some of these explanatory statements were related to fall and pressure ulcer events, while others were … Pressure Ulcer Event Very busy environment due to COVID-19 crisis and less time and attention paid to … Pressure Ulcer Event Patient is critically ill, intubated, COVID-19 positive, in multisystem organ

42. AHRQ's Quality & Patient Safety Programs by Setting: Hospital | Agency for Healthcare Research and Quality
    healthcare411.ahrq.gov/patient-safety/settings/hospital/index.html
    March 01, 2024 - Ulcers in Hospitals Re-Engineered Discharge Toolkit QI Toolkit Venous Thromboembolism … Preventing Pressure Ulcers in Hospitals is a toolkit that assists hospital staff in implementing effective … pressure ulcer prevention practices through an interdisciplinary approach to care. … Hospitals Training Program supports the training of hospital staff on how to implement AHRQ's Preventing Pressure … Ulcers in Hospitals Toolkit.

43. Best Practices in Pressure Injury Prevention
    healthcare411.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/pressure_ulcer_prevention/module3/module3_pu-bestpractices_slides.pptx
    November 20, 2014 - documentation forms Lacking ways to empower staff to report abnormal skin findings: Consider using Tool 3C: Pressure … Ulcer Identification Pocket Pad. 11 ID Pocket Pad Tool 3C 12 Practice Insight Or note location … 27 Practice Insight EHR Care Plans Triggered Based on Risk Assessment Braden Scale for Predicting Pressure … Sore Risk SENSORY PERCEPTION 1.

44. National Scorecard on Rates of Hospital-Acquired Conditions 2010 to 2015: Interim Data From National Efforts To Make Health Care Safer | Agency for Healthcare Research and Quality
    healthcare411.ahrq.gov/hai/pfp/2015-interim.html
    December 01, 2016 - About 42 percent of this reduction is from adverse drug events, about 23 percent from pressure ulcers … Ulcers MPSMS (2015) Hospital-Acquired Pressure Ulcers 1,190,000 36.3 Surgical Site Infections … Ulcers were modified in 2012 from earlier higher projections. … ulcer, rather than on the incremental cost due to the HAC. … [7] The AHRQ-developed pressure ulcer toolkit and falls toolkit are online.

45. Methods To Estimate the Baseline 2010 PFP National Hospital-Acquired Condition Rate (pdf file)
    healthcare411.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/pfp/pfphac.pdf
    September 01, 2014 - Obstetric Adverse Events PSI OB Trauma in Vaginal Delivery With (PSI 18) and Without Instrument (PSI 19) Pressure … Ulcers MPSMS Hospital-Acquired Pressure Ulcers Surgical Site Infections NHSN SSIs combined for 17 procedures … Ulcers Hospital-Acquired Pressure Ulcers 53.03 62.45 0.85 VAP Ventilator-Associated Pneumonia … Discharges (HCUP) 2010 PFP Measured HACs per 1,000 Discharges Pressure Ulcer MPSMS Hospital-Acquired … Pressure Ulcers 1,317,211 32,750,000 40.220 Surgical Site Infection NHSN SSIs for 17 procedures in

46. NPSD Dashboards | Agency for Healthcare Research and Quality
    healthcare411.ahrq.gov/npsd/data/dashboard/index.html
    October 01, 2023 - Pressure Ulcer Dashboard Details the documentation of increased risk for pressure ulcer following a … risk assessment; and the timing of the first risk assessment for reported pressure ulcers or sDTIs.

47. How To Measure Pressure Injury Rates and Prevention Practices
    healthcare411.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/pressure_ulcer_prevention/module5/module5_pressureinjury-msmt_slides.pptx
    July 02, 2008 - Care plan addressing every deficit on pressure ulcer risk factor assessment has been developed and is … 46 Next Steps Over the next several weeks, we will meet weekly to refine your Action Plan for the Pressure … Ulcer Prevention Program.

