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patientregistry.ahrq.gov/patient-safety/settings/hospital/candor/modules/facguide3/apb.html
August 01, 2022 - Opportunity Guidance
AHRQ Grants Policy Notices
AHRQ Informed Consent & Authorization Toolkit for Minimal Risk … Leadership and Culture:
Are governance/senior leaders regularly and thoroughly briefed on risks and … Are patient safety risks, hazards, and opportunities discussed and documented at board meetings? … Is a risk manager available at all times to respond to patient safety incidents?
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patientregistry.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/pressure_ulcer_prevention/module4/module4_pu-implementation_slides.pptx
November 20, 2014 - Conducting pressure injury risk
assessments.
Planning care for risk prevention. … Unit staff tell the Wound Care Team about high-risk patients or if skin problems occur. … Page 65
23
Electronic Health Record Opportunities
What information about pressure injury risk factors … logical place in the record to collect, organize, and assess information about patient pressure injury risk … plan/documentation
Staff Education: RN, CEO, CNO, PCT
2-hour didactic competency training:
Braden risk
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patientregistry.ahrq.gov/patient-safety/settings/ambulatory/index.html
July 01, 2022 - Opportunity Guidance
AHRQ Grants Policy Notices
AHRQ Informed Consent & Authorization Toolkit for Minimal Risk … It is a customizable "train the trainer" program plus specialized tools to reduce risks to patient safety … Toolkit to Engage High-Risk Patients in Safe Transitions Across Ambulatory Settings is designed to help
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patientregistry.ahrq.gov/talkingquality/measures/understand/patient-comments.html
February 01, 2016 - Opportunity Guidance
AHRQ Grants Policy Notices
AHRQ Informed Consent & Authorization Toolkit for Minimal Risk … J Risk Uncertain 1997;14(3):235–57. [4] Schwartz LM, Woloshin S, Black WC, Welch HG. … What does it mean to understand a risk? Evaluating risk comprehension. … Risk as feelings. Psychol Bull 2001 Mar;127(2):267-86. [7] Redelmeier DA, Rozin P, Kahneman D.
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patientregistry.ahrq.gov/nhguide/toolkits.html
September 01, 2017 - Opportunity Guidance
AHRQ Grants Policy Notices
AHRQ Informed Consent & Authorization Toolkit for Minimal Risk … Residents and their family members may not know how antibiotics should be used or understand the risks … them understand what the nursing home is doing to make sure antibiotics are used properly, what the risks
-
patientregistry.ahrq.gov/hai/cusp/videos/index.html
September 01, 2019 - Opportunity Guidance
AHRQ Grants Policy Notices
AHRQ Informed Consent & Authorization Toolkit for Minimal Risk … and Independent Input Identify Your Unit's Safety Issues Develop a Plan of Action How Will You Know Risk … Identifying Contributing Factors What Will You Do to Reduce the Risk of Recurrence?
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patientregistry.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/strategies/medication/safemedication.pptx
May 01, 2017 - Admin.
3
High-Alert Medications1
High-alert medications are “drugs that bear a heightened risk of … These medications require special safeguards to reduce the risk of errors, such as the following:
Improving … Ensures a shared mental model of plan of care and perceived risks—
between shifts
between units
between … Admin.
15
Key Safety Elements: Patient and Family Engagement
Discuss risks and benefits of oxytocin … Admin.
26
Key Safety Elements: Patient and Family Engagement
Discuss risks and benefits of intrapartum
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patientregistry.ahrq.gov/evidencenow/heart-health/smoking/pcor.html
August 01, 2018 - Opportunity Guidance
AHRQ Grants Policy Notices
AHRQ Informed Consent & Authorization Toolkit for Minimal Risk … Resource description: This EvidenceNOW fact sheet provides an overview of PCOR findings about the risks
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patientregistry.ahrq.gov/news/newsletters/e-newsletter/876.html
August 01, 2023 - Opportunity Guidance
AHRQ Grants Policy Notices
AHRQ Informed Consent & Authorization Toolkit for Minimal Risk … monitoring, also based on the systematic review, found postpartum home monitoring significantly reduced the risk … Implementation of suicide risk estimation analytics to support mental health care for quality improvement … Factors associated with lung cancer risk factor documentation. … Adapting an electronic STI risk assessment program for use in pediatric primary care.
