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241. Language, Literacy, and Communication Regarding Medication in an Anticoagulation Clinic: Are Pictures Better Than Words? (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Schillinger.pdf
     January 01, 2004 - drug events.2 Effective communication regarding medications can help avoid medication-related errors3 … drug events at rates disproportionate to its use,2 routinely identifying discordance and developing … drug events. … Adverse drug events in ambulatory care. N Engl J Med 2003;348(16):1556–64. 2. … Incidence and preventability of adverse drug events among older persons in the ambulatory setting.

242. Final Progress Report: Topical Vancomycin for Neurosurgery Wound Prophylaxis (pdf file)
     www.ahrq.gov/sites/default/files/2024-03/connolly-report.pdf
     January 01, 2024 - Final Progress Report: Topical Vancomycin for Neurosurgery Wound Prophylaxis Title: Topical Vancomycin for Neurosurgery Wound Prophylaxis Principal Investigator: Connolly, Edward Sander Team Members: Jared Knopman, MD - Site PI (Cornell) Emilia Bagiella, PhD - Site PI (Mount Sinai) Franklin Lowy, MD - Co-Investigato…

243. Final Progress Report: Addressing methodological and ethical issues in pediatric medication safety research (pdf file)
     www.ahrq.gov/sites/default/files/2024-02/carpenter-report.pdf
     January 01, 2024 - teams; ethical issues in pediatric drug development; measuring child-reported outcomes; and preventing adverse … drug events in pediatric populations. … Adverse Drug Reactions in Children: The Impact on Clinical Care and Prescribing Practices (Jennifer … Communication in Pharmacy Settings Speakers: Delesha Carpenter, Julia Gilmartin, Oksana Pyzik 13 4.38 0.65 Adverse … Drug Reactions in Children: The Impact on Clinical Care and Prescribing Practices Speaker: Jennifer

244. Information to Help Hospitals Get Started (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/howtogetstarted/How_to_Use_Guide_Ldr_Slide_508.pdf
     June 02, 2025 - within a month of discharge, of which ¾ could be prevented • Common complications post-discharge are adverse … drug events, healthcare-associated infections, and procedural complications • Many complications

245. Making Healthcare Safer Practices: 12. Infusion Pumps (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/research/findings/making-healthcare-safer/mhs3/infusion-pumps-1.pdf
     March 01, 2020 - Studies have found that IV infusion is associated with 54 percent of all adverse drug events, 56 percent … drug events. … drug events. … In addition, the number of adverse drug events more severe than level 2—defined as events that reach … drug events

246. Create a Safe Medicine List Together (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/medicinelist-slides-508.pdf
     June 02, 2025 - • Adverse drug events • Unsafe medicine issues • Medicine adherence • Satisfaction • Reported use … We will use several measures to evaluate effectiveness: How many adverse drug events occur pre- and

247. Silence A Commentary | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/reports/liability/silence.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 Carole Hemmelgarn Three

248. Antibiotic Stewardship Program (ASP) Development
     www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/program-dev-slides.pptx
     June 01, 2021 - Antibiotic Stewardship Program (ASP) Development Developing an Antibiotic Stewardship Program Long-Term Care AHRQ Safety Program for Improving Antibiotic Use AHRQ Pub. No. 17(21)-0029 June 2021 Developing a Program 1 Objectives Name the goals of antibiotic stewardship and why it is important in long-term care (LT…

249. Final Progress Report: Improving Safe Use of Direct Oral Anticoagulants: A Population Health Approach (pdf file)
     www.ahrq.gov/sites/default/files/2024-10/barnes-report.pdf
     January 01, 2024 - Finally, DOACs are leading contributors of adverse drug events leading to emergency department visits … promising anticoagulation stewardship intervention that aims to improve safe use of DOACs and reduce adverse … drug events. … National Action Plan for Adverse Drug Event Prevention. … National Action Plan for Adverse Drug Event Prevention2014. 23. Glasgow RE, Vogt TM, Boles SM.

250. Advances in Patient Safety | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/reports/advances/index.html
     July 01, 2022 - Elizabeth Duthie, Barbara Favreau, Angelo Ruperto, Janet Mannion, Ellen Flink, Ruth Leslie Reporting of Adverse … Drug Events: Examination of a Hospital Incident Reporting System (   PDF , 287 KB) Radhika Desikan … Glasgow Development of a Computerized Adverse Drug Event (ADE) Monitor in the Outpatient Setting (

251. Final Progress Report: APPLIED STRATEGIES FOR IMPROVING PATIENT SAFETY (ASIPS) (pdf file)
     www.ahrq.gov/sites/default/files/2024-02/pace-report.pdf
     January 01, 2024 - Final Progress Report: APPLIED STRATEGIES FOR IMPROVING PATIENT SAFETY (ASIPS) Final Report APPLIED STRATEGIES FOR IMPROVING PATIENT SAFETY (ASIPS) Principal Investigator: Wilson D. Pace, MD* Key Personnel: David West, PhD * Deborah S. Main, PhD* John Westfall, MD* Daniel Harris, PhD** Organizational Aff…

