The AHRQ PSNet Collection comprises an extensive selection of resources relevant to the patient safety community. These resources come in a variety of formats, including literature, research, tools, and Web sites. Resources are identified using the National Library of Medicine’s Medline database, various news and content aggregators, and the expertise of the AHRQ PSNet editorial and technical teams.
This study explored the association of state-level opioid-reduction policy implementation (a prescription drug monitoring program [PDMP], pain clinic legislation, and opioid prescribing guidelines) with rates of pediatric opioid poisoning in New York. PMDP implementation and pain clinic legislation were both associated with reductions in opioid poisoning rates for most age groups. Analyses of prescribing guidelines did not show a change in the rate of opioid poisoning.
Prior research suggests that text paging in the health care setting may not be the most effective mode of communication for promoting patient safety. Researchers analyzed 575 distinct text pages regarding 217 patients and found that the messages lacked standardization, often did not indicate the level of urgency, and were frequently unclear. A related commentary considers structured versus fluid communication in health care.
This study discovered that perianesthesia nurses more consistently report serious adverse events compared to minor ones even though the latter may provide equal opportunities for improvement and prevention.
Bourgeois FT, Mandl KD, Valim C, et al. Pediatrics. 2009;124:e744-e750.
According to this analysis of data from 1995 to 2005, nearly 600,000 physician visits yearly are attributable to adverse drug events (ADEs) in children. As documented in earlier research, immunosuppressive and chemotherapy medications were associated with the highest risk of an ADE. Prior studies have found that many ADEs in children are attributable to incorrect medication administration by parents, and parental education has been investigated as a means of preventing such errors. A case of parental error in administering medication to an infant is discussed in this AHRQ WebM&M commentary.