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Showing results for "adverse event".
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9321. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/46499/psn-pdf
      May 17, 2018 - safety culture is a core patient safety activity, but the relationship between safety culture and adverse … evaluation-association-between-nursing-home-survey-patient-safety-culture-nhsops-measures-and https://psnet.ahrq.gov/primer/culture-safety https://psnet.ahrq.gov/primer/adverse-events-near-misses-and-errors

9322. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/74253/psn-pdf
      January 12, 2022 - and researchers of how the unique situational factors caused by the pandemic have impacted hospital adverse … their procedures and documentation protocols to learn what works best for their institution to prevent adverse … become available, highlighting where innovative approaches were successful at reducing the risk of adverse … Burnout and its relationship to self-reported quality of patient care and adverse events during COVID … Patient safety concerns in COVID-19-related events: a study of 343 event reports from 71 hospitals in

9323. The nature of reported safety events related to care coordination in the operating room setting in a tertiary academic center. | PSNet
      psnet.ahrq.gov/issue/nature-reported-safety-events-related-care-coordination-operating-room-setting-tertiary
      May 11, 2022 - In the perioperative setting of one hospital, insufficient handoffs were  the most common event type … September 15, 2021 Outpatient insulin-related adverse events due to mix-up errors: findings

9324. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/34791/psn-pdf
      March 28, 2005 - The findings suggest that approximately 5% of all admissions are attributable to adverse drug reactions … Additional results presented include the type of adverse effects, admissions resulting from noncompliance

9325. Diagnostic errors. | PSNet
      psnet.ahrq.gov/issue/diagnostic-errors
      March 21, 2024 - Copy Citation Related Resources From the Same Author(s) Prevention of adverse … November 23, 2024 Reducing adverse obstetrical outcomes through safety sciences.

9326. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/42064/psn-pdf
      March 16, 2013 - evidence supporting 10 patient safety practices, including methods to prevent particularly common adverse … events such as diagnostic errors, adverse events after hospital discharge, and medication errors.

9327. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/847731/psn-pdf
      April 19, 2023 - This commentary shares thoughts from a variety of experts in response to a 2023 analysis of adverse

9328. Multiple latent failures align to allow a serious drug interaction to harm a patient. | PSNet
      psnet.ahrq.gov/issue/multiple-latent-failures-align-allow-serious-drug-interaction-harm-patient
      June 10, 2018 - latent failures  led to patient harm, this article encourages health care providers investigating adverse … 2023 Inaccurate penicillin allergy labeling, the electronic health record, and adverse

9329. Reduction in pediatric identification band errors: a quality collaborative. | PSNet
      psnet.ahrq.gov/issue/reduction-pediatric-identification-band-errors-quality-collaborative
      March 14, 2022 - Safety Concerns and the LGBTQ+ Population February 1, 2023 The nature of adverse … November 21, 2016 Sustaining and spreading the reduction of adverse drug events in a

9330. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45684/psn-pdf
      January 01, 2020 - multilevel analysis of U.S. hospital patient safety culture relationships with perceptions of voluntary event … Hospital Patient Safety Culture Relationships With Perceptions of Voluntary Event Reporting. … However, significant barriers to reporting exist and most systems capture only a fraction of adverse … Survey of Patient Safety Culture to better understand what aspects of safety culture might affect event … https://psnet.ahrq.gov/issue/can-we-use-incident-reports-detect-hospital-adverse-events https://psnet.ahrq.gov

9331. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/35023/psn-pdf
      March 04, 2011 - Building a framework for trust: critical event analysis of deaths in surgical care. … Building a framework for trust: critical event analysis of deaths in surgical care. … commentary discusses the role of the Scottish Audit of Surgical Mortality (SASM) on trends in adverse … Findings include a decrease over time in the percentage of deaths for which adverse events in management … conclude that voluntary mortality audits may lead to important changes in practice and focusing on adverse

9332. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45468/psn-pdf
      October 11, 2017 - Identification and characterization of adverse drug events in primary care. … Identification and Characterization of Adverse Drug Events in Primary Care. … https://psnet.ahrq.gov/issue/identification-and-characterization-adverse-drug-events-primary-care Adverse … drug event during a change in medications. … Less than 10% of patients experienced an adverse drug event, which the authors conclude represents an

