AHRQ Patient Safety Network

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Administration Errors

Origin/Sponsor

•Africa (1)

•Asia (11)

•Australia and New Zealand (6)

•Central and South America (4)

Resource Types

•Journal Article (204)

•Legislation/Regulation (4)

•Newspaper/Magazine Article (30)

•Press Release/Announcement (10)

•Special or Theme Issue (3)

•Tools/Toolkit (3)

•Grant (1)

Error Types

•Epidemiology of Errors and Adverse Events (107)

•Active Errors (125)

•Latent Errors (31)

•Near Miss (11)

Approach to Improving Safety

•Quality Improvement Strategies (56)

•Legal and Policy Approaches (19)

•Error Reporting and Analysis (68)

•Communication Improvement (35)

•Human Factors Engineering (77)

•Teamwork (5)

•Specialization of Care (13)

•Logistical Approaches (19)

•Culture of Safety (14)

•Technologic Approaches (72)

•Education and Training (61)

Clinical Areas

•Allied Health Services (1)

•Medicine (182)

•Nursing (68)

•Pharmacy (78)

Target Audience

•Health Care Providers (222)

•Health Care Executives and Administrators (215)

•Non-Health Care Professionals (85)

•Patients (20)

Setting of Care

•Hospitals (171)

•Psychiatric Facilities (2)

•Residential Facilities (12)

•Ambulatory Care (19)

•Outpatient Surgery (2)

•Patient Transport (2)

1 - 20 of 263

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STUDY

Medication administration errors in assisted living: scope, characteristics, and the importance of staff training.

Zimmerman S, Love K, Sloane PD, Cohen LW, Reed D, Carder PC; Center for Excellence in Assisted Living-University of North Carolina Collaborative. J Am Geriatr Soc. 2011;59:1060-1068.

COMMENTARY

Wrong Route for Nutrients

Scott-Cawiezell JR, AHRQ WebM&M [serial online]. July 2008.

STUDY

The influence of formulation and medicine delivery system on medication administration errors in care homes for older people.

Alldred DP, Standage C, Fletcher O, et al. BMJ Qual Saf. 2011;20:397-402.

BOOK/REPORT

External Inquiry into the adverse incident that occurred at Queen's Medical Centre, Nottingham, 4th January 2001.

Toft B. London, England: Department of Health; 2001.

STUDY

Computerized decision support for medication dosing in renal insufficiency: a randomized, controlled trial.

Terrell KM, Perkins AJ, Hui SL, Callahan CM, Dexter PR, Miller DK. Ann Emerg Med. 2010;56:623-629.

STUDY

Repeat medication errors in nursing homes: contributing factors and their association with patient harm.

Crespin DJ, Modi AV, Wei D, et al. Am J Geriatr Pharmacother. 2010;8:258-270.

PRESS RELEASE/ANNOUNCEMENT

Serious medication errors from intravenous administration of nimodipine oral capsules.

MedWatch Safety Alert, FDA Drug Safety Communication. Silver Spring, MD: US Food and Drug Administration; August 2, 2010.

COMMENTARY

Double Dosing, by the Rules

Cohen H. AHRQ WebM&M [serial online]. February/March 2009.

NEWSPAPER/MAGAZINE ARTICLE

Proper positioning of pharmacy label on Hospira PCA vials will avoid interference with scanning.

ISMP Medication Safety Alert! Acute Care Edition. August 14, 2008;13:1-3.

STUDY

Addressing delays in medication administration for patients transferred from the hospital to the nursing home: a pilot quality improvement project.

Ward KT, Bates-Jensen B, Eslami MS, et al. Am J Geriatr Pharmacother. 2008;6:205-211.

STUDY

Injection practices among clinicians in United States health care settings.

Pugliese G, Gosnell C, Bartley JM, Robinson S. Am J Infect Control. 2010;38:789-798.

STUDY

Time-dependent drug–drug interaction alerts in care provider order entry: software may inhibit medication error reductions.

van der Sijs H, Lammers L, van den Tweel A, et al. J Am Med Inform Assoc. 2009;16:864-868.

STUDY

Medication errors in paediatric outpatients.

Kaushal R, Goldmann DA, Keohane CA, et al. Qual Saf Health Care. 2010;19:e30.

STUDY

Medication administration errors for older people in long-term residential care.

Szczepura A, Wild D, Nelson S. BMC Geriatr. 2011;11:82.

STUDY

Effect of bar-code technology on the safety of medication administration.

Poon EG, Keohane CA, Yoon CS, et al. N Engl J Med. 2010;362:1698-1707.

STUDY

Automated drug dispensing system reduces medication errors in an intensive care setting.

Chapuis C, Roustit M, Bal G, et al. Crit Care Med. 2010;38:2275-2281.

STUDY

Identifying and reducing medication errors in psychiatry: creating a culture of safety through the use of an adverse event reporting mechanism.

Jayaram G, Doyle D, Steinwachs D, Samuels J. J Psychiatr Pract. 2011;17:81–88.

STUDY

Competence and certification of registered nurses and safety of patients in intensive care units.

Kendall-Gallagher D, Blegen MA. Am J Crit Care. 2009;18:106-113.

PRESS RELEASE/ANNOUNCEMENT

Relenza (zanamivir) inhalation powder.

MedWatch Safety Alert. Silver Spring, MD: US Food and Drug Administration; October 9, 2009.

STUDY

Anticoagulation-associated adverse drug events.

Piazza G, Nguyen TN, Cios D, et al. Am J Med. 2011;124:1136-1142.

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