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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Chan.pdf
July 01, 2004 - Development of a Multipurpose Dataset to Evaluate Potential Medication Errors in Ambulatory Settings … 225
Development of a Multipurpose
Dataset to Evaluate Potential Medication
Errors in Ambulatory … Research on Therapeutics (CERT) participated in a
descriptive study of the frequency of potential medication … errors in hospitalized patients,
remarkably little is known about medication errors in the outpatient … Ten health plans of the HMO Research Network have participated in this
study of medication errors in
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www.ahrq.gov/prevention/guidelines/tobacco/clinicians/presentations/2008update-full/slide125.html
October 01, 2014 - Clinical guidelines for prescribing medication for treating tobacco use and dependence (Continued) … What other factors may influence medication selection? … Is a patient's prior experience with a medication relevant? … Prior successful experience (sustained abstinence with the medication) suggests that the medication may … However, it is difficult to draw firm conclusions from prior failure with a medication.
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol4/Advances-Miller_93.pdf
March 12, 2008 - the medication is scanned. … all medication orders before dispensing a medication, removing it from
floor stock, or removing it … The barcodes from the
medication and patient armband are scanned prior to administration of the medication … A medication error was defined using the
National Coordinating Council for Medication
Error Reporting … The medication
safety team is also reinforcing the importance
of utilizing the electronic medication
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www.ahrq.gov/sites/default/files/wysiwyg/npsd/Generic_Dashboard_Data_2025.xlsx
January 01, 2025 - 2.3%
Medication or Other Su Laboratory, including pathology department 467 0.1%
Medication or … 7093 1.4%
Medication or Other Su Outpatient care area 22147 4.4%
Medication or Other … 17.1%
Medication or Other Su Adult (18-64 years) Unknown Death * *
Medication or Other Su Adult (18 … 585 70.5%
Medication or Other Su UNK Female Severe Harm * *
Medication or Other Su UNK Female … 1.7%
Medication or Other Su Under 18 Female No Harm 6509 54.1%
Medication
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www.ahrq.gov/patient-safety/about/areas/improve-discharge.html
August 01, 2024 - Reconciliation MATCH Toolkit Impact Case Studies: Georgia Hospitals Improve Medication Reconciliation … Process With AHRQ Toolkit Two Indiana Facilities Use AHRQ Toolkit To Revise Medication Reconciliation … Medication Reconciliation Process With AHRQ Toolkit Massachusetts Hospital Improves Medication Reconciliation … Hospitals Improve Medication Reconciliation Process Using AHRQ Toolkit (KT-CQUIPS-93) Four Missouri … Use AHRQ Toolkit To Improve Medication Reconciliation Across Care Settings Six New Jersey Hospitals
-
www.ahrq.gov/sites/default/files/2024-01/magid-report.pdf
January 01, 2024 - The primary outcome of the study will be the occurrence of
medication errors. … Errors
Medication errors can occur at any of several points in the process of medication
use, including … medication use
process (Bates et al 1996). … Verifies Relevance
of Alert
No Error Detected
Medication Label
Printed
Medication
Dispensed
Problem … All three projects resulted in a measurable decrease in medication errors.
-
www.ahrq.gov/sites/default/files/2024-02/taber-report.pdf
January 01, 2024 - Medication safety issues, which
encompass both medication errors and adverse drug events, are a predominant … These medication errors are usually the result of
unintentional medication nonadherence (MNA); patients … Televisits enabled the pharmacist to
conduct medication reviews to identify any medication safety issues … Medication
errors were defined as the participant taking a different medication than intended, based … ultimately, the study did not improve medication
adherence.
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www.ahrq.gov/es/patient-safety/settings/hospital/match/appendix/index.html
July 01, 2022 - Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation
Appendix … Page
Table of Contents
Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication … Developing Change: Designing the Medication Reconciliation Process
Chapter 4. … Developing and Pilot Testing Change: Implementing the Medication Reconciliation Process
Chapter 5. … High-Risk Situations for Medication Reconciliation
Conclusion
References
Appendix: The MATCH Work
-
www.ahrq.gov/patient-safety/settings/hospital/match/appendix/index.html
July 01, 2022 - Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation
Appendix … Page
Table of Contents
Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication … Developing Change: Designing the Medication Reconciliation Process
Chapter 4. … Developing and Pilot Testing Change: Implementing the Medication Reconciliation Process
Chapter 5. … High-Risk Situations for Medication Reconciliation
Conclusion
References
Appendix: The MATCH Work
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www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/ipe-large-org-webcast-fishkin.pdf
March 24, 2020 - Health Plan
PhysiciansHospitals
+
HCAHPS Case Study: Medication Communication
17 | Copyright … HCAHPS Case
Study:
Medication
Communication
Composite
12. … education
materials
RN references
colored folder which
contains medication
sheet
RN reviews “ … folder that houses the medication education materials. … medication name,
purpose, and 1-2 possible side effects
RN references, initials and dates on
medication
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www.ahrq.gov/research/findings/final-reports/index.html?page=17
January 01, 2024 - grants administered since 2000 on a variety of patient safety topics, such as measure development, medication … Safety, Patient and Family Engagement Publication Date: June 2007
Medication Reconciliation … Grant Number: U18 HS 015904 Topic(s): Communication and Teamwork, Medication Safety Publication Date … : June 2007
Embracing the PBRN Model to Improve the Medication Use Process ( application/pdf … Safety Publication Date: June 2007
Using Barcode Technology to Improve Medication Safety
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www.ahrq.gov/patient-safety/settings/hospital/match/figure-11.html
July 01, 2022 - Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation
Figure … Developing Change: Designing the Medication Reconciliation Process
Chapter 4. … Developing and Pilot Testing Change: Implementing the Medication Reconciliation Process
Chapter 5. … Independent reviewer evaluation is in addition to current medication reconciliation process. … reconciliation failures) with the current medication reconciliation process.