9333. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45871/psn-pdf
      January 01, 2019 - The relationship between safety culture and voluntary event reporting in a large regional ambulatory … The Relationship Between Safety Culture and Voluntary Event Reporting in a Large Regional Ambulatory … https://psnet.ahrq.gov/issue/relationship-between-safety-culture-and-voluntary-event-reporting-large- … regional-ambulatory Detection of adverse events is particularly challenging in ambulatory settings … These results suggest that safety culture promotes reporting of adverse events.

9334. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/45714/psn-pdf
      December 20, 2017 - US emergency department visits for outpatient adverse drug events, 2013–2014. … US Emergency Department Visits for Outpatient Adverse Drug Events, 2013-2014. … Adverse drug events (ADEs) in outpatient settings can cause significant morbidity and mortality. … Drug Event Prevention. … https://psnet.ahrq.gov/issue/national-action-plan-adverse-drug-event-prevention

9335. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/37701/psn-pdf
      February 22, 2011 - Use of a handheld computer application for voluntary medication event reporting by inpatient nurses … Use of a handheld computer application for voluntary medication event reporting by inpatient nurses … https://psnet.ahrq.gov/issue/use-handheld-computer-application-voluntary-medication-event-reporting- … by low clinician reporting rates and the fact that they identify a relatively small percentage of adverse … rates-and-types-events-reported-established-incident-reporting-systems-two-us-hospitals https://psnet.ahrq.gov/issue/confidential-clinician-reported-surveillance-adverse-events-among-medical-inpatients

9336. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/34845/psn-pdf
      June 30, 2011 - The JCAHO patient safety event taxonomy: a standardized terminology and classification schema for near … misses and adverse events. … The JCAHO patient safety event taxonomy: a standardized terminology and classification schema for near … misses and adverse events. … https://psnet.ahrq.gov/issue/jcaho-patient-safety-event-taxonomy-standardized-terminology-and- classification-schema-near

9337. Examining the validity of AHRQ's Patient Safety Indicators (PSIs): is variation in PSI composite score related to hospital organizational factors? | PSNet
      psnet.ahrq.gov/issue/examining-validity-ahrqs-patient-safety-indicators-psis-variation-psi-composite-score-related
      November 10, 2010 - drug event triggers designed for the outpatient setting. … September 25, 2019 Consensus building for development of outpatient adverse drug event … August 4, 2015 Using estimated true safety event rates versus flagged safety event rates … June 25, 2014 Using AHRQ Patient Safety Indicators to detect postdischarge adverse events … August 21, 2013 National trends in hospital-acquired preventable adverse events after

9338. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/35889/psn-pdf
      March 10, 2011 - Automated surveillance for adverse drug events at a community hospital and an academic medical center … Automated surveillance for adverse drug events at a community hospital and an academic medical center … https://psnet.ahrq.gov/issue/automated-surveillance-adverse-drug-events-community-hospital-and- academic-medical-center … This study determined that an automated adverse drug event (ADE) surveillance system captured higher … event rates than did existing voluntary systems, particularly in a community setting.

9339. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/38935/psn-pdf
      March 01, 2017 - December 23, 2016 Sentinel Event Alert. August 27, 2009;(43):1-3. … striving to achieve high reliability status—consistently providing high quality care while minimizing adverse … In this sentinel event alert, the Joint Commission calls for senior health care leaders to establish … addressing errors at the sharp end, and maintain robust structures for analyzing and responding to adverse … This Sentinel Event Alert was retired in March 2017.

9340. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/47189/psn-pdf
      August 17, 2018 - Association of opioid-related adverse drug events with clinical and cost outcomes among surgical patients … Association of Opioid-Related Adverse Drug Events With Clinical and Cost Outcomes Among Surgical Patients … https://psnet.ahrq.gov/issue/association-opioid-related-adverse-drug-events-clinical-and-cost-outcomes … drug event during their admission. … Patients who experienced an opioid-related adverse drug event had longer hospital stays, greater inpatient