AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (36)

•Diagnostic Errors (35)

•Identification Errors (37)

•Discontinuities, Gaps, and Hand-Off Problems (45)

•Fatigue and Sleep Deprivation (3)

•Medication Safety (165)

•Medical Complications (75)

•Nonsurgical Procedural Complications (10)

•Surgical Complications (86)

•Transfusion Complications (2)

•Psychological and Social Complications (28)

Origin/Sponsor

•Australia and New Zealand (7)

Resource Types

•Journal Article (77)

•Legislation/Regulation (11)

•Meeting/Conference (1)

•Newsletter/Journal (2)

•Newspaper/Magazine Article (249)

•Press Release/Announcement (20)

•Special or Theme Issue (1)

•Tools/Toolkit (23)

•Web Resource (67)

•Grant (3)

Error Types

•Epidemiology of Errors and Adverse Events (53)

•Active Errors (102)

•Latent Errors (53)

•Near Miss (1)

Approach to Improving Safety

•Quality Improvement Strategies (132)

•Legal and Policy Approaches (174)

•Error Reporting and Analysis (186)

•Communication Improvement (185)

•Human Factors Engineering (53)

•Teamwork (12)

•Specialization of Care (17)

•Logistical Approaches (18)

•Culture of Safety (63)

•Technologic Approaches (65)

•Education and Training (113)

Clinical Areas

•Allied Health Services (2)

•Medicine (310)

•Nursing (11)

•Pharmacy (71)

Target Audience
< All

Patients

Setting of Care

•Hospitals (294)

•Psychiatric Facilities (1)

•Residential Facilities (7)

•Ambulatory Care (56)

•Outpatient Surgery (9)

•Patient Transport (2)

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NEWSPAPER/MAGAZINE ARTICLE classic

Doctor’s orders killed cancer patient: Dana-Farber admits drug overdose caused death of Globe columnist, damage to second woman.

Knox RA. The Boston Globe. March 23, 1995; Metro/Region section: 1.

NEWSPAPER/MAGAZINE ARTICLE

How safe do patients feel?

Wolosin R, Vercler L, Matthews J. Patient Safety & Quality Healthcare. November/December 2005;2:40-44.

COMMENTARY

The Role of the Patient in Improving Patient Safety

Gibson R. AHRQ WebM&M [serial online]. March 2007.

COMMENTARY

Language Barrier

Flores G. AHRQ WebM&M [serial online]. April 2006.

BOOK/REPORT

2009 National Healthcare Quality Report.

Rockville, MD: Agency for Healthcare Research and Quality; March 2010. AHRQ Publication No. 10-0003.

NEWSPAPER/MAGAZINE ARTICLE

Standards, audits, and saying I'm sorry: an engineer's family proposes solutions.

Wojcieszak D. Patient Safety Qual Healthc. May/June 2005;2:6, 8-9.

BOOK/REPORT

National Priorities and Goals: Aligning Our Efforts to Transform America's Healthcare.

National Priorities Partnership. Washington, DC: National Quality Forum; 2008. ISBN: 1933875194.

STUDY

Pediatric medication safety and the media: what does the public see?

Stebbing C, Kaushal R, Bates DW. Pediatrics. 2006;117:1907-1914.

COMMENTARY

In Conversation with...Sorrel King

AHRQ WebM&M [serial online]. March 2007.

AUDIOVISUAL

Good News: How Hospitals Heal Themselves [documentary].

Washington, DC: CCM, Inc.; 2006. Crawford-Mason C (producer), Dobyns L (reporter); Management Wisdom Video Series.

AWARD RECIPIENT

2006 Quest for Quality Prize.

Runy LA. Hosp Health Netw. September 2006.

MULTI-USE WEBSITE

Mississippi Patient Safety Coalition.

385B Highland Colony Parkway, Suite 504, Ridgeland, MS 39157.

AUDIOVISUAL

Chasing Zero: Winning the War on Healthcare Harm.

Austin, TX: Texas Medical Institute for Technology and the Quaid Foundation; 2010.

COMMENTARY

Liability reform should make patients safer: "Avoidable classes of events" are a key improvement.

Bovbjerg RR, Tancredi LR. J Law Med Ethics. 2005;33:478-500.

COMMENTARY

Urine a Tough Position.

Gandhi TK. AHRQ WebM&M [serial online]. October 2003.

BOOK/REPORT classic

When Things Go Wrong: Responding to Adverse Events.

A Consensus Statement of the Harvard Hospitals. Burlington: Massachusetts Coalition for the Prevention of Medical Errors; 2006.

NEWSPAPER/MAGAZINE ARTICLE

Plan would compile, analyze medical errors.

Gaul GM. The Washington Post. July 29, 2005:A06.

GRANT RECIPIENT

Improving Patient Safety Through Simulation Research.

Rockville, MD: Agency for Healthcare Research and Quality; June 2008.

PRESS RELEASE/ANNOUNCEMENT

Governor signs Executive Order creating new Division of Patient Safety.

Evanston, IL: Office of the Governor; July 13, 2006.

NEWSPAPER/MAGAZINE ARTICLE

Survive your doctor.

Holt TE. Men's Health. November 3, 2006.

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