AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (55)

•Diagnostic Errors (28)

•Identification Errors (17)

•Discontinuities, Gaps, and Hand-Off Problems (70)

•Fatigue and Sleep Deprivation (39)

•Medication Safety (163)

•Medical Complications (95)

•Nonsurgical Procedural Complications (17)

•Surgical Complications (87)

•Transfusion Complications (3)

•Psychological and Social Complications (38)

Origin/Sponsor

•Africa (3)

•Asia (3)

•Australia and New Zealand (16)

•Central and South America (3)

Resource Types

•Clinical Guideline (1)

•Journal Article (441)

•Legislation/Regulation (10)

•Meeting/Conference (20)

•Newsletter/Journal (2)

•Newspaper/Magazine Article (85)

•Press Release/Announcement (5)

•Special or Theme Issue (22)

•Tools/Toolkit (17)

•Web Resource (42)

•Grant (4)

Error Types

•Epidemiology of Errors and Adverse Events (88)

•Active Errors (103)

•Latent Errors (37)

•Near Miss (13)

Approach to Improving Safety
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Education and Training

•Students (29)

•Residents and Fellows (84)

•Continuing Education (32)

•Online Education (19)

•Simulators (41)

•Teamwork Training (66)

•Patient Education (50)

Clinical Areas

•Allied Health Services (7)

Target Audience

•Health Care Providers (478)

•Health Care Executives and Administrators (583)

•Non-Health Care Professionals (366)

•Patients (57)

Setting of Care

•Hospitals (416)

•Psychiatric Facilities (2)

•Residential Facilities (14)

•Ambulatory Care (35)

•Outpatient Surgery (5)

•Patient Transport (2)

1 - 20 of 719

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NEWSPAPER/MAGAZINE ARTICLE

Leveraging technical and managerial changes to improve safety.

Pronovost P, Heifetz RA. Hosp Health Netw. March 27, 2007.

STUDY

An intervention to decrease catheter-related bloodstream infections in the ICU.

Pronovost P, Needham D, Berenholtz S, et al. N Engl J Med. 2006;355:2725-2732.

COMMENTARY

Preventing catheter-related bloodstream infections: thinking outside the checklist.

Perencevich EN, Pittet D. JAMA. 2009;301:1285-1287.

ORGANIZATIONAL POLICY/GUIDELINES

Tubing misconnections—a persistent and potentially deadly occurrence.

Sentinel Event Alert. April 3, 2006;(36):1-3.

COMMENTARY

Disruptive clinician behavior: a persistent threat to patient safety.

Porto G, Lauve R. Patient Safety Qual Healthc. July/August 2006;3:16-24.

TOOLKIT

Making Strides in Safety.

Chicago, IL: American Medical Association.

MULTI-USE WEBSITE

PreventInfection.org.

Association for Professionals in Infection Control and Epidemiology.

AWARD RECIPIENT

A comprehensive grassroots model for statewide safety improvement.

Joshi M, Kazandjian V, Martin P, et al. Jt Comm J Qual Patient Saf. 2005;31:671-677.

NEWSPAPER/MAGAZINE ARTICLE

Empowered to improve.

Gardner E. Mod Healthc. May 18, 2009;39:28-31.

NEWSPAPER/MAGAZINE ARTICLE

Clear liquids may place patients at risk.

PA-PSRS Patient Saf Advis. December 2005;2:29-31.

STUDY

Nurses' perceptions of subspecialization in pediatric cardiac intensive care unit: quality and patient safety implications.

Kane JM, Preze E. J Nurs Care Qual. 2009;24:354-361.

STUDY

Airway carts: a systems-based approach to airway safety.

Kane BG, Bond WF, Worrilow CC, Richardson DM, on behalf of the Lehigh Valley Hospital Airway Task Force. J Patient Saf. 2006;2:154-161.

NEWSPAPER/MAGAZINE ARTICLE

The role of the chief executive officer in maximizing patient safety.

Shorr AS. Healthc Exec. March-April 2007;22:19, 21-22, 24, 26.

STUDY

Adherence to simple and effective measures reduces the incidence of ventilator-associated pneumonia: [L'observation de mesures simples et efficaces reduit l'incidence de pneumonie associee a la ventilation mecanique].

Baxter AD, Allan J, Bedard J, et al. Can J Anaesth. 2005;52:535-541.

COMMENTARY

Breakage of a PICC Line

Dimov V. AHRQ WebM&M [serial online]. April 2009.

SPECIAL OR THEME ISSUE

Interprofessional Approaches to Patient Safety.

J Interprof Care. 2006;20:455-571.

NEWSPAPER/MAGAZINE ARTICLE

Get me out alive.

Feldman R. The Washington Post. May 2, 2006:HE01.

COMMENTARY

Changing the work environment in ICUs to achieve patient-focused care: the time has come.

McCauley K, Irwin RS. Chest. 2006;130:1571-1578.

TOOLKIT

A Systems Approach to Quality Improvement in Long-Term Care: Safe Medication Practices Workbook.

Waltham, MA: Masspro, Massachusetts Coalition for the Prevention of Medical Errors, Massachusetts Extended Care Foundation; 2007.

COMMENTARY classic

Transforming healthcare: a safety imperative.

Leape L, Berwick D, Clancy C, et al; Lucian Leape Institute at the National Patient Safety Foundation. Qual Saf Health Care. 2009;18:424-428.

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