AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (94)

•Diagnostic Errors (152)

•Identification Errors (74)

•Discontinuities, Gaps, and Hand-Off Problems (487)

•Fatigue and Sleep Deprivation (32)

•Medication Safety (720)

•Medical Complications (259)

•Nonsurgical Procedural Complications (60)

•Surgical Complications (158)

•Transfusion Complications (12)

•Psychological and Social Complications (59)

Origin/Sponsor

•Africa (4)

•Asia (26)

•Australia and New Zealand (66)

•Central and South America (5)

•Europe (269)

•North America (1439)

Resource Types

•Audiovisual (14)

•Award (11)

•Book/Report (104)

•Clinical Guideline (4)

•Journal Article (1388)

•Legislation/Regulation (28)

•Meeting/Conference (12)

•Newsletter/Journal (1)

•Newspaper/Magazine Article (186)

•Press Release/Announcement (23)

•Special or Theme Issue (26)

•Tools/Toolkit (40)

•Web Resource (50)

•Grant (2)

Error Types

•Epidemiology of Errors and Adverse Events (486)

•Active Errors (586)

•Latent Errors (195)

•Near Miss (41)

Approach to Improving Safety

•Quality Improvement Strategies (503)

•Legal and Policy Approaches (150)

•Error Reporting and Analysis (450)

•Communication Improvement (693)

•Human Factors Engineering (266)

•Teamwork (127)

•Specialization of Care (149)

•Logistical Approaches (141)

•Culture of Safety (206)

•Technologic Approaches (406)

•Education and Training (360)

Clinical Areas

•Allied Health Services (7)

•Complementary and Alternative Medicine (1)

Target Audience
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Health Care Providers

•Allied Health Professionals (3)

•Clinical Technologists (9)

Setting of Care

•Psychiatric Facilities (11)

•Residential Facilities (41)

•Ambulatory Care (339)

•Outpatient Surgery (29)

•Patient Transport (20)

1 - 20 of 1889

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NEWSPAPER/MAGAZINE ARTICLE

Electronic prescribing vulnerabilities: height and weight mix-up leads to dosing error.

ISMP Medication Safety Alert! Acute Care Edition. August 26, 2010;15:1-3.

STUDY

Discontinuation of antihyperglycemic therapy after acute myocardial infarction: medical necessity or medical error?

Lovig KO, Horwitz L, Lipska K, Kosiborod M, Krumholz HM, Inzucchi SE. Jt Comm J Qual Patient Saf. 2012;38:403-407.

COMMENTARY

Medication Reconciliation Victory after an Avoidable Error

Cutler TW. AHRQ WebM&M [serial online]. February/March 2009.

STUDY

Using consumer-based kiosk technology to improve and standardize medication reconciliation in a specialty care setting.

Lesselroth B, Adams S, Felder R, et al. Jt Comm J Qual Patient Saf. 2009;35:264-271.

STUDY

Checking it twice: an evaluation of checklists for detecting medication errors at the bedside using a chemotherapy model.

White RE, Trbovich PL, Easty AC, Savage P, Trip K, Hyland S. Qual Saf Health Care. 2010;19:562-567.

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.

STUDY

Chemotherapy safety and severe adverse events in cancer patients: strategies to efficiently avoid chemotherapy errors in in- and outpatient treatment.

Markert A, Thierry V, Kleber M, Behrens M, Engelhardt M. Int J Cancer. 2009;124:722-728.

REVIEW

Medication errors in chemotherapy: incidence, types and involvement of patients in prevention. A review of the literature.

Schwappach DLB, Wernli M. Eur J Cancer Care (Engl). 2009;19:285-292.

COMMENTARY

Recurrent Hypoglycemia: A Care Transition Failure?

Eytan T. AHRQ WebM&M [serial online]. October 2008.

REVIEW

Addressing postdischarge adverse events: a neglected area.

Tsilimingras D, Bates DW. Jt Comm J Qual Patient Saf. 2008;34:85-97.

MEASUREMENT TOOL/INDICATOR

2012 ISMP International Medication Safety Self Assessment for Oncology.

Institute for Safe Medication Practices and Institute for Safe Medication Practices Canada.

MULTI-USE WEBSITE

Preventing Infections During Cancer Treatment.

Centers for Disease Control and Prevention.

STUDY

Creating a better discharge summary: improvement in quality and timeliness using an electronic discharge summary.

O'Leary KJ, Liebovitz SM, Feinglass J, et al. J Hosp Med. 2009;4:219-225.

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.

COMMENTARY

Language Barrier

Flores G. AHRQ WebM&M [serial online]. April 2006.

COMMENTARY

Patient Safety: A Perspective from Office Practice.

Baron RJ. AHRQ WebM&M [serial online]. May 2009.

STUDY

Interruptions during the delivery of high-risk medications.

Trbovich P, Prakash V, Stewart J, Trip K, Savage P. J Nurs Adm. 2010;40:211-218.

STUDY

Improving the quality of the surgical morbidity and mortality conference: a prospective intervention study.

Mitchell EL, Lee DY, Arora S, et al. Acad Med. 2013 Apr 24; [Epub ahead of print].

COMMENTARY

Reengineering hospital discharge: a protocol to improve patient safety, reduce costs, and boost patient satisfaction.

Clancy CM. Am J Med Qual. 2009;24:344-346.

STUDY

An effort to improve electronic health record medication list accuracy between visits: patients' and physicians' response.

Staroselsky M, Volk LA, Tsurikova R, et al. Int J Med Inform. 2008;77:153-160.

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