-
www.ahrq.gov/es/patient-safety/settings/hospital/match/figure-11.html
July 01, 2022 - Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation
Figure … Developing Change: Designing the Medication Reconciliation Process
Chapter 4. … Developing and Pilot Testing Change: Implementing the Medication Reconciliation Process
Chapter 5. … Independent reviewer evaluation is in addition to current medication reconciliation process. … reconciliation failures) with the current medication reconciliation process.
-
www.ahrq.gov/sites/default/files/wysiwyg/npsd/Generic_Dashboard_Data_2024.xlsx
January 01, 2024 - 14.5%
Medication or Other Substance Other area within the facility 32,057 9.5%
Medication or Other … Substance Unknown 2,508 0.7%
Medication or Other Substance Other location 6,367 1.9%
Medication or … or Other Substance Communication 5,835 4.3%
Medication or Other Substance Data 1,562 1.2%
Medication … Medication or Other Substance Under 18 Unknown Severe Harm * *
Medication or Other Substance Under … 0.1%
Medication or Other Substance Adult (18-64 years) Female Mild Harm 19,851 28.0%
Medication or
-
www.ahrq.gov/sites/default/files/2024-02/jones-report.pdf
January 01, 2024 - patient experiences one medication error a day.7 This lack of reliability in hospitals’
medication … Incidence and Prevalence of Medication Errors and Medication Error Reporting
Due to the variety of terminology … Taxonomy of medication errors. … Medication errors observed in 36
health care facilities. … Medication error information collected prior to project
Medication error information collected CAHs
-
www.ahrq.gov/funding/grantee-profiles/grtprofile-zhou.html
July 01, 2024 - Zhou has used AHRQ funding to conduct groundbreaking patient safety research on medication reconciliation … “This led to an interest in medication-related alerts, drug-drug interactions, and drug-allergy interactions … This helps prevent medication prescribing errors. … In fact, this project included more than just medication allergy information; it also included food and … Errors and Adverse Drug Events Medication Safety Consistent with its mission, AHRQ provides a broad
-
www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-88-measure-1-section-5-attachment-3.pdf
June 02, 2025 - of medical records of attention deficit hyperactivity disorder
(ADHD) patients on psychostimulant medication … whose medical records are reviewed
Process
Follow-up care for children
prescribed ADHD medication … who remained on the medication for at least 210 days and who, in addition to
the visit in the initiation … during the 12-
month Intake Period, who remained on the medication for at least 210 days
Process … , who remained on the medication
for at least 210 days.
-
www.ahrq.gov/sites/default/files/wysiwyg/policymakers/chipra/factsheets/fullreports/chipra-89-adhd-behavior-section-5-attach-3.pdf
June 02, 2025 - of medical records of attention deficit hyperactivity disorder
(ADHD) patients on psychostimulant medication … whose medical records are reviewed
Process
Follow-up care for children
prescribed ADHD medication … who remained on the medication for at least 210 days and who, in addition to
the visit in the initiation … during the 12-
month Intake Period, who remained on the medication for at least 210 days
Process … , who remained on the medication
for at least 210 days.
-
www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/outcomes/chipra-146-section-6-figure-1.pdf
June 02, 2025 - Health Plan model
Legend
f1= Counseling on Transition Self-Management
f2= Counseling on Prescription Medication … .090 6.615 <.001
Q67 .561 .112 5.027 <.001
Q8 .665 .130 5.128 <.001
Counseling on Prescription Medication … .076 6.306 <.001
Q67 .694 .093 7.489 <.001
Q8 .551 .114 4.809 <.001
Counseling on Prescription Medication … .1 7.515 <.001
Q67 .447 .105 4.269 <.001
Q8 .469 .113 4.152 <.001
Counseling on Prescription Medication … Plan n=250 n=323
Counseling on Transition Self-management 29% 32% .46
Counseling on Prescription Medication
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www.ahrq.gov/patient-safety/settings/hospital/match/appendix/app-12.html
July 01, 2022 - Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation
Appendix … Developing Change: Designing the Medication Reconciliation Process
Chapter 4. … Medication errors are the most common health care errors. … The Institute for Safe Medication Practices
Institute for Safe Medication Practices (ISMP) is the … Nation's only nonprofit organization devoted entirely to medication error prevention and safe medication