AHRQ Patient Safety Network

The Collection > Anticoagulants

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Anticoagulants

Origin/Sponsor

•Australia and New Zealand (2)

•Central and South America (1)

Resource Types

•Clinical Guideline (2)

•Journal Article (47)

•Legislation/Regulation (1)

•Newspaper/Magazine Article (18)

•Press Release/Announcement (3)

•Tools/Toolkit (1)

•Web Resource (2)

Error Types

•Epidemiology of Errors and Adverse Events (22)

•Active Errors (24)

•Latent Errors (7)

•Near Miss (1)

Approach to Improving Safety

•Quality Improvement Strategies (19)

•Legal and Policy Approaches (7)

•Error Reporting and Analysis (26)

•Communication Improvement (15)

•Human Factors Engineering (20)

•Teamwork (1)

•Specialization of Care (16)

•Logistical Approaches (5)

•Technologic Approaches (29)

•Education and Training (10)

Clinical Areas

•Medicine (62)

•Nursing (5)

•Pharmacy (31)

Target Audience

•Health Care Providers (59)

•Health Care Executives and Administrators (48)

•Non-Health Care Professionals (10)

•Patients (11)

Setting of Care

•Hospitals (57)

•Residential Facilities (6)

•Ambulatory Care (7)

•Outpatient Surgery (1)

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COMMENTARY

Improving heparin safety: a multidisciplinary invited conference.

Peterson C, Ham CW, Vanderveen T. Hosp Pharm. 2008;43:491-497.

NEWSPAPER/MAGAZINE ARTICLE

Anticoagulant safety practices call for pharmacist supervision.

Scott A. Drug Topics (Health-System Edition). November 10, 2008.

ORGANIZATIONAL POLICY/GUIDELINES

Preventing errors relating to commonly used anticoagulants.

Sentinel Event Alert. September 24, 2008;(41):1-4.

COMMENTARY

2009 National Patient Safety Goals.

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

STUDY

Impact of a standard medication chart on prescribing errors: a before-and-after audit.

Coombes ID, Stowasser DA, Reid C, Mitchell CA. Qual Saf Health Care. 2009;18:478-485.

NEWSPAPER/MAGAZINE ARTICLE

Action needed to prevent dangerous heparin-insulin confusion.

ISMP Medication Safety Alert! Acute Care Edition. May 3, 2007;12:1-2.

COMMENTARY

Anticoagulation patient safety goal compliance at a university health system: methods for achieving the goal.

Franco AC, Maxwell P, Green K, Barthol C. Hosp Pharm. 2009;44:776-780, 784.

STUDY

Harmful medication errors involving unfractionated and low-molecular-weight heparin in three patient safety reporting programs.

Grissinger MC, Hicks RW, Keroack MA, Marella WM, Vaida A. Jt Comm J Qual Patient Saf. 2010;36:195-202.

NEWSPAPER/MAGAZINE ARTICLE

Collaboration focused on priority issues promotes safety.

ISMP Medication Safety Alert! Acute Care Edition. October 10, 2008;13:1-3.

STUDY

Unintended effects of a computerized physician order entry nearly hard-stop alert to prevent a drug interaction: a randomized controlled trial.

Strom BL, Schinnar R, Aberra F, et al. Arch Intern Med. 2010;170:1578-1583.

NEWSPAPER/MAGAZINE ARTICLE

MGH faces suit over drug error that killed woman.

Valencia MJ. Boston Globe. March 10, 2011.

STUDY

Anticoagulation-associated adverse drug events.

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

NEWSPAPER/MAGAZINE ARTICLE

Officials investigate infants' heparin OD at Texas hospital.

Vonfremd M, Ibanga I. ABC News.com. July 10, 2008.

STUDY

Patient reported receipt of medication instructions for warfarin is associated with reduced risk of serious bleeding events.

Metlay JP, Hennessy S, Localio AR, et al. J Gen Intern Med. 2008;23:1589-1594.

STUDY

Adverse drug events among hospitalized Medicare patients: epidemiology and national estimates from a new approach to surveillance.

Classen DC, Jaser L, Budnitz DS. Jt Comm J Qual Patient Saf. 2010;36:12-21, AP1-AP9.

STUDY

Racial disparities in the frequency of patient safety events: results from the National Medicare Patient Safety Monitoring System.

Metersky ML, Hunt DR, Kliman R, et al. Med Care. 2011;49:504-510.

NEWSPAPER/MAGAZINE ARTICLE

Heparin overdose in three infants revisits hospital error issues.

Phend C. MedPage Today. November 26, 2007.

STUDY

Improvement in the detection of adverse drug events by the use of electronic health and prescription records: an evaluation of two trigger tools.

Nwulu U, Nirantharakumar K, Odesanya R, McDowell SE, Coleman JJ. Eur J Clin Pharmacol. 2013;69:255-259.

NEWSPAPER/MAGAZINE ARTICLE

Hospital drug errors far from uncommon.

Lin R-G II, Watanabe T. Los Angeles Times. November 22, 2007;A1.

STUDY

Clinical and safety impact of an inpatient pharmacist-directed anticoagulation service.

Schillig J, Kaatz S, Hudson M, Krol GD, Szandzik EG, Kalus JS. J Hosp Med. 2011;6:322-328.

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