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www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/prevhosp/transfer.html
September 01, 2017 - AHRQ’s Safety Program for Nursing Homes: On-Time Preventable Hospital and Emergency Department Visits
Electronic Reports
Transfer Risk Report
Table 1. Sample High-Risk Transfer Report
Facility Name:
Unit:
Report Date:
Resident Name and Advance Directive Status
# ED Visits Within:
ED Discharg…
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hcup-us.ahrq.gov/reports/methods/MS2023-01-NHQDRMethodsReport_508.pdf
November 21, 2023 - Methods Report Describing 2016-2020 HCUP Data in the National Healthcare Quality and Disparities Report (NHQDR) Methods Series Report 2023-01
HCUP Methods Series
Methods Applying AHRQ Quality Indicators to Healthcare
Cost and Utilization Project (HCUP) Data for the 2023
National Healthcare Quality and Disparities …
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psnet.ahrq.gov/issue/impact-drug-shortage-medication-errors-and-clinical-outcomes-pediatric-intensive-care-unit
November 16, 2022 - Study
Impact of a drug shortage on medication errors and clinical outcomes in the pediatric intensive care unit.
Citation Text:
Hughes KM, Goswami ES, Morris JL. Impact of a Drug Shortage on Medication Errors and Clinical Outcomes in the Pediatric Intensive Care Unit. J Pediatr Pharmacol…
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psnet.ahrq.gov/issue/improving-medication-error-reporting-hospice-care
June 22, 2022 - Study
Improving medication error reporting in hospice care.
Citation Text:
Boyer R, McPherson ML, Deshpande G, et al. Improving medication error reporting in hospice care. Am J Hosp Palliat Care. 2009;26(5):361-7. doi:10.1177/1049909109335145.
Copy Citation
Format:
DOI Go…
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/injuries/fallspx/manapc.html
December 01, 2017 - The Falls Management Program: A Quality Improvement Initiative for Nursing Facilities
Appendix C. Case Study and Program Examples
Previous Page Next Page
Table of Contents
The Falls Management Program: A Quality Improvement Initiative for Nursing Facilities
Chapter 1. Introduction and Program Over…
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hcup-us.ahrq.gov/reports/methods/2020-04.pdf
January 01, 2020 - 2019NHQDRMethodsReport
HCUP Method Series
Methods Applying AHRQ Quality Indicators to Healthcare
Cost and Utilization Project (HCUP) Data for the 2019
National Healthcare Quality and Disparities Report (QDR)
Report #2020-04
Contact Information:
Healthcare Cost and Utilization Project (HCUP)
Agency for Heal…
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hcup-us.ahrq.gov/reports/methods/MS2021-03-NHQDRMethodsReport.pdf
December 09, 2021 - Methods Applying AHRQ Quality Indicators to Healthcare Cost and Utilization Project (HCUP) Data for the 2021 National Healthcare Quality and Disparities Report (NHQDR)
HCUP Methods Series
Methods Applying AHRQ Quality Indicators to Healthcare Cost
and Utilization Project (HCUP) Data for the 2021 National
Healthcar…
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hcup-us.ahrq.gov/reports/methods/MS2022-01-NHQDRMethodsReport.pdf
October 28, 2022 - HCUP Methods Series
Methods Applying AHRQ Quality Indicators to Healthcare
Cost and Utilization Project (HCUP) Data for the 2022
National Healthcare Quality and Disparities Report (NHQDR)
Report #2022-01
Contact Information:
Healthcare Cost and Utilization Project (HCUP)
Agency for Healthcare Res…
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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa/139-nv-hap-prevention-essential-one-pager.docx
October 01, 2024 - NV-HAP Prevention Essential Practices1-4
Practice routine oral care.4,5-8
Staphylococcus aureus is a common pathogen in dental plaque.
Conduct an individualized assessment and plan for each patient considering their ability to perform self-care independently.
At minimum, the oral care regimen should include: toothbrus…
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psnet.ahrq.gov/issue/cdc-guideline-prescribing-opioids-chronic-pain-united-states-2016
June 14, 2019 - Organizational Policy/Guidelines
CDC guideline for prescribing opioids for chronic pain—United States, 2016.
