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digital.ahrq.gov/sites/default/files/docs/publication/uc1hs016156-obrien-final-report-2009.pdf
January 01, 2009 - Quantitative data on outcomes related to implementation
effectiveness and patient safety were monitored … Outcomes related to implementation effectiveness and patient safety
were monitored. … clinical data in
patients’ EHRs in each of the CAHs. … There was less discussion about anticipated benefits to patient safety than expected. … However, interviewees did report that patient safety increased dramatically in these hospitals via
use
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effectivehealthcare.ahrq.gov/sites/default/files/related_files/allergy-seasonal_executive.pdf
July 01, 2013 - effective during pregnancy, but their use may be restricted
because of concerns about maternal and fetal safety … treatment for mild SAR
• The comparative effectiveness and safety of SAR
treatments used in combination … all outcomes of interest were patient
reported. … SAR/PAR results (N = 4)
● Unable to obtain article (N = 2)
● Incomplete data (N = 1)
● Efficacy/safety … magnitude
and direction of change in drug disposition may facilitate
application of effectiveness and safety
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psnet.ahrq.gov/issue/cost-implications-actual-and-potential-adverse-events-prevented-interventions-critical-care
June 28, 2010 - This study discovered that chart review activities and participation in patient care rounds were associated … July 13, 2016
Accuracy of a chatbot in answering questions that patients should ask before … Administration Blur
June 24, 2020
Medication histories in critically ill patients … September 6, 2016
Developing a medication patient safety program, part 2: process and … May 11, 2014
Improving medication safety in the ICU: the pharmacist's role.
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psnet.ahrq.gov/issue/breast-cancer-screening-and-overdiagnosis
March 16, 2022 - breast cancer and the resulting overtreatment can cause physical, emotional, and financial harm to patients … December 2, 2020
Using Failure Mode, Effect and Criticality Analysis to improve safety … medication administration, and closed-loop electronic medication management systems on work processes and safety … April 21, 2021
How to scale up quality and safety program with the home care accreditation … June 23, 2021
Time-ordered comorbidity correlations identify patients at risk of mis-
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psnet.ahrq.gov/issue/effect-50-hour-workweek-limitation-training-surgical-residents-switzerland
October 27, 2010 - June 24, 2009
Effect of patient- and medication-related factors on inpatient medication … June 26, 2019
Lessons learned implementing a complex and innovative patient safety learning … February 14, 2017
Program director perceptions of surgical resident training and patient … October 7, 2009
Resident duty hours in surgery for ensuring patient safety, providing … to the Report of the Institute of Medicine, "Resident Duty Hours: Enhancing Sleep, Supervision, and Safety
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psnet.ahrq.gov/issue/analysis-australian-newspaper-coverage-medication-errors
February 15, 2012 - Effects of two commercial electronic prescribing systems on prescribing error rates in hospital in-patients … March 23, 2011
Disentangling quality and safety indicator data: a longitudinal, comparative … November 2, 2018
View More
Related Resources
Hospital safety: your … June 18, 2013
High-profile investigations into hospital safety problems in England did … not prompt patients to switch providers.
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psnet.ahrq.gov/issue/harvey-cushings-open-and-thorough-documentation-surgical-mishaps-dawn-neurologic-surgery
November 16, 2022 - March 3, 2011
A coproduced family reporting intervention to improve safety surveillance … January 15, 2020
Comparing NICU teamwork and safety climate across two commonly used … View More
Related Resources
Association of overlapping surgery with patient … resident participation on morbidity and mortality in neurosurgical procedures: an analysis of 16,098 patients … May 20, 2009
Resident duty hour regulation and patient safety: establishing a balance
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www.ahrq.gov/sites/default/files/wysiwyg/sops/events/webinar/2-SOPS_101_Webcast_2020-Gray.pdf
January 01, 2020 - safety culture within healthcare
settings
9
What is Patient Safety Culture? … Safety
• Work Pressure and Pace
• Overall Rating on Patient Safety
10
Survey Development Process … • Raise staff awareness about patient safety;
• Assess patient safety culture;
• Identify strengths and … Identify patient safety culture areas for improvement
2. … AHRQ Surveys on Patient Safety Culture
Areas of Patient Safety Culture Assessed Across SOPS Surveys
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psnet.ahrq.gov/issue/deployment-second-victim-peer-support-program-replication-study
January 12, 2022 - Assessing the perceived level of institutional support for the second victim after a patient … safety event. … Collective insights from patient safety leaders in Maryland. … March 15, 2017
Sources and magnitude of error in preparing morphine infusions for nurse–patient … November 30, 2016
The safety culture in a children's hospital.
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psnet.ahrq.gov/web-mm/misread-label
August 28, 2024 - proprietary reviews of proposed names, trademarks, packaging, and labeling for pharmaceutical industry clients … safety incident data. … safety. … across health, social care and patient safety: a systematic review of reviews. … February 12, 2020
How can patient-held lists of medication enhance patient safety?
