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21. Methodological Challenges in Describing Medication Dosing Errors in Children (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/McPhillips.pdf
    January 01, 2004 - error. … Finally, existing data sources from which medication error detection is possible often lack the necessary … to effectively prevent medication errors from occurring. … Medication error prevention by clinical pharmacists in two children’s hospitals. … The impact of computerized physician order entry on medication error prevention.

22. Final Progress Report: TOP-MEDS CERT: Tools for Optimizing Medication Safety (pdf file)
    www.ahrq.gov/sites/default/files/2024-01/lambert-report.pdf
    January 01, 2024 - U19HS021093) Study 1 Purpose and Scope Drug name confusion is a common type of medication error and … Results Drug name confusions are a common type of medication error, and they often have harmful effects … In five of the 16 orders (31%), no medication error occurred. … Automated detection of look-alike/sound-alike medication errors. … Retrospective detection of potential medication errors involving drugs with similar names.

23. Final Progress Report: Technology To Improve Medication Safety in Nursing Homes (pdf file)
    www.ahrq.gov/sites/default/files/2024-01/scott-cawiezell-report.pdf
    January 01, 2024 - During the analyses, medication error was considered with and without wrong-time medication error, because … error, the research team made a decision to analyze medication errors differently than earlier studies … Although the ICC was lower when considering medication errors without wrong-time medication errors ( … errors when wrong-time medication errors were included (Scott-Cawiezell et al., 2007). … errors associated with an interruption (and including wrong-time medication errors), 29.2% (RN 24.6%

24. Appendix, Sample Letter to Discipline-Specific Leaders on Meeting Regarding Training and Implementation Strategy for Medication Reconciliation | Agency for Healthcare Research and Quality
    www.ahrq.gov/es/patient-safety/settings/hospital/match/appendix/app-8.html
    July 01, 2022 - Plan [Insert Organization Logo Here] [Insert date] To [Insert Stakeholder] , Medication … errors are one of the highest single-volume sources of medical errors. … Unfortunately, many of these medication errors are associated with direct harm to patients.

25. Appendix, Sample Letter to Discipline-Specific Leaders on Meeting Regarding Training and Implementation Strategy for Medication Reconciliation | Agency for Healthcare Research and Quality
    www.ahrq.gov/patient-safety/settings/hospital/match/appendix/app-8.html
    July 01, 2022 - Plan [Insert Organization Logo Here] [Insert date] To [Insert Stakeholder] , Medication … errors are one of the highest single-volume sources of medical errors. … Unfortunately, many of these medication errors are associated with direct harm to patients.

26. Final Progress Report: Implementing a Program of Patient Safety in Small, Rural Hospitals (pdf file)
    www.ahrq.gov/sites/default/files/2024-02/jones-report.pdf
    January 01, 2024 - Error Reporting and Prevention (NCC MERP) Index for Categorizing Medication Errors to assess the severity … 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

27. Final Progress Report: The Effect of EMR on Medication Safety: A SPUR-Net Study (pdf file)
    www.ahrq.gov/sites/default/files/2024-01/kuo-report.pdf
    January 01, 2024 - The National Coordinating Council for Medication Error Reporting and Prevention3 defines a "medication … error" as follows: "A medication error is any preventable event that may cause or lead to inappropriate … errors from the National Coordinating Council for Medication Error Reporting and Prevention. … Medication errors between EMR and PMR clinics were compared. … The National Coordinating Council for Medication Error Reporting and Prevention: About Medication Error

28. Final Progress Report: Addressing Preventable Medication Use Variance in Mississippi (pdf file)
    www.ahrq.gov/sites/default/files/2024-01/brown-report.pdf
    January 01, 2024 - error; and e) to understand how people would react to future experiences with medication errors. … 4) Medication error reporting system. … "The Use of Web-based Occurrence Reports in Documenting Medication Errors: Part 1." … "The Use of Web-based Occurrence Reports in Documenting Medication Errors: Part 2." … "The use of data mining techniques in assessing medication errors."

29. Final Report: Improving Drug Safety (pdf file)
    www.ahrq.gov/sites/default/files/2024-01/magid-report.pdf
    January 01, 2024 - All KPCO members with the targeted characteristics that increase the risk of medication error or patient … Improving Drug Safety 1 UC1 HS14249 9 Most medication error reduction strategies have focused … To determine whether a medication error had occurred, all medications dispensed were reviewed by a clinical … First, most medication error prevention programs have been studied in the inpatient setting. … Second, although most medication error reduction strategies have focused on the point of prescribing

30. Medication Management Transactions and Errors in Family Medicine Offices: A Pilot Study (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol4/Advances-Lynch_37.pdf
    March 21, 2008 - Gandhi, et al.,2 and Blendon, et al.,5 found that the most common primary care medication errors are … No investigator has explored the extent to which office processes contribute to medication errors. … A secondary objective was to determine the frequency of medication errors associated with specific factors … Type of medication. Error rates varied widely by the type of medication (Table 4). … Not all medication errors result in patient harm.

31. Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families | Agency for Healthcare Research and Quality
    www.ahrq.gov/patient-safety/reports/engage/medlist.html
    October 01, 2022 - This strategy helps to improve documentation because we can see the medications and decrease medication … errors. … Studies show that 5 to 7 percent of prescriptions result in a medication error. … That’s at least 160 million medication errors annually .

32. Final Progress Report: Improving Transplant Med Safety through a Pharmacist-Led, mHealth-Based Program (pdf file)
    www.ahrq.gov/sites/default/files/2024-02/taber-report.pdf
    January 01, 2024 - error. … Of more concern, nearly one in eight kidney transplant recipients will experience a medication error … The type of medication error was recorded and included both administrative and clinical subtypes. … Medication error severity was determined using a previously validated scale. … All 68 participants in both arms experienced at least one medication error during the study.

33. Improving Healthcare Safety by Enhancing Medication Safety (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/highlights/ps-project-highlights-medication-safety.pdf
    April 30, 2025 - errors in various settings and populations, ■ High-risk medication errors and approaches to improve … error reporting have used medication error reports to improve patient safety through a better understanding … errors, of which many more are reported, to better understand and prevent harmful medication errors … error. … reduce the frequency of medication errors.

34. Evaluation of Medications Removed from Automated Dispensing Machines Using the Override Function Leading to Multiple System Changes (pdf file)
    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 - they do not prevent medication errors. … Numerous medication errors secondary to ADM override have been identified in the literature. … A medication error was defined using the National Coordinating Council for Medication Error Reporting … Medication errors, 2nd edition. Washington, DC: APhA Publications; 2007. 3. Paparella S. … National Coordinating Council for Medication Error Reporting and Prevention; 2005 December.

35. Final Progress Report: : State of the Science on Safe Medication Administration (pdf file)
    www.ahrq.gov/sites/default/files/2024-01/barnsteiner-report.pdf
    January 01, 2024 - Scope and Methods: One out of every three adverse drugs events precipitated by a medication error occurs … How does team participation affect medication errors? … • Do magnet hospitals have lower rates of medication errors? … • Does a nurse’s level of experience or education correlate with her medication error rate? … What patient-centered approaches result in medication error reduction in ambulatory or outpatient and

36. Imbedding Research in Practice to Improve Medication Safety (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol4/Advances-Raebel_53.pdf
    May 07, 2008 - The primary outcome measure for each project was the incidence of medication errors, defined as the … Existing data were analyzed to demonstrate medication error problems and to document problem scope. … Medication errors were reduced in all projects. … We have recently introduced selected medication error alerts into the KPCO EMR system. … Medication errors drop with Kaiser alert system. Rocky Mountain News; May 27, 2005. 4.

37. Final Progress Report: Systems Approach for Improving Region-Wide Patient Safety (pdf file)
    www.ahrq.gov/sites/default/files/2024-10/sirio2-report.pdf
    January 01, 2024 - Medication Errors and MedMARx. … Adverse Drug Events (ADEs), which can result from a medication error, occur at a rate of 2.4% to 4.6% … The purpose of MedMARx is to allow hospitals to report, track, and share medication error data in a … on Medication Error Reporting and Prevention (NCCMERP). … Perceived Barriers in Using a Region-Wide Medication Error Reporting System.

38. Final Progress Report: Improving Medication Safety Across Clinical Settings (pdf file)
    www.ahrq.gov/sites/default/files/2024-01/bates-report.pdf
    January 01, 2024 - the rates, types, and predictors of medication errors and ADEs … of 6.3 serious medication errors per 1000 patient-days. … Overall, we found a total of 219 IV medication errors. … However, there was no impact on the serious medication error rate or the preventable ADE rate. … error prevention.

39. Final Progress Report: Risk Models To Improve Long-Term Care Medication Safety (pdf file)
    www.ahrq.gov/sites/default/files/2024-01/higginson-report.pdf
    January 01, 2024 - Relationship between medication errors and adverse drug events. … Medication errors observed in 36 health care facilities. … Medication Errors. American Pharmaceutical Assoc. … The problems of detecting medication errors in hospitals. … Medication Error Frequency by Stage and Medication Error Category Category Prescribing/Ordering Dispensing

40. Making Healthcare Safer Practices: 12. Infusion Pumps (pdf file)
    www.ahrq.gov/sites/default/files/wysiwyg/research/findings/making-healthcare-safer/mhs3/infusion-pumps-1.pdf
    March 01, 2020 - errors (the percentage of syringes used with a medication error) dropped from 17.7 percent to 2.3 percent … Errors" OR "Product Recalls and Withdrawals" OR "Workflow") OR (AB "Medication Error*" OR "Workflow … Errors" OR "Product Recalls and Withdrawals" OR "Workflow") OR (AB "Medication Error*" OR "Workflow … Errors") OR (AB "Medication Error*" OR "Adverse Event")) AND ((MH "Education") OR AB (Inservice or … Errors") OR (AB "Medication Error*" OR "Adverse Event")) AND ((MH "Education") OR (AB Inservice or