AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (2)

•Diagnostic Errors (12)

•Identification Errors (2)

•Discontinuities, Gaps, and Hand-Off Problems (44)

•Medication Safety (129)

•Medical Complications (25)

•Surgical Complications (6)

•Transfusion Complications (1)

•Psychological and Social Complications (7)

Origin/Sponsor

•Australia and New Zealand (5)

•North America (155)

Resource Types

•Audiovisual (1)

•Book/Report (6)

•Clinical Guideline (2)

•Journal Article (183)

•Legislation/Regulation (1)

•Meeting/Conference (1)

•Newspaper/Magazine Article (10)

•Special or Theme Issue (2)

•Tools/Toolkit (3)

•Web Resource (2)

Error Types

•Epidemiology of Errors and Adverse Events (90)

•Active Errors (36)

•Latent Errors (15)

•Near Miss (3)

Approach to Improving Safety

•Quality Improvement Strategies (45)

•Legal and Policy Approaches (16)

•Error Reporting and Analysis (46)

•Communication Improvement (71)

•Human Factors Engineering (13)

•Teamwork (4)

•Specialization of Care (13)

•Logistical Approaches (10)

•Culture of Safety (24)

•Technologic Approaches (40)

•Education and Training (36)

Clinical Areas
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Geriatrics

Target Audience

•Health Care Providers (164)

•Health Care Executives and Administrators (140)

•Non-Health Care Professionals (45)

•Patients (9)

Setting of Care

•Hospitals (86)

•Psychiatric Facilities (3)

•Residential Facilities (79)

•Ambulatory Care (50)

•Patient Transport (1)

1 - 20 of 214

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STUDY

Effects of an enhanced discharge planning intervention for hospitalized older adults: a randomized trial.

Altfeld SJ, Shier GE, Rooney M, et al. Gerontologist. 2012 Sep 7; [Epub ahead of print].

STUDY

Adverse drug events resulting from patient errors in older adults.

Field TS, Mazor KM, Briesacher B, Debellis KR, Gurwitz JH. J Am Geriatr Soc. 2007;55:271-276.

STUDY

In-home medication reviews: a novel approach to improving patient care through coordination of care.

Willis JS, Hoy RH, Jenkins WD. J Community Health. 2011;36:1027-1031.

STUDY

Older patients' perceptions of "unnecessary" tests and referrals: a national survey of Medicare beneficiaries.

Herndon MB, Schwartz LM, Woloshin S, et al. J Gen Intern Med. 2008;23:1547-1554.

STUDY

Physician patient communication failure facilitates medication errors in older polymedicated patients with multiple comorbidities.

Mira JJ, Orozco-Beltrán D, Pérez-Jover V, et al. Fam Pract. 2013;30:56-63.

STUDY

Educating seniors to be patient safety self-advocates in primary care.

Elder NC, Regan SL, Pallerla H, Levin L, Post DM, Cegala DJ. J Patient Saf. 2008;4:106-112.

CLINICAL GUIDELINE

Primary care–relevant interventions to prevent falling in older adults: a systematic evidence review for the U.S. Preventive Services Task Force.

Michael YL, Whitlock EP, Lin JS, Fu R, O'Connor EA, Gold R; US Preventive Services Task Force. Ann Intern Med. 2010;153:815-825.

STUDY

Clinical outcomes from the use of Medication Report when elderly patients are discharged from hospital.

Midlöv P, Deierborg E, Holmdahl L, Höglund P, Eriksson T. Pharm World Sci. 2008;30:840-845.

NEWSPAPER/MAGAZINE ARTICLE

Why doctors make mistakes.

Groopman J. AARP Magazine. September/October 2008.

AUDIOVISUAL

Healthcare 411: Making hospital discharges safer for seniors.

Rockville, MD: Agency for Healthcare Research and Quality. June 3, 2009.

STUDY

classic

Fall prevention in acute care hospitals: a randomized trial.

Dykes PC, Carroll DL, Hurley A, et al. JAMA. 2010;304:1912-1918.

STUDY

Consistency between coded poison center data and fatality abstract narratives for therapeutic error deaths in older adults.

Hayes BD, Klein-Schwartz W. Clin Toxicol (Phila). 2010;48:68-71.

STUDY

Inappropriate medication use in the elderly: results from a quality improvement project in 99 primary care practices.

Wessell AM, Nietert PJ, Jenkins RG, Nemeth LS, Ornstein SM. Am J Geriatr Pharmacother. 2008;6:21-27.

COMMENTARY

Global priorities for patient safety research.

Bates DW, Larizgoitia I, Prasopa-Plaizier N, Jha AK; Research Priority Setting Working Group of the WHO World Alliance for Patient Safety. BMJ. 2009;338:b1775.

STUDY

Older patients' understanding of emergency department discharge information and its relationship with adverse outcomes.

Hastings SN, Barrett A, Weinberger M, et al. J Patient Saf. 2011;7:19-25.

NEWSPAPER/MAGAZINE ARTICLE

Nursing homes seen deficient on basic care.

Dembner A. Boston Globe. July 3, 2006;Health Science section:A1.

STUDY

Failure to engage hospitalized elderly patients and their families in advance care planning.

Heyland DK, Barwich D, Pichora D, et al; ACCEPT (Advance Care Planning Evaluation in Elderly Patients) Study Team; Canadian Researchers at the End of Life Network (CARENET). JAMA Intern Med. 2013 Apr 1; [Epub ahead of print].

STUDY

Do older patients' perceptions of safety highlight barriers that could make their care safer during organisational care transfers?

Scott J, Dawson P, Jones D. BMJ Qual Saf. 2012;22:112-117.

STUDY

Polypharmacy in hospitalized older adult cancer patients: experience from a prospective, observational study of an oncology-acute care for elders unit.

Flood KL, Carroll MB, Le CV, Brown CJ. Am J Geriatr Pharmacother. 2009;7:151-158.

STUDY

Patient education to prevent falls among older hospital inpatients: a randomized controlled trial.

Haines TP, Hill A-M, Hill KD, et al. Arch Intern Med. 2011;171:516-524.

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