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4421. Automated surveillance for adverse drug events at a community hospital and an academic medical center. | PSNet
      psnet.ahrq.gov/issue/automated-surveillance-adverse-drug-events-community-hospital-and-academic-medical-center
      September 23, 2020 - Study Automated surveillance for adverse drug events at a community hospital and an academic medical center. Citation Text: Kilbridge PM, Campbell UC, Cozart HB, et al. Automated surveillance for adverse drug events at a community hospital and an academic medical center. J Am Med Infor…

4422. High rate of implementation of proposed actions for improvement with the Healthcare Failure Mode Effect Analysis method: evaluation of 117 analyses. | PSNet
      psnet.ahrq.gov/issue/high-rate-implementation-proposed-actions-improvement-healthcare-failure-mode-effect-analysis
      December 09, 2020 - Study High rate of implementation of proposed actions for improvement with the Healthcare Failure Mode Effect Analysis method: evaluation of 117 analyses. Citation Text: Öhrn A, Ericsson C, Andersson C, et al. High Rate of Implementation of Proposed Actions for Improvement With the Healt…

4423. A novel ICU hand-over tool: the glass door of the patient room. | PSNet
      psnet.ahrq.gov/issue/novel-icu-hand-over-tool-glass-door-patient-room
      October 12, 2009 - Commentary A novel ICU hand-over tool: the glass door of the patient room. Citation Text: Wessman BT, Sona C, Schallom M. A Novel ICU Hand-Over Tool: The Glass Door of the Patient Room. J Intensive Care Med. 2017;32(8):514-519. doi:10.1177/0885066616653947. Copy Citation Format: …

4424. Common contributing factors of diagnostic error: a retrospective analysis of 109 serious adverse event reports from Dutch hospitals. | PSNet
      psnet.ahrq.gov/issue/common-contributing-factors-diagnostic-error-retrospective-analysis-109-serious-adverse-event
      September 14, 2022 - Study Common contributing factors of diagnostic error: a retrospective analysis of 109 serious adverse event reports from Dutch hospitals. Citation Text: Hooftman J, Dijkstra AC, Suurmeijer I, et al. Common contributing factors of diagnostic error: a retrospective analysis of 109 serious…

4425. Making Healthcare Safer Practices: 14. Delirium (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/research/findings/making-healthcare-safer/mhs3/delirium-1.pdf
      March 01, 2020 - The literature is clear that unrecognized, untreated delirium leads to adverse events such as falls, … Risk of Bias (High, Moderate, Low) Babine et al., 20181 Education and training to reduce falls … and length of stay via delirium recognition Retrospective study looking at delirium and falls. … Two chart reviews were performed on patient falls as identified in the hospital safety reporting … The fall rates in 2011 and 2012 were 3.01 and 2.82 falls per 1,000 patient days and in 2013 decreased

4426. An Ambulatory Care Curriculum for Advancing Patient Safety (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Mottur.pdf
      June 01, 2005 - Programmatically, it falls under AHRQ’s overall patient safety initiative aimed at medical societies

4427. Building Capacity for Patient Safety | PSNet
      psnet.ahrq.gov/perspective/building-capacity-patient-safety
      July 31, 2023 - We were working not on falls or adverse drug reactions, but on the overarching issues that could make

4428. In Conversation with... Regina Hoffman about Building Capacity for Patient Safety | PSNet
      psnet.ahrq.gov/perspective/conversation-regina-hoffman-about-building-capacity-patient-safety
      July 31, 2023 - We were working not on falls or adverse drug reactions, but on the overarching issues that could make

4429. HIT implementation in critical access hospitals: ... [J Med Syst. 2011] - PubMed - NCBI
      digital.ahrq.gov/sites/default/files/docs/library/20703529.html
      January 01, 2011 - HIT implementation in critical access hospitals: ... [J Med Syst. 2011] - PubMed - NCBI Warning: The NCBI web site requires JavaScript to function. more... NCBI Skip to main content Skip to navigation Resources All Resources Chem…

