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201. Patient Experience as a Source for Understanding the Origins, Impact, and Remediation of Diagnostic Errors, Volume 2: Eliciting Patient Narratives (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/topics/dxsafety-patient-experience-vol2.pdf
     July 01, 2023 - Patient Experience as a Source for Understanding the Origins, Impact, and Remediation of Diagnostic Errors, Volume 2: Eliciting Patient Narratives PATIENT SAFETY e Issue Brief 12 Patient Experience as a Source for Understanding the Origins, Impact, and Remediation of Diagnostic Errors Volume 2: Eliciting Patie…

202. Meeting Minutes, March 2018 | Agency for Healthcare Research and Quality
     www.ahrq.gov/news/events/nac/2018-03-nac/nacmtg0317-minutes.html
     July 01, 2018 - For example, rates of HACs related to adverse drug events have been falling for the past 5 years.

203. Chapter 6. Track Performance with Metrics | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/hospital/vtguide/guide6.html
     May 01, 2016 - having significant drops in hemoglobin while on anticoagulation can spur chart review to determine if an adverse … drug event occurred, to assess the level of harm, and to examine the case for error. 20 An approach … reviewed for a list of "triggers" for further review. 21 Triggers potentially related to anticoagulant adverse … drug events (ADEs), such as an elevated INR, elevated PTT, use of anticoagulant reversal agents, change

204. The Integration of Hospitalists into U.S. Academic Medical Centers
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/mindfulness-061014.pptx
     March 07, 2014 - The Integration of Hospitalists into U.S. Academic Medical Centers Mindfulness: Engaging Frontline Providers in Antimicrobial Stewardship 1 CAPT Arjun Srinivasan, MD Associate Director for Healthcare Associated Infection Prevention Programs Division of Healthcare Quality Promotion Scott Flanders, MD Professor of Med…

205. Mindfulness: Engaging Frontline Providers in Antimicrobial Stewardship (June 10, 2014) | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/cauti-tools/archived-webinars/mindfulness-transcript.html
     December 01, 2017 - In 2008, we looked at data on outpatient visits to emergency departments for adverse drug events related … presented to an emergency room, and the attending clinician who saw them in the ER thought that they had an adverse … drug event attributed to antibiotics. … percentage of those were unnecessary, there's opportunities to prevent emergency department visits for adverse … drug events because many of these patients were probably getting antibiotics that they maybe didn't

206. Chapter 6. Assessment and Process Evaluation | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/hospital/match/chapter-6.html
     July 01, 2022 - The third measure identifies adverse drug events (ADEs) from unreconciled medication on admission.

207. Strategy 4: IDEA Discharge Planning (Tool 4) (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy4/Strat4_Tool_4_PPT_508.pdf
     April 02, 2025 - within a month of discharge, of which ¾ could be prevented • Common complications post-discharge are adverse … drug events, hospital-acquired infections, and procedural complications • Many complications can

208. National Healthcare Quality and Disparities Report (QDR): Care Coordination Chartbook (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/chartbooks/carecoordination/qdr2015-chartbook-carecoordination.pdf
     June 16, 2016 - CPOE is associated with a 13% to 99% reduction in medication errors and a 30% to 84% reduction in adverse … drug events (ADEs) (Ammenwerth, et al., 2008) … CPOE is associated with a 13% to 99% reduction in medication errors and a 30% to 84% reduction in adverse … drug events (ADEs) (Ammenwerth, et al., 2008) … The effect of electronic prescribing on medication errors and adverse drug events: a systematic review

209. AHRQ Safety Program for MRSA Prevention
     www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa/008-antibiotic-stewardship-slides.pptx
     October 01, 2022 - AHRQ Safety Program for MRSA Prevention AHRQ Safety Program for MRSA Prevention Antibiotic Stewardship and MRSA Reduction ICU & Non-ICU AHRQ Pub. No. 25-0007 October 2024 AHRQ Safety Program for MRSA Prevention | ICU & Non-ICU Antibiotic Stewardship 1 Educational Objectives Understand the goals of antibiotic ste…

