PATIENT SAFETY PRIMERS
Wrong-Site, Wrong-Procedure, and Wrong-Patient Surgery
North America (36)
Journal Article (34)
Newspaper/Magazine Article (6)
Web Resource (1)
Epidemiology of Errors and Adverse Events (19)
Active Errors (28)
Latent Errors (7)
Near Miss (2)
Approach to Improving Safety
Quality Improvement Strategies (10)
Legal and Policy Approaches (3)
Error Reporting and Analysis (13)
Communication Improvement (18)
Human Factors Engineering (12)
Logistical Approaches (2)
Culture of Safety (1)
Technologic Approaches (16)
Education and Training (4)
Health Care Providers (32)
Health Care Executives and Administrators (37)
Non-Health Care Professionals (15)
Setting of Care
Ambulatory Care (3)
Outpatient Surgery (2)
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Computerization can create safety hazards: a bar-coding near miss.
McDonald CJ. Ann Intern Med. 2006;144:510-516.
Mix-up: baby nursed by wrong mother.
Cisneros N. ABC-7/KGO-TV. June 10, 2006.
Causes, consequences, detection, and prevention of identification errors in laboratory diagnostics.
Lippi G, Blanckaert N, Bonini P, et al. Clin Chem Lab Med. 2009;47:143-153.
Patients put at risk by NHS computer fault.
Gray R. Scotland on Sunday. January 8, 2006.
Specimen labeling errors in surgical pathology: an 18-month experience.
Layfield LJ, Anderson GM. Am J Clin Pathol. 2010;134:466-470.
Wristbands as aids to reduce misidentification: an ethnographically guided task analysis.
Smith AF, Casey K, Wilson J, Fischbacher-Smith D. Int J Qual Health Care. 2011;23:590-599.
Incorrect surgical procedures within and outside of the operating room: a follow-up report.
Neily J, Mills PD, Eldridge N, et al. Arch Surg. 2011;146 1235-1239.
Decreasing patient misidentification before chemotherapy administration.
Spruill A, Eron B, Coghill A, Talbert G. Clin J Oncol Nurs. 2009;13:716-717.
Patient misidentification in laboratory medicine: a qualitative analysis of 227 root cause analysis reports in the Veterans Health Administration.
Dunn EJ, Moga PJ. Arch Pathol Lab Med. 2010;134:244-255.
Doctor removes ovaries from wrong patient.
Bramson K, Mooney T. Providence Journal. August 18, 2006.
Minimizing electronic health record patient–note mismatches.
Wilcox AB, Chen YH, Hripcsak G. J Am Med Inform Assoc. 2011;18:511-514.
Building a Memory: Preventing Harm, Reducing Risks and Improving Patient Safety.
Scobie S, Thomson R. London, England: National Patient Safety Agency; 2005.
Preventing wrong site, procedure, and patient events using a common cause analysis.
Mallett R, Conroy M, Saslaw LZ, Moffatt-Bruce S. Am J Med Qual. 2012;27:21-29.
Is the test result correct? A questionnaire study of blood collection practices in primary health care.
Söderberg J, Wallin O, Grankvist K, Brulin C. J Eval Clin Pract. 2010;16:707-711.
Oops, sorry, wrong patient! A patient verification process is needed everywhere, not just at the bedside.
ISMP Medication Safety Alert! Acute Care Edition. March 10, 2011;16:1-4.
Use of an anatomic marking form as an alternative to the Universal Protocol for Preventing Wrong Site, Wrong Procedure and Wrong Person Surgery.
Knight N, Aucar J. Am J Surg. 2010;200:803-807.
Barcode technology: its role in increasing the safety of blood transfusion.
Turner CL, Casbard AC, Murphy MF. Transfusion. 2003;43:1200-1209.
Matching identifiers in electronic health records: implications for duplicate records and patient safety.
McCoy AB, Wright A, Kahn MG, Shapiro JS, Bernstam EV, Sittig DF. BMJ Qual Saf. 2013;22:219-224.
The use of patient pictures and verification screens to reduce computerized provider order entry errors.
Hyman D, Laire M, Redmond D, Kaplan DW. Pediatrics. 2012;130:e211-e219.
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