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PATIENT SAFETY PRIMERS
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Safety Target
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Device-related Complications (76)
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Diagnostic Errors (168)
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Identification Errors (36)
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Discontinuities, Gaps, and Hand-Off Problems (208)
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Fatigue and Sleep Deprivation (22)
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Medication Safety (418)
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Medical Complications (206)
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Nonsurgical Procedural Complications (36)
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Epidemiology of Errors and Adverse Events (288)
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Latent Errors (138)
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Approach to Improving Safety
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Error Reporting and Analysis (376)
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Human Factors Engineering (203)
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Culture of Safety (194)
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Allied Health Services (7)
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Target Audience
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Health Care Providers (1298)
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Health Care Executives and Administrators (1032)
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Non-Health Care Professionals (483)
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Patients (134)
Setting of Care
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Hospitals (1163)
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Psychiatric Facilities (21)
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Residential Facilities (34)
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Ambulatory Care (144)
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Outpatient Surgery (16)
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Patient Transport (8)
1 - 20
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COMMENTARY
When “Psychiatric” Symptoms are Not.
Goldberg RJ. AHRQ WebM&M [serial online]. February 2003.
COMMENTARY
Which End is Which?
Campbell AR. AHRQ WebM&M [serial online]. April 2003.
COMMENTARY
Code Blue—Where To?
Adams BD. AHRQ WebM&M [serial online]. October 2007.
REVIEW
Inpatient suicide: preventing a common sentinel event.
Tishler CL, Reiss NS. Gen Hosp Psychiatry. 2009;31:103-109.
COMMENTARY
The pursuit of better diagnostic performance: a human factors perspective.
Henriksen K, Brady J. BMJ Qual Saf. 2013 May 23; [Epub ahead of print].
COMMENTARY
The Dangerous Detour.
Gibson J, Taylor D. AHRQ WebM&M [serial online]. June 2003.
STUDY
Diagnostic errors and temporal stability in bipolar disorder.
López J, Baca E, Botillo C, et al. Actas Esp Psiquiatr. 2008;36:205-209.
COMMENTARY
Back to Basics
Hellman R. AHRQ WebM&M [serial online]. March 2007.
COMMENTARY
Inappropriate Antibiotic Use.
Babcock HM, Fraser VJ. AHRQ WebM&M [serial online]. June 2003.
COMMENTARY
Crossing the Line.
Feldman JP, Gould MK. AHRQ WebM&M [serial online]. March 2004.
NEWSPAPER/MAGAZINE ARTICLE
Proper positioning of pharmacy label on Hospira PCA vials will avoid interference with scanning.
ISMP Medication Safety Alert! Acute Care Edition. August 14, 2008;13:1-3.
COMMENTARY
Improving heparin safety: a multidisciplinary invited conference.
Peterson C, Ham CW, Vanderveen T. Hosp Pharm. 2008;43:491-497.
NEWSPAPER/MAGAZINE ARTICLE
Oral syringes: a crucial and economical risk-reduction strategy that has not been fully utilized.
ISMP Medication Safety Alert! Acute Care Edition. October 22, 2009;14:1-3.
COMMENTARY
Do Not Disturb!
Duffy FD, Cassel CK. AHRQ WebM&M [serial online]. October 2007.
NEWSPAPER/MAGAZINE ARTICLE
We know
what
they did wrong, but not
why
: the case for 'frame-based' feedback.
Rudolph J, Raemer D, Shapiro J. Clin Teach. 2013;10:186-189.
COMMENTARY
Assessing diagnostic reasoning: a consensus statement summarizing theory, practice, and future needs.
Ilgen JS, Humbert AJ, Kuhn G, et al. Acad Emerg Med. 2012;19:1454-1461.
COMMENTARY
Crushing Chest Pain: A Missed Opportunity.
Graber M. AHRQ WebM&M [serial online]. January 2004.
STUDY
'August is always a nightmare': results of the Royal College of Physicians of Edinburgh and Society of Acute Medicine August transition survey.
Vaughan L, McAlister G, Bell D. Clin Med. 2011;11:322-326.
COMMENTARY
Not a Miscarriage.
Learman LA. AHRQ WebM&M [serial online]. June 2003.
BOOK/REPORT
Advances in Patient Safety: New Directions and Alternative Approaches.
Rockville, MD: Agency for Healthcare Research and Quality; July 2008. AHRQ Publication Nos. 080034 (1-4).
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