AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (7)

•Diagnostic Errors (12)

•Identification Errors (7)

•Discontinuities, Gaps, and Hand-Off Problems (20)

•Fatigue and Sleep Deprivation (5)

•Medication Safety (83)

•Medical Complications (14)

•Nonsurgical Procedural Complications (8)

•Surgical Complications (43)

•Transfusion Complications (1)

•Psychological and Social Complications (9)

Origin/Sponsor
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United Kingdom

Resource Types

•Audiovisual (2)

•Book/Report (32)

•Clinical Guideline (1)

•Journal Article (199)

•Legislation/Regulation (1)

•Newspaper/Magazine Article (12)

•Press Release/Announcement (1)

•Special or Theme Issue (6)

•Tools/Toolkit (2)

•Web Resource (2)

Error Types

•Epidemiology of Errors and Adverse Events (68)

•Active Errors (39)

•Latent Errors (16)

•Near Miss (11)

Approach to Improving Safety

•Quality Improvement Strategies (64)

•Legal and Policy Approaches (19)

•Error Reporting and Analysis (118)

•Communication Improvement (51)

•Human Factors Engineering (38)

•Teamwork (30)

•Specialization of Care (9)

•Logistical Approaches (12)

•Culture of Safety (34)

•Technologic Approaches (26)

•Education and Training (56)

Clinical Areas

•Allied Health Services (1)

•Medicine (182)

•Nursing (37)

•Pharmacy (21)

Target Audience

•Health Care Providers (203)

•Health Care Executives and Administrators (208)

•Non-Health Care Professionals (93)

•Patients (7)

Setting of Care

•Hospitals (142)

•Psychiatric Facilities (6)

•Residential Facilities (2)

•Ambulatory Care (17)

•Outpatient Surgery (2)

•Patient Transport (4)

1 - 20 of 258

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STUDY

Medication errors in intravenous drug preparation and administration: a multicentre audit in the UK, Germany and France.

Cousins DH, Sabatier B, Begue D, Schmitt C, Hoppe-Tichy T. Qual Saf Health Care. 2005;14:190-195.

COMMENTARY

'Balancing risk, that is my life': The politics of risk in a hospital operating theatre department.

McDonald R, Waring J, Harrison S. Health Risk Soc. 2005;7:397-411.

CLINICAL GUIDELINE

Recommendations from the British Committee for Standards in Haematology and National Patient Safety Agency.

Baglin TP, Cousins D, Keeling DM, Perry DJ, Watson HG. Br J Haematol. 2006;136:26-29.

STUDY

Observational assessment of surgical teamwork: a feasibility study.

Undre S, Healey AN, Darzi A, Vincent CA. World J Surg. 2006;30:1774-1783.

BOOK/REPORT

Report 6: Managing Risk and Minimising Mistakes in Services to Children and Families.

Bostock L, Bairstow S, Fish S, Macleod F. London, England: Social Care Institute for Excellence; 2005. ISBN: 1904812279.

COMMENTARY

Implementing a systematic response to medication errors.

Larsen D, Cole R, Higton P. Nurs Stand. 2007;21:35-40.

STUDY

Exploring error in team-based acute care scenarios: an observational study from the United Kingdom.

Tallentire VR, Smith SE, Skinner J, Cameron HS. Acad Med. 2012;87:792-798.

STUDY

Which clinical errors lead to the referral of UK paediatricians to the National Clinical Assessment Service?

Raine J, Scarrott D. Eur J Pediatr. 2012;171:1449-1452.

COMMENTARY

Reducing adverse events in blood transfusion.

Stainsby D, Russell J, Cohen H, Lilleyman J. Br J Haematol. 2005;131:8-12.

STUDY

An observational study of medication administration errors in old-age psychiatric inpatients.

Haw C, Stubbs J, Dickens G. Int J Qual Health Care. 2007;19:210-216.

COMMENTARY

Improving patient safety in radiotherapy by learning from near misses, incidents and errors.

Williams MV. Br J Radiol. 2007;80:297-301.

STUDY

Adverse incidents, patient flow and nursing workforce variables on acute psychiatric wards: the Tompkins Acute Ward Study.

Bowers L, Allan T, Simpson A, Nijman H, Warren J. Int J Soc Psychiatry. 2007;53:75-84.

COMMENTARY

Wrong site surgery.

Fraser SG, Adams W. Br J Ophthalmol. 2006;90:814-816.

STUDY

Adverse events and near miss reporting in the NHS.

Shaw R, Drever F, Hughes H, Osborn S, Williams S. Qual Saf Health Care. 2005;14:279-283.

STUDY

Using the internet to deliver education on drug safety.

Franklin BD, O'Grady K, Parr J, Walton I. Qual Saf Health Care. 2006;15:329-333.

STUDY

Medication administration errors for older people in long-term residential care.

Szczepura A, Wild D, Nelson S. BMC Geriatr. 2011;11:82.

STUDY

Using a multi-method, user centred, prospective hazard analysis to assess care quality and patient safety in a care pathway.

Dean J, Hutchinson A, Hamilton Escoto K, Lawson R. BMC Health Serv Res. 2007;7:89.

STUDY

Interdisciplinary communication in the intensive care unit.

Reader TW, Flin R, Mearns K, Cuthbertson BH. Br J Anaesth. 2007;98:347-52.

NEWSPAPER/MAGAZINE ARTICLE

When surgery goes wrong: weighing up the risks.

Feinmann J. The Independent. November 14, 2006.

COMMENTARY

Teamwork and team training in the ICU: where do the similarities with aviation end?

Reader TW, Cuthbertson BH. Crit Care. 2011;15:313.

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