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Showing results for "adverse events".
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121. Executive Briefing
     healthcare411.ahrq.gov/sites/default/files/wysiwyg/teamstepps/leadership-brief/ts-leadershipbrief.pptx
     January 01, 2013 - 10 years and identified communication failure as the leading root cause of sentinel events. … Outcome Score, which describes the adverse event score per delivery A 50% decrease in the Severity Index … , which measures the average severity of each delivery with an adverse event Intensive Care Units2 After … years and identified communication failure as the leading root cause of sentinel events. … events and close calls. 19 What Does it Cost?

122. Search Evidence-Based Reports | Agency for Healthcare Research and Quality
     healthcare411.ahrq.gov/research/findings/evidence-based-reports/search.html?page=1
     November 01, 2023 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … Permanente Research Affiliates Report Status: Final Efficacy of Dental Services for Reducing Adverse … Events in Those Receiving Chemotherapy for Cancer Date: July 2023 Report Type: Rapid Evidence Product … Scientific Resource Center Report Status: Final Efficacy of Dental Services for Reducing Adverse … Events in Those Undergoing Insertion of Implantable Cardiovascular Devices Date: July 2023 Report

123. Defining the New AHRQ: A Race for 21st Century Care | Agency for Healthcare Research and Quality
     healthcare411.ahrq.gov/news/blog/ahrqviews/defining-new-ahrq.html
     January 01, 2021 - billion), adverse drug events ($4.1 billion), and falls ($1.5 billion), while diagnostic errors have … By advancing our efforts to reduce these events, we can lessen these avoidable financial burdens and, … understanding where value is gained and lost, and incorporating strategies that are proven to reduce or prevent adverse … The 21 st Century Care Initiative presents a major opportunity to reduce preventable adverse medical … events and improve medication management through new, evidence-based, individualized care management

124. AHRQ Views: Biden Administration Tackles Financial Strains on Healthcare Consumers | Agency for Healthcare Research and Quality
     healthcare411.ahrq.gov/news/newsletters/e-newsletter/892.html
     December 01, 2023 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … section News Newsroom Blog Newsletter AHRQ News Now Events … Making Healthcare Safer IV will provide evidence on 11 additional safety topics, including reducing adverse … events related to anticoagulants, opioid stewardship and addressing fatigue and sleepiness of clinicians … Articles featured this week include: Prescription opioid dose reductions and potential adverse events

125. AHRQ News Now | Agency for Healthcare Research and Quality
     healthcare411.ahrq.gov/news/newsletters/e-newsletter/index.html?page=2
     April 05, 2022 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … Results News Newsroom Blog Newsletter AHRQ News Now Events … ascending Top Story April 5, 2022 Dental Opioid Prescriptions Associated With Adverse … Patient-Generated Health Data Into Electronic Health Records February 8, 2022 Opioid Prescribing, Adverse … Change, Environmental Justice and AHRQ October 5, 2021 Drug Label Changes Could Reduce Adverse

126. How PSOs Help Health Care Organizations Improve Patient Safety Culture (pdf file)
     healthcare411.ahrq.gov/sites/default/files/wysiwyg/npsd/npsd-patient-safety-culture-brief.pdf
     September 01, 2016 - in the past 12 months, and about respondent perceptions of the frequency of events reported. … Watson Senior Vice President Michigan Health & Hospital Association 3 of adverse events and discussion … offers a way for PSO members to share accounts of patient safety events. … The alerts describe the reported events and provide information on how to prevent similar events. … Exploring relationships between hospital patient safety culture and adverse events.

127. Primary Care-Based Efforts To Reduce Potentially Preventable Readmissions | Agency for Healthcare Research and Quality
     healthcare411.ahrq.gov/patient-safety/settings/ambulatory/reduce-readmissions.html
     December 01, 2023 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … Patients and Families About AHRQ's Quality & Patient Safety Work Patient Safety News and Events … Readmissions High rates of readmissions are a major patient safety problem associated with adverse … events such as prescribing errors and misdiagnoses of conditions in the hospital and ambulatory care

128. Changing the System To Improve Antibiotic Safety | Agency for Healthcare Research and Quality
     healthcare411.ahrq.gov/antibiotic-use/long-term-care/safety/system-change.html
     June 01, 2021 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … Improve Antibiotic Safety – Facilitator Guide (DOCX, 2.3 MB) Learning From Antibiotic-Associated Adverse … Events  (DOCX, 226.7 KB) Page last reviewed June 2021 Page originally

129. Final Progress Report: Leveraging a Social Network of Elders and Families To Improve Medication Safety at Transitions of Care (pdf file)
     healthcare411.ahrq.gov/sites/default/files/2024-01/quintana-report.pdf
     January 01, 2024 - Usability events were grouped into thematic categories: navigation/UI events, health literacy events … Adverse drug events and medication errors in Australia. … Incidence and Preventability of Adverse Drug Events Among Older Persons in the Ambulatory Setting. … Incidence and preventability of adverse drug events among older persons in the ambulatory setting. … Evaluation of Adverse Drug Events and Medication Discrepancies in Transitions of Care Between Hospital

130. Module 4: Teamwork and Communication: Facilitator Notes | Agency for Healthcare Research and Quality
     healthcare411.ahrq.gov/hai/quality/tools/cauti-ltc/modules/implementation/long-term-modules/module4/mod4-facguide.html
     March 01, 2017 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … Slide 28: Communicating Adverse Events Say: Communication following an adverse event can been especially … Slide 30: How To Communicate About An Adverse Event Say: It is important to remember that residents … and family members can experience a number of emotions when an adverse event occurs, so communication … about an adverse event should be compassionate and sensitive.

