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381. Eliciting Patients’ Diagnostic Experiences Using Rigorous Methods | Agency for Healthcare Research and Quality
     www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-patients-source-understanding-dx-error-vol2-3.html
     June 01, 2023 - Patient Experience as a Source for Understanding the Origins, Impact, and Remediation of Diagnostic Errors Eliciting Patients’ Diagnostic Experiences Using Rigorous Methods Previous Page Next Page Table of Contents Patient Experience as a Source for Understanding the Origins, Impact, and Remediation…

382. Final Progress Report: Pediatric Medication Safety: Analyses from the MEDMARX Medication Error Reporting System (pdf file)
     www.ahrq.gov/sites/default/files/2024-01/bundy-report.pdf
     January 01, 2024 - internet-accessible database that hospitals and healthcare systems use to collect, report, track, and share adverse … drug reactions and medication errors in a standardized format.

383. Safe Medication Administration: Magnesium Sulfate | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/strategies/medication/tool-safe-mgso4.html
     July 01, 2023 - Safe Medication Administration: Magnesium Sulfate AHRQ Safety Program for Perinatal Care Purpose of the tool: This tool describes the key perinatal safety elements with examples for the safe administration of magnesium sulfate during labor. The key elements are presented within the framework of t…

384. A Process-centered Tool for Evaluating Patient Safety Performance and Guiding Strategic Improvement (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Akins.pdf
     January 01, 2003 - Systems analysis of adverse drug events. ADE Prevention Study Group. … Preventable adverse drug events in hospitalized patients: a comparative study of intensive care and

385. Unique Challenges in Approaching Diagnostic Safety in Older Adults | Agency for Healthcare Research and Quality
     www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-older-adults2.html
     September 01, 2024 - Adverse drug events from medication can often mimic acute medical conditions in older adults, thus contributing … and a “prescribing cascade,” where a second, potentially unnecessary drug is prescribed to treat the adverse … drug event.

386. Mapping a Large Patient Safety Database to the 2005 Patient Safety Event Taxonomy (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Clarke_8.pdf
     January 25, 2008 - Adverse drug reaction (not a medication error) C. Equipment, supplies, and/or devices D. … to the intentional sampling of a set number of reports from each event type, some of which (e.g., adverse … drug reactions and complications) always presume harm. 11 • The analysts may have had a bias

387. Appendix A. Grantee Profiles | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/reports/candor-demo-program/plan-grants/appa.html
     August 01, 2022 - discrepancies collected in this previous study to determine the potential for discrepancies to result in an adverse … drug event (ADE), the severity of the ADE (i.e., serious, significant, minor), the potential health

388. Improving Antipsychotic Appropriateness in Dementia Patients (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/clinicians-providers/iadapt/carnahan.pdf
     January 01, 2014 - Improving Antipsychotic Appropriateness in Dementia Patients …

389. Safe Medication Administration: Facilitator Guide | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/strategies/medication/safe-medication-fac-guide.html
     July 01, 2023 - Safe Medication Administration: Facilitator Guide AHRQ Safety Program for Perinatal Care Slide 1: Safe Medication Administration Say: The Safe Medication Administration bundle provides information on high-alert medications commonly used in labor and delivery (L&D) units, and discusses the importance of …

390. Safemed Facguide (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/strategies/medication/safemed_facguide.docx
     May 01, 2017 - AHRQ Safety Program for Perinatal Care Safe Medication Administration Safe Medication Administration SAY: The Safe Medication Administration bundle provides information on high-alert medications commonly used in labor and delivery (L&D) units, and discusses the importance of implementing safeguards for their administ…

391. 2021 National Healthcare Quality and Disparities Report Data Sources (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2021qdr-datasources.pdf
     December 31, 2021 - MPSMS is composed of 21 measures representing six types of adverse drug events (ADEs); six types of … Data Sources 84 Measure Primary Domain Data Period ADE - IV Heparin Adverse drug events 2004 … -2007 and 2009-2019 ADE - Low Molecular Weight Heparin Adverse drug events 2004-2007 and 2009- … 2019 ADE - Warfarin Adverse drug events 2004-2007 and 2009-2019 Catheter-Associated Urinary Tract … Adverse drug events among hospitalized Medicare patients: epidemiology and national estimates from a

