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81. Assessment of Pediatric Look-Alike, Sound-Alike Substitution Errors (pdf file)
    digital.ahrq.gov/sites/default/files/docs/activity/r03hs018841-basco-annual-summary-2012.pdf
    January 01, 2012 - Assessment of Pediatric Look-Alike, Sound-Alike Substitution Errors SMALL RESEARCH GRANT TO IMPROVE … 2010 – March 2013 AHRQ Funding Amount: $100,000 Summary: Look-alike, sound-alike (LASA) medication errors … While medication errors have been studied in the pediatric population, the frequency of LASA-specific … errors in pediatric prescriptions is not well documented or understood. … (Achieved) • Estimate frequencies of screening alerts (potential LASA substitution errors) in these

82. Brown, Andrew | Digital Healthcare Research
    digital.ahrq.gov/principal-investigator/brown-andrew
    January 01, 2023 - Principal Investigator Brown, Andrew Project Name Detecting Med (Medication) Errors in … Principal Investigator Brown, Andrew Project Name Detecting Med (Medication) Errors in … Principal Investigator Brown, Andrew Project Name Detecting Med (Medication) Errors in … Detecting Med Errors in Rural Hospitals Using Technology -Final Report. … Rural Hospitals Using Technology Detecting Med (Medication) Errors in Rural

83. Detecting Medication Errors in Rural Hospitals Using Technology (pdf file)
    digital.ahrq.gov/sites/default/files/docs/activity/detecting_med__medication__err_2009_update_2.pdf
    January 01, 2009 - Detecting Medication Errors in Rural Hospitals Using Technology … Project Title: Detecting Medication Errors … Data were collected from this date until August 31, 2008; in total, 805 errors were documented. … DETECTING MEDICATION ERRORS IN RURAL HOSPITALS USING TECHNOLOGY  1 … DETECTING MEDICATION ERRORS IN RURAL HOSPITALS USING TECHNOLOGY  2

84. Effect of an alternative newborn naming strategy on wrong-patient errors: a quasi-experimental study. | AHRQ Digital Healthcare Research: Informing Improvement in Care Quality, Safety, and Efficiency
    digital.ahrq.gov/etiology-medication-ordering-errors-computerized-provider-order-entry-systems/citation/effect
    January 01, 2020 - Effect of an alternative newborn naming strategy on wrong-patient errors: a quasi-experimental study. … Effect of an alternative newborn naming strategy on wrong-patient errors: a quasi-experimental study. … Principal Investigator:  Abraham, Joanna Project Name:  An Etiology for Medication Ordering Errors in

85. Assessment of Pediatric Look-Alike, Sound-Alike Substitution Errors (pdf file)
    digital.ahrq.gov/sites/default/files/docs/activity/2011_018841_basco_pdf_3.pdf
    January 01, 2011 - Assessment of Pediatric Look-Alike, Sound-Alike Substitution Errors 1 | Assessment of PediAtric Look-ALike … , sound-ALike substitution errors Small ReSeaRch GRant to ImpRove health caRe QualIty thRouGh health … InfoRmatIon technoloGy (It) (R03) Assessment of Pediatric Look-Alike, Sound-Alike Substitution Errors … While medication errors have been studied in the pediatric population, the frequency of LASA-specific … errors in pediatric prescriptions is not documented or understood well.

86. Using Electronic Records to Detect and Learn from Ambulatory Diagnostic Errors (pdf file)
    digital.ahrq.gov/sites/default/files/docs/activity/using_electronic_records_to_detect_and_learn_from_ambulatory_diagnostic_errors_2010_pdf__2.pdf
    January 01, 2010 - Using Electronic Records to Detect and Learn from Ambulatory Diagnostic Errors 1 | Using ElEctronic … rEcords to dEtEct and lEarn From ambUlatory diagnostic Errors 2010 Grant Summary Using Electronic … The project evaluated two methods to detect diagnostic errors. … The second paper will discuss clinical errors and the findings related to understanding these errors … For example, it will describe the types of events that lead to clinical errors.