48. Saving Lives and Saving Money: Hospital-Acquired Conditions Update | Agency for Healthcare Research and Quality
    healthcare411.ahrq.gov/hai/pfp/2014-final.html
    January 01, 2018 - ulcers, and about 16 percent from catheter-associated urinary tract infections (CAUTIs) ( Exhibit 4 … Most of the deaths averted occurred as a result of reductions in the rates of pressure ulcers and adverse … Ulcers MPSMS (2014) Hospital-Acquired Pressure Ulcers 1,010,000 30.9 Surgical Site Infections … Ulcers were modified in 2012 from earlier higher projections. … ulcer, rather than on the incremental cost due to the HAC. 1 AHRQ Partnership for Patients Web page

49. Methods To Estimate the Baseline 2010 PFP National Hospital-Acquired Condition Rate | Agency for Healthcare Research and Quality
    healthcare411.ahrq.gov/hai/pfp/methods.html
    December 01, 2017 - Adverse Events PSI OB Trauma in Vaginal Delivery With (PSI 18) and Without Instrument (PSI 19) Pressure … Ulcers MPSMS Hospital-Acquired Pressure Ulcers Surgical Site Infections NHSN SSIs combined … Tract Infections 18.80 25.58 0.73 Falls In-Hospital Patient Falls 12.25 14.56 0.84 Pressure … Ulcers Hospital-Acquired Pressure Ulcers 53.03 62.45 0.85 VAP Ventilator-Associated Pneumonia … Ulcer MPSMS Hospital-Acquired Pressure Ulcers 1,317,211 32,750,000 40.220 Surgical Site

50. AHRQ National Scorecard on Hospital-Acquired Conditions: Final Results for 2014 Through 2017 (pdf file)
    healthcare411.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/pfp/Updated-hacreportFInal2017data.pdf
    July 01, 2020 - ulcers/pressure injuries and falls. … ulcers/pressure injuries increased from 2014 to 2015 and then decreased somewhat from 2015 to 2016 … Ulcers/ Pressure Injuries 21.7 23.5 22.7 23.0 6% Surgical Site Infections 2.5 2.5 2.5 2.7 8% … Ulcer MPSMS Hospital-Acquired Pressure Ulcers/Pressure Injuries Surgical Site Infection NHSN SSIs … Ulcer MPSMS Hospital- Acquired Pressure 647,096 21.75 699,790 23.52 676,834 22.75 682,984 22.96

51. AHRQ National Scorecard on Hospital-Acquired Conditions: Updated Baseline Rates and Preliminary Results 2014-2016 (pdf file)
    healthcare411.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/pfp/natlhacratereport-rebaselining2014-2016_0.pdf
    January 01, 2016 - ulcers and falls. … ulcers increased from 2014 to 2016. … Ulcer MPSMS Hospital-Acquired Pressure Ulcers Surgical Site Infection NHSN SSIs for 17 procedures … Ulcer MPSMS Hospital-Acquired Pressure Ulcers 643,230 21.62 Surgical Site Infection NHSN SSIs … Ulcer MPSMS Hospital-Acquired Pressure Ulcers 0643,23 21.62 708,301 23.81 704,906 23.69 Surgical

52. Module 1: Preventing Pressure Injuries in Hospitals (doc file)
    healthcare411.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/pressure_ulcer_prevention/module1/module1_pu-whychange.docx
    July 12, 2017 - Ulcers in Hospitals Toolkit training. … Preventing in-facility pressure ulcers. … Ulcers in Hospitals Toolkit. … Preventing in-facility pressure ulcers. … Preventing in-facility pressure ulcers.

53. Introduction to the Quality Indicators Best Practices Tool (pdf file)
    healthcare411.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/d4_combo_bestpracticescover.pdf
    June 05, 2016 - Best practices forms exist for the following 14 PSIs: • PSI 03 Pressure Ulcer Rate • PSI 05 Retained … 03 Neonatal Blood Stream Infection Rate • PDI 01 Accidental Puncture or Laceration Rate • PDI 02 Pressure … Ulcer Rate • PDI 03 Retained Surgical Item or Unretrieved Device Fragment Count • PDI 05 Iatrogenic

