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 (48)

•Diagnostic Errors (93)

•Identification Errors (44)

•Discontinuities, Gaps, and Hand-Off Problems (144)

•Fatigue and Sleep Deprivation (25)

•Medication Safety (512)

•Medical Complications (133)

•Nonsurgical Procedural Complications (14)

•Surgical Complications (159)

•Transfusion Complications (9)

•Psychological and Social Complications (29)

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•Asia (17)

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•Central and South America (2)

Resource Types

•Journal Article (1063)

•Legislation/Regulation (3)

•Meeting/Conference (2)

•Newspaper/Magazine Article (46)

•Press Release/Announcement (1)

•Special or Theme Issue (1)

•Tools/Toolkit (1)

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Epidemiology of Errors and Adverse Events

Approach to Improving Safety

•Quality Improvement Strategies (203)

•Legal and Policy Approaches (57)

•Error Reporting and Analysis (464)

•Communication Improvement (196)

•Human Factors Engineering (94)

•Teamwork (29)

•Specialization of Care (80)

•Logistical Approaches (88)

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•Technologic Approaches (229)

•Education and Training (142)

Clinical Areas

•Allied Health Services (2)

Target Audience

•Health Care Providers (844)

•Health Care Executives and Administrators (857)

•Non-Health Care Professionals (319)

•Patients (43)

Setting of Care

•Hospitals (785)

•Psychiatric Facilities (4)

•Residential Facilities (30)

•Ambulatory Care (183)

•Outpatient Surgery (17)

•Patient Transport (13)

1 - 20 of 1150

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STUDY

Ambulatory prescribing errors among community-based providers in two states.

Abramson EL, Bates DW, Jenter C, et al. J Am Med Inform Assoc. 2012;19:644-648.

STUDY

Antibiotic prescribing in ambulatory pediatrics in the United States.

Hersh AL, Shapiro DJ, Pavia AT, Shah SS. Pediatrics. 2011;128:1053-1061.

STUDY

Addition of electronic prescription transmission to computerized prescriber order entry: effect on dispensing errors in community pharmacies.

Moniz TT, Seger AC, Keohane CA, Seger DL, Bates DW, Rothschild JM. Am J Health Syst Pharm. 2011;68:158-163.

STUDY

Electronic prescribing within an electronic health record reduces ambulatory prescribing errors.

Abramson EL, Barrón Y, Quaresimo J, Kaushal R. Jt Comm J Qual Patient Saf. 2011;37:470-478.

STUDY

Dispensing errors in community pharmacy: perceived influence of sociotechnical factors.

Szeinbach S, Seoane-Vazquez E, Parekh A, Herderick M. Int J Qual Health Care. 2007;19:203-09.

STUDY

Medication-error reporting and pharmacy resident experience during implementation of computerized prescriber order entry.

Weant KA, Cook AM, Armitstead JA. Am J Health Syst Pharm. 2007;64:526-530.

NEWSPAPER/MAGAZINE ARTICLE

System breakdown: 4 med errors, 250 scripts/day.

Mulligan M. Drug Topics. July 1, 2009;153:22-24,26.

STUDY

Medication prescribing errors involving the route of administration.

Lesar TS. Hosp Pharm. 2006;41:1053-1066.

STUDY

Effectiveness of a community collaborative for eliminating the use of high-risk abbreviations written by physicians.

Leonhardt KK, Botticelli J. J Patient Saf. 2006;2:147-153.

STUDY

Risk models to improve safety of dispensing high-alert medications in community pharmacies.

Cohen MR, Smetzer JL, Westphal JE, Comden SC, Horn DM. J Am Pharm Assoc. 2012;52:584-602.

STUDY

Use of the Beers criteria to predict adverse drug reactions among first-visit elderly outpatients.

Chang CM, Liu PY, Yang YH, Yang YC, Wu CF, Lu FH. Pharmacotherapy. 2005;25:831-838.

STUDY

Medication errors in the ambulatory treatment of pediatric attention deficit hyperactivity disorder.

Bundy DG, Rinke ML, Shore AD, et al. Jt Comm J Qual Patient Saf. 2008;34:552-560.

STUDY

Effect of a pharmacist on adverse drug events and medication errors in outpatients with cardiovascular disease.

Murray MD, Ritchey ME, Wu J, Tu W. Arch Intern Med. 2009;169:757-763.

STUDY

Potassium and phosphorus repletion in hospitalized patients: implications for clinical practice and the potential use of healthcare information technology to improve prescribing and patient safety.

Hemstreet BA, Stolpman N, Badesch DB, May SK, McCollum M. Curr Med Res Opin. 2006;22:2449-2455.

STUDY

Differences in medication errors between central and remote site telepharmacies.

Scott DM, Friesner DL, Rathke AM, Peterson CD, Anderson HC. J Am Pharm Assoc. 2012;52:e97-e104.

STUDY

A steep increase in domestic fatal medication errors with use of alcohol and/or street drugs.

Phillips DP, Barker GEC, Eguchi MM. Arch Intern Med. 2008;168:1561-1566.

AUDIOVISUAL PRESENTATION

Medication error death rate up 500 percent.

Spiesel S, Chadwick A. "Day to Day." National Public Radio. August 27, 2008.

STUDY

Overnight and postcall errors in medication orders.

Hendey GW, Barth BE, Soliz T. Acad Emerg Med. 2005;12:629-634.

STUDY

Dispensing errors and counseling quality in 100 pharmacies.

Flynn EA, Barker KN, Berger BA, Lloyd KB, Brackett PD. J Am Pharm Assoc. 2009;49:171-180.

STUDY

Variability in pharmacy interpretations of physician prescriptions.

Wolf MS, Shekelle P, Choudhry NK, Agnew-Blais J, Parker RM, Shrank WH. Med Care. 2009;47:370-373.

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