131. Peer Support Interaction—Nurse: Video | Agency for Healthcare Research and Quality
     healthcare411.ahrq.gov/patient-safety/settings/hospital/candor/videos/nurses.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 … institutions and practitioners can use to respond in a timely, thorough, and just way when unexpected events … This video demonstrates an example of emotional support provided for the nurse caregiver after an adverse

132. AHRQ Research Inspires Efforts at Banner Desert To Reduce Drug Errors in E.D. Patients | Agency for Healthcare Research and Quality
     healthcare411.ahrq.gov/news/newsroom/case-studies/201509.html
     January 01, 2018 - AHRQ Social Media AHRQ Stats Impact Case Studies Blog Newsletter Events … the technicians' work, the E.D. pharmacist can interpret the patient's medication history to look for adverse … events, one of the many reasons patients come to the E.D. … Study Identifier: 2015-09 AHRQ Product(s): Research Topic(s): Adverse … Drug Events (ADE), Outcomes, Patient Safety, Provider: Pharmacist Geographic

133. AHRQ Safety Program for Perinatal Care: Rapid Response for Perinatal Safety (pdf file)
     healthcare411.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/strategies/rapid-response/rapidresponse_facguide.pdf
     May 01, 2017 - This principle calls for L&D unit teams to evaluate their processes and learn from adverse events, … Rapid Response toolcall • In addition, clinical teams can debrief and analyze near misses and adverse … events, regardless of whether a rapid response was activated. … Consider these factors: o Unit data suggesting adverse events or near misses that may have been … • Regularly debrief after rapid response events, and solicit ongoing feedback from staff and patients

134. TeamSTEPPS® 2.0 Leadership Briefing | Agency for Healthcare Research and Quality
     healthcare411.ahrq.gov/teamstepps/about-teamstepps/leadershipbriefing.html
     April 01, 2017 - drug events (from 30 to 18 per 1,000 patient days). … Outcome Score, which describes the adverse event score per delivery. … A 50% decrease in the Severity Index, which measures the average severity of each delivery with an adverse … events and close calls (VA Center for Patient Safety). … events and close calls.

135. Rapid Response for Perinatal Safety: Facilitator Guide | Agency for Healthcare Research and Quality
     healthcare411.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/strategies/rapid-response/rapid-response-fac-guide.html
     July 01, 2023 - This principle calls for L&D unit teams to evaluate their processes and learn from adverse events, errors … to the Rapid Response toolcall In addition, clinical teams can debrief and analyze near misses and adverse … events, regardless of whether a rapid response was activated. … debriefings, a regular forum with a multidisciplinary team for reviewing serious maternal or neonatal adverse … Consider these factors: Unit data suggesting adverse events or near misses that may have been minimized

136. How To Use the Toolkit for Improving Perinatal Safety | Agency for Healthcare Research and Quality
     healthcare411.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/how-to-use.html
     July 01, 2023 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … Patients and Families About AHRQ's Quality & Patient Safety Work Patient Safety News and Events … team members how to apply the Comprehensive Unit-based Safety Program (CUSP) to prevent obstetrical adverse … events.

137. TeamSTEPPS Limited English Proficiency Module: Evidence Summary (pdf file)
     healthcare411.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/lep/handouts/lepevidencesum.pdf
     January 01, 2012 - Patient safety events that affect limited-English-proficient (LEP) patients tend to be more severe … 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.

138. Morningbriefing (doc file)
     healthcare411.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/toolkit/morningbriefing.doc
     August 07, 2012 - After receiving an update on the patients, proceed to Question II, unless there was an adverse event. … If an adverse event occurred, you should also use the Learn From Defects Form. II.

139. Patient Safety Organizations Program | Agency for Healthcare Research and Quality
     healthcare411.ahrq.gov/cpi/about/otherwebsites/pso.ahrq.gov/index.html
     August 01, 2022 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … the creation of PSOs and the development of Common Formats for uniform reporting of patient safety events … external experts who can assist providers in the collection, analysis, and aggregation of patient safety events … access to Common Formats (uniform definitions and reporting formats for collecting information about adverse … events).

140. Practice Improvement | Agency for Healthcare Research and Quality
     healthcare411.ahrq.gov/practiceimprovement/index.html
     August 01, 2022 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … Prevention Tools to assist nursing homes that have electronic medical record systems to prevent adverse … events. … Communication and Optimal Resolution (CANDOR) Toolkit Process for practitioners to use when unexpected events