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 (74)

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•Identification Errors (59)

•Discontinuities, Gaps, and Hand-Off Problems (178)

•Fatigue and Sleep Deprivation (28)

•Medication Safety (662)

•Medical Complications (201)

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Epidemiology of Errors and Adverse Events

Approach to Improving Safety

•Quality Improvement Strategies (281)

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•Error Reporting and Analysis (667)

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Clinical Areas

•Allied Health Services (6)

Target Audience

•Health Care Providers (1094)

•Health Care Executives and Administrators (1217)

•Non-Health Care Professionals (441)

•Patients (63)

Setting of Care

•Hospitals (1098)

•Psychiatric Facilities (6)

•Residential Facilities (41)

•Ambulatory Care (196)

•Outpatient Surgery (22)

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1 - 20 of 1551

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STUDY

Antimicrobial prescription errors in hospitalized children: role of antimicrobial stewardship program in detection and intervention.

Di Pentima MC, Chan S, Eppes SC, Klein JD. Clin Pediatr (Phila). 2009;53:715-723e1.

STUDY

Identifying causes of adverse events detected by an automated trigger tool through in-depth analysis.

Muething SE, Conway PH, Kloppenborg E, et al. Qual Saf Health Care. 2010;19:435-439.

STUDY

Trends in central line–associated bloodstream infections in a trauma-surgical intensive care unit.

Ong A, Dysert K, Herbert C, et al. Arch Surg. 2011;146:302-307.

STUDY

The safety of hospital stroke care.

Holloway RG, Tuttle D, Baird T, Skelton WK. Neurology. 2007;68:550-555.

STUDY

A comparison of voluntarily reported medication errors in intensive care and general care units.

Kane-Gill SL, Kowiatek JG, Weber RJ. Qual Saf Health Care. 2010;19:55-59.

STUDY

Incidence of adverse drug events and medication errors in Japan: the JADE Study.

Morimoto T, Sakuma M, Matsui K, et al. J Gen Intern Med. 2011;26:148-153.

REVIEW

Medication errors in paediatric care: a systematic review of epidemiology and an evaluation of evidence supporting reduction strategy recommendations.

Miller MR, Robinson KA, Lubomski LH, Rinke ML, Pronovost PJ. Qual Saf Health Care. 2007;16:116-126.

STUDY

ED overcrowding is associated with an increased frequency of medication errors.

Kulstad EB, Sikka R, Sweis RT, Kelley KM, Rzechula KH. Am J Emerg Med. 2010;28:304-309.

STUDY

Structured interdisciplinary rounds in a medical teaching unit: improving patient safety.

O’Leary KJ, Buck R, Fligiel HM, et al. Arch Intern Med. 2011;171:678-684.

STUDY

Adverse drug events in the outpatient setting: an 11-year national analysis.

Bourgeois FT, Shannon MW, Valim C, Mandl KD. Pharmacoepidemiol Drug Saf. 2010;19:901-910.

STUDY

Characteristics of medication errors and adverse drug events in hospitals participating in the California Pediatric Patient Safety Initiative.

Takata GS, Taketomo CK, Waite S; for the California Pediatric Patient Safety Initiative. Am J Health Syst Pharm. 2008;65:2036-2044.

STUDY

Supratherapeutic dosing of acetaminophen among hospitalized patients.

Zhou L, Maviglia SM, Mahoney LM, et al. Arch Intern Med. 2012;172:1721-1728.

STUDY

Adverse drug events resulting from patient errors in older adults.

Field TS, Mazor KM, Briesacher B, Debellis KR, Gurwitz JH. J Am Geriatr Soc. 2007;55:271-276.

STUDY

A trigger tool fails to identify serious errors and adverse events in pediatric otolaryngology.

Lander L, Roberson DW, Plummer KM, Forbes PW, Healy GB, Shah RK. Otolaryngol Head Neck Surg. 2010;143:480-486.

STUDY

Prescribing discrepancies likely to cause adverse drug events after patient transfer.

Boockvar KS, Liu S, Goldstein N, Nebeker J, Siu A, Fried T. Qual Saf Health Care. 2009;18:32-36.

STUDY

Safety on an inpatient pediatric otolaryngology service: many small errors, few adverse events.

Shah RK, Lander L, Forbes P, Jenkins K, Healy GB, Roberson DW. Laryngoscope. 2009;119:871-879.

REVIEW

Year in review: medication mishaps in the elderly.

Peron EP, Marcum ZA, Boyce R, Hanlon JT, Handler SM. Am J Geriatr Pharmacother. 2011;9:1-10.

STUDY

Iatrogenic events resulting in intensive care admission: frequency, cause, and disclosure to patients and institutions.

Lehmann LS, Puopolo AL, Shaykevich S, Brennan TA. Am J Med. 2005;118:409-413.

STUDY

Pediatric vaccination errors: application of the "5 rights" framework to a national error reporting database.

Bundy DG, Shore AD, Morlock LL, Miller MR. Vaccine. 2009;27:3890-3896.

STUDY

Saving lives by studying deaths: using standardized mortality reviews to improve inpatient safety.

Lau H, Litman KC. Jt Comm J Qual Patient Saf. 2011;37:400-408.

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