Results

Total Results: 1,789 records

Showing results for "adverse event".
Users also searched for: patient safety indicators

1401. Module 1: Preventing Pressure Injuries in Hospitals—Understanding Why Change Is Needed | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/settings/hospital/resource/pressureinjury/workshop/slides1.html
      October 01, 2017 - understanding that even small failures in safety protocols or processes can lead to catastrophic or adverse

1402. Slide 1 (ppt file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/health-literacy-pfe-070913.ppt
      July 01, 2013 - compliance with medical management --- increased risk of: ---poor outcomes/adverse

1403. Section 1. The Need to Address Emergency Department Crowding | Agency for Healthcare Research and Quality
      www.ahrq.gov/research/findings/final-reports/ptflow/section1.html
      July 01, 2018 - appropriate, timely care 24/7, and that they will have the capacity to protect and care for the public in the event

1404. Behavior Therapy as First-Line Treatment for Preschool-Aged Children With ADHD (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/chronic/chipra-089-fullreport.pdf
      January 30, 2017 - Such adverse effects have been described in the literature as pain, headaches, and sleep disturbance … For the nonstimulant atomoxetine, the adverse effects include initial somnolence and gastrointestinal … For the nonstimulant alpha-2–adrenergic agonists extended-release guanfacine and clonidine, adverse … An uncommon additional significant adverse effect of stimulants is the occurrence of hallucinations … How well do the measure specifications capture the event that is the subject of the measure?

1405. Surveys on Patient Safety Culture (SOPS) Hospital Survey 2.0: 2021 User Database Report Part I (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/2021-HSOPS2-Database-Report-Part-I-508-rev0921.pdf
      January 01, 2021 - 8.47% 52% 65% 70% 75% 80% 85% 97% In this unit, we are informed about changes that are made based on event … Disagree/Strongly Disagree Hospital management seems interested in patient safety only after an adverse … event happens. … (Item A6*) 62% 9.02% 37% 50% 56% 61% 67% 73% 91% When an event is reported in this unit, it feels

1406. Expediting Clinician Adoption of Safety Practices: The UCSF Venous Access Patient Safety Interdisciplinary Education Project (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Donaldson.pdf
      January 01, 2003 - learning styles contend that (1) multiple learning styles should be addressed within any given learning event … The costs of adverse drug events in hospitalized patients. … Adverse Drug Events Prevention Study Group. JAMA 1997;277(4):307–11. 12.

1407. A Conceptual Framework for Studying the Safety of Transitions in Emergency Care (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Behara.pdf
      January 01, 2004 - Does housestaff discontinuity of care increase the risk for preventable adverse events? … Using a computerized sign-out program to improve continuity of inpatient care and prevent adverse events

1408. Final Progress Report: Making Acute Care More Patient Centered, Patient Safety Learning Laboratory (PSLL) (pdf file)
      www.ahrq.gov/sites/default/files/2024-07/bates3-report.pdf
      January 01, 2024 - Kathryn.Ramage Cross-Out identifying, assessing, and mitigating threats to safety, thereby decreasing adverse … analysis at BWH, MMC, and NYP, patient falls and falls with injury were obtained from each hospital’s event … shown that patients are a valuable source of information and can correctly identify medical errors and adverse … Adverse Events, Near Misses and Errors. September 2019. … Accessed October 19, 2019. https://psnet.ahrq.gov/primer/adverse-events- near-misses-and-errors 2.

1409. Usability Testing and the Relation of Clinical Information Systems to Patient Safety (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Rogers.pdf
      January 01, 2003 - For example, clinical information systems have been advocated to reduce the risk of adverse drug events … approach is its ability to identify impact prior to implementation and to suggest redesign before adverse

1410. 040-Mrsa-Surveillance-Notes (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/hai/tools/mrsa/040-mrsa-surveillance-notes.docx
      October 01, 2024 - : Both methicillin-susceptible Staphylococcus aureus (MSSA) and MRSA infections are associated with adverse … Slide 8 MRSA Surveillance SAY: To protect patients from adverse outcomes and develop effective MRSA

1411. PowerPoint Presentation
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/esrd/clinical-care/clinicalcare_slides.pptx
      September 03, 2014 - — Culture of Safety A culture of safety is effective in reducing adverse events Organizations with a … Defects, or errors in systems, lead to unwanted outcomes such as harms (harming a patient) or adverse … Maintaining a culture of safety in your dialysis facility is effective in reducing adverse events.

