AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (162)

•Diagnostic Errors (233)

•Identification Errors (112)

•Discontinuities, Gaps, and Hand-Off Problems (491)

•Fatigue and Sleep Deprivation (98)

•Medication Safety (1388)

•Medical Complications (433)

•Nonsurgical Procedural Complications (111)

•Surgical Complications (456)

•Transfusion Complications (18)

•Psychological and Social Complications (141)

Origin/Sponsor

•Africa (7)

•Asia (55)

•Australia and New Zealand (105)

•Central and South America (12)

•Europe (445)

•North America (3296)

Resource Types

•Clinical Guideline (9)

•Journal Article (2941)

•Legislation/Regulation (62)

•Meeting/Conference (30)

•Newsletter/Journal (13)

•Newspaper/Magazine Article (361)

•Press Release/Announcement (40)

•Special or Theme Issue (68)

•Tools/Toolkit (67)

•Web Resource (119)

•Grant (9)

Error Types

•Epidemiology of Errors and Adverse Events (905)

•Active Errors (762)

•Latent Errors (278)

•Near Miss (80)

Approach to Improving Safety

•Quality Improvement Strategies (949)

•Legal and Policy Approaches (341)

•Error Reporting and Analysis (1022)

•Communication Improvement (1144)

•Human Factors Engineering (558)

•Teamwork (353)

•Specialization of Care (309)

•Logistical Approaches (315)

•Culture of Safety (482)

•Technologic Approaches (711)

•Education and Training (878)

Clinical Areas

•Allied Health Services (13)

•Complementary and Alternative Medicine (1)

Target Audience
< All

Health Care Providers

•Allied Health Professionals (7)

•Clinical Technologists (35)

Setting of Care

•Psychiatric Facilities (18)

•Residential Facilities (73)

•Ambulatory Care (409)

•Outpatient Surgery (44)

•Patient Transport (34)

1 - 20 of 4005

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NEWSPAPER/MAGAZINE ARTICLE

Action needed to prevent dangerous heparin-insulin confusion.

ISMP Medication Safety Alert! Acute Care Edition. May 3, 2007;12:1-2.

COMMENTARY

ISMP medication error report analysis.

Cohen MR, Smetzer JL. Hosp Pharm. 2010;45:282-287.

BOOK/REPORT

External Inquiry into the adverse incident that occurred at Queen's Medical Centre, Nottingham, 4th January 2001.

Toft B. London, England: Department of Health; 2001.

COMMENTARY

ISMP medication error report analysis.

Cohen MR, Smetzer JL. Hosp Pharm. 2009;44:937-938, 945.

NEWSPAPER/MAGAZINE ARTICLE

Anticoagulant safety practices call for pharmacist supervision.

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

STUDY

Pediatric vaccination errors: application of the "5 rights" framework to a national error reporting database.

Bundy DG, Shore AD, Morlock LL, Miller MR. Vaccine. 2009;27:3890-3896.

COMMENTARY

ISMP medication error report analysis.

Cohen MR, Smetzer JL. Hosp Pharm. 2009;44:18-21.

STUDY

Determinants of patient-reported medication errors: a comparison among seven countries.

Lu CY, Roughead E. Int J Clin Pract. 2011;65:733-740.

NEWSPAPER/MAGAZINE ARTICLE

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

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

COMMENTARY

ISMP medication error report analysis.

Cohen MR, Smetzer JL. Hosp Pharm. 2009;44:1062-1065.

STUDY

An exploratory study measuring verbal order content and context.

Wakefield DS, Brokel J, Ward MM, Schwichtenberg T, Groath D, Kolb M, Davis JW, Crandall D. Qual Saf Health Care. 2009;18:169-173.

STUDY

Pediatric antidepressant medication errors in a national error reporting database.

Rinke ML, Bundy DG, Shore AD, Colantuoni E, Morlock LL, Miller MR. J Dev Behav Pediatr. 2010;31:129-136.

COMMENTARY

ISMP medication error report analysis.

Cohen MR, Smetzer JL. Hosp Pharm. 2010;45:191-195.

STUDY

Medication discrepancies upon hospital to skilled nursing facility transitions.

Tjia J, Bonner A, Briesacher BA, McGee S, Terrill E, Miller K. J Gen Intern Med. 2009;24:630-635.

STUDY

Delays and errors in cardiopulmonary resuscitation and defibrillation by pediatric residents during simulated cardiopulmonary arrests.

Hunt EA, Vera K, Diener-West M, et al. Resuscitation. 2009;80:819-825.

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

Misadministration of IV insulin associated with dose measurement and hyperkalemia treatment.

ISMP Medication Safety Alert! Acute Care Edition. August 11, 2011;16:1-3.

COMMENTARY

Reducing the risk of adverse drug events in older adults.

Pretorius RW, Gataric G, Swedlund SK, Miller JR. Am Fam Physician. 2013;87:331-336.

ORGANIZATIONAL POLICY/GUIDELINES

Preventing errors relating to commonly used anticoagulants.

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

COMMENTARY

Opioids, iatrogenic harm and disclosure of medical error.

Blinderman CD. J Pain Symptom Manage. 2010;39:309-313.

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