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Showing results for "adverse events".
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121. FileNewTemplate
     pcmh.ahrq.gov/sites/default/files/wysiwyg/teamstepps/officebasedcare/ts-obc-online-module1.pptx
     March 01, 2010 - Outcome Score (WAOS), which describes the adverse event score per delivery 50% decrease in the Severity … Index, which measures the average severity of each delivery with an adverse event Mann, S., Marcus, … Reduced rate of adverse drug events Improved medication reconciliation at patient admission Haig, K. … Some of the current clinical outcomes of team training include the following-- 50% reduction in adverse … event; reduced rate of adverse drug events; and improved medication reconciliation at patient admission

122. Resource List - AHRQ Hospital Survey (pdf file)
     pcmh.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/hospital-v2-resourcelist.pdf
     April 01, 2023 - • Implement a Care for the Caregiver program for providers involved in adverse events. … • Investigate and analyze an adverse event to learn from it and prevent future adverse events. … These organizations consistently minimize adverse events despite carrying out intrinsically complex and … Patient Safety Primer: Medication Errors and Adverse Drug Events https://psnet.ahrq.gov/primers/primer … Patient Safety Primer: Medication Errors and Adverse Drug Events 23.

123. Health Literacy Tools for Providers of Medication Therapy Management | Agency for Healthcare Research and Quality
     pcmh.ahrq.gov/health-literacy/improve/pharmacy/medication-mgt.html
     September 01, 2020 - (MTM) is a patient-centric and comprehensive approach to improve medication use, reduce the risk of adverse … events, and improve medication adherence.

124. Preventing Medication Errors in Ambulatory Care: The Importance of Establishing Regimen Concordance (pdf file)
     pcmh.ahrq.gov/downloads/pub/advances/vol1/Schillinger.pdf
     January 01, 2004 - Because oral anticoagulants are associated with preventable adverse events at disproportionately high … events,4, 37 such as thrombotic events (under-treatment) or bleeding (over- treatment). … events are common18 and warfarin is involved in preventable adverse drug events at rates disproportionate … Incidence and preventability of adverse drug events among older persons in the ambulatory setting. … Adverse drug events in ambulatory care. NEJM 2003 348(16):1556– 64. 19.

125. Improving Patient Safety in Community Pharmacies: A Resource List for Users of the AHRQ Community Pharmacy Survey on Patient Safety Culture (pdf file)
     pcmh.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/community-pharmacy/pharmacy-resources.pdf
     May 01, 2023 - events and close calls. … These organizations consistently minimize adverse events despite carrying out intrinsically complex … Patient Safety Primer: Medication Errors and Adverse Drug Events https://psnet.ahrq.gov/primers/primer … /23 A growing evidence base supports specific strategies to prevent adverse drug events (ADEs). … Patient Safety Primer: Medication Errors and Adverse Drug Events 9.

126. Improving Patient Safety in Hospitals: A Resource List for Users of the AHRQ Hospital Survey on Patient Safety Culture (pdf file)
     pcmh.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/hospitalresourcelist.pdf
     January 01, 2019 - events … • Implement a Care for the Caregiver program for providers involved in adverse events. … • Investigate and analyze an adverse event to learn from it and prevent future adverse events. … These organizations consistently minimize adverse events despite carrying out intrinsically complex … drug events (ADEs).

127. AHRQ Safety Program for Perinatal Care: Rapid Response for Perinatal Safety
     pcmh.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/strategies/rapid-response/rapidresponse.pptx
     October 01, 2017 - Perinatal Safety 13 Key Safety Elements: Learn From Defects Debrief and analyze near misses and adverse … events, regardless of whether a rapid response was activated Debrief among clinical team after rapid … Response Call Log can facilitate a debrief Have a process in place to review serious maternal or neonatal adverse … Consider these factors: Unit data suggesting adverse events or near misses that may have been minimized … Debrief regularly after rapid response events, and solicit ongoing feedback from staff and patients to

128. Rapidresponse Facguide (doc file)
     pcmh.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/strategies/rapid-response/rapidresponse_facguide.docx
     May 01, 2017 - 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. … Consider these factors: · Unit data suggesting adverse events or near misses that may have been minimized … Regularly debrief after rapid response events, and solicit ongoing feedback from staff and patients.

