Results

Total Results: 2,263 records

Showing results for "adverse".

141. Disclosure Checklist | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/hospital/candor/modules/checklist5.html
     August 01, 2022 - 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.   … Be honest EXPLAIN the facts about the adverse event without the patient having to do a lot of probing

142. AHRQ National Scorecard on Hospital-Acquired Conditions: Updated Baseline Rates and Preliminary Results 2014-2016 (pdf file)
     www.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

143. Patient Safety Research in Medical Group Practices: Measurement and Data Challenges (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Wilson.pdf
     December 01, 2004 - Researchers have put forth many definitions of patient safety, errors, and adverse events. … It is important to note that not all errors will result in adverse events. … The importance of studying adverse events is obvious. Patients suffer when they occur. … The importance of studying the errors that precede the adverse events is also obvious. … Adverse drug events in high risk older outpatients. [See Comment.]

144. Appendix | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/pfp/hacrate2013-appendix.html
     October 01, 2015 - 9,200 0.28 Falls MPSMS (2013) In-Hospital Patient Falls 240,000 7.2 Obstetric Adverse … Femoral Artery Puncture for Catheter Angiographic Procedures 59,000 1.8 MPSMS (2013) Adverse … Events Associated With Hip Joint Replacements 21,000 0.63 MPSMS (2013) Adverse Events Associated … Measured HACs c Projected Cost Savings in 2013 d Projected Reductions in Deaths in 2013 e Adverse … Goal for HAC Reduction b PfP HAC Reduction Goal c Estimated PfP Additional Cost* per HAC Adverse

145. Conceptual Paradigms of Diagnostic Quality, Safety, and Excellence | Agency for Healthcare Research and Quality
     www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-terminology5.html
     April 01, 2025 - patient’s underlying condition. 11,13,14   Early on, clinicians and researchers argued that not all adverse … Thus, a subcategory of adverse events ascribed to error or substandard care, called preventable adverse … the field evolved to consider diagnostic errors as a subset of medical error, the term diagnostic adverse … Few investigators focus on these types of diagnostic adverse events. … Safety-I often defines factors that contribute to adverse events as failures or errors, even if it uses

146. 017-Ss-Importance-Ssi-Mrsa-Prevention-Fg (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-2/017-ss-importance-ssi-mrsa-prevention-fg.docx
     April 01, 2025 - It will discuss the harmful and adverse outcomes associated with MRSA and SSIs. … It will also review the adverse outcomes associated with MRSA and SSIs and the sources of MRSA as it … Outcomes SAY: This next portion of the presentation will provide an overview of SSIs and associated adverse … Because of the increase in adverse outcomes associated with SSIs caused by MRSA, the toolkit is designed … The appropriate antimicrobial agent should target what is on a patient’s skin while minimizing adverse

147. Making Effective Changes in Antibiotic Decision Making (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/safety/changes-facilitator-guide.pdf
     November 01, 2019 - How will you reduce the risk of the adverse event from happening again? 4. … In this patient’s case, antibiotic-related adverse events caused harm but when thinking of potential … Events SAY: When evaluating factors that contributed to an actual or potential adverse event, … Sometimes we forget to acknowledge the factors that mitigated potential harm from the adverse event … For example, if the adverse event was severe rash, it may be helpful to involve dermatology.

148. Final Progress Report: Advancing Patient Safety Innovation in Rheumatology (ASPIRE) (pdf file)
     www.ahrq.gov/sites/default/files/2024-02/yazdany-report.pdf
     January 01, 2024 - Results: The project generated new epidemiological evidence of patient safety risks and adverse events … Despite the frequency of ambulatory patient safety errors and adverse events, most efforts to study … Second, rare adverse events are challenging to accurately identify. … Food and Drug Administration Adverse Event Reporting System (FAERS). … Adverse drug events in the outpatient setting: an 11-year national analysis.

