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  1. ahrqpubs.ahrq.gov/news/newsletters/e-newsletter/818.html
    June 01, 2022 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … section News Newsroom Blog Newsletter AHRQ News Now Events … Study Finds Relationship Between Readmission Rates, Adverse Events in Hospitals . … Study Finds Relationship Between Readmission Rates, Adverse Events in Hospitals Patients with pneumonia … admitted to hospitals with high readmission rates were more likely to experience adverse events, a new
  2. ahrqpubs.ahrq.gov/patient-safety/resources/improve-discharge/index.html
    July 01, 2022 - PSNet Article: Vital Signs Are Still Vital: Instability on Discharge and the Risk of Post-Discharge Adverse … Readmission Rates With Mortality Rates After Hospital Discharge AHRQ PS Net Primer: Readmissions and Adverse … Toolkit To Improve Medication Reconciliation Across Care Settings Six New Jersey Hospitals Reduce Adverse … Patient Safety and Team Communication Through Daily Huddles AHRQ PSNet Primer: Medication Errors and Adverse … Drug Events AHRQ PSNet Primer: Medication Reconciliation AHRQ PSNet Perspective: Patient Safety
  3. ahrqpubs.ahrq.gov/patient-safety/settings/hospital/candor/modules/guide4.html
    August 01, 2022 - A pre-scripted immediate response to events, along with a tightened timeline for event reviews. … event or near miss is the prevention of future adverse events. … When an adverse event occurs, too often, the focus is on an individual's performance and is corrected … If these factors can be identified and modified, the chance of similar events can be reduced. … The systems approach recognizes that all adverse events have multiple contributing factors, many of which
  4. ahrqpubs.ahrq.gov/research/findings/making-healthcare-safer/index.html
    July 01, 2023 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … Harms such as adverse drug events, healthcare-associated infections, falls, and obstetric adverse events … patient safety practices in eight categories encompassing commonly occurring care- and disease-specific adverseevents and associated systemic and contextual factors.
  5. ahrqpubs.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/index.html
    November 01, 2017 - AHRQ's Safety Program for Nursing Homes: On-Time Prevention provides a strategy for preventing adverseevents in nursing homes. … uses electronic medical records to develop weekly reports that identify residents at risk of common adverseevents in nursing homes to help clinical staff intervene early. … Adverse Events Pressure Ulcer Prevention . Pressure Ulcer Healing .
  6. ahrqpubs.ahrq.gov/data/infographics/hac-rates_2019.html
    July 01, 2020 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … (PDF, 11.1 MB) Text Description: National efforts to reduce hospital-acquired conditions such as adverse … drug events and injuries from falls helped prevent 20,700 deaths and saved $7.7 billion between 2014 … Specific rates are: Adverse drug events: 28% decrease. CAUTI: 5% decrease. CLABSI: 6% decrease. … Obstetric events: 3% decrease. Pressure ulcers: 6% increase. Surgical site infections: 8% increase.
  7. ahrqpubs.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/f1_combo_returnoninvestment.pdf
    January 01, 2013 - The cost of adverse drug events in hospitalized patients. JAMA 1997;277:307-11. … Costs of adverse events in intensive care units. Crit Care Med 2007;35(11)2637-8. Pappas SH. … The cost of nurse-sensitive adverse events. J Nurs Adm 2008;38(5):230-6. … Using patient safety indicators to estimate the impact of potential adverse events on outcomes. … The costs and savings associated with prevention of adverse events by critical care nurses.
  8. ahrqpubs.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/f1_combo_returnoninvestment.docx
    January 01, 2013 - The cost of adverse drug events in hospitalized patients. JAMA 1997;277:307-11. … Costs of adverse events in intensive care units. Crit Care Med 2007;35(11)2637-8. Pappas SH. … The cost of nurse-sensitive adverse events. J Nurs Adm 2008;38(5):230-6. … Using patient safety indicators to estimate the impact of potential adverse events on outcomes. … The costs and savings associated with prevention of adverse events by critical care nurses.