54. AHRQ National Scorecard on Hospital-Acquired Conditions: Updated Baseline Rates and Preliminary Results 2014-2017 (pdf file)
    healthcare411.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/pfp/hacreport-2019.pdf
    January 01, 2019 - ulcers/pressure injuries and falls. … ulcers/pressure injuries increased from 2014 to 2015 and then decreased somewhat from 2015 to 2016 … Ulcers/ Pressure Injuries 21.7 23.5 22.7 23.0 6% 17.4 Surgical Site Infections 2.5 2.5 2.5 … Ulcer MPSMS Hospital-Acquired Pressure Ulcers/Pressure Injuries Surgical Site Infection NHSN SSIs … Ulcer MPSMS Hospital- Acquired Pressure 647,096 21.75 699,790 23.52 676,834 22.75 682,984 22.96

55. Clinical Practice Guidelines Archive | Agency for Healthcare Research and Quality
    healthcare411.ahrq.gov/prevention/guidelines/archive.html
    July 01, 2018 - Pressure Ulcer Prevention Clinical Guide / Quick Reference Guide Consumer Version: English / Spanish … Pressure Ulcer Treatment Clinical Guide / Quick Reference Guide Consumer Version: English / Spanish

56. Updated Information on the Annual Hospital-Acquired Condition Rate: 2011 and 2012 (pdf file)
    healthcare411.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/pfp/updatedhacrateinfo.pdf
    June 01, 2014 - Trauma in Vaginal Delivery With (PSI 18) and Without Instrument (PSI 19) 82,000 2.51 77,000 2.36 Pressure … Ulcer MPSMS Hospital-Acquired Pressure Ulcers 1,320,000 40.41 1,300,000 39.43 Surgical Site Infection

57. Estimating the Additional Hospital Inpatient Cost and Mortality Associated With Selected Hospital-Acquired Conditions | Agency for Healthcare Research and Quality
    healthcare411.ahrq.gov/hai/pfp/haccost2017.html
    November 01, 2017 - Pressure Ulcers. Surgical Site Infections. Venous Thromboembolism. … Ulcers          Surgical Site Infections          Ventilator Associated Pneumonia          Venous … Ulcers Surgical Site Infections (SSI) Venous Thromboembolism (VTE) Ventilator-Associated Pneumonia … Pressure Ulcers A new pressure ulcer developed during a stay, or Stage 1 or 2 pressure ulcer(s) present … ulcer.

58. C1 Prioritization Matrix (xls file)
    healthcare411.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 … Y N Pediatric PDI 01 Accidental Puncture 0.3 0.6 1 $41,204 $ 41,204 N 9 9 9 Y Y Y Y Y PDI 02 Pressure … Ulcer 0.0 0.2 0 $85,344 $ - 0 N 6 6 6 Y Y Y Y Y PDI 05 Iatrogenic Pneumothorax Rate 0.0 0.1 0

59. Toolkit for Using the AHRQ Quality Indicators | Agency for Healthcare Research and Quality
    healthcare411.ahrq.gov/patient-safety/settings/hospital/resource/qitool/index.html
    March 01, 2017 - Ulcers in Hospitals Re-Engineered Discharge Toolkit QI Toolkit Venous Thromboembolism … detailed information on best practices for selected indicators Introduction PDF [248.26 KB] PSI03 Pressure … Ulcer PDF [327 KB] PSI05 Foreign Body PDF [133.68 KB] PSI06 Pneumothorax PDF [130.62 KB] PSI07 Central … PDF [61.6 KB] IQI: Mortality Review PDF [115.84 KB] PDI01 Accidental Puncture PDF [61.67 KB] PDI02 Pressure … Ulcer PDF [109.9 KB] PDI03 Foreign Body PDF [95.97 KB] PDI05/NQI01 Iatrogenic Pneumothorax PDF [79.9

60. AHRQ's Quality & Patient Safety Programs by Setting: Long-Term Care | Agency for Healthcare Research and Quality
    healthcare411.ahrq.gov/patient-safety/settings/long-term-care/index.html
    September 01, 2021 - Safety Program for Nursing Homes: On-Time Pressure Ulcer Prevention is a team training curriculum to … help nursing homes with electronic medical records reduce the occurrence of pressure ulcers.