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161. Making Health Care Safer II, Executive Summary (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/research/findings/evidence-based-reports/services/quality/patientsftyupdate/ptsafetysum.pdf
     March 01, 2013 - drug events, or pressure ulcers. … drug events do not result in clinical harm. … drug events, or general clinical topics, such as preventing pressure ulcers; and PSPs designed to … Practices Designed for a Specific Patient Safety Target Adverse Drug Events High-alert drugs: patient … drug events; brief review Common/Low Moderate-to- high Low High Little/Moderate The Joint Commission

162. 3 Tk1 T5-Draft Policies And Procedures For The Antimicrobial Stewardship Program Final (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/nhguide/3_TK1_T5-Draft_Policies_and_Procedures_for_the_Antimicrobial_Stewardship_Program_final.docx
     October 01, 2016 - The adverse consequences of unnecessary antibiotic use include adverse drug reactions or interactions

163. Selected Best Practices and Suggestions for Improvement (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/d4n_combo_iqi-mortalityreview-bestpractices.pdf
     May 20, 2016 - department within 3 days of discharge ∗ Death associated with drug reaction ∗ Death associated with adverse … drug reaction ∗ Death associated with medication error ∗ Death associated with medical device … department within 3 days of discharge ∗ Death associated with drug reaction ∗ Death associated with adverse … drug event ∗ Death related to medical device ∗ Healthcare-associated infection ∗ Fall during hospitalization

164. Preface | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/reports/liability/preface.html
     August 01, 2017 - Transitional Care Medication Safety: Stakeholders' Perspectives Medication Discrepancies and Potential Adverse … Drug Events During Transfer of Care from Hospital to Home Since the Institute of Medicine

165. Grant Final Report: Toward an Optimal Patient Safety Information System (TOPSIS) (pdf file)
     www.ahrq.gov/sites/default/files/2024-04/koss-report.pdf
     January 01, 2024 - many healthcare organizations have the health information technology to improve their detection of adverse … drug events, medication errors and/or near misses, they rarely use the data from reporting systems … A classification for adverse drug events. J Qual Clin Pract. 1999; 19(1):23-26. 23. … Physicians' attitudes and adverse drug reaction reporting: a case-control study in Portugal, Drug Saf

166. Looking for Trouble in All the Right Places: The Legal Implications Associated with “Electronic Signatures” and High-risk Clinical Situations (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Escobar.pdf
     February 01, 2005 - Electronic identification mechanisms, which are more efficient, have been defined for adverse drug events … drug events (ADEs) among 36,653 hospitalized patients over an 18-month period. … Incidence of adverse drug events and potential adverse drug events. Implications for prevention. … Systems analysis of adverse drug events. ADE Prevention Study Group. … The incident reporting system does not detect adverse drug events: a problem for quality improvement

167. Final Progress Report: Using Barcode Technology to Improve Medication Safety (pdf file)
     www.ahrq.gov/sites/default/files/2024-01/gandhi-report.pdf
     January 01, 2024 - impact of barcode technology on pharmacy medication dispensing errors and their potential to cause adverse … drug events (ADEs). … Overall, 23.5% of undetected errors were potential adverse drug events (ADEs), of which 28% were serious … Medication dispensing errors and potential adverse drug events before and after implementing barcode

168. A Patient Safety Program & Research Evaluation of U.S. Navy Pharmacy Refill Clinics (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Reige.pdf
     March 01, 2004 - involving the pharmacist in medication renewals contributed to a significant reduction in preventable adverse … drug reactions. … Pharmacist on rounding teams reduce preventable adverse drug events in hospital general medicine units

169. Strategy 4: IDEA Discharge Planning (Tool 3) (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy4/Strat4_Tool_3_Physician_HO_508.docx
     January 01, 2010 - three-quarters of these could have been prevented or ameliorated.1 Common post-discharge complications include adverse … drug events, hospital-acquired infections, and procedural complications.1 Many of these complications

170. Medication Management Transactions and Errors in Family Medicine Offices: A Pilot Study (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol4/Advances-Lynch_37.pdf
     March 21, 2008 - Among a sample of elderly patients, Gurwitz, et al.,6 found that many adverse drug events were due to … Adverse drug events in ambulatory care. N Engl J Med 2003; 348: 1556-1564. 3. … Incidence and preventability of adverse drug events among older persons in the ambulatory setting.

