AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (4)

•Diagnostic Errors (5)

•Identification Errors (7)

•Discontinuities, Gaps, and Hand-Off Problems (28)

•Medication Safety (92)

•Medical Complications (21)

•Nonsurgical Procedural Complications (1)

•Surgical Complications (12)

•Psychological and Social Complications (3)

Origin/Sponsor

•Asia (1)

•Australia and New Zealand (1)

Resource Types

•Journal Article (80)

•Legislation/Regulation (2)

•Meeting/Conference (1)

•Newsletter/Journal (1)

•Newspaper/Magazine Article (28)

•Press Release/Announcement (2)

•Special or Theme Issue (1)

•Tools/Toolkit (18)

•Web Resource (12)

Error Types

•Epidemiology of Errors and Adverse Events (13)

•Active Errors (26)

•Latent Errors (14)

•Near Miss (1)

Approach to Improving Safety
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Patient Education

Clinical Areas

•Medicine (110)

•Nursing (3)

•Pharmacy (47)

Target Audience

•Health Care Providers (120)

•Health Care Executives and Administrators (78)

•Non-Health Care Professionals (40)

•Patients (70)

Setting of Care

•Hospitals (84)

•Residential Facilities (1)

•Ambulatory Care (44)

•Outpatient Surgery (1)

1 - 20 of 169

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NEWSPAPER/MAGAZINE ARTICLE

Medication errors: a year in review.

Institute for Safe Medication Practices. Pharmacy Practice News. October 2011:7-14.

COMMENTARY

ISMP medication error report analysis.

Cohen MR. Hosp Pharm. 2008;43:696–698.

NEWSPAPER/MAGAZINE ARTICLE

Ongoing, preventable fatal events with fentanyl transdermal patches are alarming!

ISMP Medication Safety Alert! Acute Care Edition. June 28, 2007;12:1-3.

COMMENTARY

Prevention of fatal opioid overdose.

Beletsky L, Rich JD, Walley AY. JAMA. 2012;308:1863-1864.

NEWSPAPER/MAGAZINE ARTICLE

Reducing patient harm from opiates.

ISMP Medication Safety Alert! Acute Care Edition. February 22, 2007;12:1-3.

COMMENTARY

ISMP medication error report analysis.

Cohen MC. Hosp Pharm. 2009;44:374-378.

COMMENTARY

ISMP medication error report analysis.

Cohen MR. Hosp Pharm. 2009;44:463-464.

BOOK/REPORT

Recommendations for Safe Use of Insulin in Hospitals.

Bethesda, MD: American Society of Health-System Pharmacists; 2006.

NEWSPAPER/MAGAZINE ARTICLE

Your attention please... designing effective warnings.

ISMP Medication Safety Alert! Acute Care Edition. August 24, 2006;11:1-3.

COMMENTARY

ISMP medication error report analysis.

Smetzer JL, Cohen MR. Hosp Pharm. 2008;43:869-872.

STUDY

A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial.

Gillespie U, Alassaad A, Henrohn D, et al. Arch Intern Med. 2009;169:894-900.

ORGANIZATIONAL POLICY/GUIDELINES

Preventing errors relating to commonly used anticoagulants.

Sentinel Event Alert. September 24, 2008;(41):1-4.

COMMENTARY

Developing a medication patient safety program, part 2: process and implementation.

Mark SM, Weber RJ. Hosp Pharm. 2007;42:249–254.

STUDY

Impact of a pharmacist-facilitated hospital discharge program: a quasi-experimental study.

Walker PC, Bernstein SJ, Tucker Jones JN, et al. Arch Intern Med. 2009;169:2003-2010.

STUDY

ASHP national survey of pharmacy practice in hospital settings: monitoring and patient education—2009.

Pedersen CA, Schneider PJ, Scheckelhoff DJ. Am J Health Syst Pharm. 2010;67:542-558.

FACT SHEET/FAQS

An 8-Step Check List for Medicine Safety.

Vienna, VA: The Partnership for Safe Medicines; 2005.

NEWSPAPER/MAGAZINE ARTICLE

Survey shows recession has weakened patient safety net.

ISMP Medication Safety Alert! Acute Care Edition. January 14, 2010;15:1-4.

NEWSPAPER/MAGAZINE ARTICLE

Beware of basal opioid infusions with PCA therapy.

ISMP Medication Safety Alert! Acute Care Edition. March 12, 2009;14:1-3.

STUDY

Patient-centered approach for improving prescription drug warning labels.

Webb J, Davis TC, Bernadella P, et al. Patient Educ Couns. 2008;72:443-449.

AUDIOVISUAL

Panel Discussion: Error Proofing Your Pharmacy.

Woodcliff Lake, NJ: Drug Topics; 2007.

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