87. Medication dispensing errors and potential adverse drug events before and after implementing bar code technology in the pharmacy | AHRQ Digital Healthcare Research: Informing Improvement in Care Quality, Safety, and Efficiency
    digital.ahrq.gov/health-it-tools-and-resources/health-it-costs-and-benefits-database/medication-dispensing-errors-and
    September 19, 2006 - Medication dispensing errors and potential adverse drug events before and after implementing bar code … the impact of the implementation of bar code technology in a hospital pharmacy on rates od dispensing errors … Target dispensing errors are those that bar coding is designed to prevent and target ADEs are dispensing … errors that can harm patients. … Evaluation Method:  pharmacist-observer evaluated for dispensing errors; physician reviewed chart and

88. Nanji, Karen C. | Digital Healthcare Research
    digital.ahrq.gov/principal-investigator/nanji-karen-c
    January 01, 2023 - Preventing Perioperative Medication Errors and Adverse Drug Events Through the Use of Clinical Decision … Preventing Perioperative Medication Errors and Adverse Drug Events Through the Use of Clinical Decision … Project Name Preventing Perioperative Medication Errors and Adverse Drug Events Through the Use of … Project Name Preventing Perioperative Medication Errors and Adverse Drug Events Through the Use of … Project Name Preventing Perioperative Medication Errors and Adverse Drug Events Through the Use of

89. Evaluating the Impact of an ACPOE/CDS System on Outcomes | Digital Healthcare Research
    digital.ahrq.gov/ahrq-funded-projects/evaluating-impact-acpoecds-system-outcomes
    January 01, 2023 - Ten thousand prescriptions were evaluated to identify and characterize prescribing-related errors. … E-prescribing resulted in a reduction of (potential) medication errors from 28 to 9 percent. … Characterization of prescribing errors in an internal medicine clinic. … E-prescribing is widely seen as a way to reduce medication errors. … "Therein lies greater potential to prevent errors and improve medication safety," says Devine. 

90. Lambert, Bruce | Digital Healthcare Research
    digital.ahrq.gov/principal-investigator/lambert-bruce
    January 01, 2023 - Lambert, Bruce Preventing Wrong-Drug and Wrong-Patient Errors With Indication … Preventing Wrong-Drug and Wrong-Patient Errors With Indication Alerts in CPOE Systems – Final Report. … Automated detection of wrong-drug prescribing errors. … Automated detection of look-alike/sound-alike medication errors. … Learning from errors: analysis of medication order voiding in CPOE systems.

91. A National Web Conference on the Use of Health IT To Reduce Medication Errors and Improve Patient Safety | AHRQ Digital Healthcare Research: Informing Improvement in Care Quality, Safety, and Efficiency
    digital.ahrq.gov/events/national-web-conference-use-health-it-reduce-medication-errors-and-improve-patient-safety
    August 26, 2014 - A National Web Conference on the Use of Health IT To Reduce Medication Errors and Improve Patient Safety … adherence to evidence-based interventions related to patient safety and support reductions in medical errors … This session reviewed research to improve medication management strategies to reduce errors and improve … evaluation of the potential severity of specific Look-Alike, Sound-Alike (LASA) drug name substitution errors … Describe the benefits of an electronic approach to identifying potential prescription substitution errors

92. Medication Dispensing Errors and Potential Adverse Drug Events Before and After Implementing Bar Code Technology in the Pharmacy | AHRQ Digital Healthcare Research: Informing Improvement in Care Quality, Safety, and Efficiency
    digital.ahrq.gov/health-it-tools-and-resources/health-it-bibliography/patient-safety/medication-dispensing-errors-and
    Medication Dispensing Errors and Potential Adverse Drug Events Before and After Implementing Bar Code … Pharmacy This paper evaluates whether implementation of bar code technology reduces dispensing errors … required staff to scan all doses had a 93-96% relative reduction in the incidence of target dispensing errors … The overall rates of dispensing errors and potential ADEs substantially decreased after implementing … Drug Events Before and After Implementing Bar Code Technology in the Pharmacy Keyword:  Medication Errors

93. Preventing provider errors: online total parenteral nutrition calculator | AHRQ Digital Healthcare Research: Informing Improvement in Care Quality, Safety, and Efficiency
    digital.ahrq.gov/health-it-tools-and-resources/health-it-costs-and-benefits-database/preventing-provider-errors
    April 01, 2004 - Preventing provider errors: online total parenteral nutrition calculator Authors:  Lehmann, … Hopkins Hospital Intervention:  the number of parenteral nutrition orders and the frequency and type of errors … Evaluation Method:  pharmacist-detected errors, online survey Description:  TPN-Calculator is an online … training before initial use Quality of Care and Patient Safety Outcome:  There was a 61% reduction in errors … between the control and first intervention period and an 89% reduction in errors in the second intervention

