AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (62)

•Diagnostic Errors (3)

•Identification Errors (4)

•Discontinuities, Gaps, and Hand-Off Problems (3)

•Fatigue and Sleep Deprivation (1)

•Medication Safety (38)

•Medical Complications (9)

•Nonsurgical Procedural Complications (11)

•Surgical Complications (12)

•Psychological and Social Complications (2)

Origin/Sponsor

•Australia and New Zealand (3)

•North America (136)

Resource Types

•Audiovisual (4)

•Book/Report (10)

•Journal Article (102)

•Legislation/Regulation (5)

•Meeting/Conference (2)

•Newspaper/Magazine Article (28)

•Press Release/Announcement (3)

•Special or Theme Issue (5)

•Web Resource (3)

Error Types

•Epidemiology of Errors and Adverse Events (23)

•Active Errors (23)

•Latent Errors (30)

•Near Miss (1)

Approach to Improving Safety

•Quality Improvement Strategies (26)

•Legal and Policy Approaches (5)

•Error Reporting and Analysis (32)

•Communication Improvement (8)

•Human Factors Engineering (123)

•Teamwork (5)

•Specialization of Care (4)

•Logistical Approaches (12)

•Culture of Safety (13)

•Technologic Approaches (45)

•Education and Training (19)

Clinical Areas

•Allied Health Services (2)

•Medicine (100)

•Pharmacy (6)

Target Audience
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Engineers

Setting of Care

•Hospitals (93)

•Residential Facilities (2)

•Ambulatory Care (11)

•Outpatient Surgery (2)

•Patient Transport (1)

1 - 20 of 162

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AUDIOVISUAL

Software glitches pose new, potentially dangerous problems for medical devices.

Kennedy D. "iHealthBeat." California Healthcare Foundation. July 25, 2008.

COMMENTARY

Smart pumps: advanced capabilities and continuous quality improvement.

Vanderveen T. Patient Saf Quality Healthc. January/February 2007.

NEWSPAPER/MAGAZINE ARTICLE

FDA discusses oversight, regulation of HIT at ONC Workgroup hearing on patient safety.

Health IT Law & Industry Report; February 26, 2010.

NEWSPAPER/MAGAZINE ARTICLE

Medication errors: a year in review.

Institute for Safe Medication Practices. Pharmacy Practice News. October 2011:7-14.

NEWSPAPER/MAGAZINE ARTICLE

Ensuring patient safety in wireless medical device networks.

Gehlot V, Sloane EB. Computer. April 2006;39:54-60.

NEWSPAPER/MAGAZINE ARTICLE

Preventing catheter/tubing misconnections: much needed help is on the way.

ISMP Medication Safety Alert! Acute Care Edition. July 15, 2010;15:1-2.

STUDY

classic

Evaluation of consistency in dosing directions and measuring devices for pediatric nonprescription liquid medications.

Yin HS, Wolf MS, Dreyer BP, Sanders LM, Parker RM. JAMA. 2010;304:2595-2602.

COMMENTARY

Risks related to patient bed safety.

Sharkey JE, Van Leuven K, Radovich P. J Nurs Care Qual. 2012;27:346-351.

AUDIOVISUAL

Notre Dame students design to save lives.

McFadden M. WNDU. February 21, 2012.

STUDY

Predictive combinations of monitor alarms preceding in-hospital code blue events.

Hu X, Sapo M, Nenov V, et al. J Biomed Inform. 2012;45:913-921.

NEWSPAPER/MAGAZINE ARTICLE

Latest heparin fatality speaks loudly—what have you done to stop the bleeding?

ISMP Medication Safety Alert! April 8, 2010;15:1-3.

COMMENTARY

Preventing medication errors in hospitals through a systems approach and technological innovation: a prescription for 2010.

Crane J, Crane FG. Hosp Top. Fall 2006;84:3-8.

COMMENTARY

IV medication safety software implementation in a multihospital health system.

Cassano AT. Hosp Pharm. 2006;41:151-156.

COMMENTARY

Framework for patient safety—part 1 and part 2.

Blouin AS, McDonagh KJ. J Nurs Adm. 2011;41:397-400, 450-452.

COMMENTARY

Latency of ECG displays of hospital telemetry systems: a science advisory from the American Heart Association.

Turakhia MP, Estes NA 3rd, Drew BJ, et al; Electrocardiography and Arrhythmias Committee of the American Heart Association Council on Clinical Cardiology and Council on Cardiovascular Nursing. Circulation. 2012;126:1665-1669.

STUDY

Enhancing patient safety with intelligent intravenous infusion devices: experience in a specialty cardiac hospital.

Wood JL, Burnette JS. Heart Lung. 2012;41:173-176.

COMMENTARY

MRI suites: safety outside the bore.

Gilk T. Patient Saf Qual Healthc. September/October 2006;3:16-18, 20-21.

STUDY

Recalls and safety alerts affecting automated external defibrillators.

Shah JS, Maisel WH. JAMA. 2006;296:655-660.

STUDY

Usability study of two common defibrillators reveals hazards.

Fairbanks RJ, Caplan SH, Bishop PA, Marks AM, Shah MN. Ann Emerg Med. 2007;50:424-432.

COMMENTARY

Smart pumps: implications for nurse leaders.

Kirkbride G, Vermace B. Nurs Adm Q. 2011;35:110-118.

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