Results

Total Results: 3,156 records

Showing results for "harm".

41. Network of Patient Safety Databases Falls Chartbook, 2023 (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/npsd/data/npsd-falls-chartbook-2023.pdf
    January 01, 2023 - While the AHRQ Harm Scale provides the following possible responses: No harm, Mild harm, Moderate … harm, Severe harm, Death, or Unknown harm, due to small counts across the categories of Moderate to … Severe harm, this Chartbook displays falls where the EXTENT OF HARM is categorized as No harm, Harm … (i.e., Mild harm, Moderate harm, Severe harm, or Death), or Unknown harm. … For this figure, all Incident reports with EXTENT OF HARM reported are displayed as either No harm, Harm

42. Blood Dashboard Data (xls file)
    www.ahrq.gov/sites/default/files/wysiwyg/npsd/Blood_Dashboard_Data_2024.xlsx
    January 01, 2024 - reports by type of blood product, by the process of care involved, and by the extent of residual patient harm … Blood_2 Blood_2: Type of Blood Product by Extent of Residual Harm Type of Blood Product No Harm Percentage … No Harm Frequency Harm Percentage Harm Frequency Red blood cells 96.7% 2,096 3.3% 72 Plasma 98.9% … Stage of Process When Blood or Blood Product Event Originated No Harm Percentage No Harm Frequency … Harm Percentage Harm Frequency Post-transfusion or administration 99.3% 414 * * Unknown 98.3% 283

43. Introduction to Diagnostic Errors | Agency for Healthcare Research and Quality
    www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-cognitive-load1.html
    May 01, 2024 - health problem(s) or communicate that explanation to the patient, 1 ” are a leading cause of patient harm … of Medicine in 1999, was one of the first publications to bring the issue of medical error, patient harm … continued the patient safety discussion with a focus on the impact of diagnostic errors on medical harm … In addition, diagnostic error may result in serious harm to more than 500,000 Americans each year across

44. 2024 Network of Patient Safety Databases Chartbook (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/npsd/data/npsd-medication-chartbook-2024.pdf
    January 01, 2024 - The AHRQ Harm Scale captures Residual harm to the patient after any intervention to reduce harm. … While the AHRQ Harm Scale provides the following possible responses: No harm, Mild harm, Moderate harm … as No harm, Harm (i.e., Mild harm, Moderate harm, Severe harm, or Death), or Unknown harm. … , moderate harm, and mild harm to the patient. … Harm (i.e., Mild harm, Moderate harm, Severe harm, or Death), or Unknown due to small counts across

45. Blood and Blood Product Dashboard | Agency for Healthcare Research and Quality
    www.ahrq.gov/npsd/data/dashboard/blood.html
    September 01, 2024 - This dashboard details the type of blood product involved, type of blood product by residual harm to … patient, stage of process where event originated, and stage of process where event originated by residual harm

46. Data Submission Dashboard (xls file)
    www.ahrq.gov/sites/default/files/wysiwyg/npsd/Perinatal_Dashboard_Data_2022.xlsx
    January 01, 2022 - They include the relative frequencies of reports by the extent of residual patient harm and final mode … Dashboard Name Worksheet Name Extent of Harm Perinatal_1 Final Mode of Delivery Perinatal … https://www.ahrq.gov/npsd/data/dashboard/perinatal.html Perinatal_1 Perinatal_1: Extent of Harm … Extent of Harm Percentage Frequency Total No Harm 42.3% 11,733 27,725 Mild Harm 52.0% 14,405 27,725 … Moderate Harm 4.2% 1,153 27,725 Severe Harm 0.8% 228 27,725 Death 0.5% 142 27,725 Unknown Harm 0.2%

