AHRQ Patient Safety Network

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Identification Errors

•Wrong Patient (42)

•Wrong-Site Surgery (53)

Origin/Sponsor

•Asia (2)

•Australia and New Zealand (3)

Resource Types

•Journal Article (117)

•Legislation/Regulation (5)

•Newsletter/Journal (2)

•Newspaper/Magazine Article (31)

•Special or Theme Issue (2)

•Tools/Toolkit (4)

•Web Resource (6)

Error Types

•Epidemiology of Errors and Adverse Events (59)

•Active Errors (71)

•Latent Errors (24)

•Near Miss (14)

Approach to Improving Safety

•Quality Improvement Strategies (56)

•Legal and Policy Approaches (11)

•Error Reporting and Analysis (57)

•Communication Improvement (76)

•Human Factors Engineering (50)

•Teamwork (17)

•Specialization of Care (3)

•Logistical Approaches (25)

•Culture of Safety (18)

•Technologic Approaches (50)

•Education and Training (28)

Clinical Areas

•Medicine (149)

•Nursing (16)

•Pharmacy (6)

Target Audience

•Health Care Providers (127)

•Health Care Executives and Administrators (140)

•Non-Health Care Professionals (44)

•Patients (31)

Setting of Care

•Hospitals (125)

•Psychiatric Facilities (1)

•Residential Facilities (2)

•Ambulatory Care (14)

•Outpatient Surgery (9)

1 - 20 of 182

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BOOK/REPORT

Improving America's Hospitals: A Report on Quality and Safety.

Oakbrook Terrace, IL: The Joint Commission; March 2007.

STUDY

Involvement of parents in critical incidents in a neonatal-paediatric intensive care unit.

Frey B, Ersch J, Bernet V, Baenziger O, Enderli L, Doell C. Qual Saf Health Care. 2009;18:446-449.

ORGANIZATIONAL POLICY/GUIDELINES

AORN Guidance Statement: Safe Medication Practices in Perioperative Settings Across the Life Span.

AORN J. 2006;84:276-278, 280-283.

REVIEW

Patient safety in dermatology: a review of the literature.

Cao LY, Taylor JS, Vidimos A. Dermatol Online J. 2010;16:3.

STUDY

Voluntary electronic reporting of laboratory errors: an analysis of 37,532 laboratory event reports from 30 health care organizations.

Snydman LK, Harubin B, Kumar S, Chen J, Lopez RE, Salem DN. Am J Med Qual. 2012;27:147-153.

STUDY

Surgical specimen identification errors: a new measure of quality in surgical care.

Makary MA, Epstein J, Pronovost PJ, Millman EA, Hartmann EC, Freischlag JA. Surgery. 2007;141:450-455.

STUDY

Wrong-side/wrong-site, wrong-procedure, and wrong-patient adverse events: are they preventable?

Seiden SC, Barach P. Arch Surg. 2006;141:931-939.

STUDY

Operating room briefings and wrong-site surgery.

Makary MA, Mukherjee A, Sexton BJ, et al. J Am Coll Surg. 2007;204:236-243.

STUDY

Patient misidentification in the neonatal intensive care unit: quantification of risk.

Gray JE, Suresh G, Ursprung R, et al. Pediatrics. 2006;117:e43-e47.

NEWSPAPER/MAGAZINE ARTICLE

Hospitals target risks of color wristbands.

Landro L. Wall Street Journal. April 4, 2007:D5.

NEWSPAPER/MAGAZINE ARTICLE

Never events: Utah hospitals saw nearly 60 serious errors in 2007.

May H. Salt Lake Tribune. August 18, 2008.

COMMENTARY

Right? Left? Neither!

Howell EA, Chassin MR. AHRQ WebM&M [serial online]. May 2006.

NEWSPAPER/MAGAZINE ARTICLE

The five rights: a destination without a map.

ISMP Medication Safety Alert! Acute Care Edition. January 25, 2007;12:1.

STUDY

Mislabeling of cases, specimens, blocks, and slides: a College of American Pathologists study of 136 institutions.

Nakhleh RE, Idowu MO, Souers RJ, Meier FA, Bekeris LG. Arch Pathol Lab Med. 2011;135:969-974.

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.

NEWSPAPER/MAGAZINE ARTICLE

Get me out alive.

Feldman R. The Washington Post. May 2, 2006:HE01.

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.

STUDY

The nature and occurrence of registration errors in the emergency department.

Hakimzada AF, Green RA, Sayan OR, Zhang J, Patel VL. Int J Med Inform. 2008;77:169-175.

COMMENTARY

2009 National Patient Safety Goals.

Saufl NM. J Perianesth Nurs. 2009;24:114-118.

STUDY

An intervention to decrease patient identification band errors in a children's hospital.

Hain PD, Joers B, Rush M, et al. Qual Saf Health Care. 2010;19:244-247.

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