210. IV. Evaluation Aims, Methods, and Results | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/reports/hotline/eval4.html
     May 01, 2016 - Developing and Testing the Health Care Safety Hotline: A Prototype Consumer Reporting System for Patient Safety Events IV. Evaluation Aims, Methods, and Results Previous Page Next Page Table of Contents Developing and Testing the Health Care Safety Hotline: A Prototype Consumer Reporting System for …

211. Federal Interagency Workgroup on Improving Diagnostic Safety and Quality in Healthcare (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/diagnostic/Dec-2024-IAWG-roster.pdf
     January 01, 2024 - Federal Interagency Workgroup on Improving Diagnostic Safety and Quality in Healthcare Federal Interagency Workgroup on Improving Diagnostic Safety and Quality in Healthcare *List current as of December 2, 2024 Name Agency/Department Title Craig A. Umscheid, M.D., M.S. AHRQ Director, Center for Quality Improv…

212. About the Nursing Home Antimicrobial Stewardship Guide | Agency for Healthcare Research and Quality
     www.ahrq.gov/nhguide/about/index.html
     November 01, 2024 - About the Nursing Home Antimicrobial Stewardship Guide What Is the Nursing Home Antimicrobial Stewardship Guide? The Nursing Home Antimicrobial Stewardship Guide (the Guide) provides toolkits to help nursing homes optimize their use of antibiotics. This page provides information about antimicrobial stewardshi…

213. Appendix C: VTE Measurement and Tracking | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/hospital/vtguide/appc.html
     May 01, 2016 - (May want to exclude these readmitted patients if looking exclusively at prophylactic anticoagulant adverse … drug events [ADEs].)

214. Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/reports/engage/faq.html
     April 01, 2018 - up to 57 percent of patients on five or more medicines (called polypharmacy) are at greater risk for adverse … drug events.

215. Preventing CAUTI: Focus on Culturing Stewardship | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/cauti-tools/phys-championsgd/section7.html
     May 01, 2023 - Resident Physicians as Champions in Preventing Device-Associated Infections Preventing CAUTI: Focus on Culturing Stewardship Previous Page Next Page Table of Contents Resident Physicians as Champions in Preventing Device-Associated Infections Preamble and Summary Epidemiology of Invasive Devices…

216. Build a Business Case for Quality Improvement: Facilitator Guide | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/tools/mvp/modules/cusp/build-business-case-fac-guide.html
     February 01, 2017 - Postoperative deep vein thromboses, patient falls, and adverse drug events also yield significant additional

217. Strategy 4: IDEA Discharge Planning (Implementation Handbook) (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy4/Strat4_Implement_Hndbook_508_v2.pdf
     April 01, 2011 - Common complications post-discharge include adverse drug events, hospital-acquired infections, and procedural … Patients prescribed high-risk medications or complex medication regimens may be at higher risk of adverse … drug events.4,6,8 • Inadequate preparation for discharge.

218. 009-Antibiotic-Stewardship-Guide (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa/009-antibiotic-stewardship-guide.docx
     October 01, 2024 - AHRQ Safety Program for MRSA Prevention Antibiotic Stewardship and MRSA Reduction ICU & Non-ICU Slide Title and Commentary Slide Number and Slide Antibiotic Stewardship and MRSA Reduction SAY: Welcome to this presentation on antibiotic stewardship as part of an overall approach to preventing MRSA in ICU and non-IC…

219. Biosketches | Agency for Healthcare Research and Quality
     www.ahrq.gov/news/events/ahrq-research-summit-diagnostic-safety-biosketches.html
     September 01, 2016 - Biosketches Jason Adelman, MD, MS Chief Patient Safety Officer and Associate Chief Quality Officer Columbia University Medical Center/New York-Presbyterian Hospital Dr. Adelman is the Chief Patient Safety Officer and Associate Chief Quality Officer at Columbia University Medical Center/NewYork-Presbyter…

220. Chartbook on Women's Health Care: Slide Presentation | Agency for Healthcare Research and Quality
     www.ahrq.gov/research/findings/nhqrdr/2014chartbooks/womenhealth/womenh-slides.html
     March 01, 2020 - Adverse drug events occur in 15% or more of older patients presenting to offices, hospitals, and extended … Importance: Adverse effects of medical care can arise from medical and surgical procedures as well as from adverse … drug reactions. … Reducing the risk of adverse drug events in older adults.