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Showing results for "adverse events".
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161. Selected Best Practices and Suggestions for Improvement (pdf file)
     cahps.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/d4n_combo_iqi-mortalityreview-bestpractices.pdf
     May 20, 2016 - multidisciplinary review is required to identify system processes that may result in failures in care, adverse … events, and mortality … department within 3 days of discharge ∗ Death associated with drug reaction ∗ Death associated with adverse … department within 3 days of discharge ∗ Death associated with drug reaction ∗ Death associated with adverse … Summary data of sentinel events reviewed by The Joint Commission.

162. Study Finds Racial and Ethnic Inequities in End-of-Life Prescription Opioid Access | Agency for Healthcare Research and Quality
     cahps.ahrq.gov/news/newsletters/e-newsletter/875.html
     August 01, 2023 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … section News Newsroom Blog Newsletter AHRQ News Now Events … Hospitalization due to adverse drug events in older adults with cancer: a retrospective analysis . … Relationship between in-hospital adverse events and hospital performance on 30-day all-cause mortality

163. Comparing Quality Scores to an Independent Standard | Agency for Healthcare Research and Quality
     cahps.ahrq.gov/talkingquality/translate/compare/choose/standard.html
     January 01, 2023 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … The Standard for “Never Events” There is one kind of standard that is beginning to emerge in health … care: the standard of “never” or zero percent for certain adverse and preventable events. … These events are preventable and should never happen.”

164. Hospital Survey on Patient Safety Culture Version 2.0 (doc file)
     cahps.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/SOPS-Hospital-Survey-2.0-English-05.18.21.docx
     June 09, 2016 - ” · “Patient safety” is defined as the avoidance and prevention of patient injuries or adverse events … questions when something does not seem right 1 2 3 4 5 9 SECTION D: Reporting Patient Safety Events … In the past 12 months, how many patient safety events have you reported? a. … Hospital management seems interested in patient safety only after an adverse event happens 1 2 3

165. Action Planning Worksheets | Agency for Healthcare Research and Quality
     cahps.ahrq.gov/teamstepps/instructor/essentials/implguide2.html
     November 01, 2018 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … Adverse event due to a breakdown in team skills (e.g., communications, situation monitoring, mutual support … Staff members are concerned that we could have an adverse event due to breakdowns in team skills.   … prophylactic use of beta-blockers to prevent intra-operative myocardial ischemia]; decreased rates of adverse … events or near misses)   Who will be involved in the change?

166. AHRQ Safety Program for Perinatal Care: Safe Medication Administration
     cahps.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/strategies/medication/safemedication.pptx
     May 01, 2017 - Admin. 10 Key Safety Elements: Learn From Defects Debrief and analyze near misses and adverse events … inductions outside of policy-defined indications severe maternal or neonatal morbidity and mortality events … Admin. 23 Key Safety Elements: Learn From Defects Debrief near misses and adverse events related … magnesium sulfate outside of defined indications severe maternal or neonatal morbidity and mortality events … Consider these factors: Unit data suggesting adverse events or near misses related to oxytocin, magnesium

167. Federal Interagency Workgroup: Improving Diagnostic Safety and Quality in Healthcare (pdf file)
     cahps.ahrq.gov/sites/default/files/wysiwyg/topics/dagnostic-safety-workgroupmeeting-notes-july2022.pdf
     November 03, 2022 - of our resource – Measure Dx: A Resource To Identify, Analyze, and Learn From Diagnostic Safety Events … IHS • Enhanced Adverse Event Reporting Capabilities o IHS Safety Tracking and Response (I-STAR) is deployed … Current projects include working on overdue events and development of standardized reporting at the

168. AHRQ Accelerates Efforts To Advance Health Equity | Agency for Healthcare Research and Quality
     cahps.ahrq.gov/news/newsletters/e-newsletter/907.html
     April 01, 2024 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … section News Newsroom Blog Newsletter AHRQ News Now Events … of team strategies and tools to improve performance and approaches to team-based error disclosure on adverse … events. … Articles featured this week include: Transfusion-related errors and associated adverse reactions and

169. AHRQ Signals Interest in Research To Improve Healthcare for People With Disabilities | Agency for Healthcare Research and Quality
     cahps.ahrq.gov/news/newsletters/e-newsletter/890.html
     November 01, 2023 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … section News Newsroom Blog Newsletter AHRQ News Now Events … antibiotics within 48 hours of presentation and in 13 percent of hospitalizations patients experienced an adverse … time to antibiotics varies markedly across simulated hospital scenarios, but new antibiotic-associated adverse … events were rare.

170. National Action Plans | Agency for Healthcare Research and Quality
     cahps.ahrq.gov/patient-safety/reports/national-action-plans.html
     February 01, 2018 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … Patients and Families About AHRQ's Quality & Patient Safety Work Patient Safety News and Events … National Action Plan for Adverse Drug Events identifies the Federal Government’s highest priority strategies

171. Hospital Survey on Patient Safety Culture Version 2.0 (pdf file)
     cahps.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/SOPS-Hospital-Survey-2.0-5-26-2021.pdf
     January 01, 2021 - ” • “Patient safety” is defined as the avoidance and prevention of patient injuries or adverse events … 1 2 3 4 5 9 5 SECTION D: Reporting Patient Safety Events Think about your unit/work … In the past 12 months, how many patient safety events have you reported? a. … Hospital management seems interested in patient safety only after an adverse event happens .......

