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Total Results: 490 records

Showing results for "adverse".

21. AHRQ Quality and Safety Review System (QSRS) | Agency for Healthcare Research and Quality
    pbrn.ahrq.gov/cpi/about/otherwebsites/qsrs.ahrq.gov/index.html
    March 01, 2021 - and other Federal partners—realized that hospitals needed to understand specifically how and where adverse … Therefore, CMS created the MPSMS to measure the magnitude of adverse events among hospital patients covered … Features The QSRS: Offers an expanded array of adverse event measures.

22. Communication and Optimal Resolution (CANDOR) Toolkit | Agency for Healthcare Research and Quality
    pbrn.ahrq.gov/patient-safety/settings/hospital/candor/modules.html
    August 01, 2022 - institutions include how to: Engage patients and families in disclosure communication following adverse … Implement a Care for the Caregiver program for providers involved in adverse events. … Investigate and analyze an adverse event to learn from it and prevent future adverse events.

23. Methods To Estimate the Baseline 2010 PFP National Hospital-Acquired Condition Rate (pdf file)
    pbrn.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/pfp/pfphac.pdf
    September 01, 2014 - The estimate includes a wide variety of adverse events, including the nine HACs selected for special … than as a rate for the subpopulation that has the opportunity to experience the adverse event. … In order to estimate the rate of adverse events for each of the 21 HACs for all patients for which the … events for all patients to adverse events for patients with one of the four diagnoses. … events for all diagnoses to adverse events for the four diagnoses.

24. Module 5: Response and Disclosure | Agency for Healthcare Research and Quality
    pbrn.ahrq.gov/patient-safety/settings/hospital/candor/modules/guide5/notes.html
    August 01, 2022 - Disclosure communication following an adverse event should include answers to the following questions … How will the organization prevent the adverse event from happening to another patient in the future? … It is important that the clinicians and the health care organization apologize for the adverse event, … Slide 11 Say: The Disclosure Checklist includes: What happened–identify the adverse … Apology–say you are sorry for the adverse event in a sincere manner early in the conversation.

25. AHRQ's Making Healthcare Safer Reports: Shaping Patient Safety Efforts in the 21st Century | Agency for Healthcare Research and Quality
    pbrn.ahrq.gov/research/findings/making-healthcare-safer/index.html
    July 01, 2023 - Harms such as adverse drug events, healthcare-associated infections, falls, and obstetric adverse events … patient safety practices in eight categories encompassing commonly occurring care- and disease-specific adverse

26. Updated Information on the Annual Hospital-Acquired Condition Rate: 2011 and 2012 | Agency for Healthcare Research and Quality
    pbrn.ahrq.gov/hai/pfp/hacrate2011-12.html
    January 01, 2018 - The annual estimates include a wide variety of adverse events, including the nine HACs selected for special … Normalized to 32,750,000 Discharges— Based on 2010 Baseline) 2012 PFP Measured HACs per 1,000 Discharges Adverse … 17,000 0.51 Falls MPSMS In-Hospital Patient Falls 260,000 7.80 230,000 7.16 Obstetric Adverse … Femoral Artery Puncture for Catheter Angiographic Procedures 57,000 1.75 65,000 1.97 MPSMS Adverse … Events Associated With Hip Joint Replacements 33,000 1.00 31,000 0.93 MPSMS Adverse Events

27. Declines in Hospital-Acquired Conditions (pdf file)
    pbrn.ahrq.gov/sites/default/files/wysiwyg/data/infographics/hac-rates-2019-updated.pdf
    January 01, 2019 - in Hospital- Acquired Conditions National efforts to reduce hospital-acquired conditions such as adverse … Adverse Drug Events -28% CAUTI* -5% CLABSI+ -6% Clostridioides difficile Infections -37% … Falls -5% Obstetric Adverse Events -3% Pressure Ulcers Surgical Site Infections Ventilator

