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Showing results for "adverse events".
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161. Staff-Safety-Assessment (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/staff-safety-assessment.docx
     June 01, 2021 - Safety Assessment PURPOSE OF THIS FORM: To discuss issues that may result in antibiotic-associated adverse … events or have the potential to cause adverse events that could negatively impact patient safety.

162. Choosing an Intervention and Measuring Change | Agency for Healthcare Research and Quality
     www.ahrq.gov/antibiotic-use/long-term-care/improve/intervention.html
     June 01, 2021 - The Staff Safety Assessment Form and the Learning from Antibiotic-Associated Adverse Events Form … Staff Safety Assessment Form (DOCX, 330.3 KB) Learning From Antibiotic-Associated Adverse Events Form

163. Patient and Family Engagement | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/cusp/modules/patient-family-engagement/notes.html
     September 01, 2013 - Introduction to Adverse Events Slide 23. Immediate Response to an Adverse Event 4 Slide 24. … Introduction to Adverse Events Say: Adverse events occur when a patient is harmed as a result of … Medical providers are committed to caring for their patients; however, adverse events can happen. … The Second Victim: Health Care Workers 7 Say: Adverse events are often system failures. … Organizations need to engage in strategies to address adverse events.

164. The Impact of a Patient Safety Program on Medical Error Reporting (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Woolever.pdf
     January 01, 2001 - In 1998 there were 28 (14 percent) adverse events (patient minimally effected) and 25 (9 percent) in … 2001, compared with a rate of 86.00 near misses and 14.00 adverse events in 1998 (Table 1). … Incident type 1998 2001 Near misses 86.00 90.94 Adverse events 14.00 9.06 Figure 3. … Potential identifiability and preventability of adverse events using information systems. … Rate of near misses and adverse events per 100 incident Table 2.

165. Appendix A. Recommendations for Ideal Consumer Reporting Systems | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/reports/hotline/appa.html
     May 01, 2016 - and Testing the Health Care Safety Hotline: A Prototype Consumer Reporting System for Patient Safety Events … and Testing the Health Care Safety Hotline: A Prototype Consumer Reporting System for Patient Safety Events … The system should collect information on all types of events, ranging from near-miss and no-harm events … to adverse events. … health care and whose members, employees, or affiliate entities may be the subjects of reports about adverse

166. Transforming the Morbidity and Mortality Conference into an Instrument for Systemwide Improvement (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol2/Advances-Deis_82.pdf
     June 03, 2008 - Results: Twenty-one cases (12 medical, 9 surgical) representing adverse events were presented at the … Adverse events triggering case selection included unexpected deaths (six), unplanned intubations (two … MM&I Results Twenty-one cases representing adverse events were presented in the MM&I conference series … Adverse events triggering case selection are listed in Table 2. … Adverse events triggering case presentations Case N Unexpected deaths 6 Unplanned intubation

167. Global Assessment of Pediatric Patient Safety (GAPPS) Trigger Tool (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/acute/chipra-143-fullreport.pdf
     April 01, 2018 - The Canadian Adverse Events Study: The incidence of adverse events among hospital patients in Canada … Detecting adverse events using information technology. … Adverse Events in Hospitals: Methods for Identifying Events. … Adverse events among children in Canadian hospitals: The Canadian Paediatric Adverse Events Study. … Adverse events and preventable adverse events in children.

168. AHRQ's Safety Program for Nursing Homes: On-Time Pressure Ulcer Prevention | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/pruprev/factraining.html
     December 01, 2014 - Slide 6: On-Time Reports Being Developed for Four Adverse Events Say: On-Time reports are being … developed to help prevent four adverse events: pressure ulcers, pressure ulcers that are not healing … Commitment to work with a Facilitator to learn how to use the reports to prevent adverse events. … The reports: Focus on preventing adverse events. Are proactive rather than reactive. … Remind staff members that the On-Time reports can help identify risk for adverse events and that using

169. Is There an Association Between Patient Safety Indicators and Hospital Teaching Status? (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol2/Advances-Rivard_97.pdf
     April 28, 2008 - Conclusion: Further research is needed on the relationship of residency programs to adverse events. … For example, older and sicker patients are often at higher risk for incurring adverse events.4, 7, 8 … Postoperative adverse events in teaching and nonteaching hospitals. … Patient risk factors for adverse drug events in hospitalized patients. … Hospital ownership and preventable adverse events. J Gen Intern Med 2000; 15: 211-219. 24.

170. Final Progress Report: Effects of Extended Work Hours on ICU Patient Safety (pdf file)
     www.ahrq.gov/sites/default/files/2024-09/czeisler-report.pdf
     January 01, 2024 - Compared to other industries, medicine has a relatively high rate of serious errors and adverse events … The most common causes of adverse events were medication use, wound infections, operative complications … In a study of ADEs in a 700-bed hospital, adverse drug events (ADEs) and preventable ADEs were estimated … Preventable adverse events were not significantly different. 10 When broadening the assessment to … No adverse events occurred.

