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digital.ahrq.gov/health-it-tools-and-resources/ahrq-funded-project-resources-archives/lessons-learned-successes-and
January 01, 2023 - This review pertains to a project that standardized pressure ulcer data elements and electronic documentation
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/pressure_ulcer_prevention/module5/module5_pressureinjury-msmt_slides.pptx
June 02, 2025 - 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.
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psnet.ahrq.gov/node/49860/psn-pdf
April 01, 2019 - lower mortality within 12 months and fewer complications (such as pneumonia, urinary tract infections,
pressure … ulcers, and thromboembolic events) compared with patients operated on after 48 hours.(7)
Surgery for … ulcers, and significant functional decline. … outcomes and results in fewer
medical complications, including pneumonia, urinary tract infections, pressure … ulcers, and
thromboembolic events.
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www.ahrq.gov/research/publications/ahrq-info-quality-gdlns-update.html
June 01, 2018 - that give easy-to-understand guidance on how to implement quality improvements, such as Preventing Pressure … Ulcers in Hospitals: A Toolkit for Improving the Quality of Care and the AHRQ Health Literacy Universal
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www.ahrq.gov/sites/default/files/wysiwyg/npsd/Data_Submission_Dashboard_Data_2024.xlsx
January 01, 2024 - 10.5%
Surgery or Anesthesia CFER-H V1.1 25,264 9.4%
Surgery or Anesthesia CFER-H V1.2 132,724 5.2%
Pressure … Ulcer CFER-H V1.1 16,374 6.1%
Pressure Ulcer CFER-H V1.2 124,964 4.9%
Device or Medical/Surgical Supply
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psnet.ahrq.gov/node/46404/psn-pdf
December 07, 2017 - Adverse
events included medication errors and hospital-acquired conditions, such as pressure ulcers
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psnet.ahrq.gov/node/39777/psn-pdf
November 04, 2012 - The
most common preventable errors were pressure ulcers—considered a never event—and health
care–associated
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psnet.ahrq.gov/node/45769/psn-pdf
December 21, 2016 - tract infections, central line–associated bloodstream infections,
falls, obstetric adverse events, pressure … ulcers, surgical site infections, ventilator-associated pneumonias,
and postoperative venous thromboembolisms
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/fallsprev/fallpxoverview.pptx
October 01, 2017 - On-Time Overview
5
October 2017
5
On-Time Reports for Four Adverse Events
Four Reports
Pressure Ulcer … Prevention
Pressure Ulcer Healing
Falls Prevention
Preventable Hospital and ED Visits
On-Time Overview … leading clinicians
Reports tested in clinical settings for feasibility and ease of use
Large decline in pressure … ulcer incidence rate seen in Pressure Ulcer Prevention Program Evaluation
October 2017
On-Time Overview
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hcup-us.ahrq.gov/reports/statbriefs/sb237-Patient-Safety-Adverse-Events-2011-2014.pdf
January 01, 2014 - The PSIs focus on adverse events during the
hospital stay (such as pressure ulcers), complications associated … Ulcer Rate Wounds caused by unrelieved pressure on the skin usually
around bony prominences
PSI … ulcers (23.1 percent
decrease). … ulcers
(69.1 percent), death rate in low-mortality DRGs (68.9 percent), and iatrogenic pneumothorax … The 10 risk-adjusted rates contributing to PSI 90 are as follows:
Pressure Ulcer Rate (PSI 03)
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/prevhosp/ontime-preventablehospitaledvisits-overview.pptx
May 01, 2017 - May 2017
On-Time Overview
5
5
On-Time Reports for Four
Adverse Events
Four Reports
Pressure Ulcer … Prevention
Pressure Ulcer Healing
Falls Prevention
Preventable Hospital and ED Visits
May 2017
On-Time … leading clinicians
Reports tested in clinical settings for feasibility and ease of use
Large decline in pressure … ulcer incidence rate seen in Pressure Ulcer Prevention Program Evaluation
May 2017
On-Time Overview
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psnet.ahrq.gov/issue/assessment-nursing-home-reporting-major-injury-falls-quality-measurement-nursing-home-compare
August 24, 2022 - Download Citation
Related Resources From the Same Author(s)
Accuracy of pressure … ulcer events in US nursing home ratings. … September 14, 2022
Accuracy of pressure ulcer events in US nursing home ratings.
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psnet.ahrq.gov/node/45511/psn-pdf
July 21, 2017 - Investigators compared a global measure of safety, which
included pressure ulcers, venous thromboembolism
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psnet.ahrq.gov/node/44388/psn-pdf
October 14, 2015 - The study
looked at four nursing-sensitive adverse outcomes: pressure ulcers, falls with injuries, catheter-associated
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psnet.ahrq.gov/node/45595/psn-pdf
April 19, 2017 - for medical error–related mortality draws attention away from other crucial patient harms,
such as pressure … ulcers and medication safety, both of which rarely contribute to mortality but are of high
priority
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digital.ahrq.gov/document-type/project-sunset-review
January 01, 2023 - This review pertains to a project that standardized pressure ulcer data elements and electronic documentation
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psnet.ahrq.gov/node/45036/psn-pdf
February 15, 2017 - Nearly half of the events were considered preventable,
with the most common types of events including pressure … ulcers, delirium, and medication errors.
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psnet.ahrq.gov/node/43539/psn-pdf
March 26, 2015 - For example, the PSI for pressure ulcers demonstrated a high
false-negative rate, meaning that ICD-10
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psnet.ahrq.gov/issue/technical-rationality-and-decentring-patients-and-care-delivery-critique-unavoidable-context
October 08, 2016 - June 14, 2019
Medical device-related pressure ulcers: a systematic review and meta-analysis
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/d4_combo_bestpracticescover.pdf
June 02, 2025 - 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