28. Resources and Tools To Improve Discharge and Transitions of Care and Reduce Readmissions | Agency for Healthcare Research and Quality
    pbrn.ahrq.gov/patient-safety/resources/improve-discharge/index.html
    July 01, 2022 - PSNet Article: Vital Signs Are Still Vital: Instability on Discharge and the Risk of Post-Discharge Adverse … Readmission Rates With Mortality Rates After Hospital Discharge AHRQ PS Net Primer: Readmissions and Adverse … Toolkit To Improve Medication Reconciliation Across Care Settings Six New Jersey Hospitals Reduce Adverse … Patient Safety and Team Communication Through Daily Huddles AHRQ PSNet Primer: Medication Errors and Adverse

29. AHRQ National Scorecard on Hospital-Acquired Conditions: Final Results for 2014 Through 2017 (pdf file)
    pbrn.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/pfp/Updated-hacreportFInal2017data.pdf
    July 01, 2020 - the same 28 measures of patient safety events, including many types of hospital-acquired infections, adverse … For example, measured adverse drug events continued to drop from 2014 to 2017, while measured pressure … National number of adverse events captured by PSIs 18 and 19 on obstetric injury and national number … To estimate the rate of adverse events for each of the 21 HACs for all patients for which the MPSMS … Due to changes in how some conditions and adverse events are described in ICD-9 and ICD-10, the data

30. National Scorecard on Rates of Hospital-Acquired Conditions 2010 to 2015: Interim Data From National Efforts To Make Health Care Safer | Agency for Healthcare Research and Quality
    pbrn.ahrq.gov/hai/pfp/2015-interim.html
    December 01, 2016 - safety has occurred during a period of concerted attention by hospitals throughout the country to reduce adverse … About 42 percent of this reduction is from adverse drug events, about 23 percent from pressure ulcers … The MPSMS methodology to identify adverse events within each chart is identical to prior years. … It should be noted that for every year from 2010 to 2014, the VTE adverse events contributed less than … indicated that in 2012 and 2013, adverse events were less frequent at hospitals that had implemented

31. AHRQ National Scorecard on Hospital-Acquired Conditions: Updated Baseline Rates and Preliminary Results 2014-2017 (pdf file)
    pbrn.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/pfp/hacreport-2019.pdf
    January 01, 2019 - the same 28 measures of patient safety events, including many types of hospital-acquired infections, adverse … For example, measured adverse drug events continued to drop from 2014 to 2017, while measured pressure … Preliminary 2017 2019 Goal (20% Reduction of each HAC) Adverse Drug Events 33.7 30.0 27.1 … National number of adverse events captured by PSIs 18 and 19 on obstetric injury and national number … Due to changes in how some conditions and adverse events are described in ICD-9 and ICD-10, the data

32. Saving Lives and Saving Money: Hospital-Acquired Conditions Update | Agency for Healthcare Research and Quality
    pbrn.ahrq.gov/hai/pfp/2014-final.html
    January 01, 2018 - safety has occurred during a period of concerted attention by hospitals throughout the country to reduce adverse … About 40 percent of the overall reduction is from adverse drug events, about 28 percent from pressure … Most of the deaths averted occurred as a result of reductions in the rates of pressure ulcers and adverse … Events Associated With Hip Joint Replacements 19,000 0.59 MPSMS (2014) Adverse Events Associated … indicated that in 2012 and 2013, adverse events were less frequent at hospitals that have implemented

33. Gap Analysis Facilitator's Guide: Appendix B | Agency for Healthcare Research and Quality
    pbrn.ahrq.gov/patient-safety/settings/hospital/candor/modules/facguide3/apb.html
    August 01, 2022 - Is there a clear process for communication among staff in response to adverse events? … Identification and Analysis of Actual and Potential Adverse Events: Is there a process in place for … identifying, managing, and analyzing adverse events, near miss events, and unsafe conditions? … Do staff have access to a system for reporting adverse events? … Is an attempt made to disclose within the first 24 hours following an adverse event?

