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721. Final Progress Report: Transdisciplinary Learning Lab To Eliminate Patient Harm and Reduce Waste (pdf file)
     www.ahrq.gov/sites/default/files/2025-03/sapirstein-report.pdf
     January 01, 2025 - Systems analysis of adverse drug events. ADE Prevention Study Group. JAMA. 1995; 274: 35-43. 10.

722. Final Progress Report: Diagnostic Error in Dystonia (pdf file)
     www.ahrq.gov/sites/default/files/2025-03/tanner-report.pdf
     January 01, 2025 - Final Progress Report: Diagnostic Error in Dystonia 5R01HS018413-02 REVISED Tanner CM I FINAL PROGRESS REPORT Project Title: Principal Investigator: Team Members: Project Dates: Federal Project Officer: Acknowledgment of Agency Support and Grant Number: DIAGNOSTIC ERROR IN DYSTONIA Tanner, Caroline M., MD, …

723. Patient Safety Learning Pilot: Narratives from the Frontlines (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Kellie_30.pdf
     April 21, 2008 - Additional methods include a telephone hotline for the reporting of adverse drug events and retrospective

724. 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…

725. Improving Healthcare Safety by Enhancing Care Coordination (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/highlights/ps-project-highlights-care-coordination.pdf
     June 30, 2025 - as a model for improving the safety of other medications associated with high rates of preventable adverse … drug events and for improving safety for vulnerable nursing home residents at special risk for medication-related

726. AHRQ-Funded Patient Safety Project Highlights (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/highlights/ps-project-highlights-pfe.pdf
     January 01, 2023 - The most common medication topics raised by families were scheduling (24%) and adverse drug reactions … in response to 8 percent of family-initiated dialogue, with most changes preventing or addressing adverse … drug reactions or scheduling issues.

727. Paul Tedrick (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/mindfulness-transcript.doc
     June 10, 2014 - 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

728. Improving the Value of Patient Safety Reporting Systems (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Pronovost_95.pdf
     June 12, 2008 - Improving the Value of Patient Safety Reporting Systems Improving the Value of Patient Safety Reporting Systems Peter J. Pronovost, MD, PhD; Laura L. Morlock, PhD; J. Bryan Sexton, PhD; Marlene R. Miller, MD, MSc; Christine G. Holzmueller, BLA; David A. Thompson, DNSc, MS; Lisa H. Lubomski, PhD; Albert W. Wu, M…

729. PS Grantee | Agency for Healthcare Research and Quality
     www.ahrq.gov/research/findings/final-reports/index.html?page=10
     January 01, 2024 - Grantee Final Reports: Patient Safety Final reports from research grants administered since 2000 on a variety of patient safety topics, such as measure development, medication safety, and diagnostic safety. The Agency for Healthcare Research and Quality Center for Quality Improvement and Patient Safety subdivis…

730. Behavioral Health Risk Assessment (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/perinatal/chipra-0085-fullreport.pdf
     December 31, 2015 - Behavioral Health Risk Assessment Behavioral Health Risk Assessment Section 1. Basic Measure Information 1.A. Measure Name Behavioral Health Risk Assessment 1.B. Measure Number 0085 1.C. Measure Description Please provide a non-technical description of the measure that conveys what it measures to a broad …

731. 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

732. Final Progress Report: Putting a Face on Hospital Medical Errors: Communication (pdf file)
     www.ahrq.gov/sites/default/files/2024-11/stewart-report.pdf
     January 01, 2024 - Final Progress Report: Putting a Face on Hospital Medical Errors: Communication FINAL REPORT Putting a Face on Hospital Medical Errors: Communication Project funded by: Agency for Healthcare Research and Quality Grant No. 1R03HS016122-01 September 29, 2005-September 30, 2006 Federal Project Officer: Elizabeth D…

733. Final Progress Report: Developing Definitions, Measurement Strategies, and Links to Medication Errors (pdf file)
     www.ahrq.gov/sites/default/files/2024-01/savage-report.pdf
     January 01, 2024 - Moreover, Thomas et al. (2000) found that adverse drug events account for up to 19% of adverse events

734. Evaluation of Medications Removed from Automated Dispensing Machines Using the Override Function Leading to Multiple System Changes (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol4/Advances-Miller_93.pdf
     March 12, 2008 - time the medication was reviewed by pharmacy; whether there was a medication error or subsequent adverse … drug reaction (ADR); indication for medication administered; and whether the nurse scanned the medication

735. Strategy 4: IDEA Discharge Planning (Implementation Handbook) (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy4/Strat4_Implement_Hndbook_508_v2.docx
     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.

736. Maternal and Child Health Care: Care Coordination Measures | Agency for Healthcare Research and Quality
     www.ahrq.gov/research/findings/nhqrdr/chartbooks/healthyliving/mchcare-measures.html
     June 01, 2018 - Chartbook on Healthy Living Maternal and Child Health Care: Care Coordination Measures Previous Page Next Page Table of Contents Chartbook on Healthy Living Acknowledgments Healthy Living Summary Healthy Living Measures Maternal and Child Health Care Maternal and Child Health Care: Eff…

737. Appendix 3: Data Abstraction (xls file)
     www.ahrq.gov/sites/default/files/wysiwyg/research/findings/ta/topicrefinement/ced-appendix3-data-abstraction.xlsx
     June 24, 2022 - Appendix 3: Data Abstraction TableOfContent Table of content Abstraction of criteria from existing sources Sheet number [Click to go to specific sheet] Pearson et. al 2018, white paper 1 Duke Margolis 2017, white paper 2 International Society for Pharmacoepidemiology (ISPE) position paper 3 Berger et al…

738. Decision Support System Design and Implementation for Outpatient Prescribing: The Safety in Prescribing Study (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Feldstein.pdf
     January 01, 2004 - Impact of basic computerized prescribing on outpatient medication errors and adverse drug events.

739. The AAFP Patient Safety Reporting System: Development and Legal Issues Pertinent to Medical Error Tracking and Analysis (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Phillips.pdf
     January 01, 2004 - The AAFP Patient Safety Reporting System: Development and Legal Issues Pertinent to Medical Error Tracking and Analysis 121 The AAFP Patient Safety Reporting System: Development and Legal Issues Pertinent to Medical Error Tracking and Analysis Robert L. Phillips, Susan M. Dovey, John S. Hickner, Deborah Graha…

740. Manage-Resident-Uti-Facilitator-Guide (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/manage-resident-UTI-facilitator-guide.docx
     June 01, 2021 - AHRQ Safety Program for Improving Antibiotic Use 1 Management of the Resident With a Suspected Urinary Tract Infection Long-Term Care Slide Title and Commentary Slide Number and Slide Management of the Resident With a Suspected Urinary Tract Infection Long-Term Care SAY: Welcome to the presentation titled “Man…