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psnet.ahrq.gov/node/73515/psn-pdf
August 01, 2022 - specific focus on early illness detection, acute illness management, reduction of polypharmacy through
medication … for improvement.3 For example, QI may focus on improving
advance directive completion or conducting medication … INTERACT are educational
trainings for providers as well as clinical and education tools, such as a medication … reconciliation
worksheet, a “stop and watch” early warning tool, and templates for progress notes and … APRN-conducted
medication reviews for long-stay nursing home residents.
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psnet.ahrq.gov/web-mm/sloppy-and-paste
February 02, 2011 - potential risk for patient harm, fraud, or tort claim, have been reported in 10% of patient EMRs.( 4 ) Medication … reconciliation discrepancies are particularly noteworthy, since such errors are noted in almost 40% … of EMR patient medication lists.( 5 ) There are also reports of incredible copy-and-paste persistence … Medication history taking in emergency department triage is inaccurate and incomplete. … Follow-up
June 14, 2023
WebM&M Cases
Refused Medication
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psnet.ahrq.gov/web-mm/check-twice-transport-once
March 15, 2023 - or an incorrect report or handoff between staff, and can result in errors such as missed or delayed medication … administration or orders. 5 Such medication, treatment, and equipment errors can have potentially … Ventilator and intravenous medication administration tubing may not be long enough to maneuver into and … The checklist included patient demographic, procedural, medication and overall status data and required … Reconciliation Mishap
January 1, 2018
HIM functions in healthcare quality
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psnet.ahrq.gov/web-mm/wrong-catheter-right-patient
May 16, 2022 - Institutions hoped to leverage this technology to reduce verbal order use and prevent medication prescribing … However, a survey conducted by the Institute for Safe Medication Practices in 2017 indicated that for … (For example, pharmacists assess the dose, route, and indication for medication orders and radiology … Additionally, unlike verification for medication or imaging orders, the standard protocol for verifying … Reconciliation
August 5, 2022
WebM&M Cases
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psnet.ahrq.gov/issue/exploring-situational-awareness-diagnostic-errors-primary-care
September 20, 2011 - January 19, 2012
Medicines reconciliation using a shared electronic health care record
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psnet.ahrq.gov/node/60542/psn-pdf
May 27, 2020 - life-threatening-infant-overdose-sodium-chloride
infant’s family and attending physician met regularly for discussions and reconciliation … Four main system errors contributed to the medication error made in the care of
this patient. … Systemic Causes of In-Hospital Intravenous
Medication Errors: A Systematic Review. … Technology utilization to prevent medication errors. Curr Drug Saf.
2010;5(1):13-8.
16. … Interventions to reduce
pediatric medication errors: a systematic review.
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psnet.ahrq.gov/web-mm/safety-and-quality-long-term-care
January 01, 2016 - For example, in the Institute of Medicine report on Preventing Medication Errors, approximately 800,000 … Preventing Medication Errors: Quality Chasm Series. … October 10, 2015
Medication reconciliation: a qualitative analysis of clinicians' perceptions … August 15, 2013
Medication safety teams' guided implementation of electronic medication … February 12, 2020
Predictors of nursing home nurses' willingness to report medication
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psnet.ahrq.gov/issue/implementation-and-evaluation-prototype-consumer-reporting-system-patient-safety-events
February 12, 2020 - August 20, 2018
Improving reconciliation following medical injury: a qualitative study
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psnet.ahrq.gov/issue/views-and-experiences-patients-and-health-care-professionals-disclosure-adverse-events
August 25, 2021 - December 6, 2023
Patient, carer and family experiences of seeking redress and reconciliation
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psnet.ahrq.gov/classics
August 01, 2023 - Reconciliation
(14)
Read Back Protocols
(7)
SBAR
(4)
Structured … a comprehensive list of commonly confused medication names, including look-alike and sound-alike name … Drug name confusion can easily lead to medication errors, and the ISMP has recommended interventions … Patients taking oral anti-cancer drugs may experience severe side effects and medication errors. … in reducing controlled substance medication errors in hospitals.
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psnet.ahrq.gov/issue/selecting-safe-and-easier-use-products-healthcare-using-human-factors-specification-and
February 21, 2018 - September 15, 2021
Technical patient safety solutions for medicines reconciliation on
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psnet.ahrq.gov/innovation/missouri-quality-initiative-moqi-reduces-hospitalizations-among-nursing-home-residents
July 23, 2024 - specific focus on early illness detection, acute illness management, reduction of polypharmacy through medication … for improvement. 3 For example, QI may focus on improving advance directive completion or conducting medication … INTERACT are educational trainings for providers as well as clinical and education tools, such as a medication … reconciliation worksheet, a “stop and watch” early warning tool, and templates for progress notes and … APRN-conducted medication reviews for long-stay nursing home residents.
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psnet.ahrq.gov/web-mm/doctor-dont-treat-thyself
August 21, 2024 - Related Resources From the Same Author(s)
Exploring the impact of pharmacist-supported medication … August 21, 2024
Patient perceptions and experiences with medication-related activities … Effectiveness of a 'Do not interrupt' bundled intervention to reduce interruptions during medication … December 21, 2017
Pharmacist-led admission medication reconciliation before and after … the implementation of an electronic medication management system.
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psnet.ahrq.gov/issue/patient-feedback-safety-improvement-primary-care-results-feasibility-study
December 02, 2020 - May 1, 2019
Improving reconciliation following medical injury: a qualitative study of
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psnet.ahrq.gov/issue/perceptions-us-and-uk-incident-reporting-systems-scoping-review
January 19, 2022 - October 18, 2023
Patient, carer and family experiences of seeking redress and reconciliation
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psnet.ahrq.gov/issue/open-disclosure-among-general-practitioners-second-victim-patient-safety-incident-cross
February 15, 2023 - September 27, 2023
Patient, carer and family experiences of seeking redress and reconciliation
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psnet.ahrq.gov/issue/implementation-high-reliability-organization-framework-large-integrated-health-care-system
July 14, 2018 - March 27, 2024
Patient, carer and family experiences of seeking redress and reconciliation
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psnet.ahrq.gov/issue/health-care-risk-managers-consensus-management-inappropriate-behaviors-among-hospital-staff
June 16, 2021 - April 17, 2024
Patient, carer and family experiences of seeking redress and reconciliation
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psnet.ahrq.gov/web-mm/recurrent-hypoglycemia-care-transition-failure
December 23, 2020 - medical record (EMR) systems, because the patient's primary care team can receive a legible printed medication … However, even when there is an EMR-generated medication list, the documentation generated by the hospital … In the most advanced integrated systems in use today, medication reconciliation activity can be performed … With access to the information about the change in medication regimen and associated discharge information … In the hospital, a family member who has access to the patient's medication administration record may
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psnet.ahrq.gov/node/861881/psn-pdf
January 31, 2024 - And the nurse
said, “No, I mean the medication you get orally, or IV, besides the radiation.” … Could you talk a little bit about medication-related safety events? … Ric Ricciardi: The risk of medication error occurs at many points throughout the system. … It could also be a dosage error in the prescribing of the medication. … Perhaps they could do follow-up, community assessments, and medication
reconciliation after the patient