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patientregistry.ahrq.gov/research/findings/final-reports/index.html?page=2
September 01, 2018 - Planning
(7)
Nursing Homes
(7)
Patient Safety Measure Development and Implementation
(7)
Risk … Patient Safety Tools Publication Date: April 2016
Developing and Disseminating a Patient Safety Risk … Grant Number: R13 HS 021824 Topic(s): Detection/Triggers, Healthcare Facility Design, Risk Assessment … Development of a Community-Wide Real-Time Health Information Exchange–Based Hospital Readmission Risk … Grant Number: R21 HS 022578 Topic(s): Patient Safety Tools, Risk Assessment Publication Date: September
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patientregistry.ahrq.gov/patient-safety/settings/hospital/fall-prevention/webinar/slides.html
June 01, 2018 - Slide 18
Challenge
Inadequate Risk Assessments and Reassessments
Image of young man with clipboard … and image of rubber stamp
Slide 19
Opportunity
Accurate and effective risk assessments
Employing … critical thinking and clinical judgment
Consistency in approach
Identifying and communicating risk … possible time
Slide 20
Tools
Morse Fall Scale (3H)
STRATIFY Scale (3G)
Medication Fall Risk … target education to address gaps in staff knowledge
Environmental safety
Medications associated with risk
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patientregistry.ahrq.gov/patient-safety/resources/learning-lab/ehrll-long-desc.html
April 01, 2022 - Opportunity Guidance
AHRQ Grants Policy Notices
AHRQ Informed Consent & Authorization Toolkit for Minimal Risk … highly reliable systems that address communication and coordination challenges that pose patient safety risks … Lessons learned suggest future work should involve multidisciplinary teams, risk-based stratification … clinical pathway can reduce the deep surgical site infection rate after posterior spinal fusion in high-risk … Risk factors for increased blood loss during spinal fusion for children with neuromuscular scoliosis
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patientregistry.ahrq.gov/funding/grantee-profiles/grtprofile-huang.html
December 01, 2023 - Opportunity Guidance
AHRQ Grants Policy Notices
AHRQ Informed Consent & Authorization Toolkit for Minimal Risk … If a person is colonized with MRSA, they have an increased risk of developing a MRSA infection and also … Removing MRSA from the patient cuts the risk of infection and transmission of the germ to other people … nursing homes because residents are older and more prone to having health conditions that increase their risk
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patientregistry.ahrq.gov/teamstepps-program/welcome-guides/new-trainers.html
July 01, 2023 - Opportunity Guidance
AHRQ Grants Policy Notices
AHRQ Informed Consent & Authorization Toolkit for Minimal Risk … TeamSTEPPS 3.0 tools and concepts can help you teach your students to better understand these risks and … The expanded functionalities available in electronic health records risk an overdependence on technologies … all these factors contribute to fatigue and burnout that create additional challenges for teams and risks
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patientregistry.ahrq.gov/sites/default/files/wysiwyg/evidencenow/cooperatives/evidencenow-executive-summary-nc.pdf
November 01, 2017 - they need to help their patients adopt the
ABCS of cardiovascular disease prevention: Aspirin in high-risk … and
almost one-third of deaths are caused by CVD (the CVD mortality rate is 251 per
100,000).2 CVD risk … Over 90 percent of practices have access to CVD
risk stratification tools. … ASCVD Risk Estimator Update 2014. … http://tools.acc.org/ASCVD-Risk-Estimator/#page_about
6 http://www.implementationscience.com/content
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patientregistry.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/fallprevention-training/module2/module2_slides_fallprev.pptx
August 24, 2017 - services staff
Facilities engineer
Managers
Senior manager
Quality improvement/safety/risk … Determine who will complete the fall risk factor assessment on admission. Tool 4A. … Cathy April √
Tool 4C Assess Staff Education and Training Peggy and Jim April √
Determine How Risk … Team June √
Get Team buy-in on who does risk assessment and when (Nursing/4 hours). … Determine who will complete the fall risk factor assessment on admission. Tool 4A.
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patientregistry.ahrq.gov/funding/grantee-profiles/grtprofile-chui.html
March 01, 2022 - Opportunity Guidance
AHRQ Grants Policy Notices
AHRQ Informed Consent & Authorization Toolkit for Minimal Risk … Chui hypothesized that making older adults aware of high-risk OTC medications would facilitate their … evaluate this intervention in 63 AAH pharmacies to enhance patients’ awareness of and attention to risks
-
patientregistry.ahrq.gov/sites/default/files/wysiwyg/research/findings/ta/topicrefinement/liquid-biopsy-topicrefinement.pdf
July 29, 2021 - the importance of the false
positive rate may vary greatly for each cancer type, depending on the risks … Comment: It is not necessary to include "high risk" in the diagnosis paradigm. … Genetic/Familial High-Risk Assessment:
Colorectal.(Version 3. 2019). … liquid biopsy or otherwise,
necessarily and appropriately differ for different cancers because the risks … and benefits of
subsequent treatments and interventions differ, and therefore so too do the risks and
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patientregistry.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/fallprevention-training/module1/module1_slides_fallprev.pptx
June 16, 2017 - Identifying and communicating risk at the earliest possible time.
‹#›
14
Toolkit Approach
The Toolkit … on optimizing the effectiveness of interventions by:
Tailoring interventions to address individual risk … (3-12/05)
Added Alert re-
meds to Scale
(11-12/05)
Developed Education
Brochure on meds
and fall risk … 05)
Started AARs
(safety
huddles) on
test units 10-
12/06
Teachback
w/pts 11/06
Put pts on high risk … ,
Morse score > 50, on
anticoagulants, low
platelets 12/06
Use yellow wrist bands
on high falls risk
-
patientregistry.ahrq.gov/funding/policies/index.html
March 01, 2022 - Opportunity Guidance
AHRQ Grants Policy Notices
AHRQ Informed Consent & Authorization Toolkit for Minimal Risk … Protection of Human Subjects
The AHRQ Informed Consent and Authorization Toolkit for Minimal Risk … AHRQ Informed Consent & Authorization Toolkit for Minimal Risk Research
This toolkit contains information