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Total Results: 2,263 records

Showing results for "adverse".

301. Clinical Informatics and Its Usefulness for Assessing Risk and Preventing Falls and Pressure Ulcers in Nursing Home Environments (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Teigland.pdf
     March 01, 2004 - The adverse outcomes addressed in this study—falls and pressure ulcers—are associated with considerable … The goal of the project is to determine whether adverse outcomes for nursing home residents can be … Logistic regression was used to model the risk of an adverse event in the next quarter. … and adverse event did not occur); and (3) “unexpected” or potentially avoidable adverse outcomes (i.e … ., resident was “low risk” based on comprehensive risk model, but adverse event occurred).

302. Results | Agency for Healthcare Research and Quality
     www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-test-result-communication4.html
     July 01, 2024 - One study compiled problems and adverse events from a single institution using patient complaints, staff … (R9) Adverse outcomes related to test result release: Participants in clinical and operational roles … Participants identified few known reports of adverse events ranging in severity that were related to … We haven’t had many [reports of adverse outcomes]. … This is a pretty exceptional thing, but those are the two [known adverse events] that came before our

303. Improving the Safety of Heparin Administration by Implementing a Human Factors Process Analysis (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Harder.pdf
     May 19, 2003 - Further, 13.6 percent of the adverse events led to the death of the patient. … Death occurred in 6.6 percent (SD of 1.2 percent) of the adverse events. … Incidence of adverse events and negligence in hospitalized patients. … Incidence and types of adverse events and negligent care in Utah and Colorado. … The nature of adverse events in hospitalized patients.

304. Network of Patient Safety Databases Chartbook, 2019 (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/npsd/data/npsd-chartbook-2019.pdf
     January 01, 2019 - include additional information the provider considers to be necessary for further documentation of adverse … For example, 2,438 Medication or Other Substance events that were reported as Adverse reaction in patient … It should also be noted that reports involving an Adverse reaction in Patient Safety Network of … For example, 2,438 Medication or Other Substance events that were reported as Adverse Patient Safety … The exclusion criteria for Medication or Other Substance reports are: ■ Adverse drug reaction with

305. Physician Event Reporting: Training the Next Generation of Physicians (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Nguyen.pdf
     May 01, 2003 - Hilborne Abstract Physician reporting of adverse events and unsafe situations remains extremely … Each adverse event or near miss should be viewed and used as a learning experience to better understand … Because adverse events usually occur as a result of multiple failures, it is imperative that medical … Discussion Traditional physician adverse event reporting behavior Physicians traditionally use a … Reasons for not reporting adverse incidents: an empirical study.

306. Issue Brief 26: Exploration of Foundational Terminology and Paradigms for Improving Diagnosis (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/diagnostic/resources/issue-briefs/dxsafety-terminology.pdf
     April 01, 2025 - Thus, a subcategory of adverse events ascribed to error or substandard care, called preventable adverse … Few investigators focus on these types of diagnostic adverse events. … Adverse Events, Diagnostic Adverse Events Defined under the Safety Paradigm section above, adverse … Incidence of adverse events and negligence in hospitalized patients. … The nature of adverse events in hospitalized patients.

307. Saving Lives and Saving Money: Hospital-Acquired Conditions Update | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/pfp/interimhacrate2014.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 this reduction is from adverse drug events, about 28 percent from pressure ulcers … Most of the deaths averted occurred as a result of reductions in the rates of pressure ulcers and adverse … paper by Furukawa, et al. ( Journal of Patient Safety , in press) indicated that in 2012 and 2013, adverse … Although the paper did not study trends in EHR adoption or trends in adverse event rates, one may hypothesize

308. Patient Experience, Patient Safety, and Provider Well-Being: Associations and Paths (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/2023-virtual-research-meeting-summary-patient-experience.pdf
     January 01, 2023 - Black adults, compared to White adults, are more likely to report preventable adverse events. … However, compared to White adults, Black adults were 64 percent more likely to report an adverse event … Future research should seek to understand better ways to communicate that will, in turn, prevent adverse … Patients perceive that issues arise due to a combination of errors/adverse events and communication … We make the case (a) that patient 14 safety surveys must inquire about all adverse events, not

309. Summary | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/reports/hotline/summary.html
     May 01, 2016 - out by the Institute of Medicine, 2   and the AHRQ Common Formats, a which includes definitions of adverse … events and forms for adverse event reporting. … any relevant information collected from other sources within their organizations (such as an existing adverse … the identified goals (patient safety improvement, public monitoring and accountability, research on adverse … Overall, the number of consumer reports was disappointing, given the potential reservoir of adverse events

310. Return on Investment Tool (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/pdi/f1_pdi_returnoninvestment.docx
     January 01, 2013 - The cost of adverse drug events in hospitalized patients. JAMA 1997;277:307-11. … Costs of adverse events in intensive care units. Crit Care Med 2007;35(11)2637-8. Pappas SH. … The cost of nurse-sensitive adverse events. J Nurs Adm 2008;38(5):230-6. … The costs and savings associated with prevention of adverse events by critical care nurses. … allows users to track the change in rate of any type of adverse event over time.

