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Total Results: 2,230 records

Showing results for "adverse".

121. A | Agency for Healthcare Research and Quality
     www.ahrq.gov/topics/a.html
     August 11, 2025 - Topics Browse A - Z A Access to Care Adverse Drug Events (ADE) Adverse Events

122. Transforming the Morbidity and Mortality Conference into an Instrument for Systemwide Improvement (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol2/Advances-Deis_82.pdf
     June 03, 2008 - ) is a traditional forum that provides clinicians with an opportunity to discuss medical error and adverse … Results: Twenty-one cases (12 medical, 9 surgical) representing adverse events were presented at the … Adverse events triggering case selection included unexpected deaths (six), unplanned intubations (two … Adverse events triggering case selection are listed in Table 2. … Conference participants identified the leading contributors to adverse or “near-miss” outcomes.

123. Final Progress Report: Interactive HIT to promote ambulatory safety among vulnerable diabetes patients (pdf file)
     www.ahrq.gov/sites/default/files/2024-11/sarkar-report.pdf
     January 01, 2024 - PURPOSE The objective of this study was to characterize adverse events and potential adverse events … We hypothesized that diabetes patients will experience adverse events and potential adverse events, … Discussion We detected adverse events and potential adverse events in the course of conducting an automated … Adverse and potential adverse events among a low-income, urban, ambulatory population with diabetes. … Adverse and potential adverse events among a low-income, urban, ambulatory population with diabetes.

124. Patient and Family Engagement | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/cusp/modules/patient-family-engagement/notes.html
     September 01, 2013 - Introduction to Adverse Events Slide 23. Immediate Response to an Adverse Event 4 Slide 24. … How to Communicate About an Adverse Event 6 Slide 26. … What if an Adverse Event Occurs on the Unit? … Introduction to Adverse Events Say: Adverse events occur when a patient is harmed as a result of … of emotions when an adverse event occurs.

125. Vaccine Recommendations and Guidelines of the Advisory Committee on Immunization Practices (ACIP) | Agency for Healthcare Research and Quality
     www.ahrq.gov/nursing-home/resources/vaccine-recommendations-guidelines.html
     August 01, 2022 - to timing and spacing of immunobiologics; contraindications and precautions; preventing and managing adverse

126. AHRQ's Safety Program for Nursing Homes: On-Time Pressure Ulcer Prevention | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/pruprev/factraining.html
     December 01, 2014 - Nursing home staff generally do a good job of investigating and following up after an adverse event, … It is more difficult for staff to identify which residents are at risk for a future adverse event. … The reports: Focus on preventing adverse events. Are proactive rather than reactive. … Investigate root causes when an adverse event occurs. … Discussion questions are tailored to the On-Time adverse event being addressed.

127. Appendix: Incidence of Hospital-Acquired Conditions in the Partnership for Patients: Estimates and Projected and Measured Impact | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/pfp/interimhac2014-ap1.html
     November 01, 2015 - 5,000 0.2 Falls MPSMS (2014) In-Hospital Patient Falls 260,000 7.9 Obstetric Adverse … Femoral Artery Puncture for Catheter Angiographic Procedures 74,000 2.3 MPSMS (2014) Adverse … Events Associated With Hip Joint Replacements 19,000 0.59 MPSMS (2014) Adverse Events Associated … Goal for HAC Reduction f PfP HAC Reduction Goal g Estimated PfP Additional Cost* per HAC Adverse … 25% 10,000 $17,000 Falls 200,000 25% 50% 12.5% 25,000 $7,234 Obstetric Adverse

128. CHIPRA 233: Section 3, Table 2, FDA Pregnancy Category Rating (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/availability/chipra-233-hrob-section-3-table-2.pdf
     June 02, 2025 - Category C Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate … Category D There is positive evidence of human fetal risk based on adverse reaction data from investigational … have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse

129. AHRQ Safety Program for Perinatal Care: Monitoring for Perinatal Safety: Patient and Family Engagement
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/teamwork/engage/engagement.pptx
     May 01, 2017 - Events An adverse event is an injury to a patient caused by medical intervention rather than by the … The mission of health care providers is to help and care for patients without harming them, but adverse … Prompt, compassionate, and honest communication with the patient and family after an adverse event is … essential. 17 AHRQ Safety Program for Perinatal Care Patient & Family Immediate Response to an Adverse … Organizations should be prepared to respond and communicate proactively when adverse events occur.