171. Final Progress Report: Mining complex clinical data for patient safety research (pdf file)
     www.ahrq.gov/sites/default/files/2024-07/hripcsak-report.pdf
     January 01, 2024 - Detecting adverse events for patient safety research: a review of current methodologies. … Detecting Adverse Events Using Information Technology. … Detection of adverse events using conflicts in the electronic medical record (poster). … Using computerized data to identify adverse drug events in outpatients. … Electronically screening discharge summaries for adverse medical events.

172. Early Mobility in the Intensive Care Unit: Facilitator Guide | Agency for Healthcare Research and Quality
     www.ahrq.gov/hai/tools/mvp/modules/technical/early-mobility-icu-fac-guide.html
     February 01, 2017 - Slide 11: Safety Say: There were no serious adverse events. … Patients were started on a careful trial of activity, and close watch was kept for adverse events. … Slide 14: Adverse Events Say: Nine patients had a total of 14 adverse events. … This study had no documented adverse events in either arm. … The adverse events discussed in these articles range from agitation to transient physiological events

173. Physician Event Reporting: Training the Next Generation of Physicians (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Nguyen.pdf
     May 01, 2003 - Hilborne Abstract Physician reporting of adverse events and unsafe situations remains extremely … Because adverse events usually occur as a result of multiple failures, it is imperative that medical … events occur. … events. … events are not the result of one mistake.

174. Data Measures Guide (pdf file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/vae/datameasures-guide.pdf
     January 01, 2017 - Event Incidence Rate Numerator Total number of adverse events which occurred during mobilization … Events Numerator Total number of adverse events in each of the 25 categories which occurred during … /Trach & Mech Vent were marked “Y” Example Display top 10 adverse events. … event occur Target Low adverse event rate Mobility NOT Intubated: Distribution of Adverse Events … Events (cont) Example Display top 10 adverse events.

175. Final Progress Report: Evaluate the Effects of the Massachusetts Reporting System (pdf file)
     www.ahrq.gov/sites/default/files/2024-11/ridley-report.pdf
     January 01, 2024 - They decided to use the phrase “negative effects” instead of “adverse events.” … A pre- specified list of adverse events and an evidence-based clinical case definition for each AE was … For the self-reported adverse events, two physicians reviewed patients’ responses from the survey, in … which they provided open-ended responses that described possible adverse events. … Adverse drug events were the highest type of adverse event reported by patients and recorded in the

176. Final Progress Report: Transitional Care Medication Safety and Reducing Medical Liability: Closing the Chasm (pdf file)
     www.ahrq.gov/sites/default/files/2024-01/corbett-report.pdf
     January 01, 2024 - events, and medical liability during hospital-to-community transitions within a complex healthcare … events while minimizing medical liability. … Research indicates that rates of adverse drug events (ADEs) in ambulatory care may be up to four times … The incidence and severity of adverse events affecting patients after discharge from the hospital. … Adverse drug events in ambulatory care. New England Journal of Medicine, 348, 1556–1564.

177. Facilitator Guide: Build Your SSI Prevention Bundle (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/technical/early-mobility-icu-facguide.docx
     January 01, 2017 - Slide 10 Safety SAY: There were no serious adverse events. … Patients were started on a careful trial of activity, and close watch was kept for adverse events. … Slide 13 Adverse Effects SAY: Nine patients had a total of 14 adverse events. … This study had no documented adverse events in either arm. … The adverse events discussed in these articles range from agitation to transient physiological events

178. On-Time Pressure Ulcer Healing: Facilitator Training Instructor's Guide | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/pruhealing/guide.html
     December 01, 2017 - Slide 6: On-Time Reports for Four Adverse Events  Say: There are four sets of On-Time reports … to help prevent four adverse events: pressure ulcers, pressure ulcers that are not healing appropriately … Commitment to work with a Facilitator to learn how to use the reports to prevent adverse events. … The reports: Focus on preventing adverse events. Are proactive rather than reactive. … Improve root cause analyses when adverse events occur.

179. Pf-Engagement-Facilitator-Guide (doc file)
     www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/perinatal-care/modules/teamwork/engage/pf-engagement-facilitator-guide.docx
     May 01, 2017 - Slide 16 SAY: Adverse events occur when a patient is harmed as a result of receiving medical care. … Medical providers are committed to caring for their patients; however, adverse events can happen. … Slide 21 SAY: Adverse events are often system failures. … Hospitals today recognize that health care workers are the second victims of adverse events and often … Organizations need to engage in strategies to address adverse events.

180. CANDOR Event Checklist | Agency for Healthcare Research and Quality
     www.ahrq.gov/patient-safety/settings/hospital/candor/modules/checklist4.html
     August 01, 2022 - How to use this tool: Use the checklist to ensure that appropriate action is taken following an adverse … Online: Review and prioritize events. … Report any adverse event to the appropriate professional responsible for patient safety events. … Collect medical records and other documents to establish timeline of events. … ; or Centers fpr Medicare & Medicaid Services' "never" events.