AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (261)

•Diagnostic Errors (260)

•Identification Errors (166)

•Discontinuities, Gaps, and Hand-Off Problems (618)

•Fatigue and Sleep Deprivation (125)

•Medication Safety (1660)

•Medical Complications (606)

•Nonsurgical Procedural Complications (120)

•Surgical Complications (497)

•Transfusion Complications (30)

•Psychological and Social Complications (204)

Origin/Sponsor

•Australia and New Zealand (142)

•Central and South America (10)

•Europe (582)

•North America (4654)

Resource Types

•Audiovisual (77)

•Bibliography (4)

•Book/Report (358)

•Clinical Guideline (10)

•Journal Article (3853)

•Legislation/Regulation (75)

•Meeting/Conference (47)

•Newsletter/Journal (14)

•Newspaper/Magazine Article (673)

•Press Release/Announcement (53)

•Special or Theme Issue (86)

•Tools/Toolkit (91)

•Web Resource (165)

Error Types

•Epidemiology of Errors and Adverse Events (1131)

•Active Errors (953)

•Latent Errors (394)

•Near Miss (99)

Approach to Improving Safety

•Quality Improvement Strategies (1375)

•Legal and Policy Approaches (658)

•Error Reporting and Analysis (1540)

•Communication Improvement (1288)

•Human Factors Engineering (709)

•Teamwork (409)

•Specialization of Care (378)

•Logistical Approaches (418)

•Culture of Safety (832)

•Technologic Approaches (1019)

•Education and Training (1183)

Clinical Areas

•Allied Health Services (21)

•Complementary and Alternative Medicine (1)

•Dentistry (5)

•Medicine (3518)

•Nursing (565)

•Pharmacy (653)

Target Audience

•Health Care Providers (3980)

•Health Care Executives and Administrators (4322)

•Non-Health Care Professionals (2131)

•Patients (519)

Setting of Care

•Hospitals (3620)

•Psychiatric Facilities (23)

•Residential Facilities (95)

•Ambulatory Care (508)

•Outpatient Surgery (50)

•Patient Transport (38)

1 - 20 of 5563

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STUDY

Intravenous infusion safety technology: return on investment.

Danello SH, Maddox RR, Schaack GJ. Hosp Pharm. 2009;44:680-687, 696.

COMMENTARY

Preparing your hospital for compliance with The Joint Commission's National Patient Safety Goals.

Murdaugh L, Jordin R. Hosp Pharm. 2008;43:728-733.

NEWSPAPER/MAGAZINE ARTICLE

Misprogramming PCA concentration leads to dosing errors.

ISMP Medication Safety Alert! Acute Care Edition. August 28, 2008;13:1-3.

COMMENTARY

Improving heparin safety: a multidisciplinary invited conference.

Peterson C, Ham CW, Vanderveen T. Hosp Pharm. 2008;43:491-497.

STUDY

A case study on the safety impact of implementing smart patient-controlled analgesic pumps at a tertiary care academic medical center.

Tran M, Ciarkowski S, Wagner D, Stevenson JG. Jt Comm J Qual Patient Saf. 2012;38:112-119.

COMMENTARY

ISMP medication error report analysis.

Smetzer JL, Cohen MR. Hosp Pharm. 2008;43;788-792.

NEWSPAPER/MAGAZINE ARTICLE

Medication errors occurring with the use of bar-code administration technology.

PA-PSRS Patient Saf Advis. December 2008;5:122-126.

NEWSPAPER/MAGAZINE ARTICLE

Anticoagulant safety practices call for pharmacist supervision.

Scott A. Drug Topics (Health-System Edition). November 10, 2008.

NEWSPAPER/MAGAZINE ARTICLE

Epidural-IV route mix-ups: reducing the risk of deadly errors.

ISMP Medication Safety Alert! Acute Care Edition. July 3, 2008;13:1-3.

ORGANIZATIONAL POLICY/GUIDELINES

Preventing errors relating to commonly used anticoagulants.

Sentinel Event Alert. September 24, 2008;(41):1-4.

STUDY

Medication safety initiative in reducing medication errors.

Nguyen EE, Connolly PM, Wong V. J Nurs Care Qual. 2010;25:224-230.

STUDY

classic

Effect of bar-code technology on the safety of medication administration.

Poon EG, Keohane CA, Yoon CS, et al. N Engl J Med. 2010;362:1698-1707.

REVIEW

Bar code technology and medication administration error.

Young J, Slebodnik M, Sands L. J Patient Saf. 2010;6;115-120.

COMMENTARY

ISMP medication error report analysis.

Cohen MR. Hosp Pharm. 2008;43:696–698.

COMMENTARY

ISMP medication error report analysis.

Cohen MR. Hosp Pharm. 2009;44:654-657.

COMMENTARY

Learning accountability for patient outcomes.

Pronovost PJ. JAMA. 2010;304:204-205.

BOOK/REPORT

Inpatient Computerized Provider Order Entry: Findings from the AHRQ Health IT Portfolio.

Dixon BE, Zafar A, for AHRQ National Resource Center for Health IT. Rockville, MD: Agency for Healthcare Research and Quality; January 2009. AHRQ Publication No. 09-0031-EF.

STUDY

Bar-code verification: reducing but not eliminating medication errors.

Henneman PL, Marquard JL, Fisher DL, et al. J Nurs Adm. 2012;42:562-566.

COMMENTARY

A new frontier in patient safety.

McCannon J, Berwick DM. JAMA. 2011;305:2221-2222.

STUDY

PCA safety data review after clinical decision support and smart pump technology implementation.

Prewitt J, Schneider S, Horvath M, Hammond J, Jackson J, Ginsberg B. J Patient Saf. 2013;9:103-109.

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