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psnet.ahrq.gov/issue/effect-pharmacy-based-centralized-intravenous-admixture-service-prevalence-medication-errors
December 01, 2021 - In this before-and-after study, IAPE data were collected to evaluate the safety of a pharmacy-based … The effect of a transitional pharmaceutical care program on the occurrence of ADEs after discharge … October 13, 2021
Medication-related hospital readmissions within 30 days of discharge … by face-to-face feedback to prescribers on adverse drug events recognition and prevention in older inpatients … June 1, 2022
Medication-related interventions delivered both in hospital and following discharge
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psnet.ahrq.gov/issue/under-mined
October 27, 2010 - This article describes some of the challenges in collecting, storing, coding, and sharing data to help … Download Citation
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Making inpatient … quality and safety of care using "technovigilance": an ethnographic case study of secondary use of data … Engaging patients in medication reconciliation via a patient portal following hospital discharge
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psnet.ahrq.gov/issue/neurologic-patient-safety-depth-study-malpractice-claims
November 11, 2015 - Related Resources From the Same Author(s)
Organization and representation of patient safety data … May 15, 2024
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psnet.ahrq.gov/web-mm/delay-treatment-failure-contact-patient-leads-significant-complications
February 01, 2004 - inform the patient of the result.( 5 ) The same issues afflict handling of abnormal test results for inpatients … "( 10 ) Data provide some support for giving patients access to their test results.( 11 ) The literature … There are few data on the incidence of malpractice cases related to inadequate patient notification and … The ED discharge instructions given to Rory Staunton's parents contained a line for pending tests and … March 1, 2015
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psnet.ahrq.gov/issue/estimating-economic-cost-nurse-sensitive-adverse-events-amongst-patients-medical-and-surgical
July 11, 2018 - This retrospective study, based on patient discharge data from three Irish hospitals, characterized nursing-sensitive … Results indicate that 16% of patients experienced at least one nurse-sensitive adverse event during their inpatient … December 8, 2021
Shift-to-shift nursing handover interventions associated with improved inpatient
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psnet.ahrq.gov/web-mm/continuity-errors-resident-clinic
October 02, 2019 - chance that their patients received pap smears in the resident clinic approached zero (unpublished data … and outpatient time (e.g., 4 inpatient weeks followed by 1 outpatient week or 6 inpatient weeks followed … safety, the learning environment, and resident–patient relationships, but no actual patient outcomes data … Frequent measurement and sharing of data are first steps to achieving a culture of shared responsibility … WebM&M Cases
Be Picky about your PICCs—Fragmented Care and Poor Communication at Discharge
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psnet.ahrq.gov/issue/sociocultural-factors-influencing-incident-reporting-among-physicians-and-nurses
May 18, 2016 - September 9, 2009
A randomised controlled trial assessing the efficacy of an electronic discharge … December 6, 2017
The incidence and severity of adverse events affecting patients after discharge … ICD-10 codes for patient safety indicators for large-scale surveillance using administrative hospital data … : Patients' expectations and experiences of feeling safe in an acute psychiatric inpatient ward.