172. Register Now: August 22 Webinar by National Action Alliance Will Address Engaging Boards and Executive Leadership in Safety | Agency for Healthcare Research and Quality
     cahps.ahrq.gov/news/newsletters/e-newsletter/874.html
     August 01, 2023 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … section News Newsroom Blog Newsletter AHRQ News Now Events … available to improve the safety culture of labor and delivery units and decrease maternal and neonatal adverse … events resulting from poor communication and system failures. … Articles featured this week include: Anticoagulation-associated adverse drug events in hospitalized

173. Chlorhexidine Bathing Routine Reduces Infections in Nursing Homes | Agency for Healthcare Research and Quality
     cahps.ahrq.gov/news/newsletters/e-newsletter/884.html
     October 01, 2023 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … section News Newsroom Blog Newsletter AHRQ News Now Events … Relationship between in-hospital adverse events and hospital performance on 30-day all-cause mortality … Risk factors for opioid-related adverse drug events among older adults after hospitalization for major

174. Communication Assessment Guide | Agency for Healthcare Research and Quality
     cahps.ahrq.gov/patient-safety/settings/hospital/candor/modules/guide5.html
     August 01, 2022 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … Patients and Families About AHRQ's Quality & Patient Safety Work Patient Safety News and Events … communicators who participate in conversations with patients, families, and caregivers following an adverse … demonstrate all of the skills and competencies should be involved in delivering communication about adverse … events to patients, families, and caregivers.

175. Gap Analysis Facilitator's Guide: Appendix A | Agency for Healthcare Research and Quality
     cahps.ahrq.gov/patient-safety/settings/hospital/candor/modules/facguide3/apa.html
     August 01, 2022 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … Patients and Families About AHRQ's Quality & Patient Safety Work Patient Safety News and Events … management Disruptive behavior and/or code of conduct Investigation of occurrences (i.e., sentinel events …  ___ Bylaws for medical staff and/or hospital Peer review process Oversight/management of adverse … or "harm" events ___  ___ Organizational safety and/or quality plan FMEAs or other

176. Final Progress Report: Reduction of Nephrotoxic Medication-Associated Acute Kidney Injury in Children (pdf file)
     cahps.ahrq.gov/sites/default/files/2024-02/goldstein-report.pdf
     January 01, 2024 - events and achieved a 60% reduction in surgical site infections in designated cardiac, neurosurgery … , and orthopedic procedures35 and a 34.5% reduction in overall adverse drug events. … Occurrence of adverse, often preventable, events in community hospitals involving nephrotoxic drugs or … A trigger tool to identify adverse events in the intensive care unit. … Incidence of adverse drug events and potential adverse drug events. Implications for prevention.

177. Evidence Summary: Why focus on safety for patients with limited English proficiency? | Agency for Healthcare Research and Quality
     cahps.ahrq.gov/teamstepps/lep/handouts/lepevidencesum.html
     December 01, 2012 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … TeamSTEPPS® Enhancing Safety for Patients With Limited English Proficiency Module Patient safety events … receive professional interpretation services. 3 Hospitals have been held liable for LEP patient safety events … Language proficiency and adverse events in U.S. hospitals: a pilot study.

178. PS Grantee Report | Agency for Healthcare Research and Quality
     cahps.ahrq.gov/research/findings/final-reports/index.html?page=2
     September 01, 2018 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … Review Process of High-Risk Drugs Using a Patient-Centered, Telemedicine-Based Approach to Prevent Adverse … Drug Events in the Nursing Home ( application/pdf 471675 ) Principal Investigators: Kane-Gill, … 023464 Topic(s): Medication Safety, Nursing Homes Publication Date: September 2018 Reducing Adverse … Drug Events from Anticoagulants, Diabetes Agents and Opioids in Primary Care ( application/pdf 470629

179. Safemed Facguide (doc file)
     cahps.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/strategies/medication/safemed_facguide.docx
     May 01, 2017 - learning from defects for oxytocin administration include— Debriefing and analyzing near misses and adverse … Having a process in place to review severe maternal or neonatal morbidity and mortality events. … key safety elements of learning from defects are the same as for oxytocin: Debriefing near misses and adverse … events related to magnesium sulfate use. … Consider these factors: · Unit data suggesting adverse events or near misses related to oxytocin, magnesium

180. Patient Safety Tools | Agency for Healthcare Research and Quality
     cahps.ahrq.gov/research/findings/evidence-based-reports/makinghcsafer.html
     June 01, 2022 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … hospitals and nursing homes (including skilled nursing facilities) to collect data for all types of adverse … events, near misses, and unsafe conditions. … Research suggests that adverse events affect patients with limited English proficiency more frequently … If chest tubes are inserted incorrectly, patients can suffer adverse outcomes and even fatal complications