AHRQ Patient Safety Network

The Collection > Nurses

PATIENT SAFETY PRIMERS
Nursing and Patient Safety

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Safety Target

•Device-related Complications (42)

•Diagnostic Errors (8)

•Identification Errors (26)

•Discontinuities, Gaps, and Hand-Off Problems (93)

•Fatigue and Sleep Deprivation (17)

•Medication Safety (302)

•Medical Complications (75)

•Nonsurgical Procedural Complications (16)

•Surgical Complications (107)

•Transfusion Complications (3)

•Psychological and Social Complications (19)

Origin/Sponsor

•Asia (13)

•Australia and New Zealand (17)

•Central and South America (1)

Resource Types

•Clinical Guideline (5)

•Journal Article (670)

•Legislation/Regulation (13)

•Meeting/Conference (2)

•Newsletter/Journal (3)

•Newspaper/Magazine Article (64)

•Press Release/Announcement (8)

•Special or Theme Issue (14)

•Tools/Toolkit (15)

•Web Resource (11)

Error Types

•Epidemiology of Errors and Adverse Events (120)

•Active Errors (102)

•Latent Errors (46)

•Near Miss (16)

Approach to Improving Safety

•Quality Improvement Strategies (223)

•Legal and Policy Approaches (29)

•Error Reporting and Analysis (176)

•Communication Improvement (200)

•Human Factors Engineering (108)

•Teamwork (96)

•Specialization of Care (43)

•Logistical Approaches (93)

•Culture of Safety (132)

•Technologic Approaches (113)

•Education and Training (156)

Clinical Areas

•Allied Health Services (2)

•Medicine (463)

•Nursing (425)

•Pharmacy (68)

Target Audience
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Nurses

Setting of Care

•Hospitals (521)

•Psychiatric Facilities (2)

•Residential Facilities (14)

•Ambulatory Care (35)

•Outpatient Surgery (3)

•Patient Transport (3)

1 - 20 of 826

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NEWSPAPER/MAGAZINE ARTICLE

Wrong-site surgery.

Butcher L. Hosp Health Netw. November 2011.

NEWSPAPER/MAGAZINE ARTICLE

'Wrong site' surgeries on the rise.

Davis R. USA Today. April 17, 2006.

NEWSPAPER/MAGAZINE ARTICLE

Lights. Camera. Robot Action!

Shute N. U.S. News & World Report. January 23, 2006;140:62-63.

COMMENTARY

Surgical site verification: A through Z.

Dunn D. J Perianesth Nurs. 2006;21:317-328.

STUDY

Error, stress, and teamwork in medicine and aviation: cross sectional surveys.

Sexton JB, Thomas EJ, Helmreich RL. BMJ. 2000;320:745-749.

ORGANIZATIONAL POLICY/GUIDELINES classic

Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery.

The Joint Commission.

COMMENTARY

Implementing the World Health Organization surgical safety checklist: a model for future perioperative initiatives.

Styer KA, Ashley SW, Schmidt S, Zive EM, Eappen S. AORN J. 2011;94:590-598.

STUDY

From the flight deck to the operating room: an initial pilot study of the feasibility and potential impact of true interdisciplinary team training using high-fidelity simulation.

Paige J, Kozmenko V, Morgan B, et al. J Surg Educ. 2007;64:369-377.

BOOK/REPORT

Recommendations for Safe Use of Insulin in Hospitals.

Bethesda, MD: American Society of Health-System Pharmacists; 2006.

ORGANIZATIONAL POLICY/GUIDELINES

ACOG Committee Opinion #464: patient safety in the surgical environment.

ACOG Committee on Patient Safety and Quality Improvement. Obstet Gynecol. 2010;116:786-790.

STUDY

Operating room briefings and wrong-site surgery.

Makary MA, Mukherjee A, Sexton BJ, et al. J Am Coll Surg. 2007;204:236-243.

NEWSPAPER/MAGAZINE ARTICLE

Safety in ASCs: putting patients first.

Dix K. Today's Surgicenter. December 1, 2006.

MULTI-USE WEBSITE

National Time Out Day.

AORN Patient Safety First.

COMMENTARY

On the quest for Six Sigma.

Moorman DW. Am J Surg. 2005;189:253-258.

ORGANIZATIONAL POLICY/GUIDELINES

Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society.

Chow WB, Rosenthal RA, Merkow RP, Ko CY, Esnaola NF. J Am Coll Surg. 2012;215:453-466.

COMMENTARY

Surgical count practice variability and the potential for retained surgical items.

Edel EM. AORN J. 2012;95:228-238.

STUDY

Bridging the communication gap in the operating room with medical team training.

Awad SS, Fagan SP, Bellows C, et al. Am J Surg. 2005;190:770-774.

COMMENTARY

Creating high reliability in health care organizations.

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

STUDY

Rules and guidelines in clinical practice: a qualitative study in operating theatres of doctors' and nurses' views.

McDonald R, Waring J, Harrison S, Walshe K, Boaden R. Qual Saf Health Care. 2005;14:290-294.

STUDY

Discovering healthcare cognition: the use of cognitive artifacts to reveal cognitive work.

Nemeth C, O’Connor M, Klock PA, Cook R. Org Stud. 2006;27:1011-1035.

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