AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (6)

•Diagnostic Errors (2)

•Identification Errors (7)

•Discontinuities, Gaps, and Hand-Off Problems (11)

•Fatigue and Sleep Deprivation (1)

•Medication Safety (34)

•Medical Complications (27)

•Nonsurgical Procedural Complications (1)

•Surgical Complications (27)

•Transfusion Complications (1)

•Psychological and Social Complications (10)

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•Australia and New Zealand (5)

Resource Types

•Journal Article (116)

•Legislation/Regulation (1)

•Meeting/Conference (1)

•Newspaper/Magazine Article (13)

•Special or Theme Issue (6)

•Tools/Toolkit (6)

•Web Resource (12)

Error Types

•Epidemiology of Errors and Adverse Events (29)

•Active Errors (6)

•Latent Errors (2)

Approach to Improving Safety
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Benchmarking

Clinical Areas

Target Audience

•Health Care Providers (89)

•Health Care Executives and Administrators (154)

•Non-Health Care Professionals (83)

•Patients (19)

Setting of Care

•Hospitals (119)

•Residential Facilities (3)

•Ambulatory Care (8)

•Outpatient Surgery (2)

•Patient Transport (1)

1 - 20 of 184

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STUDY

Medication errors with the use of allopurinol and colchicine: a retrospective study of a national, anonymous Internet-accessible error reporting system.

Mikuls TR, Curtis JF, Allison JJ, Hicks RW, Saag KG. J Rheumatol. 2006;33:562-566.

DATABASE/DIRECTORY

MEDMARX®.

Rockville, MD: U.S. Pharmacopeia; 2011.

COMMENTARY

Health information technology is a vehicle, not a destination: a conversation with David J. Brailer.

Milstein A. Health Aff (Millwood). 2007;26:w236-w241.

STUDY

Is the availability of hospital IT applications associated with a hospital's risk adjusted incidence rate for patient safety indicators: results from 66 Georgia hospitals.

Culler SD, Hawley JN, Naylor V, Rask KJ. J Med Syst. 2007;31:319-327.

STUDY

The long road to patient safety: a status report on patient safety systems.

Longo DR, Hewett JE, Ge B, Schubert S. JAMA. 2005;294:2858-2865.

STUDY

The effect of the fit between organizational culture and structure on medication errors in medical group practices.

Kaissi A, Kralewski J, Dowd B, Heaton A. Health Care Manage Rev. 2007;32:12-21.

STUDY

Utility of an online medication-error-reporting system.

Savage SW, Schneider PJ, Pedersen CA. Am J Health Syst Pharm. 2005;62:2265-2270.

STUDY

Targeted chart review of pediatric patient safety events identified by the Agency for Healthcare Research and Quality's Patient Safety Indicators methodology.

Scanlon MC, Miller M, Harris JM II, Schulz K, Sedman A. J Patient Saf. 2006;2:191-197.

COMMENTARY

Using the Communication and Teamwork Skills (CATS) assessment to measure health care team performance.

Frankel A, Gardner R, Maynard L, Kelly A. Jt Comm J Qual Patient Saf. 2007;33:549-558.

NEWSPAPER/MAGAZINE ARTICLE

Practitioners agree on medication reconciliation value, but frustration and difficulties abound.

ISMP Medication Safety Alert! Acute Care Edition. July 13, 2006;11:1-2.

COMMENTARY

Measuring preventable harm: helping science keep pace with policy.

Pronovost PJ, Colantuoni E. JAMA. 2009;301:1273-1275.

STUDY

Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder.

Makary MA, Sexton JB, Freischlag JA, et al. J Am Coll Surg. 2006;202:746-752.

STUDY

Toward higher-performance health systems: adults' health care experiences in seven countries, 2007.

Schoen C, Osborn R, Doty MM, Bishop M, Peugh J, Murukutla N. Health Aff (Millwood). 2007;26:w717–w734.

MULTI-USE WEBSITE classic

National Surgical Quality Improvement Program.

American College of Surgeons.

BOOK/REPORT classic

Improving America's Hospitals: The Joint Commission's Annual Report on Quality and Safety 2011.

Oakbrook Terrace, IL: The Joint Commission; September 2011.

BOOK/REPORT

HealthGrades Quality Study: Third Annual Patient Safety in American Hospitals Study.

Golden, CO: Health Grades, Inc.; April 2006.

COMMENTARY

EMR Entry Error: Not So Benign

Koppel R. AHRQ WebM&M [serial online]. April 2009.

NEWSPAPER/MAGAZINE ARTICLE

Building a case for medication reconciliation.

Nurse Advise-ERR. April 2006;4:1-3.

STUDY

Patterns in nursing home medication errors: disproportionality analysis as a novel method to identify quality improvement opportunities.

Hansen RA, Cornell PY, Ryan PB, Williams CE, Pierson S, Greene SB. Pharmacoepidemiol Drug Saf. 2010;19:1087-1094.

STUDY

Clinical and economic outcomes attributable to health care–associated sepsis and pneumonia.

Eber MR, Laxminarayan R, Perencevich EN, Malani A. Arch Intern Med. 2010;170:347-353.

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