47. NPSD Data Spotlight: Patterns of Fall Interventions (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/npsd/data/spotlights/spotlight-patterns-fall-interventions.pdf
    September 01, 2023 - For this analysis, reported EXTENT of HARM were further dichotomized as either No harm or Harm (i.e … ., Mild harm, Moderate harm, Severe harm or Death). … Specifically, we examined the no-harm rate, or the percentage of falls that resulted in no harm to … harm to the patient. … Events Resulting in No Harm to Patient No-harm Rate (%) Low bed, Items in reach, Visible

48. Blood Dashboard Data (xls file)
    www.ahrq.gov/sites/default/files/wysiwyg/npsd/Blood_Dashboard_Data_2023.xlsx
    January 01, 2023 - reports by type of blood product, by the process of care involved, and by the extent of residual patient harm … Blood_2 Blood_2: Type of Blood Product by Extent of Residual Harm Type of Blood Product No Harm Percentage … No Harm Frequency Harm Percentage Harm Frequency Total Red blood cells 96.5% 2,013 3.5% 73 3,003 … Stage of Process When Blood or Blood Product Event Originated No Harm Percentage No Harm Frequency … Harm Percentage Harm Frequency Total Post-transfusion or administration 99.0% 392 1.0% 4 1,927 Sample

49. Conceptual Paradigms of Diagnostic Quality, Safety, and Excellence | Agency for Healthcare Research and Quality
    www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-terminology5.html
    April 01, 2025 - or risk of harm. … actions, diagnostic safety can refer to two different types of harm. … harm, as used by the Joint Commission).  … The goal of Safety-I is to prevent, avoid, minimize, or mitigate error and harm. … The goal is not just to prevent harm, but to achieve success.

50. Data Submission Dashboard (xls file)
    www.ahrq.gov/sites/default/files/wysiwyg/npsd/Perinatal_Dashboard_Data_2021.xlsx
    January 01, 2021 - Dashboard Name Worksheet Name Extent of Harm Perinatal_1 Final Mode of Delivery Perinatal … https://www.ahrq.gov/npsd/data/dashboard/perinatal.html Perinatal_1 Perinatal_1: Extent of Harm … Extent of Harm Percentage Frequency Total No Harm 41.4% 10,881 26,263 Mild Harm 52.8% 13,864 26,263 … Moderate Harm 4.3% 1,121 26,263 Severe Harm 0.8% 213 26,263 Death 0.5% 132 26,263 Unknown Harm 0.2%

51. Final Progress Report: Reducing Harm to Patients from Diagnostic Errors (pdf file)
    www.ahrq.gov/sites/default/files/2025-03/berner-report.pdf
    January 01, 2025 - Final Progress Report: Reducing Harm to Patients from Diagnostic Errors Final Progress Report Reducing … Harm to Patients from Diagnostic Errors Eta S. … discuss ongoing research on diagnostic error • To stimulate creative thought directed at reducing harm … Adv Health Sci Educ Theory Pract. 2009 Sep;14 Suppl 1:107-12. 9 Final Progress Report Reducing Harm

52. Network of Patient Safety Databases Chartbook, 2023 (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/npsd/data/npsd-chartbook-2023-rev.pdf
    January 01, 2023 - Residual harm is captured by AHRQ’s Harm Scale and is defined as harm to the patient after discovery … harm, Moderate harm, Severe harm, Death, or Unknown harm. … Incident events where the EXTENT OF HARM is categorized as No harm, Harm, or Unknown harm. … harm, Mild harm, Moderate harm, Severe harm, Death, or Unknown harm. … events where the EXTENT OF HARM was reported as No harm, Harm, or Unknown harm.