Citation Text:
Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016. MMWR Recomm Rep. 2016;65(1):1-49. doi:10.15585/mmwr.rr…
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psnet.ahrq.gov/issue/analysis-iatrogenic-and-hospital-medication-errors-reported-united-states-poison-centers
November 28, 2018 - Study
Analysis of iatrogenic and in-hospital medication errors reported to United States poison centers: a retrospective observational study.
Citation Text:
Leonard JB, McFadden C, Feemster AA, et al. Analysis of iatrogenic and in-hospital medication errors reported to United States pois…
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/cusp/physician-staff-engagement-slides.pptx
January 01, 2017 - Show them the evidence
Share stories about when staff do the right thing
Example—When they use minimal sedation
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digital.ahrq.gov/sites/default/files/docs/resource/Dataform_1_Prescription_Screening_Form.pdf
June 16, 2021 - Dataform 1
Page 1 of 4
Center of Excellence for Patient Safety Research and Practice 1/26/08
Dataform 1: Prescription Screening Form Version 0.10
DATAFORM 1
Prescription Screening Form
1. Study ID Number: ____ ____-____ ____ ____ ____ ____
2. Reviewer ID Number: …
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psnet.ahrq.gov/issue/adverse-drug-event-rates-high-cost-and-high-use-drugs-intensive-care-unit
April 11, 2012 - Study
Adverse-drug-event rates for high-cost and high-use drugs in the intensive care unit.
Citation Text:
Kane-Gill SL, Rea RS, Verrico MM, et al. Adverse-drug-event rates for high-cost and high-use drugs in the intensive care unit. Am J Health Syst Pharm. 2006;63(19):1876-81.
Copy …
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psnet.ahrq.gov/perspective/zero-harm-striving-reduce-preventable-harms-point-counterpoint-and-areas-agreement
September 24, 2024 - harm, but not direct attention to other preventable but more difficult to assess harms, such as over-sedation … result in focusing on reducing harms like bed sores, without addressing more complex harms like over-sedation … learned that there are specific things you can do to prevent it: elevate the head of the bed, daily sedation
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psnet.ahrq.gov/issue/national-drug-shortages-worsen-during-covid-19-crisis-proposal-comprehensive-model-monitor
April 06, 2022 - Commentary
National drug shortages worsen during COVID-19 crisis: proposal for a comprehensive model to monitor and address critical drug shortages.
Citation Text:
Piatek OI, Ning JC-min, Touchette DR. National drug shortages worsen during COVID-19 crisis: proposal for a comprehensive mo…
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psnet.ahrq.gov/issue/opioid-prescribing-united-states-and-after-centers-disease-control-and-preventions-2016
November 17, 2021 - Study
Classic
Opioid prescribing in the United States before and after the Centers for Disease Control and Prevention's 2016 opioid guideline.
Citation Text:
Bohnert ASB, Guy GP, Losby JL. Opioid prescribing in the United States before and after the Centers for …
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psnet.ahrq.gov/web-mm/delirium-or-dementia
September 27, 2023 - mixed variants of delirium (see below for explanation) are at risk for overmedication (particularly sedation
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psnet.ahrq.gov/issue/preventing-medication-errors-long-term-care-results-and-evaluation-large-scale-web-based
June 15, 2011 - Study
Preventing medication errors in long-term care: results and evaluation of a large scale web-based error reporting system.
Citation Text:
Pierson S, Hansen RA, Greene SB, et al. Preventing medication errors in long-term care: results and evaluation of a large scale web-based error…
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psnet.ahrq.gov/issue/inpatient-fall-prevention-programs-patient-safety-strategy-systematic-review
May 26, 2016 - Review
Inpatient fall prevention programs as a patient safety strategy: a systematic review.
Citation Text:
Miake-Lye IM, Hempel S, Ganz DA, et al. Inpatient fall prevention programs as a patient safety strategy: a systematic review. Ann Intern Med. 2013;158(5 Pt 2):390-396. doi:10.732…