AHRQ Patient Safety Network

The Collection > Active Errors

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Safety Target

•Device-related Complications (56)

•Diagnostic Errors (131)

•Identification Errors (66)

•Discontinuities, Gaps, and Hand-Off Problems (97)

•Fatigue and Sleep Deprivation (5)

•Medication Safety (378)

•Medical Complications (75)

•Nonsurgical Procedural Complications (36)

•Surgical Complications (131)

•Transfusion Complications (5)

•Psychological and Social Complications (34)

Origin/Sponsor

•Asia (8)

•Australia and New Zealand (20)

•Central and South America (2)

Resource Types

•Clinical Guideline (2)

•Journal Article (582)

•Legislation/Regulation (5)

•Meeting/Conference (3)

•Newspaper/Magazine Article (150)

•Press Release/Announcement (13)

•Special or Theme Issue (6)

•Tools/Toolkit (7)

•Web Resource (9)

•Grant (1)

Error Types
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Active Errors

•Noncognitive Errors ("Slips & Lapses") (60)

•Cognitive Errors ("Mistakes") (101)

Approach to Improving Safety

•Quality Improvement Strategies (198)

•Legal and Policy Approaches (101)

•Error Reporting and Analysis (216)

•Communication Improvement (235)

•Human Factors Engineering (185)

•Teamwork (34)

•Specialization of Care (35)

•Logistical Approaches (44)

•Culture of Safety (62)

•Technologic Approaches (184)

•Education and Training (192)

Clinical Areas

•Allied Health Services (6)

•Medicine (630)

•Nursing (85)

•Pharmacy (134)

Target Audience

•Health Care Providers (666)

•Health Care Executives and Administrators (564)

•Non-Health Care Professionals (244)

•Patients (102)

Setting of Care

•Hospitals (531)

•Psychiatric Facilities (5)

•Residential Facilities (13)

•Ambulatory Care (125)

•Outpatient Surgery (16)

•Patient Transport (10)

1 - 20 of 815

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REVIEW

Nonhospital health care–associated hepatitis B and C virus transmission: United States, 1998-2008.

Thompson ND, Perz JF, Moorman AC, Holmberg SD. Ann Intern Med. 2009;150:33-39.

REVIEW

Monitoring for medication errors in outpatient settings.

Balkrishnan R, Foss CE, Pawaskar M, Uhas AA, Feldman SR. J Dermatolog Treat. 2009;20:229-232.

STUDY

Medication reconciliation in ambulatory care: attempts at improvement.

Nassaralla CL, Naessens JM, Hunt VL, et al. Qual Saf Health Care. 2009;18:402-407.

COMMENTARY classic

Balancing "no blame" with accountability in patient safety.

Wachter RM, Pronovost PJ. N Engl J Med. 2009;361:1401-1406.

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

Alternatives to potentially inappropriate medications for use in e-prescribing software: triggers and treatment algorithms.

Hume AL, Quilliam BJ, Goldman R, Eaton C, Lapane KL. BMJ Qual Saf. 2011;20:875-884.

STUDY

Effect of a weight-based prescribing method within an electronic health record on prescribing errors.

Ginzburg R, Barr WB, Harris M, Munshi S. Am J Health Syst Pharm. 2009;66:2037-2041.

STUDY

The impact of computerized provider order entry on medication errors in a multispecialty group practice.

Devine EB, Hansen RN, Wilson-Norton JL, et al. J Am Med Inform Assoc. 2010;17:78-84.

COMMENTARY

ISMP medication error report analysis.

Cohen MC. Hosp Pharm. 2009;44:374-378.

GRANT RECIPIENT

AHRQ Projects to Prevent Healthcare-Associated Infections, Fiscal Year 2011.

Rockville, MD: Agency for Healthcare Research and Quality; October 2011. AHRQ Publication No. 09-P013-4-E.

STUDY

Infection control assessment of ambulatory surgical centers.

Schaefer MK, Jhung M, Dahl M, et al. JAMA. 2010;303:2273-2279.

STUDY

Medication error reporting in nursing homes: identifying targets for patient safety improvement.

Greene SB, Williams CE, Pierson S, Hansen RA, Carey TS. Qual Saf Health Care. 2010;19:218-222.

STUDY

The management of test results in primary care: does an electronic medical record make a difference?

Elder NC, McEwen TR, Flach J, Gallimore J, Pallerla H. Fam Med. 2010;42:327-333.

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.

COMMENTARY

ISMP medication error report analysis.

Cohen MR, Smetzer JL. Hosp Pharm. 2009;44:847-853.

STUDY

Electronic prescribing improves medication safety in community-based office practices.

Kaushal R, Kern LM, Barrón Y, Quaresimo J, Abramson EL. J Gen Intern Med. 2010;25:530-536.

STUDY

Pediatric antidepressant medication errors in a national error reporting database.

Rinke ML, Bundy DG, Shore AD, Colantuoni E, Morlock LL, Miller MR. J Dev Behav Pediatr. 2010;31:129-136.

STUDY

Medication errors in paediatric outpatients.

Kaushal R, Goldmann DA, Keohane CA, et al. Qual Saf Health Care. 2010;19:e30.

BOOK/REPORT

Patient Safety Authority Annual Reports.

Harrisburg, PA: Patient Safety Authority; April 2012.

STUDY

Injection practices among clinicians in United States health care settings.

Pugliese G, Gosnell C, Bartley JM, Robinson S. Am J Infect Control. 2010;38:789-798.

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