53. Commitment To Advance Patient and Workforce Safety | Agency for Healthcare Research and Quality
    www.ahrq.gov/action-alliance/commitment/index.html
    October 01, 2024 - commitment strengthens the community as it continues its collective journey towards zero preventable harm … Alliance for Patient and Workforce Safety Commitment Vision Safe care everywhere, zero preventable harm … safety and well-being; and learning health system development toward our vision of zero preventable harm

54. Implementation Guide for the CANDOR Process | Agency for Healthcare Research and Quality
    www.ahrq.gov/patient-safety/settings/hospital/candor/impguide.html
    August 01, 2022 - reference for organizational leaders who are committed to improving their response to unexpected patient harm … report, To Err Is Human: Building a Safer Health System , the problems associated with injury and harm … the United States provides some of the best health care in the world, unsafe health care processes harm … This statistic represents only one type of patient harm that results during the delivery of patient care … A CANDOR event is defined as an event that involves unexpected harm (physical, emotional, or financial

55. NPSD Dashboards | Agency for Healthcare Research and Quality
    www.ahrq.gov/npsd/data/dashboard/index.html
    September 01, 2024 - The dashboard charts detail event type, report type by event type, extent of harm by event type, event … type by extent of harm, and extent of harm.   … Blood Product Dashboard Details the type of blood product involved, type of blood product by residual harm … Falls Dashboard Details the extent of harm due to falls, the presence of fall assistance, presence of … fall assistance by patient harm, type of fall injury, and fall location.      

56. Appropriate Disclosure to a Patient: Video | Agency for Healthcare Research and Quality
    www.ahrq.gov/patient-safety/capacity/candor/videos/app-disclosure.html
    February 01, 2017 - practitioners can use to respond in a timely, thorough, and just way when unexpected events cause patient harm … This video demonstrates an example of appropriate disclosure of harm to a patient.

57. Inappropriate Disclosure to a Patient: Video | Agency for Healthcare Research and Quality
    www.ahrq.gov/patient-safety/capacity/candor/videos/inapp-disclosure.html
    February 01, 2017 - practitioners can use to respond in a timely, thorough, and just way when unexpected events cause patient harm … This video demonstrates an example of inappropriate disclosure of harm to a patient.

58. Foundational Terminology for Diagnosis Relating to Suboptimal Processes and Outcomes | Agency for Healthcare Research and Quality
    www.ahrq.gov/diagnostic-safety/resources/issue-briefs/dxsafety-terminology7.html
    April 01, 2025 - References The early attention on improvement for diagnosis responded to cases of harm … problematic for diagnosis as most diagnostic errors are real but generally not tangible (except for the harm … e.g., difference between admitting and discharge diagnoses). 39,40   Near-Miss Not all errors cause harm … The concept of “error without harm” or an error rescued before harm impacts a specific patient is referred … If someone intervenes to prevent harm, it is sometimes referred to as a good catch . 11 Undesirable

59. AHRQ Safety Expert Chosen To Co-Chair National Effort to Reduce Patient Harm | Agency for Healthcare Research and Quality
    www.ahrq.gov/news/newsroom/press-releases/national-steering-committee.html
    May 01, 2018 - AHRQ Safety Expert Chosen To Co-Chair National Effort to Reduce Patient Harm Press Release Date … for Patient Safety is charged with creating a National Action Plan for the Prevention of Health Care Harm … and to continue the quest to eliminate patient harm and affirm safety as a national priority. … The Call to Action frames harm from health care as an issue that affects all of society and demands a

60. Data Submission Dashboard (xls file)
    www.ahrq.gov/sites/default/files/wysiwyg/npsd/Pressure_Ulcer_Dashboard_Data_2022.xlsx
    January 01, 2022 - They include the relative frequencies of reports by the extent of residual patient harm, documented risk … Dashboard Name Worksheet Name Extent of Harm PRU_1 Documented Increased Risk for Pressure Ulcer … https://www.ahrq.gov/npsd/data/dashboard/pressure-ulcer.html PRU_1 PRUl_1: Extent of Harm … Extent of Harm Percentage Frequency Total No Harm 24.6% 19,627 79,630 Mild Harm 69.0% 54,905 79,630 … Moderate Harm 3.2% 2,554 79,630 Severe Harm 0.4% 351 79,630 Death 0.004% 3 79,630 Unknown Harm 2.8%