AHRQ Patient Safety Network

The Collection > United States of America

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Safety Target

•Device-related Complications (122)

•Diagnostic Errors (166)

•Identification Errors (87)

•Discontinuities, Gaps, and Hand-Off Problems (373)

•Fatigue and Sleep Deprivation (87)

•Medication Safety (1282)

•Medical Complications (289)

•Nonsurgical Procedural Complications (50)

•Surgical Complications (300)

•Transfusion Complications (11)

•Psychological and Social Complications (136)

Origin/Sponsor
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United States of America

•United States Federal Government (171)

•State Governments and Agencies (17)

Resource Types

•Audiovisual (89)

•Award (19)

•Book/Report (168)

•Clinical Guideline (8)

•Journal Article (1922)

•Legislation/Regulation (45)

•Meeting/Conference (21)

•Newsletter/Journal (9)

•Newspaper/Magazine Article (641)

•Press Release/Announcement (34)

•Special or Theme Issue (27)

•Tools/Toolkit (79)

•Web Resource (100)

•Grant (5)

Error Types

•Epidemiology of Errors and Adverse Events (624)

•Active Errors (457)

•Latent Errors (171)

•Near Miss (40)

Approach to Improving Safety

•Quality Improvement Strategies (708)

•Legal and Policy Approaches (405)

•Error Reporting and Analysis (900)

•Communication Improvement (887)

•Human Factors Engineering (331)

•Teamwork (150)

•Specialization of Care (202)

•Logistical Approaches (247)

•Culture of Safety (342)

•Technologic Approaches (618)

•Education and Training (619)

Clinical Areas

•Allied Health Services (9)

Target Audience

•Health Care Providers (2260)

•Health Care Executives and Administrators (1961)

•Non-Health Care Professionals (987)

•Patients (657)

Setting of Care

•Hospitals (1835)

•Psychiatric Facilities (12)

•Residential Facilities (53)

•Ambulatory Care (432)

•Outpatient Surgery (29)

•Patient Transport (9)

1 - 20 of 3167

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AUDIOVISUAL PRESENTATION

Medication error death rate up 500 percent.

Spiesel S, Chadwick A. "Day to Day." National Public Radio. August 27, 2008.

STUDY

Signal and noise: applying a laboratory trigger tool to identify adverse drug events among primary care patients.

Brenner S, Detz A, López A, Horton C, Sarkar U. BMJ Qual Saf. 2012;21:670-675.

STUDY

Sources and types of discrepancies between electronic medical records and actual outpatient medication use.

Orrico KB. J Manag Care Pharm. 2008;14:626-631.

STUDY

Educating seniors to be patient safety self-advocates in primary care.

Elder NC, Regan SL, Pallerla H, Levin L, Post DM, Cegala DJ. J Patient Saf. 2008;4:106-112.

STUDY

Patient reported receipt of medication instructions for warfarin is associated with reduced risk of serious bleeding events.

Metlay JP, Hennessy S, Localio AR, et al. J Gen Intern Med. 2008;23:1589-1594.

NEWSPAPER/MAGAZINE ARTICLE

Survey results: community liaison programs to decrease hospital readmissions.

ISMP Medication Safey Alert! Acute Care Edition. March 7, 2013;18:1-3.

STUDY

A steep increase in domestic fatal medication errors with use of alcohol and/or street drugs.

Phillips DP, Barker GEC, Eguchi MM. Arch Intern Med. 2008;168:1561-1566.

STUDY

Retail pharmacy staff perceptions of design strengths and weaknesses of electronic prescribing.

Odukoya O, Chui MA. J Am Med Inform Assoc. 2012;19:1059-1065.

STUDY

Improving medication reconciliation in the outpatient setting.

Varkey P, Cunningham J, Bisping S. Jt Comm J Qual Patient Saf. 2007;33:286-292.

REVIEW

E-prescribing: a focused review and new approach to addressing safety in pharmacies and primary care.

Odukoya OK, Chui MA. Res Social Adm Pharm. 2012 Oct 10; [Epub ahead of print].

COMMENTARY

What medications does your patient take? Enhancing medication safety in the outpatient setting.

Institute for Healthcare Improvement. March 14, 2007.

MULTI-USE WEBSITE

Getting Safer Care.

Agency for Healthcare Research and Quality.

COMMENTARY

ISMP medication error report analysis.

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

NEWSPAPER/MAGAZINE ARTICLE

To protect against drug errors, ask questions.

Brody JE. New York Times. January 2, 2007:F7.

NEWSPAPER/MAGAZINE ARTICLE

Small patients, big consequences in medical errors.

Tarkan L. New York Times. September 14, 2008;Health section:7.

TOOLKIT

Engaging Patients in Improving Ambulatory Care.

Aligning Forces for Quality. Princeton, NJ: Robert Wood Johnson Foundation; 2013.

STUDY

Cognitive errors and logistical breakdowns contributing to missed and delayed diagnoses of breast and colorectal cancers: a process analysis of closed malpractice claims.

Poon EG, Kachalia A, Puopolo AL, Gandhi TK, Studdert DM. J Gen Intern Med. 2012;27:1416-1423.

PRESS RELEASE/ANNOUNCEMENT

Safety warnings regarding use of fentanyl transdermal (skin) patches.

FDA Public Health Advisory. Silver Spring, MD: US Food and Drug Administration; December 21, 2007.

STUDY

Patient safety perceptions of primary care providers after implementation of an electronic medical record system.

McGuire MJ, Noronha G, Samal L, Yeh HC, Crocetti S, Kravet S. J Gen Intern Med. 2013;28:184-192.

COMMENTARY

The art of apology: when and how to seek forgiveness.

Roberts RG. Fam Pract Manag. July/August 2007;14:44-49.

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