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www.talkingquality.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2019qdr-final-es-cs061721.pdf
December 01, 2020 - Importance of Patient Safety
Mortality
Prevalence
Cost
Findings on Patient Safety
Improving Trend: Adverse … Drug Events With Heparin and Factor Xa
Improving Trend: Inpatient Adverse Drug Events With Anticoagulants
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www.talkingquality.ahrq.gov/news/newsletters/e-newsletter/888.html
November 01, 2023 - Studies
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Events … Adverse drug event prevention and detection in older emergency department patients .
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www.talkingquality.ahrq.gov/coronavirus/long-covid.html
March 01, 2024 - Studies
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Events … pattern and progression or worsening over time, with the possibility of severe and life-threatening events … to improve the care of people living with multiple chronic conditions who are at increased risk for adverse
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www.talkingquality.ahrq.gov/teamstepps/instructor/essentials/implguide.html
November 01, 2018 - Studies
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Events … supporting the need for a TeamSTEPPS Intervention could originate from a variety of sources, including adverse … Available organizational data, (e.g., adverse event and near miss reports, AHRQ Patient Safety Culture … so that facilities may also use the Guide to develop TeamSTEPPS Action Plans in response to sentinel events
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www.talkingquality.ahrq.gov/sites/default/files/wysiwyg/professionals/education/curriculum-tools/teamstepps/instructor/fundamentals/module10/igmeasure.pdf
January 01, 2004 - PSIs
are a set of measures that provide information about potential in-
hospital complications and adverse … events (outcomes) following
surgeries, procedures, and childbirth. … The PSIs can be used to help hospitals identify potential adverse
events that might require further … also include
indicators for complications occurring in-hospital that may
represent patient safety events … Such events can be mitigated
with the implementation of TeamSTEPPS tools and strategies.
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www.talkingquality.ahrq.gov/teamstepps/instructor/essentials/implguide1.html
November 01, 2018 - Studies
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Events … You may start by doing simple counts of your target events or clinical outcomes and displaying these … Prophylactic Antibiotic Administration
Number of patients admitted to labor & delivery who incurred an adverse … event or near miss / Total number of patients admitted to labor & delivery = Rate of Labor & Delivery Adverse … & Near-Miss Events
Number of live-born full-term neonates with birth trauma (injury) / Total number
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www.talkingquality.ahrq.gov/questions/resources/glossary.html
November 01, 2020 - Studies
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Events … Top of Page
M
Medical Error: An unintended but preventable adverse effect of care, whether or … Morbidity also refers to adverse effects caused by a treatment.
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www.talkingquality.ahrq.gov/funding/policies/nofoguidance/index.html
January 01, 2024 - Studies
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Events … Surveillance, measurement, detection, and reporting of patient safety events. … Determination of the clinical efficacy and effectiveness of preventive interventions, including unintended adverse
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www.talkingquality.ahrq.gov/teamstepps/readiness/informationitems.html
April 01, 2016 - Studies
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Events … Objective information can originate from a variety of sources, including adverse event and near-miss
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www.talkingquality.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/perinatal/chipra-0085-fullreport.pdf
December 31, 2015 - convention is to estimate reliability at two
points: (1) at a minimum number of quality reporting events … per physician and (2) at the average
number of quality reporting events per physician. … We set the minimum number required as 10
events. … Limiting the reliability analysis to only those physicians with a minimum number of
events reduces the … bias introduced by the inclusion of physicians without a significant number of
events.
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www.talkingquality.ahrq.gov/patient-safety/settings/hospital/resource/safety-assess.html
October 01, 2020 - Studies
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Events … Patients and Families
About AHRQ's Quality & Patient Safety Work
Patient Safety News and Events
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www.talkingquality.ahrq.gov/hai/tools/ambulatory-surgery/sections/sustainability/management/overview-fac-notes.html
June 01, 2017 - Studies
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Events … ASCs have an excellent safety record, but events do happen. … checklists and other examples of safety standard work can help you avoid both near misses and serious safety events … An analysis of risk factors and adverse events in ambulatory surgery .
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www.talkingquality.ahrq.gov/sites/default/files/wysiwyg/nursing-home/materials/covid19-vaccine-confidence-curriculum-learning-guide-staff.pdf
March 01, 2021 - o The Vaccine Adverse Event Reporting System (VAERS – pronounced “vairs”), managed by the
CDC and the … Events Reported after COVID-19 Vaccination | CDC
https://www.youtube.com/watch? … • The Vaccine Adverse Event Reporting System (VAERS (pronounced “vairs”)), managed by the CDC and … Vaccines and Allergic Reactions
• CDC - V-Safe After Vaccination Health Checker App
2 Selected Adverse … Events Reported after COVID-19 Vaccination | CDC
https://www.cdc.gov/vaccines/covid-19/toolkits/long-term-care
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www.talkingquality.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/hospital/hospwebinar/just-culture-webcast-transcript-508-compliant.pdf
June 01, 2017 - She leads the analytics of all serious
adverse events, and her current project schedule includes improving … alarm safety, TeamSTEPPS, peer support
learning following adverse events, and participation in the … There are also two outcome items, Patient Safety Grade and Number of Events Reported in the Past 12 Months … that we might search for policies related to, like corrective action, our
sentinel event policy, our adverse … It helps us to improve
our offerings and plan future events that meet your needs.
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www.talkingquality.ahrq.gov/news/newsletters/e-newsletter/880.html
September 01, 2023 - Studies
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Events … section
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Events … of implementation factors related to addressing social determinants to reduce racial disparities in adverse
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www.talkingquality.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/qitoolkit/combined/b1_combo_applyingqis.pdf
March 01, 2016 - Expected rate = Expected events/Eligible population
Risk-adjusted rate = (Observed events/Expected … = for each QI indicator, the total sum of events that occurred in the eligible
population for that … specific indicator
Expected events = for each QI indicator, the total sum of events expected to occur … The expected probabilities for the set of discharges are
summed to obtain the number of expected events … (Note that a lower rate for a PSI signifies better
performance because fewer adverse events have occurred
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www.talkingquality.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/perinatal/chipra-0083-fullreport.pdf
March 01, 2016 - is aimed at preventing inappropriate and unnecessary episiotomies during birth,
which can lead to adverse … The evidence behind the inappropriate use of episiotomy and its link to an increased risk of
adverse … We set the minimum number required
as 10 events. … events. … events were 0.77 and 0.34, respectively.
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www.talkingquality.ahrq.gov/patient-safety/resources/learning-lab/index.html
February 01, 2024 - drug events. … Emergency department boarding and adverse hospitalization outcomes among patients admitted to a general … drug events. … patient safety events. … events, and improve efficiency for ED healthcare providers.
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www.talkingquality.ahrq.gov/teamstepps/readiness/index.html
August 01, 2015 - Studies
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Events … Objective information can originate from a variety of sources, including adverse event and near-miss
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www.talkingquality.ahrq.gov/news/blog/ahrqviews/uneven-impact-covid19.html
December 01, 2021 - Studies
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Events … this section
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