PATIENT SAFETY PRIMERS
Device-related Complications (2)
Diagnostic Errors (2)
Identification Errors (5)
Discontinuities, Gaps, and Hand-Off Problems (4)
Medication Safety (14)
Medical Complications (3)
Surgical Complications (7)
Transfusion Complications (1)
North America (27)
Journal Article (30)
Newspaper/Magazine Article (1)
Epidemiology of Errors and Adverse Events (6)
Active Errors (18)
Latent Errors (9)
Near Miss (3)
Approach to Improving Safety
Allied Health Services (1)
Health Care Providers (27)
Health Care Executives and Administrators (24)
Non-Health Care Professionals (16)
Setting of Care
Residential Facilities (1)
Ambulatory Care (2)
Outpatient Surgery (2)
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Around the Block.
Minichiello T. AHRQ WebM&M [serial online]. March 2005.
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.
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.
Medication orders are written clearly and transcribed accurately – implementing Medication Management Standard 3.20 and National Patient Safety Goal 2b.
Laselle TJ,May SK. Hosp Pharm. 2006;41:82-87.
Management of test results in family medicine offices.
Elder NC, McEwen TR, Flach JM, Gallimore JJ. Ann Fam Med. 2009;7:343-351.
Churchill WW, Fiumara K. AHRQ WebM&M [serial online]. April 2009.
Too Tight Control.
Rubin HR, Fajtova VT. AHRQ WebM&M [serial online]. May 2004.
Cucina R. AHRQ WebM&M [serial online]. April 2005.
Staying safe: simple tools for safe surgery.
Karl RC. Bull Am Coll Surg. April 2007;92:16-22.
Medication errors associated with documented allergies.
PA-PSRS Patient Saf Advis. September 2008;5:75-80.
A proactive risk avoidance system using failure mode and effects analysis for "same-name" physician orders.
Tarpey K, Schaaf E, Lakhani U, Balcitis J. Jt Comm J Qual Patient Saf. 2010;36:461-467.
Errors with concentrated epinephrine in otolaryngology.
Shah RK, Hoy E, Roberson DW, Nielsen D. Laryngoscope. 2008 Nov; 118: 1928-30.
Moved Too Soon.
Lindenauer P. AHRQ WebM&M [serial online]. October 2004.
"Superficial" Report Leads to "Deep" Problem.
Dhaliwal G. AHRQ WebM&M [serial online]. December 2009.
Gaba DM. AHRQ WebM&M [serial online]. October 2004.
Identifying opportunities for quality improvement in surgical site infection prevention.
Gagliardi AR, Eskicioglu C, McKenzie M, Fenech D, Nathens A, McLeod R. Am J Infect Control. 2009;37:398-402.
July 2011 Author in the Room Teleconference
Schiff GD. Institute for Healthcare Improvement; Journal of the American Medical Association. July 20, 2011.
Double Dosing, by the Rules
Cohen H. AHRQ WebM&M [serial online]. February/March 2009.
Use of the common gas outlet for supplementary oxygen during Caesarean section.
Edsell ME, Erasmus PD. Anaesthesia. 2005;60:1152-1153.
What have we learned about interventions to reduce medical errors?
Woodward HI, Mytton OT, Lemer C, et al. Annu Rev Public Health. 2010;31:479-497.
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