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www.ahrq.gov/sites/default/files/wysiwyg/cpi/about/mission/budget/2021/FY_2021_CJ_NIRSQ.pdf
January 01, 2021 - Nearly half of opioid stays among women
aged 65 years and older were due to adverse events. … Research has shown that preventable adverse events constitute nearly 60% of
harms experienced by residents … QSRS will generate adverse event rates, trend performance over
time, and unlike MPSMS, QSRS was designed … to also serve as a local hospital and health system
tool to identify and measure adverse events to … events, cost, and utilization).
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Shimada_65.pdf
April 04, 2008 - PSIs) developed by the Agency for Healthcare
Research and Quality identify potential patient safety events … time.3, 4, 5, 8
Previous research using PSIs has demonstrated that the odds of experiencing an adverse … Consequently,
some events were extremely rare: only one Asian American and two American Indians had … Discussion
Our goal was to examine whether patient safety events varied across different races in the … How often
are potential “Patient Safety Events” present on
admission?
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy3/Strat3_Implement_Hndbook_508.docx
August 01, 2010 - Nurse shift changes require the successful transfer of information between nurses to prevent adverse … events and medical errors. … One study found that more than 70 percent of adverse events are caused by breakdowns in communication … are on the Centers for Medicare and Medicaid Services’ list of hospital-acquired complications “never events … communication during nurse transitions, for example:
Reduce the incidence of never events by 5 percent
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www.ahrq.gov/sites/default/files/wysiwyg/research/findings/final-reports/18465-Kesselheim-draft-1.pdf
January 01, 2015 - off-label”) uses of widely available prescription drugs
and the scientific, market, and regulatory/legal events … these selected datasets, assessing the effect of various scientific, market, and
regulatory/legal events … time trend before the first
event, and binary terms and linear time trends for each of the studied events … a costly treatment that does not benefit patients and increases the risk
for dangerous thrombotic events … The pharmaceutical market’s adverse effects (Bad Pharma (Goldacre,
2012)).
-
www.ahrq.gov/sites/default/files/2024-01/kesselheim-report.pdf
January 01, 2024 - off-label”) uses of widely available prescription drugs
and the scientific, market, and regulatory/legal events … these selected datasets, assessing the effect of various scientific, market, and
regulatory/legal events … time trend before the first
event, and binary terms and linear time trends for each of the studied events … a costly treatment that does not benefit patients and increases the risk
for dangerous thrombotic events … The pharmaceutical market’s adverse effects (Bad Pharma (Goldacre,
2012)).
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www.ahrq.gov/patient-safety/reports/issue-briefs/education-dx-outcomes-7.html
March 01, 2022 - Inadequacies of physical examination as a cause of medical errors and adverse events: a collection of … Serious misdiagnosis-related harms in malpractice claims: The "Big Three"—vascular events, infections … Internal medicine residents' exposure to and confidence in managing hospital acute clinical events .
-
www.ahrq.gov/diagnostic-safety/resources/issue-briefs/education-dx-outcomes-7.html
March 01, 2022 - Inadequacies of physical examination as a cause of medical errors and adverse events: a collection of … Serious misdiagnosis-related harms in malpractice claims: The "Big Three"—vascular events, infections … Internal medicine residents' exposure to and confidence in managing hospital acute clinical events .
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/pdi/g2_pdi_specifictoolstosupportchange.pdf
January 01, 2011 - • Sentinel events: transfusion reaction,
wrong blood type, wrong-site surgery,
foreign body left … in during procedure,
medical equipment-related adverse
events, medication errors … • Other care-related adverse events:
patient falls, in-hospital hip fracture or
fall
http://www.oecd.org … Hospital of Philadelphia annually
reviews all findings from root cause analyses
of serious safety events … This electronic toolbox provides States with
tools they can use or modify as they develop
or improve adverse
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/g2_combo_specifictoolstosupportchange.pdf
January 01, 2011 - • Sentinel events: transfusion reaction, wrong
blood type, wrong-site surgery, foreign body
left … in during procedure, medical equipment-
related adverse events, medication errors … • Other care-related adverse events: patient
falls, in-hospital hip fracture or fall
http://www.oecd.org … Hospital of Philadelphia annually reviews
all findings from root cause analyses of serious safety
events … This electronic toolbox provides States with tools
they can use or modify as they develop or improve
adverse
-
www.ahrq.gov/research/findings/studies/index.html?page=72
January 01, 2024 - Keywords: Medication, Medication: Safety, Provider: Nurse, Adverse Drug Events (ADE), Adverse Events … The researchers describe such decisions as events of naturalistic decision-making which are influenced
-
www.ahrq.gov/health-literacy/professional-training/lepguide/app-e.html
September 01, 2020 - Update presents 34 practices that have been demonstrated to be effective in reducing the occurrence of adverse … healthcare events.
-
www.ahrq.gov/patient-safety/reports/issue-briefs/dxsafety-pediatric-safety-5.html
August 01, 2023 - In addition, we must consider challenges such as developing clinician trust and mitigating possible adverse
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/pharmhealthlit/pharmlit/pharmlitap3.pdf
October 15, 2007 - Common severe side or adverse effects,
interactions and contraindications that can
happen, including
-
www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-pediatric-safety-5.html
August 01, 2023 - In addition, we must consider challenges such as developing clinician trust and mitigating possible adverse
-
www.ahrq.gov/research/findings/nhqrdr/chartbooks/healthyliving/mch-ref.html
April 01, 2018 - New frontiers in patient-reported outcomes: adverse event reporting, comparative effectiveness, and quality
-
www.ahrq.gov/sites/default/files/2024-09/evans-report.pdf
January 01, 2024 - Clinician exposure to acute occupational stress events can activate the sympathetic nervous
system, … Therefore, individual interviews may have
been subject to recall bias, or significant events ongoing … interesting counterpoint to this data is that management becomes more interested
in patient safety after an adverse … use these insights to improve resident preparation, wellness, and resilience in the face of future
adverse … events.
-
www.ahrq.gov/patient-safety/patients-families/consumer-exp/reporting/appa.html
August 01, 2022 - Designing Consumer Reporting Systems for Patient Safety Events
Appendix A. … Previous Page Next Page
Table of Contents
Designing Consumer Reporting Systems for Patient Safety Events
-
www.ahrq.gov/sites/default/files/publications/files/postdisphone.pdf
February 14, 2013 - Medicines
High Alert Medicines
Use the guide below to help monitor medicines with significant risk for adverse … events.
-
www.ahrq.gov/sites/default/files/publications/files/postdisphone.docx
January 31, 2013 - Medicines
High Alert Medicines
Use the guide below to help monitor medicines with significant risk for adverse … events.
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/red/toolkit/postdisphone.pdf
February 14, 2013 - Medicines
High Alert Medicines
Use the guide below to help monitor medicines with significant risk for adverse … events.