130. Final Progress Report: Making Ambulatory Procedural Care Safer: STAMP-Based Risk Assessment and Redesign (pdf file)
     www.ahrq.gov/sites/default/files/2024-01/dierks-report.pdf
     January 01, 2024 - Simply because the system has not realized a catastrophic adverse event does not mean that it is ‘ … ‘unsuccessful’ waiving (i.e., waiving with a subsequent adverse event) increases time pressure. … Exposure leads to a transition to one of two outcomes: 1) adverse event/harm or 2) no adverse event … A Hybrid Methodology for Modeling Risk of Adverse Events in Complex Healthcare Settings. … On Modeling Risk of Adverse Events in Complex Healthcare Settings.

131. AHRQ National Scorecard on Hospital-Acquired Conditions: Final Results for 2014 Through 2017 (pdf file)
     www.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

132. 1 Preventablehospitaledvisits-Overview-Ig (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/prevhosp/1_preventablehospitaledvisits-overview-ig.pdf
     June 02, 2025 - The reports: • Focus on preventing adverse events. • Are proactive rather than reactive. … These questions explore what the facility does to screen for risk of an adverse event. … The goal is to focus on preventing adverse events. … • Improve root cause analyses when adverse events occur. … Discussion questions are tailored to the On-Time adverse event being addressed.

133. Grand Rounds Presentation | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/hospital/candor/grand-rounds.html
     August 01, 2022 - event. 1.5% experienced harm that contributed to their death. 44% of adverse events were preventable … Slide 7 Say: Open and honest communication after an adverse event is not easy and does require … Potential decrease in adverse events being litigated, which can potentially lead to lower malpractice … Slide 19 Say: The CANDOR process involves a thorough investigation of the adverse event … Resolution should lead to a settlement of issues related to the adverse event,but doesn’t always lead

134. ICU-to-Ward Transitions | Agency for Healthcare Research and Quality
     www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-care-transitions3.html
     June 01, 2023 - academic medical centers, one survey 57 showed that 87 percent of residents recalled at least one adverse … Not surprisingly, at least 20 percent of patients discharged from the ICU experience an adverse event … , with more than one-third of these adverse events deemed preventable. 63 These adverse events are associated … Ineffective verbal and written handoffs have been estimated to lead to approximately 10 percent of adverse … event related to the ICU-ward handoff, and most of these adverse events were rooted in communication

135. Final Progress Report: Management of Direct Anticoagulants to Lower Adverse Events in Atrial Fibrillation (MODL-AF) (pdf file)
     www.ahrq.gov/sites/default/files/2024-02/king-report.pdf
     January 01, 2024 - Final Progress Report: Management of Direct Anticoagulants to Lower Adverse Events in Atrial Fibrillation … (MODL-AF) Project Title: Management of Direct Anticoagulants to Lower Adverse Events in Atrial Fibrillation

136. Updated Information on the Annual Hospital-Acquired Condition Rate: 2011 and 2012 | Agency for Healthcare Research and Quality
     www.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 … 32,750,000 Discharges— Based on 2010 Baseline) 2012 PFP Measured HACs per 1,000 Discharges Adverse … 0.51 Falls MPSMS In-Hospital Patient Falls 260,000 7.80 230,000 7.16 Obstetric Adverse … 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

137. Open Wide Learning Lab (OWLL): Improving Patient Safety in Dentistry | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/resources/learning-lab/owll-long-desc.html
     August 01, 2025 - aimed to improve patient safety in dental settings by establishing a learning health system that used adverse … Identifying contributing factors associated with dental adverse events through a pragmatic electronic … An observational retrospective study of adverse events and behavioral outcomes during pediatric dental … Identifying contributing factors associated with dental adverse events through a pragmatic electronic … An observational retrospective study of adverse events and behavioral outcomes during pediatric dental

138. On-Time Pressure Ulcer Healing: Facilitator Training Instructor's Guide | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/pruhealing/guide.html
     December 01, 2017 - Nursing home staff generally do a good job of investigating and following up after an adverse event, … The reports: Focus on preventing adverse events. Are proactive rather than reactive. … Investigate root causes when an adverse event occurs. … Improve root cause analyses when adverse events occur. … Discussion questions are tailored to the On-Time adverse event being addressed.

139. CANDOR Event Checklist | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/hospital/candor/modules/checklist4.html
     August 01, 2022 - How to use this tool: Use the checklist to ensure that appropriate action is taken following an adverse … Report any adverse event to the appropriate professional responsible for patient safety events.

140. Global Assessment of Pediatric Patient Safety (GAPPS) Trigger Tool | Agency for Healthcare Research and Quality
     www.ahrq.gov/pqmp/measures/global-assessment.html
     August 01, 2021 - Pediatric Patient Safety PQMP COE:  CEPQM Associated NQF # and Name:  3136, GAPPS: Rate of Preventable Adverse