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pbrn.ahrq.gov/patient-safety/reports/advances-new-directions/index.html
July 01, 2022 - Physician-Reported Adverse Events and Medical Errors in Obstetrics and Gynecology ( PDF , 109 KB ) … Using ICD-9-CM Codes in Hospital Claims Data to Detect Adverse Events in Patient Safety Surveillance … News Media and Health Care Providers at the Crossroads of Medical Adverse Events ( PDF , 129 KB ) … Views of Emergency Medicine Trainees on Adverse Events and Negligence: Survey Results from an Emergency … Drug Events: Study Methods ( PDF , 646 KB ) Andrew L.
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pbrn.ahrq.gov/hai/pfp/index.html
July 01, 2020 - Condition Rate ( PDF , 237 KB)
To improve how the Nation tracks its progress on reducing HACs and other adverse … events, AHRQ is developing the AHRQ Quality and Safety Review System . … This patient safety surveillance system will capture information about HACs and other adverse events
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pbrn.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 … Drug Events
Summary of Evidence
Update
(Not reviewed)
Protocols for High-Risk Drugs: Reducing … Adverse Drug Events Related to Anticoagulants
Summary of Evidence
Update
(Not reviewed)
The
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pbrn.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/chartbooks/patientsafety/2017qdr-patsafchartbook.pdf
October 01, 2018 - drug event to warfarin (Adverse
drug events) … Procedure-related events.
Adverse drug events. … events associated with hip joint replacement, adverse events
associated with knee joint replacement … events associated with hip joint replacement, adverse events
associated with knee joint replacement … Events
30-Day Mortality for Colorectal Surgery
Adverse Drug Events
Adverse Events With Hypoglycemic
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pbrn.ahrq.gov/research/findings/evidence-based-reports/search.html
May 01, 2024 - Events Associated With COVID-19 Pharmaceutical Treatments Date: March 2024
Report Type: Rapid Evidence … Status: Final
Computerized Clinical Decision Support To Prevent Medication Errors and Adverse … Drug Events Date: February 2024
Report Type: Rapid Evidence Product Affiliation: Southern California … International—University of North Carolina at Chapel Hill Report Status: Final
Reducing Adverse … Drug Events Related to Anticoagulant Use in Adults Date: January 2024
Report Type: Rapid Evidence
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pbrn.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.
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pbrn.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.
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pbrn.ahrq.gov/funding/grantee-profiles/grtprofile-fairbanks.html
December 01, 2023 - care, where the complexity of the system and the fragility of the patients creates a greater risk for adverse … events. … a 2-year AHRQ grant in 2005 to evaluate an emergency medicine clinical pharmacist program to avoid adverse … drug events in emergency department (ED) patients. … Fairbanks evaluated over 10,000 ED cases for adverse events, and interviewed ED physicians and nurses
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pbrn.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 adverse … events. … events increases after hospitalization. … events.
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pbrn.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.
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pbrn.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.
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pbrn.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.
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pbrn.ahrq.gov/patient-safety/settings/labor-delivery/index.html
July 01, 2023 - Patients and Families
About AHRQ's Quality & Patient Safety Work
Patient Safety News and Events … improve the patient safety culture of labor and delivery (L&D) units and decrease maternal and neonatal adverse … events resulting from poor communication and system failures.
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pbrn.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.
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pbrn.ahrq.gov/sites/default/files/wysiwyg/research/findings/ta/prp/prp-wound-care.pdf
September 17, 2020 - • There is no statistically significant difference in adverse events and serious adverse
events between … Adverse Events
Appendix L. … There was no statistically
significant difference in adverse events (AEs) and serious adverse events … Categories of adverse events
Type of Adverse Events Example
Dermatological Adverse event Dermatitis … • There was no significant difference on adverse events (AEs) and serious adverse events
between
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pbrn.ahrq.gov/patient-safety/settings/hospital/candor/videos/nurses.html
August 01, 2022 - 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
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pbrn.ahrq.gov/hai/universal-icu-decolonization/index.html
September 01, 2013 - Safety and Adverse Events
The REDUCE MRSA Trial (Randomized Evaluation of Decolonization … Safety and Adverse Events
Authors
University of California Irvine
Susan Huang, MD, MPH
Adrijana
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pbrn.ahrq.gov/opioids/health-systems-research.html
July 01, 2021 - Older adults have a high prevalence of chronic pain and are especially vulnerable to adverse events from … Characterizing Opioid-Related Adverse Events in Older Adults After Hospital Discharge. … Prescribing of opioids at hospital discharge and associated adverse patient outcomes.
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pbrn.ahrq.gov/patient-safety/settings/ambulatory/reduce-readmissions.html
December 01, 2023 - 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
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pbrn.ahrq.gov/patient-safety/settings/hospital/candor/modules/guide6.html
August 01, 2022 - ensure that these tiers of support are provided to caregivers after they have in been involved in an adverse … responsible for item or Action Plan
Reporting Culture
Are policies in place to support reporting adverse … clinical events? … Does your facility review patient safety events openly and share lessons learned? … YES NO
Adverse Event Investigation Process
Is an adverse event policy in place?