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- Communication Improvement 1
- Culture of Safety 2
- Error Reporting and Analysis 2
- Human Factors Engineering 4
- Legal and Policy Approaches 2
- Quality Improvement Strategies
- Clinical Information Systems 4
- Identification Errors 3
- Interruptions and distractions 1
- Medical Complications 1
- Medication Safety 3
- Surgical Complications 2
- Health Care Executives and Administrators 5
Health Care Providers
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- Non-Health Care Professionals 5
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Cases & Commentaries
- Web M&M
Harold S. Kaplan, MD; February 2004
Blood typing tubes for a married couple brought to an ED after a trauma are labeled with the opposite stickers. By coincidence, the wife's blood type was already on file. An alert blood-bank technologist catches the mistake.
Perspectives on Safety > Perspective
with commentary by Ashish K. Jha, MD, MPH, The Transformation of Patient Safety at the VA, September 2006
Five years after the landmark Crossing the Quality Chasm report by the Institute of Medicine (IOM), the quality and safety of health care in the United States remains far from ideal.(1) It is easy to feel pessimistic. Can health care organizations really...
Rogoski RR. Health Manage Technol. August 2005;26:12,14,16,18.
This article reports on two efforts to reduce medical errors through information technology implementation.
ISMP Medication Safety Alert! Acute Care Edition. May 21, 2009;14:1-3.
This article shares results from a survey regarding look-alike or sound-alike (LASA) medication confusion and lists strategies to reduce such errors.
Journal Article > Commentary
Bates DW, Wachter RM, Vanderveen T. Patient Saf Qual Healthc. July/August 2009;6:22-27.
This piece shares insights from an interactive audio conference regarding the potential impact of information technology on safe medication delivery.
Journal Article > Study
Wrong-patient blood transfusion error: leveraging technology to overcome human error in intraoperative blood component administration.
Hensley NB, Koch CG, Pronovost PJ, et al. Jt Comm J Qual Patient Saf. 2019;45:190-198.