U.S. Department of Health and Human Services
Agency for Healthcare Research and Quality: Advancing Excellence in Health Care
Sign up for a Free Account
van de Plas A, Slikkerveer M, Hoen S, et al. BMJ Qual Improv Rep. 2017;6:u215011.w5936.
van de Plas A ; Slikkerveer M ; Hoen S; et al. Experiences with Lean Six Sigma as improvement strategy to reduce parenteral medication administration errors and associated potential risk of harm. BMJ Qual Improv Rep. 2017; 6
This commentary describes the results of a Six Sigma improvement project to reduce risks of parenteral medication administration errors that cause harm. Strategies tested included education, drug delivery modifications, and ensuring administration instructions were available.
Chasing the 6-sigma: drawing lessons from the cockpit culture.
Hickey EJ, Halvorsen F, Laussen PC, Hirst G, Schwartz S, Van Arsdell GS. J Thorac Cardiovasc Surg. 2018;155:690-696.e1.
Using Six Sigma to improve patient safety in the perioperative process.
Galli BJ, Riebling N, Paraso C, Lehmann G, Yule M. Patient Saf Qual Healthc. July/August 2013;10:36-41.
Improving insulin distribution and administration safety using Lean Six Sigma methodologies.
Yamamoto J, Abraham D, Malatestinic B. Hosp Pharm. 2010;45:212-224.
Applying Lean Sigma solutions to mistake-proof the chemotherapy preparation process.
Aboumatar HJ, Winner L, Davis R, et al. Jt Comm J Qual Patient Saf. 2010;36:79-86, AP1-AP4.
Mistake-proofing healthcare: why stopping processes may be a good start.
Grout JR, Toussaint JS. Bus Horiz. 2010;53:149-156.
The Henry Ford Production System: reduction of surgical pathology in-process misidentification defects by bar code-specified work process standardization.
Zarbo RJ, Tuthill JM, D'Angelo R, et al. Am J Clin Pathol. 2009;131:468-477.
Reducing patient risk from prescription instruction errors—a six sigma approach.
O'Dell ML, Andell JL. Milwaukee, WI: American Society for Quality; 2008.
Deploying Six Sigma in a health care system as a work in progress.
Christianson JB, Warrick LH, Howard R, Vollum J. Jt Comm J Qual Patient Saf. 2005;31:603-613.
Using Six Sigma to reduce medication errors in a home-delivery pharmacy service.
Castle L, Franzblau-Isaac E, Paulsen J. Jt Comm J Qual Saf. 2005;31:319-324.
Lean Six Sigma reduces medication errors.
Esimai G. Qual Prog. April 2005;38:51-57.
On the quest for Six Sigma.
Moorman DW. Am J Surg. 2005;189:253-258.
Promoting patient safety with perioperative hand-off communication.
Robinson NL. J Perianesth Nurs. 2016;31:245-253.
Improving hand hygiene at eight hospitals in the United States by targeting specific causes of noncompliance.
Chassin MR, Mayer C, Nether K. Jt Comm J Qual Patient Saf. 2015;41:4-12.
Using Lean "automation with a human touch" to improve medication safety: a step closer to the "perfect dose."
Ching JM, Williams BL, Idemoto LM, Blackmore CC. Jt Comm J Qual Patient Saf. 2014;40:341-350.
The role of failure mode and effects analysis in health care.
Fibuch E, Ahmed A. Physician Exec. Jul-Aug 2014;40:28-32.
Using Lean to improve medication administration safety: in search of the "perfect dose."
Ching JM, Long C, Williams BL, Blackmore CC. Jt Comm J Qual Patient Saf. 2013;39:195-204.
Applying Lean methods to improve quality and safety in surgical sterile instrument processing.
Blackmore CC, Bishop R, Luker S, Williams BL. Jt Comm J Qual Patient Saf. 2013;39:99-105.
Butcher L. Hosp Health Netw. November 2011.
Vaitheeswaran V. Economist. April 16, 2009;Special Report:6-8.
Implementation of patient safety rounds in a children's hospital.
Yee PL, Edwards ML, Dixon J, Gleason NS. Nurs Adm Q. 2009;33:48-53.
Designing and implementing a comprehensive quality and patient safety management model: a paradigm for perioperative improvement.
Herzer KR, Mark LJ, Michelson JD, Saletnik LA, Lundquist CA. J Patient Saf. 2008;4:84-92.
New York-Presbyterian Hospital: translating innovation into practice.
Johnson T, Currie G, Keill P, Corwin SJ, Pardes H, Reich Cooper M. Jt Comm J Qual Patient Saf. 2005;31:554-560.
The Forgotten Radiographic Read
Clinton J. Coil, MD, MPH, and Mallory D. Witt, MD
Maximize benefits of IV workflow management systems by addressing workarounds and errors.
ISMP Medication Safety Alert! Acute Care Edition. September 7, 2017;22:1-4.
PSNET: Patient Safety Network
PSNet is produced for the Agency for Healthcare Research and Quality by a team of editors at the University of California, San Francisco with guidance from a prominent Technical Expert/Advisory Panel. The AHRQ PSNet site was designed and implemented by Silverchair.
Agency for Healthcare Research and Quality
5600 Fishers Lane
Rockville, MD 20857
Telephone: (301) 427-1364