1412. Barcode Medication Administration: Lessons Learned from an Intensive Care Unit Implementation (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol3/Wideman.pdf
      April 20, 2004 - biological products by the year 2006.2 The FDA has predicted that the ruling* will prevent nearly 500,000 adverse … are conducted twice each month by the ICU medical director and the patient safety manager to gather adverse … event data and information related to near misses. … A physician- based voluntary system for adverse events and medical errors.

1413. Slide 1
      www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/chartbooks/carecoordination/qdr2015-chartbook-carecoordination.pptx
      June 16, 2016 - Transitions increase the risk of adverse events due to the potential for miscommunication as responsibility … Patients need to understand their medication (indications, administration, adverse effects) to safely … The adoption and effective use of health information technology can: Help reduce medical errors and adverse … The effect of electronic prescribing on medication errors and adverse drug events: a systematic review … The incidence and severity of adverse events affecting patients after discharge from hospital.

1414. The Patient Safety Education Project: An international Collaboration (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol2/Advances-Emanuel_19.pdf
      February 20, 2008 - Fundamental patient safety practices—such as learning from adverse events, working in effective teams … , standardizing tools and procedures, and open disclosure of adverse events—are far from universal in … Patient safety, though, relies on methods that make use of reporting and analyzing adverse events and

1415. Strategy 3: Nurse Bedside Shift Report Implementation Handbook (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy3/Strat3_Implement_Hndbook_508.docx
      August 01, 2010 - Nurse shift changes require the successful transfer of information between nurses to prevent adverse … One study found that more than 70 percent of adverse events are caused by breakdowns in communication … Sentinel event root cause and trend data.

1416. Department of Health and Human Services National Institutes of Health - National Institute for Research on Safety and Quality (NIRSQ) (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/cpi/about/mission/budget/2021/FY_2021_CJ_NIRSQ.pdf
      January 01, 2021 - Nearly half of opioid stays among women aged 65 years and older were due to adverse events. … event reporting and surveillance in order to identify trends and prevent future patient harm. … PSOs collect data using AHRQ’s Common Formats for Event Reporting - Hospitals, a standardized reporting … QSRS will generate adverse event rates, trend performance over time, and unlike MPSMS, QSRS was designed … The Patient Safety Act promotes increased voluntary patient safety event reporting and analysis, as

1417. Final Progress Report: Risk Assessment of the Testing Processes of Access Community Health Network (pdf file)
      www.ahrq.gov/sites/default/files/2024-12/eder-report.pdf
      January 01, 2024 - patient phone survey; 3) an audit of the management of four critical, abnormal test results; 4) event … office systems engineering assessments, chart audits, patient phone interviews, staff-generated event … Event reports, completed by providers and staff, to raise staff and physician awareness of safety issues … Only four sites submitted event reports despite all 10 intervention sites agreeing to complete and being … provided an abundance of event reports and staff given the opportunity to complete forms anonymously

1418. Section 5. Preparing to Launch | Agency for Healthcare Research and Quality
      www.ahrq.gov/research/findings/final-reports/ptflow/section5.html
      July 01, 2018 - Next, the patient flow team participated in a 3-1/2-day kaizen (i.e., continuous quality improvement) event … The team met weekly for 1 month after the kaizen event to discuss progress on these followup tasks, as

1419. AHRQ Stats | Agency for Healthcare Research and Quality
      www.ahrq.gov/news/newsroom/ahrq-stats.html
      July 01, 2025 - Adverse Drug Events Involving Hypoglycemic Agents In 2021, 7.5 percent of Hispanic patients, 6.6 percent … percent of patients with an “other” or unknown race, and 4.0 percent of White patients experienced adverse … (Source: Complications, Adverse Drug Events, High Costs, and Disparities in Multisystem Inflammatory … (Source: Healthcare Cost and Utilization Project Statistical Brief #237: Patient Safety and Adverse … (Source: Healthcare Cost and Utilization Project Statistical Brief #237: Patient Safety and Adverse

1420. AHRQ's Health Services Research Dissertation Grant Program: New Starts Fiscal Year 2012 (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/funding/training-grants/grants/active/dissrt12/dissrt12.pdf
      January 31, 2014 - research project will contribute to a technology- based, multifaceted approach for reducing inpatient adverse