AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (18)

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•Identification Errors (49)

•Discontinuities, Gaps, and Hand-Off Problems (317)

•Fatigue and Sleep Deprivation (12)

•Medication Safety (261)

•Medical Complications (75)

•Nonsurgical Procedural Complications (15)

•Surgical Complications (136)

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•Clinical Guideline (1)

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•Special or Theme Issue (19)

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Error Types

•Epidemiology of Errors and Adverse Events (152)

•Active Errors (156)

•Latent Errors (66)

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Approach to Improving Safety
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Communication Improvement

•Communication between Providers (638)

•Provider-Patient Communication (262)

Clinical Areas

•Allied Health Services (1)

•Medicine (680)

•Nursing (98)

•Pharmacy (104)

Target Audience

•Health Care Providers (757)

•Health Care Executives and Administrators (857)

•Non-Health Care Professionals (337)

•Patients (95)

Setting of Care

•Hospitals (708)

•Psychiatric Facilities (4)

•Residential Facilities (19)

•Ambulatory Care (116)

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1 - 20 of 1017

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NEWSPAPER/MAGAZINE ARTICLE

What pilots can teach hospitals about patient safety.

Murphy K. New York Times. October 31, 2006:F5.

BOOK/REPORT

Committed to Safety: Ten Case Studies on Reducing Harm to Patients.

McCarthy D, Blumenthal D. New York, NY: The Commonwealth Fund; April 2006.

TOOLKIT

Patient Safety Rounding Toolkit.

Dana-Farber Cancer Institute.

STUDY

Risk of medication errors at hospital discharge and barriers to problem resolution.

Enguidanos SM, Brumley RD. Home Health Care Serv Q. 2005;24:123-135.

REVIEW

What is patient safety culture? A review of the literature.

Sammer CE, Lykens K, Singh KP, Mains DA, Lackan NA. J Nurs Scholarsh. 2010;42:156-165.

COMMENTARY

ISMP medication error report analysis.

Cohen MR. Hosp Pharm. 2009;44:654-657.

COMMENTARY

Keeping safety a priority in home care and hospice: one agency's journey.

Mullin L. Home Healthc Nurse. 2010;28:63-70.

STUDY

Assessing and improving safety culture throughout an academic medical centre: a prospective cohort study.

Paine LA, Rosenstein BJ, Sexton JB, Kent P, Holzmueller CG, Pronovost PJ. Qual Saf Health Care. 2010;19:547-554.

COMMENTARY

Crossing to safety: transforming healthcare organizations for patient safety.

Ralston JD, Larson EB. J Postgrad Med. 2005;51:61-67.

NEWSPAPER/MAGAZINE ARTICLE

Our long journey towards a safety-minded just culture. Part I: Where we've been.

ISMP Medication Safety Alert! Acute Care Edition. September 7, 2006;11:1-3.

STUDY

Patient Safety Leadership WalkRounds.

Frankel A, Graydon-Baker E, Neppl C, Simmonds T, Gustafson M, Gandhi TK. Jt Comm J Qual Improv. 2003;29:16-26.

SPECIAL OR THEME ISSUE

Patient Safety in Pediatric Emergency Medicine.

Frush KS, Hohenhaus SM, eds. Clin Ped Emerg Med. 2006;7:213-277.

BOOK/REPORT

Pulse Report 2009: Safety Culture: Staff Perspectives on American Health Care.

South Bend, IN: Press Ganey Associates, Inc: 2009.

STUDY

Creating safety culture on nursing units: human performance and organizational system factors that make a difference.

Moody RF, Pesut DJ, Harrington CF. J Patient Saf. 2006;2:198-206.

AUDIOVISUAL

Empowering Better Nursing Care.

Robert Wood Johnson Foundation.

STUDY

A novel method for reproducibly measuring the effects of interventions to improve emotional climate, indices of team skills and communication, and threat to patient outcome in a high-volume thoracic surgery center.

Nurok M, Lipsitz S, Satwicz P, Kelly A, Frankel A. Arch Surg. 2010;145:489-495.

COMMENTARY

Crew resource management: applications in healthcare organizations.

Oriol MD. J Nurs Adm. 2006;36:402-406.

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

Neurologic patient safety: an in-depth study of malpractice claims.

Glick TH, Cranberg LD, Hanscom RB, Sato L. Neurology. 2005;65:1284-1286.

STUDY

Rethinking resident supervision to improve safety: from hierarchical to interprofessional models.

Tamuz M, Giardina TD, Thomas EJ, Menon S, Singh H. J Hosp Med. 2011;6:448-456.

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