AHRQ Patient Safety Network

The Collection > Nurses

PATIENT SAFETY PRIMERS
Nursing and Patient Safety

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Safety Target

•Device-related Complications (49)

•Diagnostic Errors (8)

•Identification Errors (29)

•Discontinuities, Gaps, and Hand-Off Problems (102)

•Fatigue and Sleep Deprivation (19)

•Medication Safety (343)

•Medical Complications (78)

•Nonsurgical Procedural Complications (17)

•Surgical Complications (102)

•Transfusion Complications (2)

•Psychological and Social Complications (21)

Origin/Sponsor

•Asia (26)

•Australia and New Zealand (35)

•Central and South America (3)

Resource Types

•Clinical Guideline (5)

•Journal Article (741)

•Legislation/Regulation (14)

•Meeting/Conference (2)

•Newsletter/Journal (3)

•Newspaper/Magazine Article (68)

•Press Release/Announcement (8)

•Special or Theme Issue (13)

•Tools/Toolkit (15)

•Web Resource (11)

Error Types

•Epidemiology of Errors and Adverse Events (141)

•Active Errors (120)

•Latent Errors (54)

•Near Miss (22)

Approach to Improving Safety

•Quality Improvement Strategies (230)

•Legal and Policy Approaches (33)

•Error Reporting and Analysis (192)

•Communication Improvement (220)

•Human Factors Engineering (123)

•Teamwork (100)

•Specialization of Care (44)

•Logistical Approaches (103)

•Culture of Safety (120)

•Technologic Approaches (132)

•Education and Training (167)

Clinical Areas

•Allied Health Services (2)

•Medicine (486)

•Nursing (489)

•Pharmacy (77)

Target Audience
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Nurses

Setting of Care

•Hospitals (582)

•Psychiatric Facilities (6)

•Residential Facilities (19)

•Ambulatory Care (39)

•Outpatient Surgery (4)

•Patient Transport (4)

1 - 20 of 901

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COMMENTARY

Medication reconciliation in acute care: ensuring an accurate drug regimen on admission and discharge.

Rodehaver C. Jt Comm J Qual Patient Saf. 2005;31:406-413.

STUDY

ASHP national survey of pharmacy practice in hospital settings: dispensing and administration—2011.

Pedersen CA, Schneider PJ, Scheckelhoff DJ. Am J Health Syst Pharm. 2012;69:768-785.

STUDY

Errors associated with medications removed from automated dispensing machines using override functions.

Kester K, Baxter J, Freudenthal K. Hosp Pharm. 2006;41:535-537.

NEWSPAPER/MAGAZINE ARTICLE

What pilots can teach hospitals about patient safety.

Murphy K. New York Times. October 31, 2006:F5.

COMMENTARY

Citrate Mix-Up

Weber RJ. AHRQ WebM&M [serial online]. May 2006.

NEWSPAPER/MAGAZINE ARTICLE

Promethazine conundrum: IV can hurt more than IM injection!

ISMP Medication Safety Alert! Acute Care Edition. November 2, 2006;11:1-3.

STUDY

Detection, classification, and correction of defective chemotherapy orders through nursing and pharmacy oversight.

Mertens WC, Brown DE, Parisi R, et al. J Patient Saf. 2008;4:195-200.

NEWSPAPER/MAGAZINE ARTICLE

Don't underestimate the impact of change on risk potential.

ISMP Medication Safety Alert! Acute Care Edition. September 11, 2008;13:1-3.

STUDY

Use of a standardized protocol to decrease medication errors and adverse events related to sliding scale insulin.

Donihi AC, DiNardo MM, DeVita MA, Korytkowski MT. Qual Saf Health Care. 2006;15:89-91.

STUDY

Adverse drug events in hospitalized cardiac patients.

Fanikos J, Cina JL, Baroletti S, Fiumara K, Matta L, Goldhaber SZ. Am J Cardiol. 2007;100:1465-1469.

STUDY

High rates of adverse drug events in a highly computerized hospital.

Nebeker JR, Hoffman JM, Weir CR, Bennett CL, Hurdle JF. Arch Intern Med. 2005;165:1111-1116.

COMMENTARY

ISMP medication error report analysis.

Cohen MR. Hosp Pharm. 2005;40:556-557.

NEWSPAPER/MAGAZINE ARTICLE

Guidelines for timely medication administration: response to the CMS "30-minute rule."

ISMP Medication Safety Alert! Acute Care Edition. January 13, 2011;16:1-4.

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.

STUDY

Assessing and monitoring override medications in automated dispensing devices.

Kowiatek JG, Weber RJ, Skledar SJ, Frank S, DeVita M. Jt Comm J Qual Patient Saf. 2006;32:309-317.

STUDY

Potentially inappropriate prescribing in elderly veterans: are we using the wrong drug, wrong dose, or wrong duration?

Pugh MJ, Fincke BG, Bierman AS, et al. J Am Geriatr Soc. 2005;53:1282-1289.

NEWSPAPER/MAGAZINE ARTICLE

"Near injury" alters procedures at Virginia Mason.

Ostrom CM. The Seattle Times. May 21, 2005.

STUDY

Emergency department visits for outpatient adverse drug events: demonstration for a national surveillance system.

Budnitz DS, Pollock DA, Mendelsohn AB, Weidenbach KN, McDonald AK, Annest JL. Ann Emerg Med. 2005;45:197-206.

COMMENTARY

Surprise Wire

Pearl JM, Donaldson NE. AHRQ WebM&M [serial online]. July/August 2005.

AUDIOVISUAL

Preventing fatal heparin overdoses.

Food and Drug Administration (FDA) Patient Safety News. Show #58. December 2006.

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