129. Survey on Patient Safety (facility version) (doc file)
     pcmh.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/facilscanform.doc
     November 15, 2019 - · “Patient safety” is defined as the avoidance and prevention of patient injuries or adverse events … to ask questions when something does not seem right (1 (2 (3 (4 (5 SECTION D: Frequency of Events … Management in this facility seems interested in patient safety only after an adverse event happens … Shift changes are problematic for patients in this facility (1 (2 (3 (4 (5 SECTION G: Number of Events

130. Engaging Patients and Families in the Medical Home - Table 4 | PCMH Resource Center
     pcmh.ahrq.gov/page/engaging-patients-and-families-medical-home-table-4
     June 01, 2010 - practice team Share information about medications and treatments received in other settings Report on adverse … events and potential safety problems Patients and families engaged in practice improvement Participate

131. Patient Narratives Can Catalyze Staff Improvement and Bolster Survey Scores | Agency for Healthcare Research and Quality
     pcmh.ahrq.gov/news/newsletters/e-newsletter/900.html
     February 01, 2024 - section News Newsroom Blog Newsletter AHRQ News Now Events … Reducing Adverse Events Related to Anticoagulants . Implicit Bias Training . Deprescribing . … Computerized Clinical Decision Support To Prevent Medication Errors and Adverse Drug Events .

132. TeamSTEPPS® 2.0 Leadership Briefing | Agency for Healthcare Research and Quality
     pcmh.ahrq.gov/teamstepps/about-teamstepps/leadershipbriefing.html
     April 01, 2017 - 10 years and identified communication failure as the leading root cause of sentinel events. … drug events (from 30 to 18 per 1,000 patient days). … Outcome Score, which describes the adverse event score per delivery. … events and close calls (VA Center for Patient Safety). … events and close calls.

133. Executive Briefing
     pcmh.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?

134. Evidence Summary: Why focus on safety for patients with limited English proficiency? | Agency for Healthcare Research and Quality
     pcmh.ahrq.gov/teamstepps/lep/handouts/lepevidencesum.html
     December 01, 2012 - 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.

135. Module 4: Teamwork and Communication: Facilitator Notes | Agency for Healthcare Research and Quality
     pcmh.ahrq.gov/hai/quality/tools/cauti-ltc/modules/implementation/long-term-modules/module4/mod4-facguide.html
     March 01, 2017 - Slide 28: Communicating Adverse Events Say: Communication following an adverse event can been especially … Each facility has policies and procedures to follow after an adverse event occurs, and most involve working … 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.

136. Study Finds Racial and Ethnic Inequities in End-of-Life Prescription Opioid Access | Agency for Healthcare Research and Quality
     pcmh.ahrq.gov/news/newsletters/e-newsletter/875.html
     August 01, 2023 - 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

137. How PSOs Help Health Care Organizations Improve Patient Safety Culture (pdf file)
     pcmh.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.

138. Strategy 3: Nurse Bedside Shift Report | Agency for Healthcare Research and Quality
     pcmh.ahrq.gov/patient-safety/patients-families/engagingfamilies/strategy3/index.html
     December 01, 2017 - Primary Care Settings About AHRQ's Quality & Patient Safety Work Patient Safety News and Events … Nurse shift changes require the successful transfer of information between nurses to prevent adverse … events and medical errors.

139. Final Progress Report: Leveraging a Social Network of Elders and Families To Improve Medication Safety at Transitions of Care (pdf file)
     pcmh.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

140. Preventing Medication Errors Among Children With Chronic Conditions in Outpatient and Home Settings | Agency for Healthcare Research and Quality
     pcmh.ahrq.gov/funding/grantee-profiles/grtprofile-walsh.html
     October 01, 2023 - Walsh is working to prevent medication errors and adverse drug events among children, particularly those … Her team found that 10 percent of children with leukemia or lymphoma experienced adverse drug events