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www.innovations.ahrq.gov/research/findings/studies/index.html?page=480
January 01, 2024 - 1279)
2015
(1430)
2014
(662)
2013
(195)
Topics
Access to Care
(417)
Adverse … Drug Events (ADE)
(321)
Adverse Events
(736)
Alcohol Use
(61)
Ambulatory Care and Surgery … Keywords: Opioids, Medication, Substance Abuse, Screening, Adverse Drug Events (ADE), Adverse Events
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www.innovations.ahrq.gov/patient-safety/about/areas.html
February 01, 2018 - Team Training
Falls
Pressure Ulcers
Diagnostic Safety
Blood Clot Prevention and Treatment
Adverse
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/CHIPRA-BMI-Maternity-Care-Measures.pdf
February 23, 2012 - The Work Group also aimed to develop an
outcome measure assessing adverse events during birth. … (USPSTF 2009)
Alcohol and substance abuse in pregnant women have been linked to a variety of
adverse … Adverse effects of prenatal alcohol exposure can range from
subtle developmental problems, or fetal … Because of the potential adverse
consequences of prenatal alcohol exposure, short screening … Measure Importance
Relationship to
desired
outcome
Maternal obesity is associated with adverse
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www.innovations.ahrq.gov/patient-safety/settings/ambulatory/reduce-readmissions.html
December 01, 2023 - Readmissions
High rates of readmissions are a major patient safety problem associated with adverse
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/ambulatory-surgery/sections/implementation/training-tools/improving/improving.pptx
May 01, 2017 - for Ambulatory Surgery
6
Studies show that communication failures are the cause of 80 percent of adverse … for the entire team
Cards were placed in every operating room
Reduced wrong-site surgeries and other adverse … Ensures all team members are on the same page
Confirms critical information
Provides a place to discuss adverse … or potentially adverse events that occurred
Facilitates discussion of how to stop problems from reoccurring
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/topics/public-notes-meeting-summary-031121.pdf
July 22, 2021 - IHS • Enhanced Adverse Event Reporting Capabilities: IHS Safety
Tracking and Response (I-STAR) system
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/officebasedcare/handouts/teamattitude.pdf
December 09, 2015 - Adverse events may be reduced by maintaining an
information exchange with patients and their families
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www.innovations.ahrq.gov/research/findings/evidence-based-reports/makinghcsafer.html
June 01, 2022 - hospitals and nursing homes (including skilled nursing facilities) to collect data for all types of adverse … Research suggests that adverse events affect patients with limited English proficiency more frequently … If chest tubes are inserted incorrectly, patients can suffer adverse outcomes and even fatal complications
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/SOPS-Hospital-Survey-2.0-5-26-2021.pdf
January 01, 2021 - ”
• “Patient safety” is defined as the avoidance and prevention of patient injuries
or adverse events … Hospital management seems interested in
patient safety only after an adverse event
happens .......
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/evidencenow/heart-health/aspirin-algorithm.pdf
December 14, 2015 - Mediterranean diet plus positive
lifestyle changes for all
Routine monitoring and follow-up,
including for adverse
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/hospital/hospwebinar/just-culture-webcast-2-presentation.pdf
May 01, 2007 - Action Reports
– Patient Safety Activity Documentation
– Policies; Corrective Action, Sentinel
Events, Adverse
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/sops/quality-patient-safety/patientsafetyculture/hospitalscanform.pdf
December 22, 2017 - • “Patient safety” is defined as the avoidance and prevention of patient injuries
or adverse events … Hospital management seems interested in patient safety only after an
adverse event happens .......
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/hospital/resources/hospscanform.pdf
March 22, 2017 - • “Patient safety” is defined as the avoidance and prevention of patient injuries
or adverse events … Hospital management seems interested in patient safety only after an
adverse event happens .......
-
www.innovations.ahrq.gov/sites/default/files/wysiwyg/sops/quality-patient-safety/patientsafetyculture/hospitalscanform.doc
June 09, 2016 - · “Patient safety” is defined as the avoidance and prevention of patient injuries or adverse events … Hospital management seems interested in patient safety only after an adverse event happens
(1
(2
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www.innovations.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/how-to-use.html
July 01, 2023 - team members how to apply the Comprehensive Unit-based Safety Program (CUSP) to prevent obstetrical adverse
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www.innovations.ahrq.gov/news/newsroom/case-studies/index.html
February 01, 2024 - User Liaison Program (ULP)
(4)
WebM&M
(5)
Topics
Access to Care
(14)
Adverse … Impact Case Study Identifier: 2023-01 AHRQ Product(s): SHARE Approach Topic(s): Access to Care, Adverse
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/e1_combo_monitorprogress.pdf
June 05, 2016 - difficult to determine if a change in a measure (e.g., increased length of stay,
increased reporting of adverse … that are not expressed as rates
also can be used for monitoring, such as the occurrence of serious adverse
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www.innovations.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/fallprevention-training/module1/module1_tools.docx
March 01, 2013 - . † Adverse outcomes (a) Firm mattresses; low beds; appropriate chair heights and depths for easy transfer … and falls prevention) simultaneously and found an overall positive effect on the development of any adverse … However, Oliver and colleagues also note “so little empiric evidence on adverse effects of fall prevention … Designing adverse event prevention programs using quality management methods: the case of falls in hospital … Fewer adverse events as a result of the SAFE or SORRY?
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www.innovations.ahrq.gov/hai/hai-carb-funding.html
November 01, 2021 - determine the clinical efficacy and effectiveness of preventive interventions including unintended adverse
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www.innovations.ahrq.gov/talkingquality/translate/compare/choose/standard.html
January 01, 2023 - standard that is beginning to emerge in health care: the standard of “never” or zero percent for certain adverse