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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/strategies/medication/safemedication.pptx
May 01, 2017 - , high-dose)2,8,9,10,11
Use of a calibrated infusion pump
Uniform parameters for maternal and fetal monitoring … and during infusion
Use of standard NICHD* nomenclature to document and communicate electronic fetal monitoring … appropriateness of patient medication use by staff other than the ordering provider
Maternal and fetal monitoring … This scenario reinforces teamwork and communication related to—
situational awareness
parameters for monitoring … line from the intravenous port when therapy is discontinued
Uniform parameters for maternal and fetal monitoring
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www.ahrq.gov/sites/default/files/wysiwyg/nhguide/3_TK2_T3-Sample_Monthly_Summary_Reports_Final.xlsx
October 01, 2016 - Cultures
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
TOTAL
Rx = prescription; SBAR = situation
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www.ahrq.gov/patient-safety/settings/hospital/vtguide/guide5.html
October 01, 2022 - prevention protocol effectively to bear at the point of care and to build out the infrastructure for monitoring … lift adequate prophylaxis rates to 80 percent or more and set the stage for effective measurement, monitoring … Piloting measurement and monitoring techniques with early assessment is also highly recommended. … Capturing ambulation status as a discrete data element in monitoring adherence to protocols. … Monitoring order set use, and designing an ongoing process to identify patients who have fallen through
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www.ahrq.gov/es/patient-safety/settings/hospital/vtguide/guide5.html
October 01, 2022 - prevention protocol effectively to bear at the point of care and to build out the infrastructure for monitoring … lift adequate prophylaxis rates to 80 percent or more and set the stage for effective measurement, monitoring … Piloting measurement and monitoring techniques with early assessment is also highly recommended. … Capturing ambulation status as a discrete data element in monitoring adherence to protocols. … Monitoring order set use, and designing an ongoing process to identify patients who have fallen through
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www.ahrq.gov/sites/default/files/wysiwyg/teamstepps-program/curriculum/teamstepps-implementation-slides.pptx
June 02, 2025 - for Day 2
Day 2 Preview
Day 1:
Introduction
Module 1—Communication
Module 2—Team Leadership
Module 3—Situation … Monitoring
Module 4—Mutual Support
Putting It All Together
Day 2:
Should you implement TeamSTEPPS? … 35
Step 7: Develop a Sustainment Plan
Implementation
Key Actions:
For your monitoring plan, determine … Identify Components of a Monitoring Plan:
1. Measures and Targeted Outcomes:
2. … Examples include:
Ask team members how they might have approached a situation differently by using a
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www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/implementation/education-bundles/strategies-slides.html
March 01, 2017 - TeamSTEPPS focuses on team structure and the teamwork system, leadership, situation monitoring, mutual … requesting information and avoiding delays in relaying information that could compromise a resident's situation
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www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/strategies/labor-delivery-unit/ldusafety-fac-guide.html
July 01, 2023 - checklist or references or links to available checklists and other cognitive aids are provided for each situation … In this presentation, the six principles are presented by focusing first on situation-specific elements … approach to debriefing events based on the seriousness of the event, expertise available, and data monitoring
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www.ahrq.gov/sites/default/files/wysiwyg/teamstepps-program/video/module-2-team-leadership-facilitator-guide.pdf
June 02, 2025 - The patient’s daughter is upset by the situation. … ● How could the team benefit from a debrief after this situation? … How could the team benefit from a debrief after this situation? … Discuss tactics for leadership ~3 minutes
▪ Who was the leader during this situation? … Monitoring and Modifying the Plan
● Huddle—Ad hoc meeting to ensure continual progression of care to
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www.ahrq.gov/sites/default/files/2024-01/fernandez-report.pdf
January 01, 2024 - performance by developing team-
oriented goals, facilitating coordination and cooperation, and improving monitoring … studies suggest significant error rates in medication
dosing, team communication, knowledge gaps, monitoring … (Situation judgment test listed in G. … Situation Situation judgment test questions were developed to allow learners to
judgment test: receive … A long form of the
assessment with more situation judgment test questions was administered to team
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/strategies/labor-delivery-unit/ldusafety_facguide.pdf
May 01, 2017 - checklist or references or
links to available checklists and other
cognitive aids are provided for each
situation … In this
presentation, the six principles are presented
by focusing first on situation-specific elements … approach to
debriefing events based on the
seriousness of the event,
expertise available, and data
monitoring … • Using SBAR (Situation, Background,
Assessment, and Recommendation),
callouts, huddles, and closed-loop
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol4/Advances-Raebel_53.pdf
May 07, 2008 - • Patients with followup INR monitoring:
o Pre-warfarin drug-interaction alert, 45%. … The first situation (receiving alerts for
nontargeted drugs) resulted in a high false-positive alert … rate, whereas the second situation (not
receiving up-to-date clinical information) had the potential … Study demonstrated importance of
monitoring drugs with toxicity risk. … Patient safety improves with laboratory monitoring of
potentially toxic medications.