149. AHRQ’s Safety Program for Nursing Homes: On-Time Falls Prevention - Facilitator Training: Overview of On-Time (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/long-term-care/resources/ontime/fallsprev/ontimefallpxoverview-ig.pdf
     June 02, 2025 - It uses the electronic medical record, or EMR, to make staff aware of residents at risk of adverse … 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. …  Improve root cause analyses when adverse events occur. … Discussion questions are tailored to the On-Time adverse event of interest.

150. Final Progress Report: Risk and Recovery in Complex Environments: Labor and Delivery as a Model (pdf file)
     www.ahrq.gov/sites/default/files/2025-05/goldman2-report.pdf
     January 01, 2025 - Despite efforts to provide safe, effective care, adverse events still occur. … Our current understanding of the nature of medical adverse events, and our ability to develop durable … This tool uses computer-based modeling and simulation to estimate the likelihood of adverse events, …  What makes a case most vulnerable to adverse events? …  If perturbations (e.g., adverse events) disturb the system order, what strategies do individuals

151. 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

152. Declines in Hospital-Acquired Conditions (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/data/infographics/hac_rates_2019.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 -5% Pressure Ulcers 6% Surgical Site

153. Declines in Hospital-Acquired Conditions (pdf file)
     www.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

154. Mod01-Grand-Rounds-Slides (pdf file)
     www.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

155. Prioritization Worksheet (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/pdi/c1_pdi_prioritizationworksheetinstructions.pdf
     June 02, 2025 - Patients who experience adverse events often tend to have more comorbidities and other risk factors … and thus have accrued more costs even prior to the adverse event. … both costs and risk of the adverse event (e.g., concurrent cancer diagnosis). … Ideally, if your data permit, consider only costs that occur after the adverse event occurred. … Compare the total costs of having an adverse event (Column G, Total Cost) with the anticipated cost

156. Interim Update on 2013 Annual Hospital-Acquired Condition Rate (pdf file)
     www.ahrq.gov/sites/default/files/publications/files/interimhacrate2013_0.pdf
     October 27, 2014 - 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.

157. Prologue: Laying the Foundation (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Prologue_Henriksen_Vol1.pdf
     June 02, 2025 - Challenges of reporting quickly give rise to challenges of encoding and organizing the adverse event … Strategies and efforts aimed at adverse event surveillance, creating useable taxonomies, and addressing … Another paper examines the perceptions of health care leaders and news media professionals related to adverse … Risk is treated by safety scientists as the likelihood that exposure to a hazard will lead to adverse … underlying hazards and assessing risk—that is, the probability that exposure to a hazard will lead to an adverse

158. I. Introduction | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/reports/hotline/intro1.html
     May 01, 2016 - Importantly, none of these events were documented in the hospital’s adverse event reporting systems. … Two-thirds of the adverse events were detected by patient interview alone, demonstrating that patients … could identify adverse events of which the hospital was unaware. … Weingart and colleagues 29 found that 73 percent of adverse events occurring in primary care practices … Similarly, Weingart and colleagues, studying adverse event reports from ambulatory oncology patients,

159. Prioritization Worksheet (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/c1_combo_prioritizationworksheetinstructions.pdf
     June 02, 2025 - • Appropriate comparator: When trying to identify the cost attributable to an adverse event captured … Patients who experience adverse events often tend to have more comorbidities and other risk factors … and thus have accrued more costs even prior to the adverse event. … Therefore, choose a group that did not experience the adverse event that is as comparable as possible … Compare the total costs of having an adverse event (Column G, Total Cost) with the anticipated cost

160. Clinical Pharmacists in Emergency Medicine (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol4/Advances-fairbanks_20.pdf
     February 21, 2008 - Incidence and types of adverse events and negligent care in Utah and Colorado. … The nature of adverse events in hospitalized patients. … Incidence of adverse events and negligence in hospitalized patients. … Systems analysis of adverse drug events. ADE Prevention Study Group. … The clinical pharmacist’s role in preventing adverse drug events.