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psnet.ahrq.gov/node/47834/psn-pdf
February 27, 2019 - prevalence-underlying-causes-and-preventability-sepsis-associated-mortality-
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The degree to which sepsis contributes to inpatient … mortality and the extent to which sepsis-associated
inpatient mortality is preventable remains unknown … The authors conclude that it may be
challenging to further reduce sepsis-associated inpatient mortality … independent-cohorts
https://psnet.ahrq.gov/issue/incidence-and-trends-sepsis-us-hospitals-using-clinical-vs-claims-data
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psnet.ahrq.gov/issue/what-do-healthcare-staff-think-about-quality-and-safety-care-provided-children-and-young
February 07, 2024 - May 25, 2022
Patients' reports of adverse events: a data linkage study of Australian … May 29, 2024
Medication safety gaps in English pediatric inpatient units: an exploration … March 6, 2024
Parents' understanding of medication at discharge and potential harm in … September 6, 2023
Caregiver and clinician perspectives on discharge medication counseling
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psnet.ahrq.gov/issue/system-related-factors-contributing-diagnostic-errors
January 11, 2023 - July 7, 2010
Identification of common themes from never events data published by NHS … 14, 2021
Common general surgical never events: analysis of NHS England never event data … October 16, 2012
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psnet.ahrq.gov/issue/assessment-safety-enhancement-hospital-medication-reconciliation-process-elderly-patients
August 04, 2021 - medications with indications, improved the accuracy of the medication reconciliation process for elderly inpatients … August 4, 2021
Potential benefit of electronic pharmacy claims data to prevent medication … history errors and resultant inpatient order errors. … Project (NAP5) on accidental awareness during general anaesthesia: protocol, methods, and analysis of data … February 15, 2011
Impact of a pharmacist-facilitated hospital discharge program: a quasi-experimental
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psnet.ahrq.gov/issue/overall-performance-drug-drug-interaction-clinical-decision-support-system-quantitative
August 10, 2022 - Based on an analysis of DDI alerts and survey data regarding physician experience using the DDI module … by face-to-face feedback to prescribers on adverse drug events recognition and prevention in older inpatients … of a computer-assisted tool with automated electronic integration of population-based community drug data … March 2, 2011
Drug-drug interactions and prescription appropriateness at hospital discharge … events by application of a probabilistic, machine-learning based clinical decision support system in an inpatient
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psnet.ahrq.gov/issue/physician-satisfaction-transition-cpoe-paper-based-prescription
January 06, 2018 - March 23, 2011
Medication safety at the interface: evaluating risks associated with discharge … May 11, 2019
Reasons for computerised provider order entry (CPOE)-based inpatient medication … 2017
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A clinical data warehouse-based process for refining medication orders
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psnet.ahrq.gov/issue/medication-administration-quality-and-health-information-technology-national-study-us
December 19, 2009 - Author(s)
Patient safety concerns arising from test results that return after hospital discharge … November 16, 2022
Medical large language models are vulnerable to data-poisoning attacks … February 10, 2015
Inpatient Computerized Provider Order Entry: Findings from the AHRQ … May 26, 2011
Early cost and safety benefits of an inpatient electronic health record.
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psnet.ahrq.gov/issue/effect-work-hours-adverse-events-and-errors-health-care
August 20, 2014 - September 4, 2013
The relationship between inpatient cardiac surgery mortality and nurse … numbers and educational level: analysis of administrative data. … May 21, 2009
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psnet.ahrq.gov/issue/influence-socioeconomic-bias-emergency-medicine-resident-decision-making-and-patient-care
March 02, 2022 - qualitative analyses identified three themes which may bias decision making – overt diagnostic focus, discharge … August 19, 2020
Repurposing clinical decision support system data to measure dosing errors … October 16, 2015
The tradeoffs between safety and alert fatigue: data from a national … Influence of organizational climate and clinician morale on seclusion and physical restraint use in inpatient
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psnet.ahrq.gov/issue/patient-and-hospital-characteristics-associated-delayed-diagnosis-appendicitis
January 12, 2022 - In this population-based retrospective longitudinal study using inpatient and emergency department discharge … data from four states, researchers found that non-Hispanic Black patients were at higher risk for … respond to errors in their personal health records: mixed methods analysis of cross-sectional survey data
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psnet.ahrq.gov/issue/variation-electronic-test-results-management-and-its-implications-patient-safety-multisite
June 02, 2021 - electronic medication systems in reducing medication error rates and associated harm among hospital inpatients … between double-checking and medication administration errors: a direct observational study of paediatric inpatients … January 18, 2023
Clinical data sharing improves quality measurement and patient safety … October 5, 2022
The tradeoffs between safety and alert fatigue: data from a national … The effect of a clinical decision support for pending laboratory results at emergency department discharge
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psnet.ahrq.gov/issue/harmed-patient-alliance
October 31, 2018 - Risks to Medication Delivery Using Ambulatory Infusion Pumps – Design and Usability in Inpatient … September 6, 2024
Discharge from Mental Health Care: Making it Safe and Patient-centred … December 20, 2023
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psnet.ahrq.gov/issue/mixed-methods-evaluation-real-time-safety-reporting-hospitalized-patients-and-their-care
August 03, 2022 - recommendations for extension of AHRQ Common Formats to capture patient- and carepartner-generated safety data … Effect of digital tools to promote hospital quality and safety on adverse events after discharge … 2024
The impact of automated notification on follow-up of actionable tests pending at discharge … July 2, 2019
User-centered collaborative design and development of an inpatient safety