  9. ahrqpubs.ahrq.gov/research/findings/making-healthcare-safer/comparison.html
    September 01, 2022 - events and associated systemic and contextual factors. … Table of Contents Adverse Drug Events (ADEs): General Medication Topics ADEs: Harms Due to Anticoagulants … ADEs: Harms Due to Diabetic Agents ADEs: Reducing Adverse Drug Events in Older Adults ADEs: Harms … ) MHS III (2020) Computer Adverse Drug Event Detection and Alerts Summary of Evidence (Not reviewed … Adverse Drug Events Related to Anticoagulants Summary of Evidence Update (Not reviewed) The
  10. ahrqpubs.ahrq.gov/news/newsletters/e-newsletter/831.html
    September 01, 2022 - section News Newsroom Blog Newsletter AHRQ News Now Events … Potentially inappropriate medication administration is associated with adverse postoperative outcomes … Risk of metabolic and cardiovascular adverse events with abiraterone or enzalutamide among men with advanced … Analysis of hospital-level readmission rates and variation in adverse events among patients with pneumonia … Trajectories of prescription opioid dose and risk of opioid-related adverse events among older Medicare
  11. ahrqpubs.ahrq.gov/sops/about/patient-safety-culture.html
    March 01, 2022 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … 2 Hospitals with more positive SOPS scores had: Lower rates of in-hospital complications or adverseevents as measured by AHRQ’s patient safety indicators (PSIs). 3 Patients who reported more positive … Exploring relationships between hospital patient safety culture and adverse events. … The relationship between culture of safety and rate of adverse events in long-term care facilities.
  12. ahrqpubs.ahrq.gov/sites/default/files/wysiwyg/patient-safety/rev-reportaddendum.pdf
    March 01, 2021 - events. … If left unaddressed, behavioral health and social needs are key risk factors for postdischarge adverseevents. … events increases after hospitalization. … events.
  13. ahrqpubs.ahrq.gov/data/qualityindicators/index.html
    November 01, 2020 - hospital level, the QIs are used to support internal quality improvement, monitoring, and assessment of adverseevents related to patient safety. … Patient Safety Indicators (PSIs) help hospitals assess the incidence of adverse events and in-hospital … More specifically, they focus on potential in-hospital complications and adverse events following surgeries … PDIs focus on potentially preventable complications and iatrogenic events for pediatric patients treated
  14. ahrqpubs.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy4/Strat4_Tool_3_Physician_HO_508.pdf
    January 01, 2010 - engaging patients and families in discharge planning Nearly 20 percent of patients experience an adverse … three-quarters of these could have been prevented or ameliorated.1 Common post-discharge complications include adverse … drug events, hospital-acquired infections, and procedural complications.1 Many of these complications … The incidence and severity of adverse events affecting patients after discharge from the hospital.
  15. ahrqpubs.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/candor/module5/mod5-disclosure-checklist.pdf
    April 01, 2016 - ■ Within 60 minutes after the CANDOR event is identified, advise the patient and/or family that an adverse … ■ Identify the adverse event early in the disclosure. … ■ Explain what is known about why the adverse event occurred; do not speculate. … ■ Tell the patient whether the adverse event was preventable, if known. … Apologize ■ Say you are sorry for the adverse event in a sincere manner early in the conversation.
  16. ahrqpubs.ahrq.gov/research/findings/studies/index.html
    January 01, 2024 - Drug Events (ADE) (321) Adverse Events (737) Alcohol Use (61) Ambulatory Care and Surgery … airway outcomes, including adverse tracheal intubation (TI)-associated events (TIAEs) and/or severe … Adverse tracheal intubation events in critically ill underweight and obese children: retrospective study … Keywords: Diagnostic Safety and Quality, Medical Errors, Adverse Events, Patient Safety, Quality of … The study did not find significant differences in adverse events. AHRQ-funded; HS024511.
  17. ahrqpubs.ahrq.gov/antibiotic-use/acute-care/safety/index.html
    June 01, 2021 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … Use Commitment Poster (DOCX) Antibiotic Time Out Tool (DOCX) Identifying Antibiotic–Associated AdverseEvents Form (DOCX) Learning From Antibiotic–Associated Adverse Events Form (DOCX)
  18. ahrqpubs.ahrq.gov/hai/pfp/index.html
    July 01, 2020 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … Condition Rate ( PDF , 237 KB) To improve how the Nation tracks its progress on reducing HACs and other adverseevents, AHRQ is developing the AHRQ Quality and Safety Review System . … This patient safety surveillance system will capture information about HACs and other adverse events
  19. ahrqpubs.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy4/Strat4_Tool_3_Physician_HO_508.docx
    January 01, 2010 - for engaging patients and families in discharge planning Nearly 20 percent of patients experience an adverse … three-quarters of these could have been prevented or ameliorated.1 Common post-discharge complications include adverse … drug events, hospital-acquired infections, and procedural complications.1 Many of these complications … The incidence and severity of adverse events affecting patients after discharge from the hospital.
  20. ahrqpubs.ahrq.gov/news/newsletters/e-newsletter/852.html
    February 01, 2023 - section News Newsroom Blog Newsletter AHRQ News Now Eventsevents on health systems.  … events like multi-organ failure and heart problems, according to two AHRQ-funded studies published in … Food and Drug Administration’s Adverse Event Reporting System from January 2004 through June 2020. … It found a total of 787 reports that pointed to an adverse event from a colchicine drug interaction.

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