AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (24)

•Diagnostic Errors (5)

•Identification Errors (15)

•Discontinuities, Gaps, and Hand-Off Problems (63)

•Fatigue and Sleep Deprivation (23)

•Medication Safety (244)

•Medical Complications (75)

•Nonsurgical Procedural Complications (13)

•Surgical Complications (70)

•Transfusion Complications (1)

•Psychological and Social Complications (38)

Origin/Sponsor

•Asia (20)

•Australia and New Zealand (34)

•Central and South America (1)

Resource Types

•Clinical Guideline (2)

•Journal Article (604)

•Legislation/Regulation (6)

•Meeting/Conference (3)

•Newsletter/Journal (1)

•Newspaper/Magazine Article (39)

•Press Release/Announcement (1)

•Special or Theme Issue (19)

•Tools/Toolkit (5)

•Web Resource (6)

•Grant (1)

Error Types

•Epidemiology of Errors and Adverse Events (115)

•Active Errors (108)

•Latent Errors (57)

•Near Miss (23)

Approach to Improving Safety

•Quality Improvement Strategies (128)

•Legal and Policy Approaches (36)

•Error Reporting and Analysis (153)

•Communication Improvement (160)

•Human Factors Engineering (98)

•Teamwork (89)

•Specialization of Care (35)

•Logistical Approaches (117)

•Culture of Safety (124)

•Technologic Approaches (90)

•Education and Training (179)

Clinical Areas
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Nursing

•Medical/Surgical/Psychiatric Nursing (95)

•Critical Care Nursing (79)

•Anesthesia Nursing (17)

•Obstetrical Nursing (10)

•Emergency Nursing (28)

•Home Nursing (14)

Target Audience

•Health Care Providers (617)

•Health Care Executives and Administrators (633)

•Non-Health Care Professionals (226)

•Patients (14)

Setting of Care

•Hospitals (458)

•Psychiatric Facilities (6)

•Residential Facilities (19)

•Ambulatory Care (34)

•Outpatient Surgery (6)

•Patient Transport (2)

1 - 20 of 706

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STUDY

Causes of near misses: perceptions of perioperative nurses.

Cohoon B. AORN J. 2011;93:551-565.

STUDY

Achieving quality improvement in the nursing home: influence of nursing leadership on communication and teamwork.

Vogelsmeier A, Scott-Cawiezell J. J Nurs Care Qual. 2011;26:236-242.

COMMENTARY

"Managing up" can improve teamwork in the OR.

Smith SL. AORN J. 2010;91:576-582.

STUDY

Nurses' and nursing assistants' perceptions of patient safety culture in nursing homes.

Hughes CM, Lapane KL. Int J Qual Health Care. 2006;18:281-286.

COMMENTARY

A common body of care: the ethics and politics of teamwork in the operating theater are inseparable.

Bleakley A. J Med Philos. 2006;31:305-322.

COMMENTARY

Safety huddles in the PACU: when a patient self-medicates.

Setaro J, Connolly M. J Perianesth Nurs. 2011;26:96-102.

ORGANIZATIONAL POLICY/GUIDELINES

AORN guidance statement: creating a patient safety culture.

AORN J. 2006;83:936-942.

STUDY

Nurse and nurse assistant perceptions of missed nursing care: what does it tell us about teamwork?

Kalisch BJ. J Nurs Adm. 2009;39:485-493.

REVIEW

The Nurse's Role in Promoting a Culture of Patient Safety.

Friesen MA, Farquhar MB, Hughes R. American Nurses Association (ANA) Continuing Education, Center for American Nurses; 2005.

MEETING/CONFERENCE PROCEEDINGS

Safety in the NICU: preventing medical errors.

Stokowski LA. Highlights of the National Association of Neonatal Nurses 22nd Annual Conference [Medscape.com]. March 8, 2007.

COMMENTARY

On the scene at Children's Hospitals and Clinics of Minnesota.

Malone G, Akre M, Hauck M. Nurs Adm Q. 2009;33:54-61.

STUDY

Interruptions and miscommunications in surgery: an observational study.

Gillespie BM, Chaboyer W, Fairweather N. AORN J. 2012;95:576-590.

MULTI-USE WEBSITE

National Time Out Day.

AORN Patient Safety First. June 12, 2013.

STUDY

Discharge rounds in the 80-hour workweek: importance of the trauma nurse practitioner.

Haan JM, Dutton RP, Willis M, Leone S, Kramer ME, Scalea TM. J Trauma. 2007;63:339-343.

COMMENTARY

A team training program using human factors to enhance patient safety.

Marshall DA, Manus DA. AORN J. 2007;86:994-1011.

BOOK/REPORT

Silence Kills: The Seven Crucial Conversations for Healthcare.

Maxfield D, Grenny J, McMillan R, Patterson K, Switzler A. VitalSmarts; 2005.E45

STUDY

A relational leadership perspective on unit-level safety climate.

Thompson DN, Hoffman LA, Sereika SM, et al. J Nurs Adm. 2011;41:479-487.

COMMENTARY

Creating a culture of safety by using checklists.

Huang L, Kim R, Berry W. AORN J. 2013;97:365-368.

REVIEW

Keeping patients safe in healthcare organizations: a structuration theory of safety culture.

Groves PS, Meisenbach RJ, Scott-Cawiezell J. J Adv Nurs. 2011;67:1846-1855.

STUDY

Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder.

Makary MA, Sexton JB, Freischlag JA, et al. J Am Coll Surg. 2006;202:746-752.

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