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Showing results for "adverse events".
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101. Johns Hopkins Children’s Center Uses AHRQ-Funded I-PASS Tool to Boost Patient Safety | Agency for Healthcare Research and Quality
     preventiveservices.ahrq.gov/news/newsroom/case-studies/201903.html
     April 01, 2019 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … AHRQ Social Media AHRQ Stats Impact Case Studies Blog Newsletter Events … “Miscommunication is a leading cause of adverse events in hospital patients’ care, which is why optimizing

102. Chlorhexidine Bathing Routine Reduces Infections in Nursing Homes | Agency for Healthcare Research and Quality
     preventiveservices.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

103. Register Now: August 22 Webinar by National Action Alliance Will Address Engaging Boards and Executive Leadership in Safety | Agency for Healthcare Research and Quality
     preventiveservices.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

104. PS Grantee Report | Agency for Healthcare Research and Quality
     preventiveservices.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

105. Patient Safety Tools | Agency for Healthcare Research and Quality
     preventiveservices.ahrq.gov/research/findings/evidence-based-reports/makinghcsafer.html
     June 01, 2022 - hospitals and nursing homes (including skilled nursing facilities) to collect data for all types of adverse … events, near misses, and unsafe conditions. … Quality Indicators through free software programs that can help hospitals identify quality of care events … 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

106. Strategy 4: IDEA Discharge Planning (Tool 1) (pdf file)
     preventiveservices.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy4/Strat4_Tool_1_IDEAL_chklst_508.pdf
     January 01, 2010 - engaging patients and families in discharge planning Nearly 20 percent of patients experience an adverse … 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.

107. Strategy 3: Nurse Bedside Shift Report | Agency for Healthcare Research and Quality
     preventiveservices.ahrq.gov/patient-safety/patients-families/engagingfamilies/strategy3/index.html
     December 01, 2017 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … 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.

108. Longitudinal Evaluation of the Patient Safety and Medical Liability Reform Demonstration Program | Agency for Healthcare Research and Quality
     preventiveservices.ahrq.gov/patient-safety/reports/candor-demo-program/candor/demo-program/index.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 … These projects sought to improve patient safety by measuring safety problems, characterizing adverse … events, and conducting clinical safety interventions.

109. Agency for Healthcare Research and Quality
     preventiveservices.ahrq.gov/topics/index.html?page=1
     January 01, 2012 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … ensure safe and seamless transitions of patients from one care setting to another, reducing preventable adverse … events, drug-related errors, and other problems.

110. Agency for Healthcare Research and Quality
     preventiveservices.ahrq.gov/es/topics/index.html?page=1
     January 01, 2012 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … ensure safe and seamless transitions of patients from one care setting to another, reducing preventable adverse … events, drug-related errors, and other problems.

111. AHRQ Safety Program for Perinatal Care: Experiences from the Frontline (pdf file)
     preventiveservices.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/perinatal_care_toolkit_lowvision.pdf
     May 01, 2017 - Ways to reduce obstetrical adverse events include improving teamwork and communication among care teams … Root cause analyses of adverse events and near-misses (events that did not produce patient injury) … EARLY IMPACTS The most recent root cause analyses of adverse events and near-misses indicated that … poor communication is no longer a root cause; in fact, near-misses and adverse events attributed to … The weighted adverse events included in the measure are in-house maternal death, in-house neonatal

112. AHRQ Safety Program for Perinatal Care: Experiences from the Frontline (pdf file)
     preventiveservices.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/perinatal_care_toolkit_fullcolor.pdf
     May 01, 2017 - Ways to reduce obstetrical adverse events include improving teamwork and communication among care teams … Root cause analyses of adverse events and near-misses (events that did not produce patient injury) … EARLY IMPACTS The most recent root cause analyses of adverse events and near-misses indicated that … poor communication is no longer a root cause; in fact, near-misses and adverse events attributed to … The weighted adverse events included in the measure are in-house maternal death, in-house neonatal

