AHRQ Patient Safety Network

The Collection > United States of America

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Safety Target

•Device-related Complications (167)

•Diagnostic Errors (184)

•Identification Errors (121)

•Discontinuities, Gaps, and Hand-Off Problems (591)

•Fatigue and Sleep Deprivation (116)

•Medication Safety (1250)

•Medical Complications (482)

•Nonsurgical Procedural Complications (101)

•Surgical Complications (415)

•Transfusion Complications (22)

•Psychological and Social Complications (157)

Origin/Sponsor
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United States of America

•United States Federal Government (270)

•State Governments and Agencies (46)

Resource Types

•Clinical Guideline (9)

•Journal Article (2867)

•Legislation/Regulation (63)

•Meeting/Conference (34)

•Newsletter/Journal (16)

•Newspaper/Magazine Article (571)

•Press Release/Announcement (30)

•Special or Theme Issue (59)

•Tools/Toolkit (78)

•Web Resource (141)

•Grant (13)

Error Types

•Epidemiology of Errors and Adverse Events (838)

•Active Errors (568)

•Latent Errors (279)

•Near Miss (69)

Approach to Improving Safety

•Quality Improvement Strategies (1020)

•Legal and Policy Approaches (445)

•Error Reporting and Analysis (1126)

•Communication Improvement (1081)

•Human Factors Engineering (511)

•Teamwork (391)

•Specialization of Care (301)

•Logistical Approaches (353)

•Culture of Safety (585)

•Technologic Approaches (737)

•Education and Training (833)

Clinical Areas

•Allied Health Services (9)

Target Audience

•Health Care Providers (3064)

•Health Care Executives and Administrators (3257)

•Non-Health Care Professionals (1531)

•Patients (416)

Setting of Care

•Hospitals (2791)

•Psychiatric Facilities (15)

•Residential Facilities (78)

•Ambulatory Care (391)

•Outpatient Surgery (47)

•Patient Transport (27)

1 - 20 of 4237

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COMMENTARY

Mitigating error vulnerability at the transition of care through the use of health IT applications.

Cortelyou-Ward K, Swain A, Yeung T. J Med Syst. 2012;36:3825-3831.

NEWSPAPER/MAGAZINE ARTICLE

JCAHO tightens leash on medication reconciliation.

Perry LE. Drug Topics: Health-System Edition. March 20, 2006.

COMMENTARY

Medication reconciliation in a community, nonteaching hospital.

Wortman SB. Am J Health Syst Pharm. 2008;65:2047-2054.

STUDY

Implementation of a medication reconciliation process in an ambulatory internal medicine clinic.

Nassaralla CL, Naessens JM, Chaudhry R, Hansen MA, Scheitel SM. Qual Saf Health Care. 2007;16:90-94.

STUDY

Prescribing discrepancies likely to cause adverse drug events after patient transfer.

Boockvar KS, Liu S, Goldstein N, Nebeker J, Siu A, Fried T. Qual Saf Health Care. 2009;18:32-36.

COMMENTARY

The challenge of medication reconciliation.

Patient Safety & Quality Healthcare. May 10, 2006.

TOOLKIT

Developing a Community-Based Patient Safety Advisory Council.

Leonhardt K, Bonin K, Pagel P. Rockville, MD: Agency for Healthcare Research and Quality; April 2008. AHRQ Publication Nos. 080048.

STUDY

Results of a medication reconciliation survey from the 2006 Society of Hospital Medicine national meeting.

Clay BJ, Halasyamani L, Stucky ER, Greenwald JL, Williams MV. J Hosp Med. 2008;3:465-472.

STUDY

Improving teamwork on general medical units: when teams do not work face-to-face.

McComb SA, Henneman EA, Hinchey KT, et al. Jt Comm J Qual Patient Saf. 2012;38:471-478.

STUDY

Reconciling medications at admission: safe practice recommendations and implementation strategies.

Rogers G, Alper E, Brunelle D, et al. Jt Comm J Qual Patient Saf. 2006;32:37-50.

COMMENTARY

Patient safety beyond the hospital.

Gandhi TK, Lee TH. N Engl J Med. 2010;363:1001-1003.

ORGANIZATIONAL POLICY/GUIDELINES

Using medication reconciliation to prevent errors.

Sentinel Event Alert. January 25, 2006;(35):1-4.

MULTI-USE WEBSITE

Aware in Care.

Miami, FL: National Parkinson Foundation; October 2012.

COMMENTARY

Ten years after the IOM report: engaging residents in quality and patient safety by creating a house staff quality council.

Fleischut PM, Evans AS, Nugent WC, et al. Am J Med Qual. 2011;26:89-94.

REVIEW

Addressing postdischarge adverse events: a neglected area.

Tsilimingras D, Bates DW. Jt Comm J Qual Patient Saf. 2008;34:85-97.

STUDY

Medication discrepancies upon hospital to skilled nursing facility transitions.

Tjia J, Bonner A, Briesacher BA, McGee S, Terrill E, Miller K. J Gen Intern Med. 2009;24:630-635.

STUDY

Hospital discharge documentation and risk of rehospitalisation.

Hansen LO, Strater A, Smith L, et al. BMJ Qual Saf. 2011;20:773-778.

NEWSPAPER/MAGAZINE ARTICLE

Ensuring medication reconciliation.

Georgia K, Kinney K, Pace A, Helton K. Patient Saf Qual Healthc. November/December 2007;4:40-42,44.

STUDY

A reengineered hospital discharge program to decrease rehospitalization: a randomized trial.

Jack BW, Chetty VK, Anthony D, et al. Ann Intern Med. 2009;150:178-187.

STUDY

Role of pharmacist counseling in preventing adverse drug events after hospitalization.

Schnipper JL, Kirwin JL, Cotugno MC, et al. Arch Intern Med. 2006;166:565-571.

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