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www.ahrq.gov/patient-safety/resources/learning-lab/neonatal-interfacility-transfers-long-desc.html
January 01, 2025 - Engineer a novel transport monitoring and communication system to improve information flow within the … on bedside wait times and total transportation time. 1 , 6 A simulated Transport Communication and Monitoring … Health professional perspectives on communication and monitoring during interfacility neonatal transport … Health Professional Perspectives on Communication and Monitoring During Interfacility Neonatal Transport … Health professional perspectives on communication and monitoring during interfacility neonatal transport
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/injuries/fallspx/manapb5.html
February 01, 2023 - Your perception of the behavior may be very different from the actual situation. … Situation.
Location.
Resident motivation, feelings and agenda.
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www.ahrq.gov/patient-safety/reports/liability/baker.html
August 01, 2017 - common set of failures by the phases of the L&D care process (e.g., pre-hospital, triage/assessment, monitoring … Monitoring / Laboring
Clinician does not properly assess patient’s condition. … Delivery
Clinician fails to communicate patient risk factors/situation to new clinical team members … medications
3.30
2.76
2.33
2.50
Delivery
Clinician fails to communicate mother's risk factors/situation … medications
3.70
4.33
2.67
1.67
Delivery
Clinician fails to communicate mother's risk factors/situation
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/preventing-cauti-icu-051314.pptx
February 07, 2014 - 40
What looks like a people problem is often a situation problem. … What looks like a people problem is often a situation problem.
Shrinking movie popcorn buckets. … urinary retention protocol
Insertion and maintenance competency evaluations
ED and OR -> ICU processes
Monitoring … Last patient of the morning (11:45 a.m.)
48
75 yo M
Hx of HTN, DM2
Admitted 24 hours earlier “for monitoring … they are at high risk for a sacral decub”
“they are at risk for abdominal compartment syndrome and I’m monitoring
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www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/clabsi-cauti-icu/spot-coaching.pdf
April 01, 2022 - This mode leads to learned helplessness and an ongoing need for monitoring
and reminding. … called
“coaching” that are not coaching, such as performance counseling, reminding, teaching, and
monitoring … Do you want to talk through
options or explore ways to think about this situation?
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/toolkit/contentcalls/small_hospitals-slides/Small-and-Rural-Critical-Access-Hospitals-July-19-2011-508.ppt
January 01, 2011 - the purpose of which is to help you realize these goals, by tailoring its tools to your own unit and situation … Monitoring 6. Feedback
Science of Safety
1. Science of safety presentation
2. … Monitoring 6. Feedback
Science of Safety
1. Science of safety presentation
2.
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/strategies/labor-delivery-unit/ldusafety.pptx
May 01, 2017 - for Perinatal Care
L&D Unit Safety
6
SPPC Key Perinatal Safety Elements
for L&D Unit Safety
Situation … The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal monitoring … The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal monitoring
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www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/strategies/labor-delivery-unit/tool-obhemorrhage.html
July 01, 2023 - decide its approach to debriefing events based on seriousness of event, expertise available, and data monitoring … context of obstetric hemorrhage, this includes using standard prevention approaches per unit protocol, monitoring … approach to emphasize "what is right, not who is right":
D: Describe the specific behavior or situation … E: Express how the situation makes you feel or concerns you.
S: Suggest other alternatives.
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www.ahrq.gov/ncepcr/tools/confid-report/three-strategies.html
February 01, 2016 - giving physicians the opportunity to make feedback reports work for them
Section 3-3: Postrelease monitoring … This situation enabled the perception to grow that that their report, accessible through a secure data … Postrelease monitoring and evaluation
Like all improvement strategies, physician feedback reports can … ,” can be instructive, more systematic methods for monitoring and evaluating reports include:
Online … Complementary monitoring tools for Web-based reports
Web analytics , many of which are available