Narrow Results Clear All
- Communication Improvement 1
- Culture of Safety 1
- Education and Training 2
- Error Reporting and Analysis 2
- Human Factors Engineering 2
- Legal and Policy Approaches 1
- Quality Improvement Strategies
- Device-related Complications 1
- Discontinuities, Gaps, and Hand-Off Problems 1
- Medical Complications 3
- Medication Safety 4
- Nonsurgical Procedural Complications 1
- Surgical Complications 1
Search results for ""
Zaidi K, Curry PD Jr, Becker SC. Pharmaceutical Technology. November 2, 2005;29:102-103.
This article reports on recommendations developed by United States Pharmacopeia (USP) to improve the safety of using medical gas, including revisions to USP monographs.
Office of the Inspector General. Washington, DC: US Department of Health and Human Services; July 2006. Report No. OEI-01-04-00340.
This report shares findings from an assessment of Centers for Medicaid and Medicare Services response to nursing home complaints. The report identifies weaknesses in the current investigation process and provides recommendations for improvement.
Tools/Toolkit > Toolkit
Waltham, MA: Masspro, Massachusetts Coalition for the Prevention of Medical Errors, Massachusetts Extended Care Foundation; 2007.
This manual provides nursing home staff with a step-by-step guide for medication management to reduce medication errors in long-term care.
Journal Article > Study
The design of the SAFE or SORRY? study: a cluster randomised trial on the development and testing of an evidence based inpatient safety program for the prevention of adverse events.
van Gaal BG, Schoonhoven L, Hulscher ME, et al. BMC Health Serv Res. 2009;9:58.
This study describes the implementation of a patient safety program focused on evidence-based guidelines to reduce the incidence of pressure ulcers, falls, and urinary tract infections. The authors discuss the challenges of their program development and implementation, including the need for reliable feedback systems on performance.
Journal Article > Study
Potentially inappropriate prescribing in older people with dementia in care homes: a retrospective analysis.
Parsons C, Johnston S, Mathie E, et al. Drugs Aging. 2012;29:143-155.
This British study found that nearly 40% of elderly patients in six residential care homes were receiving at least one potentially inappropriate medication, as defined by the STOPP criteria.
Cambridge, MA: Institute for Healthcare Improvement; June 2012.
This series, developed in conjunction with the STAAR initiative, provides tactics and resources to improve transitions across various care settings.
Web Resource > Government Resource
Atlanta, GA: Centers for Disease Control and Prevention.
This Web site provides information about government initiatives to research and prevent health care–associated infections.
Tools/Toolkit > Fact Sheet/FAQs
Horsham, PA: Institute of Safe Medication Practices; 2016.
Long-term care patients often have concurrent conditions that increase their risk of medication error. This fact sheet provides a list of potential high-alert medications prevalent in long-term care settings that should be administered with particular care due to the heightened potential for harm. A past PSNet perspective discussed medication safety in nursing homes.
Journal Article > Review
The preventable proportion of healthcare-associated infections 2005–2016: systematic review and meta-analysis.
Schreiber PW, Sax H, Wolfensberger A, Clack L, Kuster SP; Swissnoso. Infect Control Hosp Epidemiol. 2018;39:1277-1295.
Health care–associated infections (HAIs) represent a significant source of preventable harm to patients. Targeted interventions have been shown to be effective in decreasing HAIs and events once deemed unavoidable, such as central line–associated bloodstream infections, are now considered preventable. In this systematic review and meta-analysis, investigators sought to determine the proportion of HAIs prevented by infection control efforts across countries of different income levels. From the 144 studies ultimately included in the analysis, they found that implementation of evidence-based interventions was associated with an overall reduction in HAIs and that there was no relationship to the financial status of the country in which the study was conducted. A past PSNet perspective discussed infection prevention and patient safety.