AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (23)

•Diagnostic Errors (3)

•Identification Errors (3)

•Discontinuities, Gaps, and Hand-Off Problems (50)

•Medication Safety (655)

•Medical Complications (11)

•Nonsurgical Procedural Complications (1)

•Surgical Complications (4)

Origin/Sponsor

•Asia (4)

•Australia and New Zealand (13)

•Central and South America (1)

Resource Types

•Journal Article (430)

•Legislation/Regulation (11)

•Meeting/Conference (6)

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•Newspaper/Magazine Article (134)

•Press Release/Announcement (22)

•Special or Theme Issue (5)

•Tools/Toolkit (17)

•Web Resource (8)

•Grant (1)

Error Types

•Epidemiology of Errors and Adverse Events (173)

•Active Errors (134)

•Latent Errors (54)

•Near Miss (12)

Approach to Improving Safety

•Quality Improvement Strategies (140)

•Legal and Policy Approaches (56)

•Error Reporting and Analysis (142)

•Communication Improvement (179)

•Human Factors Engineering (143)

•Teamwork (10)

•Specialization of Care (92)

•Logistical Approaches (37)

•Culture of Safety (32)

•Technologic Approaches (236)

•Education and Training (106)

Clinical Areas
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Pharmacy

•Hospital Pharmacy (233)

•Community Pharmacy (65)

Target Audience

•Health Care Providers (574)

•Health Care Executives and Administrators (406)

•Non-Health Care Professionals (172)

•Patients (68)

Setting of Care

•Hospitals (300)

•Psychiatric Facilities (2)

•Residential Facilities (12)

•Ambulatory Care (130)

•Outpatient Surgery (2)

1 - 20 of 673

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NEWSPAPER/MAGAZINE ARTICLE

Safety still compromised by computer weaknesses.

ISMP Medication Safety Alert! Acute Care Edition. August 25, 2005;10:1-3.

COMMENTARY

Applying Lean Sigma solutions to mistake-proof the chemotherapy preparation process.

Aboumatar HJ, Winner L, Davis R, et al. Jt Comm J Qual Patient Saf. 2010;36:79-86, AP1-AP4.

COMMENTARY

Citrate Mix-Up

Weber RJ. AHRQ WebM&M [serial online]. May 2006.

STUDY

Effects of mental demands during dispensing on perceived medication safety and employee well-being: a study of workload in pediatric hospital pharmacies.

Holden RJ, Patel NR, Scanlon MC, Shalaby TM, Arnold JM, Karsh BT. Res Social Admin Pharm. 2010;6:293-306.

NEWSPAPER/MAGAZINE ARTICLE

Survey on LASA drug name pairs: who knows what’s on your list and the best ways to prevent mix-ups?

ISMP Medication Safety Alert! Acute Care Edition. May 21, 2009;14:1-3.

STUDY

Potential medication dosing errors in outpatient pediatrics.

McPhillips HA, Stille CJ, Smith D, et al. J Pediatr. 2005;147:761-767.

NEWSPAPER/MAGAZINE ARTICLE

Handwritten-prescription ban puts pharmacists in awkward position as "enforcers."

Ostrom CM. Seattle Times. June 22, 2006:B1.

NEWSPAPER/MAGAZINE ARTICLE

Your attention please... designing effective warnings.

ISMP Medication Safety Alert! Acute Care Edition. August 24, 2006;11:1-3.

COMMENTARY

ISMP medication error report analysis.

Cohen MR, Smetzer JL. Hosp Pharm. 2010;45:13-17.

STUDY

Origins of and solutions for neonatal medication-dispensing errors.

Sauberan JB, Dean LM, Fiedelak J, Abraham JA. Am J Health Syst Pharm. 2010;67:49-57.

COMMENTARY

ISMP medication error report analysis.

Cohen MR, Smetzer JL. Hosp Pharm. 2007;42:790-792.

STUDY

Medication prescribing errors involving the route of administration.

Lesar TS. Hosp Pharm. 2006;41:1053-1066.

STUDY

Challenges in posthospital care: nurses as coaches for medication management.

Costa LL, Poe SS, Lee MC. J Nurs Care Qual. 2011;26:243-251.

STUDY

Accuracy of computer-generated, Spanish-language medicine labels.

Sharif I, Tse J. Pediatrics. 2010;125:960-965.

STUDY

The impact of abbreviations on patient safety.

Brunetti L, Santell JP, Hicks RW. Jt Comm J Qual Patient Saf. 2007;33:576-583.

COMMENTARY

ISMP medication error report analysis.

Cohen MR. Hosp Pharm. 2008;43:445-448.

PRESS RELEASE/ANNOUNCEMENT

Medication errors resulting from confusion between risperidone (Risperdal) and ropinirole (Requip).

MedWatch Safety Alert, FDA Drug Safety Communication. Silver Spring, MD: US Food and Drug Administration; June 13, 2011.

STUDY

Effects of technological interventions on the safety of a medication-use system.

Skibinski KA, White BA, Lin LI, Dong Y, Wu W. Am J Health Syst Pharm. 2007;64:90-96.

COMMENTARY

ISMP medication error report analysis.

Cohen MR. Hosp Pharm. 2008;43:696–698.

COMMENTARY

ISMP medication error report analysis.

Cohen MR, Smetzer JL. Hosp Pharm. 2010:45;352-355.

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