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ce.effectivehealthcare.ahrq.gov/news/newsletters/e-newsletter/908.html
April 01, 2024 - Home
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AHRQ News Now
Surge in Drug Shortages Occurred … Newsletter
AHRQ News Now
Events
Surge in Drug Shortages Occurred … Today's Headlines:
Surge in Drug Shortages Occurred in Wake of Pandemic, Study Finds
April 23 Webinar … Surge in Drug Shortages Occurred in Wake of Pandemic, Study Finds
A recent AHRQ-funded study on pharmaceutical … 2024
Page originally created April 2024
Internet Citation: Surge in Drug Shortages Occurred
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ce.effectivehealthcare.ahrq.gov/hai/pfp/interimhacrate2014.html
January 01, 2018 - precise causes of the decline in patient harm are not fully understood, the increase in safety has occurred … in 2014 than would have occurred if the rate of HACs had remained steady at the 2010 level ( Exhibit … Cumulatively, approximately 2.1 million fewer incidents of harm occurred in 2011, 2012, 2013, and 2014 … Most of the deaths averted occurred as a result of reductions in the rates of pressure ulcers and adverse … An estimated 2.1 million fewer harms were experienced by patients from 2010 to 2014 than would have occurred
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ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Nosek.pdf
March 01, 2004 - , 6
percent occurred in patients between the ages of 6 and 17 years, and 24 percent
occurred in patients … , while
28 percent occurred in patients 65 years of age and older. … Of the reports in which
possible patient harm may have occurred, 21 percent of the events occurred in … years, and 29 percent occurred in patients between 18 and 45
years. … occurred in patients 65 years of age and older.
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ce.effectivehealthcare.ahrq.gov/hai/pfp/interimhacrate2013.html
November 01, 2015 - precise causes of the decline in patient harm are not fully understood, the increase in safety has occurred … Costs included the initial hospital stay and costs of other inpatient sites of care that occurred within … in 2013 than would have occurred if the rate of HACs had remained steady at the 2010 level ( Exhibit … Cumulatively, approximately 1.3 million fewer incidents of harm occurred in 2011, 2012, and 2013 (compared … The majority of deaths averted occurred as a result of reductions in the rates of pressure ulcers 15
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ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/opioids/compendium/opioids-compendium-self-assessment.pdf
December 01, 2023 - .) …
…has never or very rarely
occurred. … …has occurred
sporadically in the past
but there have been no
recent updates. … …has occurred recently
but has not resulted in
changes in care for older
adults with chronic pain. … …has occurred recently
and has prompted
changes in the care
provided to older adults
with chronic … …has occurred but
without any follow-up
discussions or application
to patient care.
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ce.effectivehealthcare.ahrq.gov/hai/pfp/2015-interim.html
December 01, 2016 - over the 5 years (2011, 2012, 2013, 2014, and 2015) relative to the number of HACs that would have occurred … precise causes of the decline in patient harm are not fully understood, the increase in safety has occurred … in 2015 than would have occurred if the rate of HACs had remained steady at the 2010 level ( Exhibit … Cumulatively, approximately 3.1 million fewer incidents of harm occurred in 2011, 2012, 2013, 2014, and … on October 1, 2015, and also due in part to delays in contracting for MPSMS data analysis that occurred
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ce.effectivehealthcare.ahrq.gov/hai/pfp/2014-final.html
January 01, 2018 - precise causes of the decline in patient harm are not fully understood, the increase in safety has occurred … in 2014 than would have occurred if the rate of HACs had remained steady at the 2010 level ( Exhibit … Cumulatively, approximately 2.1 million fewer incidents of harm occurred in 2011, 2012, 2013, and 2014 … Most of the deaths averted occurred as a result of reductions in the rates of pressure ulcers and adverse … An estimated 2.1 million fewer HACs were experienced by patients from 2010 to 2014 than would have occurred
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ce.effectivehealthcare.ahrq.gov/hai/pfp/hacrate2013.html
January 01, 2018 - hospital patients over the 3 years (2011, 2012, 2013) relative to the number of HACs that would have occurred … precise causes of the decline in patient harm are not fully understood, the increase in safety has occurred … Costs included the initial hospital stay and costs of other inpatient sites of care that occurred within … in 2013 than would have occurred if the rate of HACs had remained steady at the 2010 level (Exhibit … The majority of deaths averted occurred as a result of reductions in the rates of pressure ulcers 14
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ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Duthie.pdf
January 01, 2004 - -G-
An error occurred that may have
contributed to or resulted in
permanent patient harm.
109 A … medication error occurred that
resulted in a near-death event (e.g.,
anaphylaxis, cardiac arrest). … -H-
An error occurred that required
an intervention necessary to
sustain life.
