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Showing results for "adverse event".
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9461. Exploring the impact of employee engagement and patient safety. | PSNet
      psnet.ahrq.gov/issue/exploring-impact-employee-engagement-and-patient-safety
      July 27, 2022 - June 24, 2020 Crossover of the patient satisfaction surveys, adverse events and patient … June 28, 2023 Structural racism and adverse maternal health outcomes: a systematic review … Quality and Safety Professionals Psychological and Social Complications Epidemiology of Errors and Adverse

9462. The effect of bedrails on falls and injury: a systematic review of clinical studies. | PSNet
      psnet.ahrq.gov/issue/effect-bedrails-falls-and-injury-systematic-review-clinical-studies
      March 15, 2016 - July 2, 2014 'Global Trigger Tool' shows that adverse events in hospitals may be ten … June 7, 2023 View More Related Resources A scoping review of adverse … June 13, 2012 Adverse events and near miss reporting in the NHS.

9463. Pharmacy prevalence of second victim syndrome in a comprehensive cancer center. | PSNet
      psnet.ahrq.gov/issue/pharmacy-prevalence-second-victim-syndrome-comprehensive-cancer-center
      June 03, 2020 - Adverse events can negatively impact a provider's mental and physical health, leading to "second victim … June 3, 2020 Self-reported adverse events in health care that cause harm: a population-based … January 24, 2024 Association of polypharmacy and potential drug-drug interactions with adverse

9464. A systematic review of falls in hospital for patients with communication disability: highlighting an invisible population. | PSNet
      psnet.ahrq.gov/issue/systematic-review-falls-hospital-patients-communication-disability-highlighting-invisible
      April 15, 2016 - June 3, 2020 Factors associated with post-intensive care unit adverse events: a clinical … October 29, 2014 Reason's accident causation model: application to adverse events in … Improving Diagnostic Safety and Quality April 26, 2023 A scoping review of adverse

9465. Duplicate Insulin Order | PSNet
      psnet.ahrq.gov/web-mm/duplicate-insulin-order
      May 04, 2012 - The patient recovered from the incident without apparent adverse effects. … After this event, the team received training on the ED's insulin protocol for diabetic ketoacidosis and … A Joint Commission Sentinel Event Alert highlighted inadequate handoff communication as a contributor … Sentinel Event Alert. September 11, 2017;(58):1-6. [go to PubMed] 14. … September 9, 2013 Adverse drug reactions and therapeutic errors in older adults: a hazard

9466. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/49447/psn-pdf
      June 01, 2004 - Fortunately for this patient, this mistake did not cause her adverse long-term clinical consequences … Clinical pharmacists have a positive impact on adverse drug events (13,14), yet in this case a phone … Pharmacists should be required to document their interventions to prevent adverse drug events, and should … Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. … Pharmacists on rounding teams reduce preventable adverse drug events in hospital general medicine units

9467. Missed acute myocardial infarction in the emergency department-standardizing measurement of misdiagnosis-related harms using the SPADE method. | PSNet
      psnet.ahrq.gov/issue/missed-acute-myocardial-infarction-emergency-department-standardizing-measurement
      May 12, 2021 - analysis of diagnostic error approach, or SPADE approach , measures diagnostic errors resulting in adverse … events using two analytic pathways – the ‘look back’ analysis identifies symptoms associated with adverse

9468. Evaluation of the association between Nursing Home Survey on Patient Safety culture (NHSOPS) measures and catheter-associated urinary tract infections: results of a national collaborative. | PSNet
      psnet.ahrq.gov/issue/evaluation-association-between-nursing-home-survey-patient-safety-culture-nhsops-measures-and
      April 05, 2017 - safety culture is a core patient safety activity, but the relationship between safety culture and adverse … December 21, 2017 A hybrid methodology for modeling risk of adverse events in complex … Administrators Infectious Diseases Indwelling Tubes and Catheters Epidemiology of Errors and Adverse

9469. Do junior doctors make more prescribing errors than experienced doctors when prescribing electronically using a computerised physician order entry system combined with a clinical decision support system? A cross-sectional study. | PSNet
      psnet.ahrq.gov/issue/do-junior-doctors-make-more-prescribing-errors-experienced-doctors-when-prescribing
      February 22, 2023 - The influence that electronic prescribing has on medication errors and preventable adverse … March 4, 2011 Reliability of the assessment of preventable adverse drug events in daily … August 18, 2010 Preventable and non-preventable adverse drug events in hospitalized patients

9470. Delay in Initiating Antibiotics Results in Fatal Error | PSNet
      psnet.ahrq.gov/web-mm/delay-initiating-antibiotics-results-fatal-error
      August 02, 2015 - Serious adverse outcomes occurred in 90% of the cases, including death in 31% of cases. … system allows any provider to submit an online report of any situation that created a near miss for an adverse … event or actually caused an adverse event. … February 18, 2011 WebM&M Cases A Double “Never Event”

9471. In Conversation With... Chris Cebollero, BS, CCEMT-P | PSNet
      psnet.ahrq.gov/perspective/conversation-chris-cebollero-bs-ccemt-p
      May 26, 2021 - We spoke with him about the status of safety culture in EMS and challenge associated with safety event … These approaches are most effective at detecting adverse events when a high-risk procedure has occurred … future EMS workforce and leadership, 3 , 6 but in the interim, collection and analysis of data on adverse … Welcome to the EMS Voluntary Event Notification Tool (E.V.E.N.T.)! E.V.E.N.T. … Application of the emergency medical services trigger tool to measure adverse events in prehospital emergency

9472. A meta-review of methods of measuring and monitoring safety in primary care. | PSNet
      psnet.ahrq.gov/issue/meta-review-methods-measuring-and-monitoring-safety-primary-care
      November 03, 2021 - April 15, 2020 Interventions to reduce adverse drug event-related outcomes in older adults

9473. 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.

9474. 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

9475. 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

9476. 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

9477. 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

9478. 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.

9479. 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.

9480. 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