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481. Usability Testing and the Relation of Clinical Information Systems to Patient Safety (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Rogers.pdf
     January 01, 2003 - Usability Testing and the Relation of Clinical Information Systems to Patient Safety 365 Usability Testing and the Relation of Clinical Information Systems to Patient Safety Michelle L. Rogers, Emily Patterson, Roger Chapman, Marta Render Abstract Background: The success of clinical information systems depend…

482. Patient Safety Organizations: A Summary of 2014 Profiles (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/npsd/npsd-portfolios-summary-profile-2014.pdf
     January 01, 2014 - Information Form, and Summary of Initial Report Form) and then applying Common Formats for falls, pressure … ulcers, surgery/anesthesia, medications, and blood/ blood products.

483. Standardized infection ratios for central line-associated bloodstream infections and surgical site infections, 2009–2012
     www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/chartbooks/healthyliving/qdr2015-chartbook-healthyliving.pptx
     January 01, 2020 - Centers for Disease Control and Prevention. Meningitis. http://www.cdc.gov/meningitis/index.html. … Centers for Disease Control and Prevention. … Centers for Disease Control and Prevention. … Department of Health and Human Services, Centers for Disease Control and Prevention, National Center … Weight loss also may lead to muscle wasting, infections, and increased risk of pressure ulcers.

484. Improving Patient Safety in Long-Term Care Facilities: Training Modules (pdf file)
     www.ahrq.gov/sites/default/files/publications/files/ltcinstructor.pdf
     June 01, 2012 - Falls Prevention and Management. … He has a pressure ulcer that developed weeks ago and measurements are about the same as last week. … He has a pressure ulcer that developed weeks ago and measurements are about the same as last week. … Each QI effort may have its own intervention to enhance falls prevention and management. … Falls Prevention

485. Serious Reportable Adverse Events in Health Care (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Kizer2.pdf
     December 01, 2000 - Stage 3 or 4 pressure ulcers acquired after admission to a health care facility Excludes progression … facility means any licensed facility that is organized, maintained, and operated for the diagnosis, prevention … Pharmacopeia’s MEDMARXSM system and National Coordinating Council for Medication Error Reporting and Prevention … Prevention strategies can include identifying points in the system of care where protocols should be … These solutions should be focused on systemic prevention strategies as described above.

486. Meeting Minutes, March 2021 | Agency for Healthcare Research and Quality
     www.ahrq.gov/news/events/nac/2021-03-nac/nacmtg031821-minutes.html
     July 01, 2021 - Ex Officio Members and Alternates Present Ileana Arias, Ph.D., Centers for Disease Control and Prevention … revealed improvement in patient safety overall, especially with regard to urinary tract infections and pressure … ulcers for patients in nursing homes.

487. Risk-Based Patient Safety Metrics (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Scanlon_62.pdf
     March 25, 2008 - Although injury-based metrics might aid the prevention of harm, limitations include poor discrimination … For instance, if an injury-based metric identifies a falsely high rate of decubitus ulcers at a hospital … Incidence of adverse drug events and potential adverse drug events: Implications for prevention. … Medication error prevention by clinical pharmacists in two children's hospitals. … National Coordinating Council for Medication Error Reporting and Prevention; 2002.

488. Transitioning Newborns from NICU to Home: Family Information Packet (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/settings/hospitals/nicupacket.pdf
     December 01, 2013 - Transitioning Newborns from NICU to Home: Family Information Packet 13 Transitioning Newborns from NICU to Home Family Information Packet Your Health Coach has prepared this information packet for your family to help explain the medical needs of your newborn as you prep…

489. Transitioning Newborns from NICU to Home: Family Information Packet (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/nicu_toolkit/nicupacket.pdf
     December 01, 2013 - Transitioning Newborns from NICU to Home: Family Information Packet 13 Transitioning Newborns from NICU to Home Family Information Packet Your Health Coach has prepared this information packet for your family to help explain the medical needs of your newborn as you prepare to leave the hospital. A Health Coach h…

490. Chartbook on Hispanic Health Care: Slide Presentation | Agency for Healthcare Research and Quality
     www.ahrq.gov/research/findings/nhqrdr/2014chartbooks/hispanichealth/hisph-slides.html
     March 01, 2020 - restrained daily can become weak, lose their ability to go to the bathroom by themselves, and develop pressure … ulcers or other medical conditions. … Slide 104 Prevention: Receipt of Recommended Vaccinations by Young Children The U.S. … Injury prevention. Maternal and child health. Mental health. Oral health. … = Centers for Disease Control and Prevention.

