-
www.ahrq.gov/research/findings/studies/index.html?page=305
January 01, 2024 - This review evaluated the comparative effectiveness and adverse events of cognitive behavioral therapy
-
www.ahrq.gov/sites/default/files/wysiwyg/workingforquality/cms-quality-strategy.pdf
January 01, 2020 - million healthcare-
associated infections occur each year, and these conditions lead to 99,000 deaths; adverse … medication
events cause more than 770,000 injuries and deaths each year. … The cost of treating patients who are
harmed by these events is estimated to be as high as $5 billion … eliminated
Reduce inappropriate and
unnecessary care
• Healthcare organizations continually assess adverse … events in accordance with evidence-based practices
• Healthcare cost reductions are attributable
-
www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/ready-change.html
January 01, 2013 - Have there been any adverse events that were fall related?
-
www.ahrq.gov/ncepcr/reports/2024-annual-report/recent-grants-person-centered.html
May 01, 2024 - disabilities or increased social risks with the goal of increasing functioning and decreasing pain and adverse … events.
-
www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/reports/issue-briefs/diagnostic-error-reduction.pdf
September 04, 2020 - Patient record
review of the incidence, consequences, and causes of diagnostic adverse events.
-
www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/ambulatory-care/cap-guide.docx
September 01, 2022 - moxifloxacin—are not recommended as first-line therapy due to concerns about fluoroquinolones causing adverse … events like Clostridioides difficile, tendonitis and tendon rupture, low blood sugar, changes in mental
-
www.ahrq.gov/hai/cauti-tools/archived-webinars/health-literacy-transcript.html
December 01, 2017 - they released just this past February, we know that, for example, in 2010, there were 802 sentinel events … reported to the Joint Commission, and 82 percent of those events listed communication issues as one … of the key root causes contributing to those events. … Similarly, they were involved in 61 percent of events in 2011 and 59 percent of events in 2012. … It increases their risk of poor outcomes and adverse events.
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/cauti-tools/archived-webinars/health-literacy-pfe-transcript.doc
July 09, 2013 - they released just this past February, we know that, for example, in 2010, there were 802 sentinel events … reported to the Joint Commission, and 82 percent of those events listed communication issues as one … of the key root causes contributing to those events. … Similarly, they were involved in 61 percent of events in 2011 and 59 percent of events in 2012. … It increases their risk of poor outcomes and adverse events.
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/envscan-app-f.pdf
January 01, 2015 - Consider for
Inclusion
Evidence
Level Rationale
Diagramming patients' views of root causes of
adverse … drug events in ambulatory care: an online
tool for planning education and research (Brown,
Patient … Reducing the risk of adverse drug events in older
adults (Pretorius, Am Fam Physician, 2013, PMID
23547549 … potentially
inappropriate prescriptions and screening tool to alert
doctors to the right treatment reduced adverse … events in
elderly patients.
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy2/Strat2_Implement_Hndbook_508.pdf
April 30, 2013 - where
they can interact
with the health care
team
• This handout gives information on routine events … One study found that more than 70 percent of adverse
events are caused by breakdowns in communication … to Improve Quality strategy may also help to meet other goals
related to patient safety and never events
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/cusptoolkit/modules/nursing/nursingnotes.docx
August 28, 2012 - Slide 22
SAY:
Nurse managers should obtain data on quality outcomes and adverse events monthly
-
www.ahrq.gov/sites/default/files/wysiwyg/ncepcr/tools/PCMH/cognitive-task.pdf
March 01, 2013 - macrocognitive processes include how individuals, teams, and organizations
make decisions, make sense of events … CTA methods do exist should the
reader wish to investigate the macrocognition of uncommon, critical events … information more comprehensive, organized, and readable,
and including decision aids and warnings of adverse … , what they pay attention to, what options and possibilities
they consider, how they make sense of events
-
www.ahrq.gov/patient-safety/settings/long-term-care/resource/facilities/ltc/mod1sess2.html
October 01, 2014 - Everyone—residents and staff—benefits from an environment that supports discussion and learning from near misses and adverse … events.
-
www.ahrq.gov/research/findings/factsheets/children/new-starts/2011.html
October 01, 2014 - high-acuity event, there is an elevated risk of error, failure in medical decisionmaking, and other adverse … events.
-
www.ahrq.gov/sites/default/files/wysiwyg/research/findings/ta/comments/lecvd-comments.pdf
April 01, 2017 - We have removed the word “typically” from
the description of the adverse events
Source: http://www.ahrq.gov … events
61. … are listed,
potential adverse effects of non-treatment are not
included. … among
“thrombophlebitis”, “venous thrombosis”, and
“venous thromboembolic events” are not clear. … events such as pain or ulcer infection.
-
www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/hospital/hsops_20_hit-wp-ve_data_spec.pdf
October 25, 2021 - 5 = Always
9 = Does Not Apply or Don’t Know
blank = MISSING
SECTION D: Reporting Patient Safety Events … In the past 12 months, how
many patient safety events
have you reported? … Hospital management
seems interested in patient
safety only after an adverse
event happens
F3 Column … Supervisor, Manager, or Clinical Leader
SECTION C: Communication
SECTION D: Reporting Patient Safety Events
-
www.ahrq.gov/sites/default/files/2024-07/gallagher4-report.pdf
January 01, 2024 - For example, 56 percent of the respondents chose statements that mentioned
the adverse event but not
-
www.ahrq.gov/sites/default/files/wysiwyg/ncepcr/resources/PPRNet.pdf
May 01, 2015 - practices with practice staff, clinicians, and patients to understand their
perspectives on reducing adverse … drug events.”
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/advancedpractice-guide_final508.pdf
March 26, 2018 - , families, and healthcare teams have clear roles and are fully engaged as partners
in their care, adverse … events are reduced and health outcomes are better.
-
www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/advanced-practice-guide.pdf
March 01, 2016 - families, and health care teams have clear
roles and are fully engaged as partners in their care, adverse … events are reduced and health
outcomes are better.