AHRQ Patient Safety Network

The Collection > Active Errors

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Safety Target

•Device-related Complications (55)

•Diagnostic Errors (114)

•Identification Errors (66)

•Discontinuities, Gaps, and Hand-Off Problems (130)

•Fatigue and Sleep Deprivation (5)

•Medication Safety (361)

•Medical Complications (60)

•Nonsurgical Procedural Complications (30)

•Surgical Complications (111)

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•Psychological and Social Complications (35)

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•Africa (1)

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•Clinical Guideline (2)

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•Special or Theme Issue (4)

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Error Types
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Active Errors

•Noncognitive Errors ("Slips & Lapses") (82)

•Cognitive Errors ("Mistakes") (68)

Approach to Improving Safety

•Quality Improvement Strategies (198)

•Legal and Policy Approaches (68)

•Error Reporting and Analysis (204)

•Communication Improvement (240)

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•Logistical Approaches (45)

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•Technologic Approaches (185)

•Education and Training (156)

Clinical Areas

•Allied Health Services (4)

Target Audience

•Health Care Providers (644)

•Health Care Executives and Administrators (605)

•Non-Health Care Professionals (256)

•Patients (53)

Setting of Care

•Hospitals (534)

•Psychiatric Facilities (4)

•Residential Facilities (12)

•Ambulatory Care (107)

•Outpatient Surgery (11)

•Patient Transport (11)

1 - 20 of 769

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STUDY

Does the implementation of an electronic prescribing system create unintended medication errors? A study of the sociotechnical context through the analysis of reported medication incidents.

Redwood S, Rajakumar A, Hodson J, Coleman JJ. BMC Med Inform Decis Mak. 2011;11:29.

NEWSPAPER/MAGAZINE ARTICLE

Following the patient journey to improve medicines management and reduce errors.

Crocker C. Nurs Times. 2009 Nov 24;105:12-15.

STUDY

Results of the Medications At Transitions and Clinical Handoffs (MATCH) study: an analysis of medication reconciliation errors and risk factors at hospital admission.

Gleason KM, McDaniel MR, Feinglass J, et al. J Gen Intern Med. 2010;25:441-447.

STUDY

Medicines reconciliation using a shared electronic health care record.

Moore P, Armitage G, Wright J, Dobrzanski S, Ansari N, Hammond I, Scally A. J Patient Saf. 2011;7:147-153.

STUDY

Medication safety initiative in reducing medication errors.

Nguyen EE, Connolly PM, Wong V. J Nurs Care Qual. 2010;25:224-230.

STUDY

Disclosure of hospital adverse events and its association with patients' ratings of the quality of care.

López L, Weissman JS, Schneider EC, Weingart SN, Cohen AP, Epstein AM. Arch Intern Med. 2009;169:1888-1894.

STUDY

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.

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.

STUDY

Accuracy of medication documentation in hospital discharge summaries: a retrospective analysis of medication transcription errors in manual and electronic discharge summaries.

Callen J, McIntosh J, Li J. Int J Med Inform. 2010;79:58-64.

STUDY

Developing a programme for medication reconciliation at the time of admission into hospital.

Manzorro AG, Zoni AC, Rieiro CR, et al. Int J Clin Pharm. 2011;33:603-609.

STUDY

Association of interruptions with an increased risk and severity of medication administration errors.

Westbrook JI, Woods A, Rob MI, Dunsmuir WTM, Day RO. Arch Intern Med. 2010;170:683-690.

STUDY

What do hospital staff in the UK think are the causes of penicillin medication errors?

Wilcock M, Harding G, Moore L, Nicholls I, Powell N, Stratton J. Int J Clin Pharm. 2013;35:72-78.

NEWSPAPER/MAGAZINE ARTICLE

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.

STUDY

A prospective observational study of physician handoff for intensive-care-unit-to-ward patient transfers.

Li P, Stelfox HT, Ghali WA. Am J Med. 2011;124:860-867.

STUDY

Errors and omissions in hospital prescriptions: a survey of prescription writing in a hospital.

Calligaris L, Panzera A, Arnoldo L, et al. BMC Clin Pharmacol. 2009;9:9.

STUDY

Omitted and unjustified medications in the discharge summary.

Perren A, Previsdomini M, Cerutti B, Soldini D, Donghi D, Marone C. Qual Saf Health Care. 2009;18:205-208.

REVIEW

Hospital do-not-resuscitate orders: why they have failed and how to fix them.

Yuen JK, Reid MC, Fetters MD. J Gen Intern Med. 2011;26:791-797.

STUDY

Can an electronic prescribing system detect doctors who are more likely to make a serious prescribing error?

Coleman JJ, Hemming K, Nightingale PG, et al. J R Soc Med. 2011;104:208-218.

NEWSPAPER/MAGAZINE ARTICLE

Medication errors occurring with the use of bar-code administration technology.

PA-PSRS Patient Saf Advis. December 2008;5:122-126.

STUDY

Stakeholder perspectives on handovers between hospital staff and general practitioners: an evaluation through the microsystems lens.

Göbel B, Zwart D, Hesselink G, Pijnenborg L, Barach P, Kalkman C, Johnson JK. BMJ Qual Saf. 2012;21:i106-i113.

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