113. Winners Selected in Challenge Competition To Create TeamSTEPPS Training Videos | Agency for Healthcare Research and Quality
     preventiveservices.ahrq.gov/news/newsletters/e-newsletter/878.html
     August 01, 2023 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … section News Newsroom Blog Newsletter AHRQ News Now Events … (Source: JAMA Network Open , Complications, Adverse Drug Events, High Costs, and Disparities in Multisystem … include: Common contributing factors of diagnostic error: a retrospective analysis of 109 serious adverse

114. Safe Medication Administration: Facilitator Guide | Agency for Healthcare Research and Quality
     preventiveservices.ahrq.gov/patient-safety/settings/labor-delivery/perinatal-care/modules/strategies/medication/safe-medication-fac-guide.html
     July 01, 2023 - 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. … 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

115. SOPS Bibliography | Agency for Healthcare Research and Quality
     preventiveservices.ahrq.gov/sops/bibliography/index.html
     January 01, 2024 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … The association between patient safety culture and adverse events - A scoping review. … The relationship between patient safety culture and patient safety competency with adverse events: A

116. Vaccination Tracking and Reporting Tools | Agency for Healthcare Research and Quality
     preventiveservices.ahrq.gov/nursing-home/materials/prevention/vaccine-records.html
     July 01, 2022 - Studies Blog AHRQ Views Newsletter AHRQ News Now Events … the vaccine manufacturer, additional primary dose and booster shots, dates each shot is administered, adverse … the vaccine manufacturer, additional primary dose and booster shots, dates each shot is administered, adverse

117. AHRQ Safety Program for Perinatal Care: Safe Medication Administration: Magnesium Sulfate (doc file)
     preventiveservices.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/strategies/medication/tool_safe-mgso4.docx
     May 30, 2013 - fractures.3,9 Staff with requisite training and supplies available to respond to magnesium-related adverse … Defects (CUSP Module) Key Perinatal Safety Elements Examples Debrief and analyze near misses and adverse … events related to magnesium sulfate use … Have a process in place to review severe maternal or neonatal morbidity and mortality events. … events including respiratory depression 2.

118. Program Evaluation - PowerPoint Presentation
     preventiveservices.ahrq.gov/sites/default/files/wysiwyg/hai/tools/perinatal-care-2/hemorrhage_8_program-evaluation.pptx
     July 01, 2023 - Severe Maternal Morbidity (SMM) Calls by professional organizations to review SMM to better understand adverse … maternal events to implement clinical audits and improve quality of care to increase awareness/knowledge … in SMM has been driven by: Calls by professional organizations to review SMM to better understand adverse … becoming better established and improving over time Collectively, these will lead lead to reductions in adverse … events – as shown in the impact column. 17 Evaluation Data Collection Baseline assessment survey at

119. Program Evaluation (pdf file)
     preventiveservices.ahrq.gov/sites/default/files/wysiwyg/hai/tools/perinatal-care-2/hemorrhage_8-program-evaluation-speaker-notes.pdf
     July 01, 2023 - Maternal Morbidity (SMM) □ Calls by professional organizations to review SMM  to better understand adverse … maternal events  to implement clinical audits and improve quality of care  □ Development … SMM has been driven by: • Calls by professional organizations to review SMM  to better understand adverse … maternal events  to implement clinical audits and improve quality of care  to increase awareness … becoming better established and improving over time Collectively, these will lead lead to reductions in adverse

120. Program Evaluation (pdf file)
     preventiveservices.ahrq.gov/sites/default/files/wysiwyg/hai/tools/perinatal-care-2/hypertension_8-program-evaluation-speaker-notes.pdf
     July 01, 2023 - Maternal Morbidity (SMM) □ Calls by professional organizations to review SMM  to better understand adverse … maternal events  to implement clinical audits and improve quality of care  to increase awareness … SMM has been driven by: • Calls by professional organizations to review SMM  to better understand adverse … maternal events  to implement clinical audits and improve quality of care  to increase awareness … becoming better established and improving over time Collectively, these will lead lead to reductions in adverse