AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (23)

•Diagnostic Errors (4)

•Identification Errors (6)

•Discontinuities, Gaps, and Hand-Off Problems (70)

•Medication Safety (728)

•Medical Complications (15)

•Nonsurgical Procedural Complications (1)

•Surgical Complications (6)

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•Clinical Guideline (1)

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Error Types

•Epidemiology of Errors and Adverse Events (195)

•Active Errors (118)

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Approach to Improving Safety

•Quality Improvement Strategies (147)

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Pharmacy

•Hospital Pharmacy (290)

•Community Pharmacy (81)

Target Audience

•Health Care Providers (627)

•Health Care Executives and Administrators (439)

•Non-Health Care Professionals (190)

•Patients (76)

Setting of Care

•Hospitals (364)

•Psychiatric Facilities (2)

•Residential Facilities (14)

•Ambulatory Care (152)

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1 - 20 of 752

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COMMENTARY

Medication reconciliation physician order form.

Lacy JL, Wilkinson ST. Hosp Pharm. 2006;41:1117-1120.

COMMENTARY

Medication reconciliation in acute care: ensuring an accurate drug regimen on admission and discharge.

Rodehaver C. Jt Comm J Qual Patient Saf. 2005;31:406-413.

STUDY

Implementation of an electronic system for medication reconciliation.

Kramer JS, Hopkins PJ, Rosendale JC, et al. Am J Health Syst Pharm. 2007;64:404-422.

NEWSPAPER/MAGAZINE ARTICLE

Survey results: community liaison programs to decrease hospital readmissions.

ISMP Medication Safey Alert! Acute Care Edition. March 7, 2013;18:1-3.

STUDY

Medication reconciliation for reducing drug-discrepancy adverse events.

Boockvar KS, Carlson Lacorte H, Giambanco V, Fridman B, Siu A. Am J Geriatr Pharmacother. 2006;4:236-243.

NEWSPAPER/MAGAZINE ARTICLE

JCAHO tightens leash on medication reconciliation.

Perry LE. Drug Topics: Health-System Edition. March 20, 2006.

COMMENTARY

Citrate Mix-Up

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

NEWSPAPER/MAGAZINE ARTICLE

The consumer: and now, a warning about labels.

Franklin D. New York Times. October 25, 2005:F1.

COMMENTARY

What medications does your patient take? Enhancing medication safety in the outpatient setting.

Institute for Healthcare Improvement. March 14, 2007.

BOOK/REPORT

Medication Reconciliation Handbook.

Oakbrook Terrace, IL: Joint Commission Resources and the American Society of Health-System Pharmacists; 2006. ISBN: 0866889566.

NEWSPAPER/MAGAZINE ARTICLE

Fixing the medication reconciliation breakdown.

Starr D, West L. Most Wired Magazine. November 9, 2006.

COMMENTARY

Developing a medication patient safety program, part 2: process and implementation.

Mark SM, Weber RJ. Hosp Pharm. 2007;42:249–254.

COMMENTARY

Improving care transitions: current practice and future opportunities for pharmacists.

American College of Clinical Pharmacy, Hume AL, Kirwin J, et al. Pharmacotherapy. 2012;32:e326-e337.

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.

COMMENTARY

Medication bar coding: to scan or not to scan?

Galvin L, McBeth S, Hasdorff C, Tillson M, Thomas S. Comput Inform Nurs. 2007;25:86-92.

STUDY

Effects of an automatic drug dispensing system on medication adverse event occurrences and cost containment at SAMSO.

Dib JG, Abdulmohsin SA, Farooki MU, et al. Hosp Pharm. 2006;41:1180-1184.

NEWSPAPER/MAGAZINE ARTICLE

Results of ISMP survey on high-alert medications: differences between nursing, pharmacy, and risk/quality/safety perspectives.

ISMP Medication Safety Alert! Acute Care Edition. February 9, 2012;17:1-4.

NEWSPAPER/MAGAZINE ARTICLE

Improving the safety of telephone or verbal orders.

PA-PSRS Patient Saf Advis. June 2006;3:1-5.

NEWSPAPER/MAGAZINE ARTICLE

Results of our survey on drug storage, stability, compatibility, and beyond use dating.

ISMP Medication Safety Alert! Acute Care Edition. March 22, 2012;17:1-4.

STUDY

Assessing and monitoring override medications in automated dispensing devices.

Kowiatek JG, Weber RJ, Skledar SJ, Frank S, DeVita M. Jt Comm J Qual Patient Saf. 2006;32:309-317.

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