252. Final Progress Report: Proactive Risk Assessment of Primary Care of the Elderly (pdf file)
     www.ahrq.gov/sites/default/files/2024-12/karsh-report.pdf
     January 01, 2024 - drug events. 16 Results from recent studies suggest that polypharmacy occurs in nearly 20% of patients … prescriptions per visit increases.9, 16 Research on elderly outpatients shows that, of all reported adverse … drug events (ADEs), 38% are life- threatening or fatal, and 42% of the life-threatening or fatal ADEs … drug events.9, 16, 17, 42 Fourth, the elderly have, compared to other adult age groups, higher rates … Incidence and preventability of adverse drug events among older persons in the ambulatory setting.

253. Final Progress Report: Risk-Informed Interventions in Community Pharmacy: Implementation and Evaluation (pdf file)
     www.ahrq.gov/sites/default/files/2024-02/cohen2-report.pdf
     January 01, 2024 - Testing of HAMMERS™ verified the accuracy of its estimates of preventable adverse drug events. … that combine and contribute to dispensing system failures and the overall incidence of preventable adverse … drug events. … Medication dispensing errors and potential adverse drug events before and after implementing bar code

254. Final Progress Report: Identifying and Reducing Errors in Perioperative Anesthesia Medication Delivery (pdf file)
     www.ahrq.gov/sites/default/files/2025-02/catchpole2-report.pdf
     January 01, 2025 - human factors, error, harm, safety, systems PURPOSE In the United States, medication errors and adverse … drug events cost the average teaching hospital $5.6 million annually, half of which are thought to … Medication errors, critical incidents, adverse drug events, and more: a review examining patient safety-related

255. Final Progress Report: Shared Online Health Records for Patient Safety and Care (pdf file)
     www.ahrq.gov/sites/default/files/2024-07/middleton-wald-report.pdf
     January 01, 2024 - drug events (ADEs). … drug event, patient safety, health maintenance, family history, diabetes A. … drug events (ADEs), medication list accuracy, and patient medication knowledge. … drug events (ADEs). … The rate of preventable and ameliorable adverse drug events (ADEs) and medication and allergy list accuracy

256. Improving Patient Safety in Hospitals: A Resource List for Users of the AHRQ Hospital Survey on Patient Safety Culture (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/hospital-version-2-resource-list.pdf
     December 01, 2024 - Patient Safety Primer: Medication Errors and Adverse Drug Events https://psnet.ahrq.gov/primers/primer … of the medication use pathway—prescribing, transcribing, dispensing, and administration—to prevent adverse … drug events (ADEs). … Drug Events Patient Safety Primer: Missed Nursing Care Patient Safety Primer: Reporting Patient Safety … Patient Safety Primer: Medication Errors and Adverse Drug Events 21.

257. Final Progress Report: Improving the Safety of Primary Care by Measuring Adverse Events and Improvement (pdf file)
     www.ahrq.gov/sites/default/files/2024-03/kennerly-report.pdf
     January 01, 2024 - Early work using the BI-OTT indicated that adverse drug events (ADEs) are the most common type of AE … ambulatory electronic health record (AEHR) by measuring the pre- and post-implementation AEHR frequency of adverse … drug events (ADEs), as detected by the BI-OTT. … Adverse drug events occurring following hospital discharge. J Gen Intern Med 2005;20:317-23. 4.

258. Re-engineering the Hospital Discharge: An Example of a Multifaceted Process Evaluation (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Anthony.pdf
     January 01, 2005 - Incidence of adverse drug events and potential adverse drug events. Implications for prevention.

259. Fundamentals of Medicare Patient Safety Surveillance: Intent, Relevance, and Transparency (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Hunt.pdf
     July 01, 2004 - pneumonia Postoperative DVT/PE* Hospital acquired UTI** Ventilator associated pneumonia** Adverse … drug events ** Pressure ulcers* Postoperative cardiac events* Hospital falls** Angiographic

260. 2018 National Healthcare Quality and Disparities Report Data Sources (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2018qdr-datasources.pdf
     October 01, 2019 - MPSMS is composed of 21 measures representing six types of adverse drug events (ADEs); six types of … Adverse event categories monitored by MPSMS include: • Adverse drug events. … difficile Adverse drug events 2004-2007 and 2009-2016 ADE - Digoxin Adverse drug events 2004-2007 … Adverse drug events 2004-2007 and 2009-2016 ADE - Low Molecular Weight Heparin Adverse drug events … Adverse drug events among hospitalized Medicare patients: epidemiology and national estimates from a