AHRQ Patient Safety Network

Identifying causes of adverse events detected by an automated trigger tool through in-depth analysis.

Muething SE, Conway PH, Kloppenborg E, et al. Qual Saf Health Care. 2010;19:435-439.

In this study, investigators identified possible medication errors using trigger tools, and a multidisciplinary team conducted real-time analyses to identify underlying system flaws contributing to the errors.

PubMed citation

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Resource Type

Study

Setting of Care

Children’s Hospitals

Target Audience

Health Care Providers

Quality and Safety Professionals

Information Professionals

Clinical Area

General Internal Medicine

Hospital Medicine

Pediatrics

Safety Target

Medication Errors/Preventable Adverse Drug Events

Insulin

Opiates/Narcotics

Error Types

Epidemiology of Errors and Adverse Events

Active Errors

Latent Errors

Approach to Improving Safety

Audit and Feedback

Error Analysis

Computerized Adverse Event Detection

Origin/Sponsor

United States of America