491. Recommendations to Improve Children’s Health Care Quality Measures: Background Report on the 2012 Process (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/pubs/background-2012/backgrnd2012.pdf
     January 01, 2012 - According to the Centers for Disease Control and Prevention (CDC), sexually transmitted diseases (STDs … Accessed Dec. 7, 2012. 17 Centers for Disease Control and Prevention. … children miss due to illness (CAHMI) 6,3 0081 Pediatric Global Health Scale (CHOP) N/A 7, 3.75 Prevention … 3) (AHRQ) 6,3 4.5, 2 0010 Postoperative wound dehiscence (PDI 11) (AHRQ) 6,3 5, 3.75 0005 Pressure … ulcer rate (PDI 2) (AHRQ) 7,3 6.5, 3.75 0004 Accidental puncture or laceration (PDI 1) (AHRQ) 6,2

492. Global Assessment of Pediatric Patient Safety (GAPPS) Trigger Tool (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-143-fullreport.pdf
     April 01, 2018 - ulcers—that qualify for reduced reimbursement (CMS, 2007). … : "Naloxone administration," “Health care- associated infections: positive C. difficile test,” and "Pressure … ulcer documentation." … Prevention of adverse drug events through computerized surveillance. … Atlanta, GA: Centers for Disease Control and Prevention; 2009.

493. 2018 National Healthcare Quality and Disparities Report Data Sources (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2018qdr-datasources.pdf
     October 01, 2019 - ulcers. … events associated with the hospital stay and not present on hospital admission (in-hospital falls and pressure … ulcers). … After Cardiac Surgery Postoperative Cardiac Event After Non-cardiac Surgery Hospital-Acquired Pressure … Ulcer General 2004-2007 and 2009-2016 Adverse Events Associated With Femoral Artery Puncture for

494. 2022 National Healthcare Quality and Disparities Report Data Sources (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2022qdr-datasources.pdf
     December 01, 2022 - Prevention Quality Indicators: Technical Specifications, AHRQ Quality Indicators, v2020.1 SAS. … References Centers for Disease Control and Prevention. The BRFSS Data User Guide. … Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP). … Healthcare-associated Infection Patients with one or more falls during stay Fall Stays with one or more pressure … ulcer adverse events Pressure Ulcer Venous thromboembolism/pulmonary embolism (VTE/PE) not related

495. 2023 National Healthcare Quality and Disparities Report Data Sources (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2023qdr-data-sources.pdf
     December 01, 2023 - Prevention Quality Indicators: Technical Specifications, AHRQ Quality Indicators, v2020.1 SAS. … Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP). … Atlanta, GA: Centers for Disease Control and Prevention; November 2022. … Healthcare-associated Infection (HAI) Patients with one or more falls during stay Fall Stays with one or more pressure … ulcer adverse events Pressure Ulcer Venous thromboembolism/pulmonary embolism (VTE/PE) not related

496. Final Progress Report: Pursuing Perfection in Pediatric Therapeutics (pdf file)
     www.ahrq.gov/sites/default/files/2024-01/lannon2-report.pdf
     January 01, 2024 - Innovation, the Patient-Centered Outcomes Research Institute, the Centers for Disease Control and Prevention … NPC-QIC Improvement/outcomes Frank G, Walsh KE, Wooton S, et al Impact of a Pressure Injury Prevention

497. A Playbook for Preventing CLABSI and CAUTI in the ICU Setting (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/clabsi-cauti-icu/playbook_revised.pdf
     April 01, 2022 - CLINICAL INDICATIONS for use of external catheters:32 • Stage III or Stage IV or unstageable pressure … ulcers • Moderate to severe incontinence-associated dermatitis • Daily (not hourly) measurement of … ANA CAUTI Prevention Tool. … /ana-cauti-prevention-tool/. … /infection-prevention/ana-cauti-prevention-tool/ https://www.ahrq.gov/hai/tools/cauti-hospitals/index.html

498. Engaging-Nurse-Physician-Patient-Transcript (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/engaging-nurse-physician-patient-transcript.docx
     June 02, 2025 - We've expanded to better chucks, putting in chucks that wick, because we also work with the pressure … ulcer department, our walk nurses to reduce those, and make sure that that wasn't going to affect them … To really get their attention present on the business case for CAUTI prevention. … in CAUTI prevention? … In this case the patient did already have some fall prevention tactics in place, but we did identify

499. Engaging the Nurse, Physician, Patient/Family, CUSP: Learn From Defects | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/cauti-tools/archived-webinars/engaging-nurse-physician-patient-transcript.html
     December 01, 2017 - We've expanded to better chucks, putting in chucks that wick, because we also work with the pressure … ulcer department, our walk nurses to reduce those, and make sure that that wasn't going to affect them … To really get their attention present on the business case for CAUTI prevention. … in CAUTI prevention? … In this case the patient did already have some fall prevention tactics in place, but we did identify

500. Methods (continued, 2) | Agency for Healthcare Research and Quality
     www.ahrq.gov/research/findings/final-reports/ptfamilyscan/ptfamily3a.html
     July 01, 2018 - hospital-associated infections, reducing risk of harm from patient falls, and preventing hospital-associated pressure … ulcers. 99,100 Internal Motivators Empirical work on quality improvement suggests that although