AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (42)

•Diagnostic Errors (65)

•Identification Errors (33)

•Discontinuities, Gaps, and Hand-Off Problems (83)

•Fatigue and Sleep Deprivation (44)

•Medication Safety (249)

•Medical Complications (56)

•Nonsurgical Procedural Complications (31)

•Surgical Complications (115)

•Transfusion Complications (6)

•Psychological and Social Complications (24)

Origin/Sponsor

•Australia and New Zealand (24)

•Central and South America (1)

•Europe (106)

•North America (612)

Resource Types

•Audiovisual (7)

•Book/Report (28)

•Journal Article (653)

•Legislation/Regulation (9)

•Meeting/Conference (2)

•Newsletter/Journal (2)

•Newspaper/Magazine Article (65)

•Press Release/Announcement (9)

•Special or Theme Issue (5)

•Tools/Toolkit (6)

•Web Resource (7)

Error Types

•Epidemiology of Errors and Adverse Events (300)

•Active Errors (144)

•Latent Errors (44)

•Near Miss (24)

Approach to Improving Safety

•Quality Improvement Strategies (175)

•Legal and Policy Approaches (96)

•Error Reporting and Analysis (351)

•Communication Improvement (145)

•Human Factors Engineering (112)

•Teamwork (37)

•Specialization of Care (32)

•Logistical Approaches (72)

•Culture of Safety (59)

•Technologic Approaches (121)

•Education and Training (101)

Clinical Areas

•Allied Health Services (2)

•Medicine (539)

•Nursing (43)

•Pharmacy (81)

Target Audience
< All

Risk Managers

Setting of Care

•Hospitals (438)

•Psychiatric Facilities (4)

•Residential Facilities (12)

•Ambulatory Care (50)

•Outpatient Surgery (11)

•Patient Transport (8)

1 - 20 of 795

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STUDY

Wrong-side/wrong-site, wrong-procedure, and wrong-patient adverse events: are they preventable?

Seiden SC, Barach P. Arch Surg. 2006;141:931-939.

NEWSPAPER/MAGAZINE ARTICLE

A case that shook medicine.

Lerner BH. The Washington Post. November 28, 2006:HE01.

STUDY

National surveillance of emergency department visits for outpatient adverse drug events.

Budnitz DS, Pollock DA, Weidenbach KN, et al. JAMA. 2006;296:1858-1866.

STUDY

classic

Medication errors and adverse drug events in pediatric inpatients.

Kaushal R, Bates DW, Landrigan C, et al. JAMA. 2001;285:2114-2120.

FACT SHEET/FAQS

Medication safety issue brief. Counterfeit drug prevention and identification.

American Hospital Association, American Society of Health-System Pharmacists, Hospitals and Health Networks. Hosp Health Netw. August 2005;79.29-30.

STUDY

Comparison and interpretation of urinalysis performed by a nephrologist versus a hospital-based clinical laboratory.

Tsai JJ, Yeun JY, Kumar VA, Don BR. Am J Kidney Dis. 2005;46:820-829.

REVIEW

Epidemiology of medication-related adverse events in nursing homes.

Handler SM, Wright RM, Ruby CM, Hanlon JT. Am J Geriatr Pharmacother. 2006;4:264-272.

STUDY

Risk of medication errors at hospital discharge and barriers to problem resolution.

Enguidanos SM, Brumley RD. Home Health Care Serv Q. 2005;24:123-135.

ORGANIZATIONAL POLICY/GUIDELINES

Preventing adverse events caused by emergency electrical power system failures.

Sentinel Event Alert. September 6, 2006;(37):1-3.

STUDY

Patient safety in the clinical laboratory: a longitudinal analysis of specimen identification errors.

Wagar EA, Tamashiro L, Yasin B, Hilborne L, Bruckner DA. Arch Pathol Lab Med. 2006;130:1662-1668.

STUDY

Effectiveness of a community collaborative for eliminating the use of high-risk abbreviations written by physicians.

Leonhardt KK, Botticelli J. J Patient Saf. 2006;2:147-153.

STUDY

Risk factors for adverse drug events: a 10-year analysis.

Evans RS, Lloyd JF, Stoddard GJ, Nebeker JR, Samore MH. Ann Pharmacother. 2005;39:1161-1168.

STUDY

An examination of technical efficiency, quality, and patient safety in acute care nursing units.

Mark B, Jones C, Lindley L, Ozcan Y. Policy Polit Nurs Pract. 2009;10:180-186.

STUDY

Medication errors and patient complications with continuous renal replacement therapy.

Barletta JF, Barletta GM, Brophy PD, Maxvold NJ, Hackbarth RM, Bunchman TE. Pediatr Nephrol. 2006;21:842-845.

MULTI-USE WEBSITE

Surgical Care Improvement Project.

National SCIP Partnership, Oklahoma Foundation for Medical Quality, 14000 Quail Springs Parkway, Suite 400, Oklahoma City, OK, 73134.

STUDY

Effects of technological interventions on the safety of a medication-use system.

Skibinski KA, White BA, Lin LI, Dong Y, Wu W. Am J Health Syst Pharm. 2007;64:90-96.

STUDY

Assessment of adverse drug events among patients in a tertiary care medical center.

Johnston PE, France DJ, Byrne DW, et al. Am J Health Syst Pharm. 2006;63:2218-2227.

COMMENTARY

The Wet Read

Arenson RL. AHRQ WebM&M [serial online]. March 2006.

STUDY

Critical care delivery in the United States: distribution of services and compliance with Leapfrog recommendations.

Angus DC, Shorr AF, White A, Dremsizov TT, Schmitz RJ, Kelley MA, on behalf of the Committee on Manpower for Pulmonary and Critical Care Societies (COMPACCS). Crit Care Med. 2006;34:1016-1024.

STUDY

Adverse drug events in the outpatient setting: an 11-year national analysis.

Bourgeois FT, Shannon MW, Valim C, Mandl KD. Pharmacoepidemiol Drug Saf. 2010;19:901-910.

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