4430. CDS Connect Work Group Agenda - December 2021 (pdf file)
      cds.ahrq.gov/sites/default/files/workgroups/38971/CDS_Connect_WG_December_2021_Summary.pdf
      January 01, 2021 - CDS Connect Work Group Agenda - December 2021 Clinical Decision Support (CDS) Connect Work Group (WG) Meeting Summary December 16, 2021 3:00 – 4:00 pm ET Attendees: 39 people, including 5 phone dial-ins Organization Attendees AHRQ Sponsors Chris Dymek, Edward Lomotan, Mario Teran, James Swiger (4) …

4431. CDSiC Innovation Center Quarterly Report (pdf file)
      digital.ahrq.gov/sites/default/files/Innovation%20Center%20Quarterly%20Report%20Two_Jan26.pdf
      January 01, 2024 - The projects vary in terms of expected length of time to complete based on scope, falling into one of

4432. Effectiveness of Treatments for Diabetic Peripheral Neuropathy | Effective Health Care (EHC) Program
      effectivehealthcare.ahrq.gov/products/diabetic-neuropathy/research-protocol

4433. Crosscutting Hi Impact (pdf file)
      effectivehealthcare.ahrq.gov/sites/default/files/crosscutting_hi_impact.pdf
      January 01, 2012 - lighting, soft colors, and noise abatement features, handrails, flooring that is less likely to cause falls … available resources. 35 However, this design poses many risks to the elderly population, including falls

4434. Missing Trauma | PSNet
      psnet.ahrq.gov/web-mm/missing-trauma
      March 03, 2011 - Blunt injuries are the result of falls, motor vehicle or motorcycle crashes, bicycle accidents, pedestrians

4435. Psn-Pdf (pdf file)
      psnet.ahrq.gov/node/33721/psn-pdf
      November 01, 2011 - Reducing falls and fall-related injuries in the VA system. J Healthc Saf Q. 2003;1:25-33. 8.

4436. Facilitator Guide: Science of Safety Training & Identifying Defects (doc file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/surgery/modules/onboarding/onboarding_scienceofsafety_facnotes.docx
      December 01, 2017 - Followup SAY: As with any reporting mechanism, it’s important to ensure that the completed PSSAs are not falling

4437. Final Progress Report: Labor and Delivery Nurse Staffing: A Patient Safety Intervention (pdf file)
      www.ahrq.gov/sites/default/files/2024-10/wilson-report.pdf
      January 01, 2024 - staffing and adverse outcomes for medical/surgical patients, including pressure ulcers and patient falls … care medical and surgical patients, including hospital-acquired pressure ulcers, pneumonia, patient falls … Hence, in the far two left hand columns, the implied C-section probability falls by X for each additional

4438. Screening for Cognitive Impairment in Older Adults: US Preventive Services Task Force Recommendation Statement (pdf file)
      www.uspreventiveservicestaskforce.org/home/getfilebytoken/h5Tt4jScmQJeHeztmo93hu
      February 25, 2020 - associated with adverse effects, which overall are small but occasionally serious, including syncope or falls … harms, some of which are serious, including central nervous sys- tem disturbances, bradycardia, and falls … individual studies reported increased rates of serious adverse events, such as brady- cardia, syncope, falls

4439. JAMA JATS (pdf file)
      www.uspreventiveservicestaskforce.org/home/getfilebytoken/Nop5YpEpMybx_oNPKC76-X
      July 11, 2017 - Eight trials reported on the in- cidence of important patient events, including falls, injuries, and … This trial also re- ported more falls in the intervention group (37% vs 29%; P < .001).21 Four other … trials reporting falls, 2 in older adults and 2 in general pri- mary care populations, found no difference

4440. AHRQ’s Safety Program for Nursing Homes: On-Time Preventable Hospital and Emergency Department Visits | Agency for Healthcare Research and Quality
      www.ahrq.gov/patient-safety/settings/long-term-care/resource/ontime/prevhosp/facslides.html
      September 01, 2017 - Falls Prevention. Preventable Hospital and ED Visits.