AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (122)

•Diagnostic Errors (90)

•Identification Errors (76)

•Discontinuities, Gaps, and Hand-Off Problems (360)

•Fatigue and Sleep Deprivation (64)

•Medication Safety (704)

•Medical Complications (419)

•Nonsurgical Procedural Complications (74)

•Surgical Complications (295)

•Transfusion Complications (17)

•Psychological and Social Complications (92)

Origin/Sponsor

•Africa (4)

•Asia (46)

•Australia and New Zealand (97)

•Central and South America (5)

•Europe (412)

•North America (1951)

Resource Types

•Audiovisual (23)

•Award (18)

•Book/Report (154)

•Clinical Guideline (3)

•Journal Article (1927)

•Legislation/Regulation (31)

•Meeting/Conference (10)

•Newspaper/Magazine Article (274)

•Press Release/Announcement (11)

•Special or Theme Issue (28)

•Tools/Toolkit (36)

•Web Resource (52)

•Grant (2)

Error Types

•Epidemiology of Errors and Adverse Events (692)

•Active Errors (417)

•Latent Errors (199)

•Near Miss (46)

Approach to Improving Safety

•Quality Improvement Strategies (663)

•Legal and Policy Approaches (247)

•Error Reporting and Analysis (733)

•Communication Improvement (633)

•Human Factors Engineering (359)

•Teamwork (215)

•Specialization of Care (237)

•Logistical Approaches (206)

•Culture of Safety (378)

•Technologic Approaches (431)

•Education and Training (489)

Clinical Areas

•Allied Health Services (3)

•Medicine (2111)

•Nursing (192)

•Pharmacy (258)

Target Audience

•Health Care Providers (1825)

•Health Care Executives and Administrators (2188)

•Non-Health Care Professionals (941)

•Patients (195)

Setting of Care
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Hospitals

•General Hospitals (655)

•Children’s Hospitals (60)

•Specialty Hospitals (57)

1 - 20 of 2569

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COMMENTARY

Mitigating error vulnerability at the transition of care through the use of health IT applications.

Cortelyou-Ward K, Swain A, Yeung T. J Med Syst. 2012;36:3825-3831.

STUDY

Surgical adverse outcomes and patients’ evaluation of quality of care: inherent risk or reduced quality of care?

Marang-van de Mheen PJ, van Duijn-Bakker N, Kievit J. Qual Saf Health Care. 2007;16:428-433.

COMMENTARY

The Team Checkup Tool: evaluating QI team activities and giving feedback to senior leaders.

Lubomski LH, Marsteller JA, Hsu YJ, et al. Jt Comm J Qual Patient Saf. 2008;34:619-623.

REVIEW

Systematic review: association of shift length, protected sleep time, and night float with patient care, residents' health, and education.

Reed DA, Fletcher KE, Arora VM. Ann Intern Med. 2010;153:829-842.

SPECIAL OR THEME ISSUE

Proceedings from the European Handover Research Collaborative.

Philibert I, Barach P, eds. BMJ Qual Saf. 2012;21(suppl 1):i1-i128.

STUDY

Medication reconciliation: a qualitative analysis of clinicians' perceptions.

Vogelsmeier A, Pepper GA, Oderda L, Weir C. Res Social Adm Pharm. 2012 Oct 19; [Epub ahead of print].

NEWSPAPER/MAGAZINE ARTICLE

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

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

STUDY

"It's like two worlds apart": an analysis of vulnerable patient handover practices at discharge from hospital.

Groene RO, Orrego C, Suñol R, Barach P, Groene O. BMJ Qual Saf. 2012;21:i67-i75.

STUDY

Stakeholder perspectives on handovers between hospital staff and general practitioners: an evaluation through the microsystems lens.

Göbel B, Zwart D, Hesselink G, Pijnenborg L, Barach P, Kalkman C, Johnson JK. BMJ Qual Saf. 2012;21:i106-i113.

STUDY

Saving lives by studying deaths: using standardized mortality reviews to improve inpatient safety.

Lau H, Litman KC. Jt Comm J Qual Patient Saf. 2011;37:400-408.

COMMENTARY classic

Balancing "no blame" with accountability in patient safety.

Wachter RM, Pronovost PJ. N Engl J Med. 2009;361:1401-1406.

STUDY

Identifying, understanding and overcoming barriers to medication error reporting in hospitals: a focus group study.

Hartnell N, MacKinnon N, Sketris I, Fleming M. BMJ Qual Saf. 2012;21:361-368.

REVIEW

Hospital do-not-resuscitate orders: why they have failed and how to fix them.

Yuen JK, Reid MC, Fetters MD. J Gen Intern Med. 2011;26:791-797.

STUDY

Prevalence of error-prone abbreviations used in medication prescribing for hospitalised patients: multi-hospital evaluation.

Dooley MJ, Wiseman M, Gu G. Intern Med J. 2012;42:e19-e22.

STUDY

Physician implicit review to identify preventable errors during in-hospital cardiac arrest.

Jain R, Kuhn L, Repaskey W, et al. Arch Intern Med. 2011;171:89-90.

MULTI-USE WEBSITE

Health Care–Associated Infections (HAI) Portal.

The Joint Commission.

NEWSPAPER/MAGAZINE ARTICLE

Follow ISMP guidelines to safeguard the design and use of automated dispensing cabinets (ADCs).

ISMP Medication Safety Alert! Acute Care Edition. February 12, 2009;14:1-4.

REVIEW

A systematic review of evidence on the links between patient experience and clinical safety and effectiveness.

Doyle C, Lennox L, Bell D. BMJ Open. 2013;3:e001570.

NEWSPAPER/MAGAZINE ARTICLE

Oops, sorry, wrong patient! A patient verification process is needed everywhere, not just at the bedside.

ISMP Medication Safety Alert! Acute Care Edition. March 10, 2011;16:1-4.

REVIEW

In-facility delirium programs as a patient safety strategy: a systematic review.

Reston JT, Schoelles KM. Ann Intern Med. 2013;158(5 Pt 2):375-380.

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