311. Health Systems Research | Agency for Healthcare Research and Quality
     www.ahrq.gov/opioids/health-systems-research.html
     July 01, 2021 - Older adults have a high prevalence of chronic pain and are especially vulnerable to adverse events from … Characterizing Opioid-Related Adverse Events in Older Adults After Hospital Discharge.  … Prescribing of opioids at hospital discharge and associated adverse patient outcomes.

312. Communication and Optimal Resolution (CANDOR) Toolkit Module 3: Preparing for Implementation: Change Readiness and Gap Analysis
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/candor/module3/module3-assessment-change-readiness-gap-analysis.pptx
     August 25, 2015 - An adverse event is "any injury caused by medical care" and doesn't imply "error," "negligence," or poor … The diagram, developed by Robert Watcher, shows the distinction between adverse events and errors. … Not all adverse events are medical errors and not all medical errors are adverse events. … DO: Explain the diagram to others, and ask others to provide examples of adverse events that are not … Implementing change is hard work, particularly when the change involves a response to an adverse patient

313. 5 Tk1 T5-Sample Policy Letter Final (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/nhguide/5_TK1_T5-Sample_Policy_Letter_final.docx
     October 01, 2016 - The adverse consequences of unnecessary antibiotic use include adverse drug reactions or interactions

314. 5 Tk1 T5-Sample Policy Letter Final (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/nhguide/5_TK1_T5-Sample_Policy_Letter_final.pdf
     October 01, 2016 - The adverse consequences of unnecessary antibiotic use include adverse drug reactions or interactions

315. Using Six Sigma® Methodology to Improve Handoff Communication in High-Risk Patients (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol3/Advances-Mistry_114.pdf
     May 05, 2008 - Meliones MD, MS Abstract Background: During the analyses of adverse events, a commonly described … This temporary fix is commonly referred to as a “workaround.”9, 10 During the analyses of adverse … Understanding adverse events: Human factors. Qual Health Care 1995; 4: 80-89. 5. Reason J. … The nature of adverse events in hospitalized patients. … Understanding and responding to adverse events. N Engl J Med 2003; 348: 1051-1056. 16.

316. References | Agency for Healthcare Research and Quality
     www.ahrq.gov/es/patient-safety/settings/hospital/match/references.html
     July 01, 2022 - The costs of adverse drug events in hospitalized patients. … Adverse Drug Events Prevention Study Group. JAMA 1997; 277(4):307-11. … Identifying hospital admissions due to adverse drug events using a computer-based monitor.

317. References | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/hospital/match/references.html
     July 01, 2022 - The costs of adverse drug events in hospitalized patients. … Adverse Drug Events Prevention Study Group. JAMA 1997; 277(4):307-11. … Identifying hospital admissions due to adverse drug events using a computer-based monitor.

318. Universal ICU Decolonization: An Enhanced Protocol | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/universal-icu-decolonization/index.html
     September 01, 2013 - Safety and Adverse Events The REDUCE MRSA Trial (Randomized Evaluation of Decolonization … Safety and Adverse Events Authors University of California Irvine Susan Huang, MD, MPH Adrijana

319. Network of Patient Safety Databases Chartbook, 2021 (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/npsd/data/npsd-chartbook-2021.pdf
     January 01, 2021 - For example, Medication or Other Substance events that were reported as Adverse reaction in patient … For example, Medication or Other Substance events that were reported as Adverse reaction in patient … For example, Medication or Other Substance events that were reported as Adverse reaction in patient … For example, Medication or Other Substance events that were reported as Adverse reaction in patient … For example, Medication or Other Substance events that were reported as Adverse reaction in patient

320. Final Progress Report: Patient-Centric Risk Model for Medication Safety During Care Transitions (pdf file)
     www.ahrq.gov/sites/default/files/2024-02/gurses-report.pdf
     January 01, 2024 - In the US, adverse drug events (ADEs) in community settings accounted for 2.5-11.2% of all emergency … A theoretical framework of risks and hazards for medication-related adverse events. Table 1. … Care transitions pose high risk for adverse drug events. … National surveillance of emergency department visits for outpatient adverse drug events. … Risk factors for hospital admissions associated with adverse drug events.