AHRQ Patient Safety Network

The Collection > Ambulatory Care

PATIENT SAFETY PRIMERS
Patient Safety in Ambulatory Care

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Safety Target

•Device-related Complications (6)

•Diagnostic Errors (31)

•Identification Errors (7)

•Discontinuities, Gaps, and Hand-Off Problems (74)

•Fatigue and Sleep Deprivation (1)

•Medication Safety (230)

•Medical Complications (26)

•Nonsurgical Procedural Complications (7)

•Surgical Complications (12)

•Transfusion Complications (2)

•Psychological and Social Complications (11)

Origin/Sponsor

•Asia (4)

•Australia and New Zealand (7)

Resource Types

•Clinical Guideline (1)

•Journal Article (302)

•Legislation/Regulation (9)

•Meeting/Conference (6)

•Newsletter/Journal (1)

•Newspaper/Magazine Article (41)

•Press Release/Announcement (3)

•Special or Theme Issue (5)

•Tools/Toolkit (11)

•Web Resource (8)

•Grant (1)

Error Types

•Epidemiology of Errors and Adverse Events (129)

•Active Errors (67)

•Latent Errors (23)

•Near Miss (9)

Approach to Improving Safety

•Quality Improvement Strategies (99)

•Legal and Policy Approaches (45)

•Error Reporting and Analysis (131)

•Communication Improvement (126)

•Human Factors Engineering (32)

•Teamwork (18)

•Specialization of Care (18)

•Logistical Approaches (24)

•Culture of Safety (39)

•Technologic Approaches (116)

•Education and Training (52)

Clinical Areas

•Allied Health Services (6)

Target Audience

•Health Care Providers (349)

•Health Care Executives and Administrators (258)

•Non-Health Care Professionals (131)

•Patients (32)

Setting of Care
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Ambulatory Care

•Home Care (26)

•Ambulatory Clinic or Office (91)

•Outpatient Pharmacy (69)

1 - 20 of 424

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NEWSPAPER/MAGAZINE ARTICLE

Practitioners agree on medication reconciliation value, but frustration and difficulties abound.

ISMP Medication Safety Alert! Acute Care Edition. July 13, 2006;11:1-2.

STUDY

Medication dosing errors for patients with renal insufficiency in ambulatory care.

Yap C, Dunham D, Thompson J, Baker D. Jt Comm J Qual Patient Saf. 2005;31:514-521.

STUDY

Patient-reported safety and quality of care in outpatient oncology.

Weingart SN, Price J, Duncombe D, et al. Jt Comm J Qual Patient Saf. 2007;33:83-94.

NEWSLETTER/JOURNAL

ISMP Medication Safety Alert®. Community/Ambulatory Care Edition.

Institute for Safe Medication Practices. 200 Lakeside Drive, Suite 200; Horsham, PA 19044.

STUDY

Oral chemotherapy safety practices at US cancer centres: questionnaire survey.

Weingart SN, Flug J, Brouillard D, et al. BMJ. 2007;334:407.

STUDY

Chemotherapy medication errors in a pediatric cancer treatment center: prospective characterization of error types and frequency and development of a quality improvement initiative to lower the error rate.

Watts RG, Parsons K. Pediatr Blood Cancer. 2013 Mar 20; [Epub ahead of print].

COMMENTARY

New technology, new errors: how to prime an upgrade of an insulin infusion pump.

Rule AM, Drincic A, Galt KA. Jt Comm J Qual Patient Saf. 2007;33:155-162.

STUDY

Cognitive errors and logistical breakdowns contributing to missed and delayed diagnoses of breast and colorectal cancers: a process analysis of closed malpractice claims.

Poon EG, Kachalia A, Puopolo AL, Gandhi TK, Studdert DM. J Gen Intern Med. 2012;27:1416-1423.

NEWSPAPER/MAGAZINE ARTICLE

Results of ISMP survey on high-alert medications: differences between nursing, pharmacy, and risk/quality/safety perspectives.

ISMP Medication Safety Alert! Acute Care Edition. February 9, 2012;17:1-4.

MEASUREMENT TOOL/INDICATOR

The Physician Practice Patient Safety Assessment.

Medical Group Management Association Center for Research, Health Research and Educational Trust, Institute for Safe Medication Practices. 2005.

COMMENTARY

Medication safety: look-alike/sound-alike drugs in home care.

Friedman MM. Home Healthc Nurse. 2005;23:243-253.

REVIEW

Clinical dilemmas and a review of strategies to manage drug shortages.

Rider AE, Templet DJ, Daley MJ, Shuman C, Smith LV. J Pharm Pract. 2013 Apr 3; [Epub ahead of print].

STUDY

Ambulatory prescribing errors among community-based providers in two states.

Abramson EL, Bates DW, Jenter C, et al. J Am Med Inform Assoc. 2012;19:644-648.

COMMENTARY

What medications does your patient take? Enhancing medication safety in the outpatient setting.

Institute for Healthcare Improvement. March 14, 2007.

STUDY

Diagramming patients' views of root causes of adverse drug events in ambulatory care: an online tool for planning education and research.

Brown M, Frost R, Ko Y, Woosley R. Patient Educ Couns. 2006;62:302-315.

NEWSPAPER/MAGAZINE ARTICLE

Good intention, uncertain outcome...our take on physician dispensing in offices and clinics.

ISMP Medication Safety Alert! Acute Care Edition. March 8, 2012;17:1-3.

NEWSPAPER/MAGAZINE ARTICLE

Survey results: community liaison programs to decrease hospital readmissions.

ISMP Medication Safey Alert! Acute Care Edition. March 7, 2013;18:1-3.

STUDY

Patient safety and telephone medicine: some lessons from closed claim case review.

Katz HP, Kaltsounis D, Halloran L, Mondor M. J Gen Intern Med. 2008;23:517-522.

STUDY

Potential medication dosing errors in outpatient pediatrics.

McPhillips HA, Stille CJ, Smith D, et al. J Pediatr. 2005;147:761-767.

STUDY

Drug-induced hypoglycaemia--new insight into an old problem.

Ching CK, Lai CK, Poon WT, et al. Hong Kong Med J. 2006;12:334-338.

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