110 A medication … error occurred that
resulted in a patient death. … -I-
An error occurred that may have
contributed to or resulted in the
patient’s death.
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ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Grayson.pdf
January 01, 2003 - , as compared with shifts when no errors occurred. … Subjects were first asked the dates and times
of the shift on which the error occurred and the prior … , and the last shift worked by the
subject prior to the shift on which the error occurred. … assumption that no error occurred
on the prior shift worked. … Subjects were also asked if a significant unplanned event or break in policy
occurred.
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ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/best-practices/asp-pneumonitis-one-page.pdf
November 01, 2019 - regimens for community-acquired pneumonia (CAP) (e.g., ampicillin-
sulbactam, ceftriaxone) if the event occurred … regimens for hospital-acquired pneumonia (HAP) (e.g., cefepime, piperacillin-
tazobactam) if the event occurred
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ce.effectivehealthcare.ahrq.gov/sites/default/files/2024-01/bundy-report.pdf
January 01, 2024 - Categories E through H errors not only occurred and reached the patient
but also caused harm. … In one
study of nationally representative US data, extra vaccination occurred in 21% of young children … Harmful errors occurred
with all cardiovascular drug classes. … However, because over half the errors
occurred at the administering stage of medication processing, … Not surprisingly, a large majority of reported pediatric antidepressant medication errors
occurred
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ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/learning_pt_narratives_053123-nembhard.pdf
July 03, 2023 - Problems that occurred
between patients and
clinicians or staff
7. Exceptional people
8. … exceptional people
exceptional ways to do things
problems with the practice’s day-to-day …
problems that occurred … )
0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6
Exceptional ways to do things
Exceptional people
Problems that occurred
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ce.effectivehealthcare.ahrq.gov/sites/default/files/publications/files/interimhacrate2014_2.pdf
November 19, 2015 - patients over the 4 years (2011, 2012, 2013, and 2014) relative to the number of HACs that
would have occurred … precise causes of the decline in patient harm are not fully understood, the increase
in safety has occurred … the reduction in the rate of
HACs, we estimate that approximately 790,000 fewer incidents of harm occurred … in 2014 than
would have occurred if the rate of HACs had remained steady at the 2010 level (Exhibit … Cumulatively, approximately 2.1 million fewer incidents of harm occurred in 2011, 2012, 2013,
and 2014
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ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/mvp/modules/vae/objective-outcome-tool.docx
January 01, 2017 - Total number of episodes of mechanical ventilation
How many episodes of mechanical ventilation have occurred … Total number of deaths
How many deaths have occurred in the patients who have been or were mechanically
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ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/npsd/data/spotlights/spotlight-ptsafety-and-covid-19.pdf
November 01, 2021 - There is no evidence in these reports that any other type of patient safety concern
occurred. … In several instances, the exposure occurred because staff were not following PPE protocols, such as … In other cases, the exposure occurred with an asymptomatic
individual, and was later identified when … Additional near misses occurred when the wrong blood product (e.g.,
fresh frozen plasma versus COVID … PSOs generally provided data elements for the location in the facility where the event occurred and
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ce.effectivehealthcare.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 authors
explained that these problems occurred when the pharmacy was closed and when all medications … Of the 59 instances of override, 17
(28.8 percent) occurred during a first shift (7:00 am to 3:30 pm … ); 31 (52.5 percent) occurred
during a second shift (3:00 pm to 11:30 pm); and 11 (18.6 percent) occurred … Forty-five overrides (76.3 percent) occurred on weekdays. … The largest number of overrides occurred during the second shift, which was also when the
majority of
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ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/teamstepps/longtermcare/module7/ts2-0ltc_module7_ig_summary_exsheet.pdf
April 24, 2017 - Identify the instances where a breakdown in teamwork has occurred as it relates to the
specific teamwork … SCENARIO:
A gastrointestinal outbreak has occurred within the nursing home and has affected the entire
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ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/pfp/2014FinalHACreport4Web-13Dec2016.pdf
December 01, 2016 - patients over the 4 years (2011, 2012, 2013, and 2014) relative to the number of HACs that
would have occurred … precise causes of the decline in patient harm are not fully understood, the increase
in safety has occurred … the reduction in the rate of
HACs, we estimate that approximately 798,000 fewer incidents of harm occurred … in 2014 than
would have occurred if the rate of HACs had remained steady at the 2010 level (Exhibit … Cumulatively, approximately 2.1 million fewer incidents of harm occurred in 2011, 2012, 2013,
and 2014
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ce.effectivehealthcare.ahrq.gov/sites/default/files/wysiwyg/data/infographics/hac-scorecard-2014-16.pdf
January 01, 2014 - HAC National Scorecard
2014-16
Between 2014-2016, 350,000 fewer hospital-acquired conditions (HACs)
occurred