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psnet.ahrq.gov/web-mm/transfusion-thresholds-gastrointestinal-bleeding
November 26, 2014 - Electronic health records provide templates for care and play a significant role in patient safety. … Safety in Medical, Nursing, and Other Clinical Education
March 16, 2020 … safety improvement project on hospital-wide adverse event outcomes and patient safety culture. … safety: a multi-methods survey. … December 20, 2023
Understanding the peer, manager, and system influence on patient safety
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psnet.ahrq.gov/perspective/conversation-barbara-drew-rn-phd
May 01, 2016 - Maybe it would be better for all the other patients to take that patient off the monitor if it isn't … Many of those patients are also on cardiac monitors, and there are fewer nurses per patient. … The recent Joint Commission National Patient Safety Goal on clinical alarm safety highlighted the complexities … Default settings are useful when patients first arrive on a unit; they can act as a safety net by detecting … The Joint Commission announces 2014 National Patient Safety Goal.
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digital.ahrq.gov/ahrq-funded-projects/hit-based-regional-medication-management-pharmacy-system
January 01, 2023 - Type of Care
Acute Care
Specialty Care
Health Care Theme
Medication Management
Patient … The Internet linked the MEDITECH patient information management system at each CAH to the urban hospital … urban pharmacists to CAH nursing staff and prescribers regarding medication orders positively impacted patient … Patients in geographically isolated rural CAHs received safer and more effective medication therapy than … Using Telehealth to Improve Quality and Safety: Findings from the AHRQ Health IT Portfolio (Prepared
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Connelly.pdf
January 01, 2003 - On-line Patient Safety Climate Survey: Tool Development and Lessons Learned
415
On-line Patient Safety … safety is defined as actions undertaken by individuals and
organizations to protect patients from being … safety issues.
3.19 .648 Agree
6. are not willing to admit to patients when they
make an error … Profiles in patient safety: organizational
barriers to patient safety. … In: Enhancing patient
safety and reducing errors.
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psnet.ahrq.gov/issue/novel-study-situational-awareness-among-out-hospital-providers-during-online-clinical
June 08, 2022 - September 16, 2020
Adverse events among emergency department patients with cardiovascular … November 4, 2020
Room of hazards: a comparison of differences in safety hazard recognition … October 19, 2022
View More
Related Resources
Adverse safety events … October 7, 2020
Applying principles from aviation safety investigations to root cause … July 24, 2019
Simulation as a tool to improve the safety of pre-hospital anaesthesia—a
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psnet.ahrq.gov/issue/effect-structured-medication-review-followed-face-face-feedback-prescribers-adverse-drug
January 18, 2013 - Impact of a nationwide prospective drug utilization review program to improve prescribing safety … November 28, 2018
Correlation between the number of patient-reported adverse events, … adverse drug events, and quality of life in older patients: an observational study. … November 16, 2022
Correlation between the number of patient-reported adverse events, … adverse drug events, and quality of life in older patients: an observational study.
-
psnet.ahrq.gov/issue/development-electronic-pediatric-all-cause-harm-measurement-tool-using-modified-delphi-method
July 03, 2016 - J Patient Saf. 2016;12(4):180-189. … Detecting and measuring patient safety hazards remains challenging, but assessing the potential for … J Patient Saf. 2016;12(4):180-189. … safety collaborative. … August 10, 2022
Adverse events in hospitalized pediatric patients.
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psnet.ahrq.gov/node/49791/psn-pdf
April 01, 2017 - was noted that the personnel carrying out the procedure at the bedside had not
performed the usual safety … In the current case, it is
unclear if the safety procedures mandated by the Universal Protocol were … Take-Home Points
Wrong-site errors are considered never events and represent a core patient safety problem … The current safety standard for preventing wrong-site errors includes The Joint Commission
Universal … safety.
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psnet.ahrq.gov/web-mm/late-anemia-following-rh-disease-newborn
June 17, 2010 - The patient improved and he ultimately did well with appropriate therapies. … In addition, although it is common in patient safety discussions to focus on errors of omission ( 9 ) … Safely doing less: a missing component of the patient safety dialogue. … June 17, 2010
Perspective
Getting Into Patient Safety: … Safety Research
December 1, 2003
WebM&M Cases
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psnet.ahrq.gov/issue/missed-nursing-care-emergency-departments-scoping-review
November 03, 2021 - Causes of MNC include overcrowding and patients with complex care needs, which may result in medication … June 19, 2024
Compelled disclosure of confidential information in patient safety research … April 21, 2021
Non-conveyance of older adult patients and association with subsequent … January 26, 2022
Interventions to support nurses as second victims of patient safety … January 24, 2024
Voices from frontline nurses on care quality and patient safety during