392. Approaches to Address Health Risks for Older Adults
     www.ahrq.gov/sites/default/files/wysiwyg/ncepcr/about/ncepcr-older-adults-presentation.pptx
     March 15, 2025 - Approaches to Address Health Risks for Older Adults National Center for Excellence in Primary Care 1 National Center for Excellence in Primary Care Research Presents Approaches to Address Health Risks for Older Adults January 16, 2025 Presented by: Lisa Kern, MD, MPH Alberta K. Tran, Ph.D., RN, CCRN Yu-J…

393. Strategies to Better Engineer Safety into Healthcare Delivery (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/action-alliance/engineering-safety-practice/safety-engineering-strategies.pdf
     March 06, 2025 - Strategies to Better Engineer Safety into Healthcare Delivery Page 1 of 17 Engineering Safe Practices Affinity Group Strategies to Better Engineer Safety into Healthcare Delivery March 6, 2025 Table of Contents Problem Statement ...............................................................................…

394. 2019 National Healthcare Quality and Disparities Report Quality Trends (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2019qdr-core-measures-quality.pdf
     January 01, 2019 - drug event to low-molecular-weight heparin (LMWH) and factor Xa (MPSMS) 3.5% in 2014 1.7% in 2017 … -21.9 0.008 Medication Safety Adverse drug event with IV heparin in adult hospital patients who received … 2014 1.1% in 2017 -13.1 0.113 Medication Safety Hospital patients with an anticoagulant-related adverse … drug event to warfarin (MPSMS) 4.8% in 2014 3.7% in 2017 -12.1 0.298 Medication Safety Hospital … patients who received a hypoglycemic agent who had an adverse drug event with a hypoglycemic agent

395. Health Applications for Synchronous and Asynchronous Communication | Agency for Healthcare Research and Quality
     www.ahrq.gov/diagnostic-safety/resources/issue-briefs/healthit-ed-4.html
     February 01, 2021 - Health Information Technology for Engaging Patients in Diagnostic Decision Making in Emergency Departments Health Applications for Synchronous and Asynchronous Communication Previous Page Next Page Table of Contents Health Information Technology for Engaging Patients in Diagnostic Decision Making in…

396. PS Grantee | Agency for Healthcare Research and Quality
     www.ahrq.gov/research/findings/final-reports/index.html?page=8
     January 01, 2024 - Factors, Risk Assessment Publication Date: April 2015 Enhancing the Detection and Management of Adverse … Drug Events in the Nursing Home ( application/pdf 787663 ) Principal Investigators: Handler, et

397. Impact of Staff-Led Safety Walk Rounds (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol3/Advances-Montgomery_42.pdf
     March 05, 2008 - Impact of Staff-Led Safety Walk Rounds Impact of Staff-Led Safety Walk Rounds Vicki L. Montgomery, MD, FAAP, FCCM Abstract Objectives: The primary objectives of this study were to provide a venue for discussing safety concerns and to facilitate finding solutions for everyday safety issues. Methods: The mul…

398. Antibiotic Stewardship Slides, Part 2
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/implementation/educational-bundles/urine-culturing/antibiotic-stewardship/abx-stewardship-part2.pptx
     March 01, 2017 - Antibiotic Stewardship Slides, Part 2 Antibiotic Stewardship AHRQ Pub. No. 16(17)-0003-22-EF March 2017 AHRQ Safety Program for Long-Term Care: HAIs/CAUTI Welcome to today’s educational session on antibiotic stewardship. This module is part of the Agency for Healthcare Research and Quality (or AHRQ) Safety Progra…

399. AHRQ Safety Program for MRSA Prevention: Targeting SSI
     www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa-2/004-ss-antimicrobial-prophylaxis-part-2.pptx
     April 01, 2025 - AHRQ Safety Program for MRSA Prevention: Targeting SSI AHRQ Safety Program for MRSA Prevention: Targeting SSI Antimicrobial Perioperative Prophylaxis: Part 2 Beyond the Basics Surgical Services For: Cardiac, Hip and Knee Joint Replacement, and Spinal Fusion Surgeries AHRQ Pub. No. 25-0029 April 2025 AHRQ Safety Pro…

400. Presentation: Science of Improving Patient Safety and Identifying Defects
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/surgery/modules/onboarding/onboarding_scienceofsafety_training.pptx
     December 01, 2017 - Presentation: Science of Improving Patient Safety and Identifying Defects The Science of Improving Patient Safety and Identifying Defects AHRQ Safety Program for Surgery Onboarding AHRQ Pub No. 16(18)-0004-15-EF December 2017 Science of Improving Patient Safety ‹#› AHRQ Safety Program for Surgery – …