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teamstepps.ahrq.gov/evidencenow/heart-health/cholesterol/guideline.html
September 01, 2018 - Opportunity Guidance
AHRQ Grants Policy Notices
AHRQ Informed Consent & Authorization Toolkit for Minimal Risk … 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk … published in Circulation in 2011, outlines how to treat high blood cholesterol in adults to reduce risk
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teamstepps.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/d4n_combo_iqi-mortalityreview-bestpractices.pdf
May 20, 2016 - Quality Forum states: “Healthcare organizations must systematically identify
and mitigate patient safety risks … 11 Abdominal Aortic Aneurysm (AAA) Repair Mortality Rate
• Using an individualized assessment of risk … factors for each specific patient allows
categorization of operative mortality risk into low (l%-3%
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teamstepps.ahrq.gov/patient-safety/settings/hospital/resource/qitool/webinar080116/index.html
December 01, 2017 - Area-level indicators
Risk-adjusted (age, sex,poverty)
*Not included in the AHRQ QI Toolkit
Slide … Pressure Ulcer Risk Assessment at Admission and Daily: Evaluate all patients for pressure ulcers and … pressure ulcer risk (using Braden Scale or other tool) upon admission and every 24 hours thereafter, … using valid risk assessment, with results documented in the patient's chart. … Slide 67
Looking Back and Looking Forward
Retrospective Reviews
Appropriate Risk Assessment
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teamstepps.ahrq.gov/patient-safety/settings/hospital/fall-prevention/workshop/module-1/guide.html
September 01, 2017 - Risk assessments are most effective when increased risk for a fall is identified and communicated early … They gave an update on the risk assessment process changes. … The staff are transitioning to risk-based assessment and interventions tied to each identified risk factor … Before they used more of a definitional risk-based assessment and interventions. … For example, are staff individualizing care plans according to risk factors found on risk assessment?
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teamstepps.ahrq.gov/patient-safety/settings/hospital/fall-prevention/workshop/module-5/guide.html
September 01, 2017 - When falls occur with assistance, it suggests that staff have identified at-risk patients and are in … Putting appropriate care planning in place that addresses each risk factor identified during fall risk … Slide 41
Say: For risk factor assessment to make a difference, all risk factors identified … on the risk factor assessment need to be addressed in the care plans. … Ensure that the care plans address all areas of risk.
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teamstepps.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/index.html
February 01, 2024 - Opportunity Guidance
AHRQ Grants Policy Notices
AHRQ Informed Consent & Authorization Toolkit for Minimal Risk … Fall prevention involves managing a patient's underlying fall risk factors and optimizing the hospital's … What is a standardized assessment of risk factors for falls, and how should this assessment be conducted … How should identified risk factors be used for fall prevention care planning?
3.5.
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teamstepps.ahrq.gov/downloads/pub/advances/vol1/Schillinger.pdf
January 01, 2004 - for thrombosis) or > 4.0 (at risk for hemorrhage) over 90 days, using
repeated measures analysis. … clinicians and patients regarding
warfarin regimens is unsettlingly common and places patients at risk … 200
Introduction
For patients with atrial fibrillation and other conditions associated with a risk … unsafe/high (INR > 4), or safe (INR
≤ 2 but ≥ 4), based on cutoff values associated with increased risks … Risk factors
for complications of chronic anticoagulation. A
multicenter study.