94. Develop and Validate Health IT Safety Measures to Capture Violations of the 5 Rights of Medication Safety – Final Report (pdf file)
    digital.ahrq.gov/sites/default/files/docs/citation/r01hs024538-adelman-final-report-2022.pdf
    January 01, 2022 - remain the most common types of medication errors.8 These analyses were conducted using errors … This framework distinguishes between Planning Errors, defined as errors in which the intended action … incorrectly.35 Planning Errors were further classified as Knowledge Errors, which occur because of … For example, 97% of Wrong-Patient order errors were execution errors, resulting from slips such as … errors, predominantly resulting from rule-based errors in which clinicians failed to adjust for the

95. Understanding CancelRX: Impact on Clinical Workflows, Medication Safety Risks, and Patient Outcomes | Digital Healthcare Research
    digital.ahrq.gov/ahrq-funded-projects/understanding-cancelrx-impact-clinical-workflows-medication-safety-risks-and
    January 01, 2023 - Pharmacist Physician Health Care Theme Adverse Events Clinical Workflow Medication Errors … in discontinued medications remaining available to be dispensed to the patient, risking medication errors … research developed strategies to optimize CancelRx implementation and measured its impact on dispensing errors … Measure the impact of CancelRx on patient outcomes including dispensing errors, documented adverse drug … Preventable medication errors cost the nation more than $21 billion annually across all care settings

96. A National Web Conference on the use of Health IT To Reduce Medication Errors and Improve Patient Safety (pdf file)
    digital.ahrq.gov/sites/default/files/docs/reduce-medication-errors-slides-082614.pdf
    August 26, 2014 - A National Web Conference on the use of Health IT To Reduce Medication Errors and Improve Patient Safety … A National Web Conference on the Use of Health IT to Reduce Medication Errors and Improve Patient … less commonly than dosing errors in children. … appears to be much lower than other types of pediatric medication errors … Definition: LASA Errors Previous Studies in Children Framework for Identifying Potential LASA Errors—Screening

97. NLP to Improve Accuracy and Quality of Dictated Medical Documents - Final Report (pdf file)
    digital.ahrq.gov/sites/default/files/docs/citation/r01hs024264-zhou-final-report-2019.pdf
    January 01, 2019 - For example, many of the errors that occur in typed text are non-word errors (i.e., misspellings or … On the other hand, the errors found in SR-generated text are “real-word” errors (i.e., words that are … Analyses were conducted twice, once for all errors and once for just those errors deemed clinically … that in fact did contain errors. … Errors were prevalent in SR transcriptions, with an overall error rate of 7.4%, or 7.4 errors per every

98. Assessment of Pediatric Look-Alike, Sound-Alike (LASA) Substitution Errors - 2010 | Digital Healthcare Research
    digital.ahrq.gov/ahrq-funded-projects/assessment-pediatric-look-alike-sound-alike-lasa-substitution-errors/annual-summary/2010
    January 01, 2010 - Assessment of Pediatric Look-Alike, Sound-Alike (LASA) Substitution Errors - 2010 Project … Name Assessment of Pediatric Look-Alike, Sound-Alike Substitution Errors Principal Investigator … While medication errors have been studied in the pediatric population, the frequency of LASA-specific … errors in pediatric prescriptions is not well documented or understood. … and refine a method for “flagging” individual prescriptions as potential errors.

99. Computerized Physician Order Entry and Medication Errors in a Pediatric Critical Care Unit | AHRQ Digital Healthcare Research: Informing Improvement in Care Quality, Safety, and Efficiency
    digital.ahrq.gov/health-it-tools-and-resources/health-it-costs-and-benefits-database/computerized-physician-order
    January 01, 2004 - Computerized Physician Order Entry and Medication Errors in a Pediatric Critical Care Unit … Purpose of Study:  To measure the impact of CPOE on medication order errors in the pediatric critical … Years of study:  2001-2002 Study Design:  Pre & Post Outcomes:  Rule violations, medication prescribing errors … Intervention:  Implementation of CPOE Evaluation Method:  Review of all medication orders and entering of errors … Reduction of rule violations from 6.8% (pre-CPOE) to 0.1% (post-CPOE) Reduction of medication prescribing errors

100. Assess Risk of Wrong Patient Errors in an EMR that Allows Multiple Records Open - Final Report (pdf file)
     digital.ahrq.gov/sites/default/files/docs/citation/r21hs023704-adelman-final-report-2019.pdf
     January 01, 2019 - errors 2. … These errors occurred among attending physicians (60 errors per 100,000 orders), nurse practitioners … and physician assistants (74 errors per 100,000 orders), and pharmacists (67 errors per 100,000 orders … However, near-miss errors follow the same causal pathway as errors that cause harm, and their use to … , wrong-patient errors 2.