AHRQ Patient Safety Network

The Collection > Computerized Adverse Event Detection

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Safety Target

•Device-related Complications (5)

•Diagnostic Errors (8)

•Identification Errors (2)

•Discontinuities, Gaps, and Hand-Off Problems (13)

•Fatigue and Sleep Deprivation (1)

•Medication Safety (106)

•Medical Complications (21)

•Nonsurgical Procedural Complications (2)

•Surgical Complications (12)

•Transfusion Complications (1)

•Psychological and Social Complications (2)

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•Asia (1)

•Australia and New Zealand (6)

•Europe (18)

•North America (118)

Resource Types

•Book/Report (2)

•Journal Article (120)

•Legislation/Regulation (1)

•Meeting/Conference (1)

•Newspaper/Magazine Article (23)

•Press Release/Announcement (1)

•Special or Theme Issue (1)

•Tools/Toolkit (1)

Error Types

•Epidemiology of Errors and Adverse Events (47)

•Active Errors (36)

•Latent Errors (13)

Approach to Improving Safety
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Computerized Adverse Event Detection

Clinical Areas

•Medicine (106)

•Nursing (8)

•Pharmacy (43)

Target Audience

•Health Care Providers (96)

•Health Care Executives and Administrators (115)

•Non-Health Care Professionals (98)

•Patients (4)

Setting of Care

•Hospitals (92)

•Residential Facilities (2)

•Ambulatory Care (22)

•Outpatient Surgery (3)

1 - 20 of 150

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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

Time-dependent drug–drug interaction alerts in care provider order entry: software may inhibit medication error reductions.

van der Sijs H, Lammers L, van den Tweel A, et al. J Am Med Inform Assoc. 2009;16:864-868.

STUDY

The wolf is crying in the operating room: patient monitor and anesthesia workstation alarming patterns during cardiac surgery.

Schmid F, Goepfert MS, Kuhnt D, et al. Anesth Analg. 2011;112:78-83.

STUDY

Critical drug–drug interactions for use in electronic health records systems with computerized physician order entry: review of leading approaches.

Classen DC, Phansalkar S, Bates DW. J Patient Saf. 2011;7:61-65.

STUDY

Bar code medication administration technology: characterization of high-alert medication triggers and clinician workarounds.

Miller DF, Fortier CR, Garrison KL. Ann Pharmacother. 2011;45:162-168.

STUDY

Sustaining and spreading the reduction of adverse drug events in a multicenter collaborative.

Tham E, Calmes HM, Poppy A, et al. Pediatrics. 2011;128:e438-e445.

COMMENTARY

Eptifibatide Epilogue

Churchill WW, Fiumara K. AHRQ WebM&M [serial online]. April 2009.

STUDY

Identifying causes of adverse events detected by an automated trigger tool through in-depth analysis.

Muething SE, Conway PH, Kloppenborg E, et al. Qual Saf Health Care. 2010;19:435-439.

STUDY

Impact of implementing alerts about medication black-box warnings in electronic health records.

Yu DT, Seger DL, Lasser KE, et al. Pharmacoepidemiol Drug Saf. 2011;20:192-202.

STUDY

Preventing potentially inappropriate medication use in hospitalized older patients with a computerized provider order entry warning system.

Mattison MLP, Afonso KA, Ngo LH, Mukamal KJ. Arch Intern Med. 2010;170:1331-1336.

STUDY

Electronic health record-based surveillance of diagnostic errors in primary care.

Singh H, Giardina TD, Forjuoh SN, et al. BMJ Qual Saf. 2012;22:93-100.

NEWSPAPER/MAGAZINE ARTICLE

Neuromuscular blocking agents: reducing associated wrong-drug errors.

PA-PSRS Patient Saf Advis. December 2009;6:109-114.

STUDY

Outpatient adverse drug events identified by screening electronic health records.

Gandhi TK, Seger AC, Overhage JM, et al. J Patient Saf. 2010;6;91-96.

COMMENTARY

Double Dosing, by the Rules

Cohen H. AHRQ WebM&M [serial online]. February/March 2009.

STUDY

Adverse drug event rates in six community hospitals and the potential impact of computerized physician order entry for prevention.

Hug BL, Witkowski DJ, Sox CM, et al. J Gen Intern Med. 2010;25:31-38.

STUDY

Medication-error alerts for warfarin orders detected by a bar-code-assisted medication administration system.

Fitzhenry F, Doran J, Lobo B, et al. Am J Health Syst Pharm. 2011;68:434-441.

STUDY

Predictive value of alert triggers for identification of developing adverse drug events.

Moore C, Li J, Hung CC, Downs J, Nebeker JR. J Patient Saf. 2009;5:223-228.

STUDY

Automated identification of extreme-risk events in clinical incident reports.

Ong MS, Magrabi F, Coiera E. J Am Med Inform Assoc. 2012;19:e110-e118.

STUDY

Automated identification of postoperative complications within an electronic medical record using natural language processing.

Murff HJ, FitzHenry F, Matheny ME, et al. JAMA. 2011;306:848-855.

COMMENTARY

Information technology-based approaches to reducing repeat drug exposure in patients with known drug allergies.

Cresswell KM, Sheikh A. J Allergy Clin Immunol. 2008;121:1112-1117.e7.

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