AHRQ Patient Safety Network

The Collection > Nurses

PATIENT SAFETY PRIMERS
Nursing and Patient Safety

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Safety Target

•Device-related Complications (34)

•Diagnostic Errors (6)

•Identification Errors (19)

•Discontinuities, Gaps, and Hand-Off Problems (57)

•Fatigue and Sleep Deprivation (6)

•Medication Safety (190)

•Medical Complications (52)

•Nonsurgical Procedural Complications (7)

•Surgical Complications (69)

•Transfusion Complications (3)

•Psychological and Social Complications (8)

Origin/Sponsor

•Asia (15)

•Australia and New Zealand (15)

•Central and South America (2)

Resource Types

•Clinical Guideline (4)

•Journal Article (389)

•Legislation/Regulation (9)

•Meeting/Conference (1)

•Newsletter/Journal (2)

•Newspaper/Magazine Article (50)

•Press Release/Announcement (7)

•Special or Theme Issue (2)

•Tools/Toolkit (11)

•Web Resource (9)

Error Types

•Epidemiology of Errors and Adverse Events (79)

•Active Errors (66)

•Latent Errors (33)

•Near Miss (12)

Approach to Improving Safety

•Quality Improvement Strategies (155)

•Legal and Policy Approaches (20)

•Error Reporting and Analysis (110)

•Communication Improvement (136)

•Human Factors Engineering (65)

•Teamwork (63)

•Specialization of Care (35)

•Logistical Approaches (38)

•Culture of Safety (57)

•Technologic Approaches (74)

•Education and Training (90)

Clinical Areas

•Allied Health Services (2)

•Medicine (344)

•Nursing (147)

•Pharmacy (42)

Target Audience
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Nurses

Setting of Care

•Hospitals (325)

•Psychiatric Facilities (2)

•Residential Facilities (10)

•Ambulatory Care (24)

•Outpatient Surgery (2)

•Patient Transport (3)

1 - 20 of 495

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COMMENTARY

Creating high reliability in health care organizations.

Pronovost PJ, Berenholtz SM, Goeschel CA, et al. Health Serv Res. 2006;41:1599-1617.

STUDY

A multicenter, phased, cluster-randomized controlled trial to reduce central line–associated bloodstream infections in intensive care units.

Marsteller JA, Sexton JB, Hsu YJ, et al. Crit Care Med. 2012;40:2933-2939.

STUDY

Adherence to simple and effective measures reduces the incidence of ventilator-associated pneumonia: [L'observation de mesures simples et efficaces reduit l'incidence de pneumonie associee a la ventilation mecanique].

Baxter AD, Allan J, Bedard J, et al. Can J Anaesth. 2005;52:535-541.

REVIEW

Systematic review: antimicrobial urinary catheters to prevent catheter-associated urinary tract infection in hospitalized patients.

Johnson JR, Kuskowski MA, Wilt TJ. Ann Intern Med. 2006;144:116-126.

COMMENTARY

PCA Overdose

Doyle DJ. AHRQ WebM&M [serial online]. July/August 2005.

STUDY

Error or "act of God"? A study of patients' and operating room team members' perceptions of error definition, reporting, and disclosure.

Espin S, Levinson W, Regehr G, Baker GR, Lingard L. Surgery. 2006;139:6-14.

STUDY

Safety of patients isolated for infection control.

Stelfox HT, Bates DW, Redelmeier DA. JAMA. 2003;290:1899-1905.

STUDY

Implementing and validating a comprehensive unit-based safety program.

Pronovost P, Weast B, Rosenstein B. J Patient Saf. 2005;1:33-40.

STUDY

Design and implementation of an ICU incident registry.

van der Veer S, Cornet R, de Jonge E. Int J Med Inform. 2007;76:103-108.

STUDY

Development of the ICU safety reporting system.

Wu AW, Holzmueller CG, Lubomski LH, et al. J Patient Saf. 2005;1:23-32.

STUDY

Safety Climate Survey: reliability of results from a multicenter ICU survey.

Kho ME, Carbone JM, Lucas J, Cook DJ. Qual Saf Health Care. 2005;14:273-278.

COMMENTARY

Deciphering the Code

Goldstein MK. AHRQ WebM&M [serial online]. Febuary 2006.

COMMENTARY

Teamwork and team training in the ICU: where do the similarities with aviation end?

Reader TW, Cuthbertson BH. Crit Care. 2011;15:313.

STUDY

Increased catheter-related bloodstream infection rates after the introduction of a new mechanical valve intravenous access port.

Maragakis LL, Bradley KL, Song X, et al. Infect Control Hosp Epidemiol. 2006;27:67-70.

REVIEW

Failure mode and effects analysis application to critical care medicine.

Duwe B, Fuchs BD, Hansen-Flaschen J. Crit Care Clin. 2005;21:21-30, vii.

STUDY

A system factors analysis of "line, tube, and drain" incidents in the intensive care unit.

Needham DM, Sinopoli DJ, Thompson DA, et al. Crit Care Med. 2005;33:1701-1707.

STUDY

Interruptive communication patterns in the intensive care unit ward round.

Alvarez G, Coiera E. Int J Med Inform. 2005;74:791-796.

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.

CLINICAL GUIDELINE

ACR White Paper on Magnetic Resonance (MR) Safety: Combined Papers of 2002 and 2004.

Kanal E, Borgstede JP, Barkovich AJ, et al; American College of Radiology. Reston, VA: ACR; 2004.

NEWSPAPER/MAGAZINE ARTICLE

Do no harm: promoting patient safety.

Ellis K. Surgicenteronline.com [serial online]. May 1, 2006.

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