171. Final Progress Report: Addressing Preventable Medication Use Variance in Mississippi (pdf file)
     www.ahrq.gov/sites/default/files/2024-01/brown-report.pdf
     January 01, 2024 - S.L. (2002) "The Use of Data Mining Tools in the Identification of Medication Error Near Misses and Adverse … Drug Events." … "A Comparison of Neural Network and Decision Tree Models in Detecting Adverse Drug Events in a Medical

172. Final progress Report: Anticholinergics and Cognitive Decline in the Elderly with Depression (pdf file)
     www.ahrq.gov/sites/default/files/2024-01/aparasu-report.pdf
     January 01, 2024 - Anticholinergic side-effects of drugs in elderly people.

173. Final Progress Report: Pursuing Perfection in Pediatric Therapeutics (pdf file)
     www.ahrq.gov/sites/default/files/2024-01/lannon1-report.pdf
     January 01, 2024 - Adverse Drug Events: This project developed successful strategies to decrease harm from adverse medication … Drug Events (ADEs). … 8 0 Created by Kate Rich, Dept HPCE week ending Rate per 1000 Line Days Average UCL LCL The Adverse … Drug Events work supported by the CCHMC CERT has improved care and outcomes for children in one large … The national burden of E-code-identified adverse drug events among hospitalized children using a national

174. Final Progress Report: Investigating Failures of Notification and Monitoring in Outpatient Care: the Safety Promotion Action Research and Knowledge Network (pdf file)
     www.ahrq.gov/sites/default/files/2024-11/sarkar2-report.pdf
     January 01, 2024 - Incidence and preventability of adverse drug events in hospitalized adults. … National surveillance of emergency department visits for outpatient adverse drug events. … Adverse Drug Events in U.S. Adult Ambulatory Medical Care. Health Serv R es. … Incidence and preventability of adverse drug events among older persons in the ambulatory setting … Patient reporting of suspected adverse drug reactions: a review of published literature and international

175. The “Never Antibiotics” Diagnoses: ​Viral Acute Upper Respiratory Infection: ​the Common Cold – Facilitator Guide (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/ambulatory-care/common-cold-guide.docx
     September 01, 2022 - Harm associated with antibiotics includes adverse drug events, microbiome disruption, and antibiotic … Adverse drug events from antibiotics are very common.

176. 3 Tk1 T5-Draft Policies And Procedures For The Antimicrobial Stewardship Program Final (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/nhguide/3_TK1_T5-Draft_Policies_and_Procedures_for_the_Antimicrobial_Stewardship_Program_final.pdf
     October 01, 2016 - The adverse consequences of unnecessary antibiotic use include adverse drug reactions or interactions

177. Harborview Medical Center Uses AHRQ’s Quality Indicators To Improve Patient Safety | Agency for Healthcare Research and Quality
     www.ahrq.gov/news/newsroom/case-studies/202504.html
     June 01, 2025 - Harborview Medical Center Uses AHRQ’s Quality Indicators To Improve Patient Safety Search All Impact Case Studies June 2025 Harborview Medical Center in Seattle, Washington, has improved patient safety across its facilities using AHRQ’s Quality Indicators (QIs) — standardized measures used to assess and m…

178. Prologue—Volume 1—Five Years Later—Are We Any Safer? (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/James.pdf
     January 01, 2004 - the initial IOM goal for some injury sources (for example, Brigham & Women’s Hospital in Boston for adverse … drug events [ADEs]; Intermountain Health Care’s LDS Hospital in Salt Lake City for ADEs and for postoperative … trigger systems), to successful interventions that addressed specific, single injury sources (e.g., adverse … drug events), to organizational structures (e.g., building a culture of safety; nursing roles; teamwork

179. Patient Safety | Agency for Healthcare Research and Quality
     www.ahrq.gov/ncepcr/reports/2025-annual-report/patient-safety.html
     August 01, 2025 - Medication Safety and Management Seven grants focus on reducing adverse drug events and inappropriate … provider) to reduce medication-related problems (such as inappropriate therapy, undertreated symptoms, or adverse … drug events) for children with medical complexity in an outpatient complex care program. 

180. CAUTI Prevention Implementation in a Community Hospital
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/assess-adapt-060314.pptx
     March 01, 2009 - Incidence of adverse drug events and potential adverse drug events. JAMA. 1995;274(1):29–34.