34. Mod5-Disclosure-Checklist (pdf file)
    pbrn.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/candor/module5/mod5-disclosure-checklist.pdf
    April 01, 2016 - ■ Within 60 minutes after the CANDOR event is identified, advise the patient and/or family that an adverse … ■ Identify the adverse event early in the disclosure. … ■ Explain what is known about why the adverse event occurred; do not speculate. … ■ Tell the patient whether the adverse event was preventable, if known. … Apologize ■ Say you are sorry for the adverse event in a sincere manner early in the conversation.

35. Mod01-Grand-Rounds-Slides (pdf file)
    pbrn.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/candor/grandrounds/mod01-grand-rounds-slides.pdf
    April 01, 2016 - ■ 44% of adverse events were preventable. … As we saw in the Do No Harm video, families reported how the silence they experienced after the adverse … Facilitator Notes - Grand Rounds Presentation – 3 Say: Open and honest communication after an adverse … Slide 16 6 – Facilitator Notes - Grand Rounds Presentation Say: A good response to adverse events … Patients are looking for the actions the organization is taking to prevent and learn from the adverse

36. Improving Patient Safety Systems for Limited-English-Proficient (LEP) Patients: A Guide for Hospitals | Agency for Healthcare Research and Quality
    pbrn.ahrq.gov/teamstepps/lep/hospitalguide/lephospitalguide.html
    December 01, 2012 - (continued) Slide 10: Causes of Adverse Events for LEP and Culturally Diverse Patients Slide 11: Systems … Identify common causes of adverse events for LEP and culturally diverse patients. … Language proficiency and adverse events in U.S. hospitals: a pilot study. … Return to Contents Slide 10: Causes of Adverse Events for LEP and Culturally Diverse Patients Use … Language proficiency and adverse events in U.S. hospitals: a pilot study.

37. AHRQ National Scorecard on Hospital-Acquired Conditions: Updated Baseline Rates and Preliminary Results 2014-2016 (pdf file)
    pbrn.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/pfp/natlhacratereport-rebaselining2014-2016_0.pdf
    January 01, 2016 - the same 28 measures of patient safety events, including many types of hospital-acquired infections, adverse … For example, measured adverse drug events continued to drop from 2014 to 2016, while measured pressure … The use of these five sets of charts also eliminated the need to use 2005-2006 Medicare adverse event … Rate of 21 MPSMS adverse events in the MPSMS sample provided by CMS, including those in the Surgical … National number of adverse events captured by PSIs 18 and 19 on obstetric injury and national number

38. 2013 Annual Hospital-Acquired Condition Rate and Estimates of Cost Savings and Deaths Averted From 2010 to 2013 (pdf file)
    pbrn.ahrq.gov/sites/default/files/publications/files/hacrate2013_0.pdf
    October 01, 2015 - events—such as adverse drug events, falls, and pressure ulcers—occurred. … Incidence of adverse drug events and potential adverse drug events. Implications for prevention. … Adverse drug events in hospitalized patients. … Adverse drug events in U.S. hospitals, 2004. HCUP Statistical Brief #29. … Impact of a comprehensive strategy on obstetric adverse events.

39. Improving Patient Safety Systems for Limited English Proficiency Patients
    pbrn.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/lep/hospitalguide/lephospitalguide.pptx
    January 01, 2011 - patients Provide evidence for why we should focus on LEP patient safety Identify common causes of adverse … Language proficiency and adverse events in U.S. hospitals: a pilot study. … Nearly 25 million people in the United States (8.6%) are defined as LEP and therefore at risk for adverse … competence, and patient-centered care as important elements of safe quality of care Causes of Adverse … Language proficiency and adverse events in U.S. hospitals: a pilot study.

40. Gap Analysis Facilitator's Guide: Appendix C | Agency for Healthcare Research and Quality
    pbrn.ahrq.gov/patient-safety/settings/hospital/candor/modules/facguide3/apc.html
    August 01, 2022 - Is there a clear process for communication among staff in response to adverse events?         … Identification and Analysis of Actual and Potential Adverse Events Is there a process in place for … identifying, managing, and analyzing adverse events, near miss events, and unsafe conditions?     … Do staff have access to a system for reporting adverse events?         … Is an attempt made to disclose within the first 24 hours following an adverse event?