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teamstepps.ahrq.gov/hai/cusp/modules/index.html
August 01, 2019 - Opportunity Guidance
AHRQ Grants Policy Notices
AHRQ Informed Consent & Authorization Toolkit for Minimal Risk … identify recurring negative events in your system and apply CUSP and Sensemaking tools to help reduce the risk … Toolkit introduces Just Culture principles, which emphasize shared accountability and attitudes towards risk
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teamstepps.ahrq.gov/evidencenow/projects/heart-health/about/stories/in-action/index.html
March 01, 2021 - Opportunity Guidance
AHRQ Grants Policy Notices
AHRQ Informed Consent & Authorization Toolkit for Minimal Risk … example, external consultants helped practices use their electronic health record data to identify at-risk … EvidenceNOW is having on these practices and their patients, including identifying and treating patients at risk … Oklahoma Practice
"Progress under EvidenceNOW included increasing blood pressure measurement for at-risk
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teamstepps.ahrq.gov/coronavirus/long-covid.html
March 01, 2024 - Opportunity Guidance
AHRQ Grants Policy Notices
AHRQ Informed Consent & Authorization Toolkit for Minimal Risk … many potentially overlapping entities, likely with different biological causes and different sets of risk … Further, many at-risk and minority populations face barriers that can exacerbate the impact of Long COVID … research and to improve the care of people living with multiple chronic conditions who are at increased risk
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teamstepps.ahrq.gov/news/blog/ahrqviews/investing-in-primary-care.html
July 01, 2021 - Opportunity Guidance
AHRQ Grants Policy Notices
AHRQ Informed Consent & Authorization Toolkit for Minimal Risk … care practices to improve quality of care, while achieving measurable improvements in cardiovascular risk … Older Adults , which will provide important lessons on avoiding harms in this under-recognized and high-risk … disorders to stem the epidemic of deaths and harms from opioid and polysubstance use in all population at risk
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teamstepps.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/d4y_combo_nqi03-bsi-bestpractices.pdf
May 17, 2016 - NICU) experience at least one episode of BSI.2
• Low-birth-weight infants with BSIs are at increased risk … Factors
Identify the risk factors that are most common among neonates
for bloodstream infection and … Recommended Practice: Assess neonatal patients for risk factors
• Assess all neonatal NICU patients … Risk factors for neonatal BSI include2-5:
○ Gestational age at birth <32 weeks or birth weight <1,500 … extremities or the scalp (in neonates or young infants) can be used as
an insertion site.11
○ The risks
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teamstepps.ahrq.gov/npsd/data/dashboard/falls.html
September 01, 2023 - Opportunity Guidance
AHRQ Grants Policy Notices
AHRQ Informed Consent & Authorization Toolkit for Minimal Risk … fall at-a-glance (by age), commonly reported patient activities prior to fall, and commonly reported risk
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teamstepps.ahrq.gov/news/newsletters/e-newsletter/879.html
September 01, 2023 - Opportunity Guidance
AHRQ Grants Policy Notices
AHRQ Informed Consent & Authorization Toolkit for Minimal Risk … Using OurDX prior to symptomatic ambulatory visits can help clinicians flag at-risk diagnostic processes … ordering of venous thromboembolism chemoprophylaxis is associated with increased VTE events in high-risk … Anesthesia Risk Alert program: a proactive safety initiative .
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teamstepps.ahrq.gov/research/findings/making-healthcare-safer/mhs4/index.html
April 01, 2024 - Opportunity Guidance
AHRQ Grants Policy Notices
AHRQ Informed Consent & Authorization Toolkit for Minimal Risk … telehealth became evident during the pandemic, the harms and patient safety practices to reduce the risk … telehealth became evident during the pandemic, the harms and patient safety practices to reduce the risk
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teamstepps.ahrq.gov/hai/tools/mvp/modules/vae/overview-off-ventilator-fac-guide.html
February 01, 2017 - In doing so, you will effectively reduce the risk of ventilator-associated pneumonia (VAP) and other … associated with more days to extubation, more days to hospital discharge, and higher hospital mortality risk … Slide 12: AHRQ Safety Program Goals
Say:
The two main safety program goals are: (1) reduce the risk … By getting patients off of the ventilator faster, you will reduce the risk of patient harms associated … develop lenses that allow us to see those system factors and how they influence care, we can see the risks
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teamstepps.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/community-pharmacy/pharmacy-resources.pdf
May 01, 2023 - Environmental factors
• Staff competency and education
• Patient education
• Quality process and risk … This manual is designed to help community pharmacy personnel identify potential medication
safety risks … • Build awareness of risk-identification opportunities in the community pharmacy setting. … • Maximize the appropriate application of system strategies to reduce organizational risk.
3. … Improving Medication Safety in Community Pharmacy: Assessing Risk and Opportunities for Change
3.
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teamstepps.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/fallprevention-training/module4/module4_slides_best-practices.pptx
November 20, 2014 - Example:
Perform comprehensive fall risk assessment on admission, daily, or if condition deteriorates … Team
A Unit Team comprises staff members who provide daily direct patient care by:
Conducting fall risk … for assistance with toileting)
Page 58
‹#›
Electronic Health Record
What information about fall risk … the most logical place in the record to collect, organize, and assess information about patient fall risk
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teamstepps.ahrq.gov/news/newsroom/press-releases/chlorhexidine-bathing.html
October 01, 2023 - Opportunity Guidance
AHRQ Grants Policy Notices
AHRQ Informed Consent & Authorization Toolkit for Minimal Risk … Nursing home residents are at high risk for HAIs due to age, wounds, medical devices, and other illnesses … Services agencies that show universal decolonization can be an effective tool to prevent infections for at-risk
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teamstepps.ahrq.gov/evidencenow/projects/heart-health/about/origin.html
March 01, 2021 - Opportunity Guidance
AHRQ Grants Policy Notices
AHRQ Informed Consent & Authorization Toolkit for Minimal Risk … The goal of improving care focuses on the “ABCS” of cardiovascular care: A for aspirin for those at risk … ) help small- and medium-sized practices implement the ABCS to improve heart health for patients at risk