AHRQ Patient Safety Network

The Collection > Epidemiology of Errors and Adverse Events

PATIENT SAFETY PRIMERS
Never Events
Adverse Events after Hospital Discharge

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Safety Target

•Device-related Complications (67)

•Diagnostic Errors (96)

•Identification Errors (50)

•Discontinuities, Gaps, and Hand-Off Problems (155)

•Fatigue and Sleep Deprivation (28)

•Medication Safety (572)

•Medical Complications (175)

•Nonsurgical Procedural Complications (20)

•Surgical Complications (191)

•Transfusion Complications (12)

•Psychological and Social Complications (29)

Origin/Sponsor

•Africa (1)

•Asia (30)

•Australia and New Zealand (40)

•Central and South America (8)

•Europe (200)

•North America (1039)

Resource Types

•Audiovisual (4)

•Book/Report (29)

•Journal Article (1224)

•Legislation/Regulation (3)

•Meeting/Conference (2)

•Newspaper/Magazine Article (49)

•Press Release/Announcement (2)

•Special or Theme Issue (2)

•Tools/Toolkit (1)

•Web Resource (5)

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Epidemiology of Errors and Adverse Events

Approach to Improving Safety

•Quality Improvement Strategies (242)

•Legal and Policy Approaches (58)

•Error Reporting and Analysis (536)

•Communication Improvement (215)

•Human Factors Engineering (126)

•Teamwork (44)

•Specialization of Care (90)

•Logistical Approaches (99)

•Culture of Safety (84)

•Technologic Approaches (249)

•Education and Training (166)

Clinical Areas

•Allied Health Services (3)

Target Audience

•Health Care Providers (921)

•Health Care Executives and Administrators (1073)

•Non-Health Care Professionals (380)

•Patients (44)

Setting of Care

•Hospitals (960)

•Psychiatric Facilities (6)

•Residential Facilities (31)

•Ambulatory Care (157)

•Outpatient Surgery (18)

•Patient Transport (15)

1 - 20 of 1321

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STUDY

Nurse working conditions and patient safety outcomes.

Stone PW, Mooney-Kane C, Larson EL, et al. Med Care. 2007;45:571-578.

STUDY

Longitudinal analyses of nurse staffing and patient outcomes: more about failure to rescue.

Seago JA, Williamson A, Atwood C. J Nurs Adm. 2006;36:13-21.

STUDY

Relationship between systems-level factors and hand hygiene adherence.

Dunn-Navarra AM, Cohen B, Stone PW, Pogorzelska M, Jordan S, Larson E. J Nurs Care Qual. 2011;26:30-38.

COMMENTARY

The increased incidence of anesthetic adverse events in late afternoon surgeries.

Johnson J. AORN J. 2008;88:79-87.

REVIEW

The effect of nurse staffing patterns on medical errors and nurse burnout.

Garrett C. AORN J. 2008;87:1191-1192, 1194, 1196-1200, 1202-1204.

STUDY

Hospital RNs' experiences with disruptive behavior: a qualitative study.

Walrath JM, Dang D, Nyberg D. J Nurs Care Qual. 2010;25:105-116.

STUDY

Nurses relate the contributing factors involved in medication errors.

Tang FI, Sheu SJ, Yu S, Wei IL, Chen CH. J Clin Nurs. 2007;16:447-457.

STUDY

Nurses' work schedule characteristics, nurse staffing, and patient mortality.

Trinkoff AM, Johantgen M, Storr CL, Gurses AP, Liang Y, Han K. Nurs Res. 2011;60:1-8.

STUDY

A human factors framework and study of the effect of nursing workload on patient safety and employee quality of working life.

Holden RJ, Scanlon MC, Patel NR, et al. BMJ Qual Saf. 2011;20:15-24.

STUDY

Achieving quality improvement in the nursing home: influence of nursing leadership on communication and teamwork.

Vogelsmeier A, Scott-Cawiezell J. J Nurs Care Qual. 2011;26:236-242.

STUDY

Interruptions and multitasking in nursing care.

Kalisch BJ, Aebersold M. Jt Comm J Qual Patient Saf. 2010;36:126-132.

STUDY

The impact of teamwork on missed nursing care.

Kalisch BJ, Lee KH. Nurs Outlook. 2010;58:233-241.

STUDY

An examination of technical efficiency, quality, and patient safety in acute care nursing units.

Mark B, Jones C, Lindley L, Ozcan Y. Policy Polit Nurs Pract. 2009;10:180-186.

STUDY

Do nurse and patient injuries share common antecedents? An analysis of associations with safety climate and working conditions.

Taylor JA, Dominici F, Agnew J, Gerwin D, Morlock L, Miller MR. BMJ Qual Saf. 2012;21:101-111.

STUDY

Nursing home error and level of staff credentials.

Scott-Cawiezell J, Pepper GA, Madsen RW, Petroski G, Vogelsmeier A, Zellmer D. Clin Nurs Res. 2007;16:72-78.

STUDY

Nurse staffing, burnout, and health care–associated infection.

Cimiotti JP, Aiken LH, Sloane DM, Wu ES. Am J Infect Control. 2012;40:486-490.

STUDY

Nursing care quality and adverse events in US hospitals.

Lucero RJ, Lake ET, Aiken LH. J Clin Nurs. 2010;19:2185-2195.

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.

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.

STUDY

Improving patient safety using the sterile cockpit principle during medication administration: a collaborative, unit-based project.

Fore AM, Sculli GL, Albee D, Neily J. J Nurs Manag. 2013;21:106-111.

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