AHRQ Patient Safety Network

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•Device-related Complications (3)

•Diagnostic Errors (2)

•Identification Errors (2)

•Discontinuities, Gaps, and Hand-Off Problems (2)

•Medication Safety (13)

•Medical Complications (7)

•Nonsurgical Procedural Complications (1)

•Surgical Complications (1)

•Transfusion Complications (13)

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•Epidemiology of Errors and Adverse Events (12)

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Approach to Improving Safety

•Quality Improvement Strategies (10)

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Hematology

Target Audience

•Health Care Providers (22)

•Health Care Executives and Administrators (26)

•Non-Health Care Professionals (9)

•Patients (2)

Setting of Care

•Hospitals (22)

•Ambulatory Care (3)

1 - 20 of 35

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NEWSPAPER/MAGAZINE ARTICLE

Heparin: improving treatment and reducing risk of harm.

Daner WE, Gosselin RC, Raschke R, Vanderveen T. Patient Saf Qual Healthcare. January/February 2009;6:20-25.

COMMENTARY

Dealing honestly with an honest mistake.

Liang NL, Herring ME, Bush RL. J Vasc Surg. 2010;51:494-495.

STUDY

Novel analysis of clinically relevant diagnostic errors in point-of-care devices.

Shermock KM, Streiff MB, Pinto BL, Kraus P, Pronovost PJ. J Thromb Haemost. 2011;9:1769-1775.

STUDY

Error in body weight estimation leads to inadequate parenteral anticoagulation.

Dos Reis Macedo LG, de Oliveira L, Pintão MC, Garcia AA, Pazin-Filho A. Am J Emerg Med. 2011;29:613-617.

STUDY

Clinical and safety impact of an inpatient pharmacist-directed anticoagulation service.

Schillig J, Kaatz S, Hudson M, Krol GD, Szandzik EG, Kalus JS. J Hosp Med. 2011;6:322-328.

STUDY

Mislabeled units of umbilical cord blood detected by a quality assurance program at the transplantation center.

McCullough J, McKenna D, Kadidlo D, et al. Blood. 2009:114:1684-1688.

COMMENTARY

Preventable errors in organ transplantation: an emerging patient safety issue?

Ison MG, Holl JL, Ladner D. Am J Transplant. 2012;12:2307-2312.

STUDY

Increasing patient safety and efficiency in transfusion therapy using formal process definitions.

Henneman EA, Avrunin GS, Clarke LA, et al. Transfus Med Rev. 2007;21:49-57.

STUDY

Challenges and opportunities to prevent transfusion errors: a Qualitative Evaluation for Safer Transfusion (QUEST).

Heddle NM, Fung M, Hervig T, et al; BEST Collaborative. Transfusion. 2012;52:1687-1695.

COMMENTARY

Preparing your hospital for compliance with The Joint Commission's National Patient Safety Goals.

Murdaugh L, Jordin R. Hosp Pharm. 2008;43:728-733.

STUDY

Medication errors in the homes of children with chronic conditions.

Walsh KE, Mazor KM, Stille CJ, et al. Arch Dis Child. 2011;96:581-586.

STUDY

Medication-error alerts for warfarin orders detected by a bar-code-assisted medication administration system.

Fitzhenry F, Doran J, Lobo B, et al. Am J Health Syst Pharm. 2011;68:434-441.

STUDY

Patient reported receipt of medication instructions for warfarin is associated with reduced risk of serious bleeding events.

Metlay JP, Hennessy S, Localio AR, et al. J Gen Intern Med. 2008;23:1589-1594.

STUDY

Diagnostic blood loss from phlebotomy and hospital-acquired anemia during acute myocardial infarction.

Salisbury AC, Reid KJ, Alexander KP, et al. Arch Intern Med. 2011;171:1646-1653.

STUDY

Harmful medication errors involving unfractionated and low-molecular-weight heparin in three patient safety reporting programs.

Grissinger MC, Hicks RW, Keroack MA, Marella WM, Vaida A. Jt Comm J Qual Patient Saf. 2010;36:195-202.

COMMENTARY

New technology for transfusion safety.

Dzik WH. Br J Haematol. 2007;136:181-90.

STUDY

Venous thromboembolism after trauma: a never event?

Thorson CM, Ryan ML, Van Haren RM, et al. Crit Care Med. 2012;40:2967-2973.

STUDY

The importance of leadership in preventing healthcare–associated infection: results of a multisite qualitative study.

Saint S, Kowalski CP, Banaszak-Holl J, Forman J, Damschroder L, Krein SL. Infect Control Hosp Epidemiol. 2010;31:901-907.

STUDY

Evidence-based red cell transfusion in the critically ill: quality improvement using computerized physician order entry.

Rana R, Afessa B, Keegan MT, et al; Transfusion in the ICU Interest Group. Crit Care Med. 2006;34:1892-1897.

COMMENTARY

Root cause analysis of transfusion error: identifying causes to implement changes.

Elhence P, Veena S, Sharma RK, Chaudhary RK. Transfusion. 2010;50:2772-2777.

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