AHRQ Patient Safety Network

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Safety Target

•Device-related Complications (8)

•Diagnostic Errors (6)

•Identification Errors (9)

•Discontinuities, Gaps, and Hand-Off Problems (55)

•Fatigue and Sleep Deprivation (4)

•Medication Safety (54)

•Medical Complications (22)

•Nonsurgical Procedural Complications (10)

•Surgical Complications (42)

•Psychological and Social Complications (14)

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United Kingdom

Resource Types

•Audiovisual (1)

•Book/Report (37)

•Journal Article (199)

•Legislation/Regulation (2)

•Meeting/Conference (2)

•Newspaper/Magazine Article (17)

•Special or Theme Issue (8)

•Tools/Toolkit (2)

•Web Resource (5)

Error Types

•Epidemiology of Errors and Adverse Events (49)

•Active Errors (26)

•Latent Errors (12)

•Near Miss (4)

Approach to Improving Safety

•Quality Improvement Strategies (73)

•Legal and Policy Approaches (28)

•Error Reporting and Analysis (96)

•Communication Improvement (77)

•Human Factors Engineering (45)

•Teamwork (33)

•Specialization of Care (7)

•Logistical Approaches (10)

•Culture of Safety (55)

•Technologic Approaches (27)

•Education and Training (55)

Clinical Areas

•Medicine (189)

•Nursing (9)

•Pharmacy (11)

Target Audience

•Health Care Providers (172)

•Health Care Executives and Administrators (249)

•Non-Health Care Professionals (120)

•Patients (19)

Setting of Care

•Hospitals (159)

•Psychiatric Facilities (2)

•Residential Facilities (2)

•Ambulatory Care (22)

•Outpatient Surgery (1)

•Patient Transport (7)

1 - 20 of 273

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NEWSPAPER/MAGAZINE ARTICLE

200 epidural blunders admitted after three women die.

Oakeshott I. The Sunday Times. June 18, 2006.

STUDY

A national survey of safe practice with epidural analgesia in obstetric units.

Jones R, Swales HA, Lyons GR. Anaesthesia. 2008;63:516-519.

COMMENTARY

Patient safety and adverse maternal health outcomes: the missing social inequalities 'lens.'

Murray SF, Bacchus L. BJOG. 2005;112:1339-1343.

REVIEW

The active components of effective training in obstetric emergencies.

Siassakos D, Crofts J, Winter C, Weiner C, Draycott T. BJOG. 2009;116:1028-1032.

STUDY

Multidisciplinary obstetric simulated emergency scenarios (MOSES): promoting patient safety in obstetrics with teamwork-focused interprofessional simulations.

Freeth D, Ayida G, Berridge EJ, et al. J Contin Educ Health Prof. 2009;29:98-104.

BOOK/REPORT

Saving Mothers' Lives: Reviewing Maternal Deaths to Make Motherhood Safer—2003–2005.

Lewis G, ed. London, England: The Confidential Enquiry into Maternal and Child Health; December 2007. ISBN: 9780953353682.

SPECIAL OR THEME ISSUE

Human Factors in Anaesthesia and Critical Care.

Hardman JG, Moppett IK, eds. Br J Anaesth. 2010;105:1-83.

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.

BOOK/REPORT

Breast Cancer Services in Trafford and North Manchester. An Investigation Into The Circumstances Surrounding A Serious Clinical Incident In Symptomatic Breast Services – The Baker Report.

Baker M. Manchester, England: NHS North West; February 2007.

STUDY

Content analysis of team communication in an obstetric emergency scenario.

Siassakos D, Draycott T, Montague I, Harris M. J Obstet Gynaecol. 2009;29:499-503.

REVIEW

Systematic review and evaluation of physiological track and trigger warning systems for identifying at-risk patients on the ward.

Gao H, McDonnell A, Harrison DA, et al. Intensive Care Med. 2007;33:667-79.

BOOK/REPORT

Safer Care for the Acutely Ill Patient: Learning from Serious Incidents.

Thomson R, Luettel D, Healey F, Scobie S. London, UK: National Patient Safety Agency; 2007. ISBN: 9780955634055.

STUDY

Mihai R, Scott S, Cook TM. Anaesthesia. 2009;64:829-835.

NEWSPAPER/MAGAZINE ARTICLE

When surgery goes wrong: weighing up the risks.

Feinmann J. The Independent. November 14, 2006.

STUDY

Simulation as a tool to improve the safety of pre-hospital anaesthesia—a pilot study.

Batchelder AJ, Steel A, Mackenzie R, Hormis AP, Daniels TS, Holding N. Anaesthesia. 2009;64:978-983.

BOOK/REPORT

Designing Safer Rotas for Junior Doctors in the 48-Hour Week.

Horrocks N, Pounder R. London, UK: Royal College of Physicians of London; September 2006. ISBN: 1860162886.

BOOK/REPORT

Improving safety in maternity services: a toolkit for teams.

Thomas V, Dixon A. London, UK: The King's Fund; March 2012. ISBN: 9781857176384.

STUDY

Supporting structures for team situation awareness and decision making: insights from four delivery suites.

Mackintosh N, Berridge EJ, Freeth D. J Eval Clin Pract. 2009;15:46-54.

REVIEW

Safety in obstetric critical care.

Scholefield H. Best Pract Res Clin Obstet Gynaecol. 2008;22:965-982.

TOOLKIT

Getting the Medicines Right.

London, UK: The Royal Pharmaceutical Society.

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