Narrow Results Clear All
Approach to Improving Safety
- Communication Improvement 18
- Culture of Safety 10
- Education and Training 23
- Error Reporting and Analysis 16
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Human Factors Engineering
- Checklists 17
- Legal and Policy Approaches 9
- Logistical Approaches 2
- Quality Improvement Strategies 24
- Specialization of Care 2
- Teamwork 4
- Technologic Approaches 13
Safety Target
- Device-related Complications 16
- Diagnostic Errors 2
- Discontinuities, Gaps, and Hand-Off Problems 1
- Identification Errors 3
- Interruptions and distractions 1
- Medical Complications 14
- Medication Safety 28
- Nonsurgical Procedural Complications 2
- Psychological and Social Complications 3
- Surgical Complications 6
Clinical Area
- Medicine 45
- Pharmacy 13
Target Audience
Search results for "Human Factors Engineering"
- Web Resource
- Human Factors Engineering
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Web Resource > Multi-use Website
Safety.
Center for Health Design.
Elements of the health care work environment can affect the care delivery. This website highlights design considerations for health care facilities that can help reduce noise, falls, and hospital-acquired infections. The collection includes an assessment and interactive tools to test ideas for improvement.
Legislation/Regulation
Heparin-containing medical devices and combination products: recommendations for labeling and safety testing. Draft guidance for industry and Food and Drug Administration staff.
Federal Register. Washington, DC: US Department of Health and Human Services. Baltimore, MD: Food and Drug Administration. July 9, 2015;80:39440-39441.
Heparin is a high-alert anticoagulant that has been associated with patient harm due to issues with administration and contamination. This draft guidance seeks to engage insights from the field to help improve labeling practices. The deadline for officially submitting comments was October 7, 2015.
Press Release/Announcement
FDA cautions about dose confusion and medication errors for antibacterial drug Zerbaxa (ceftolozane and tazobactam).
FDA Safety Communication. Silver Spring, MD: US Food and Drug Administration; May 20, 2015.
Dosing information on drug labels should be clearly articulated to prevent confusion. This announcement raises awareness of a drug strength labeling change regarding active ingredients in the antibacterial drug Zerbaxa to improve dosing accuracy.
Web Resource > Multi-use Website
The National Center for Human Factors Engineering in Healthcare.
MedStar Health.
This Web site hosts information on human factors engineering and describes how it can improve health care quality and safety.
Web Resource > Course Material/Curriculum
Patient Safety Curriculum.
Ann Arbor, MI: National Center for Patient Safety.
This curriculum introduces basic patient safety concepts and provides materials to support students, instructors, and faculty educators.
Audiovisual
Transforming Hospitals: Designing for Safety and Quality.
Rockville, MD: Agency for Healthcare Research and Quality; September 2007. AHRQ Publication No. 07-0076-1.
This DVD uses the experiences of three US hospitals to demonstrate how the quality and safety of each hospital's patient care services were improved by implementing evidence-based hospital design into recent construction and renovation projects.
Web Resource > Multi-use Website
SafestHospital.org.
Safest Hospital Alliance.
This Web site shares information and resources related to the Safest Hospital Alliance—a collaboration of three hospital systems to identify best practices in patient safety.
Book/Report
Coding for Success: Simple Technology for Safer Patient Care.
Healthcare Quality Directorate, Department of Health. London, England: Crown Publishing; February 16, 2007.
This report discusses the impact that automated technologies, such as radio frequency identification (RFID) and barcoding, could have on health care in the United Kingdom and provides a plan to support their adoption in the National Health Service.
Meeting/Conference > Government Resource
Public Meeting on Improving Patient Safety by Enhancing the Container Labeling for Parenteral Infusion Drug Products.
US Food and Drug Administration, Center for Drug Evaluation and Research. January 11, 2007.
The US Food and Drug Administration invited experts to comment on how labels for intravenous drugs could be designed to ensure the safe use of these medications through informed label redesign efforts.
Meeting/Conference > Government Resource
An Introduction to the Improved FDA Prescription Drug Labeling.
US Food and Drug Administration Center for Drug Evaluation and Research, Institute for Safe Medication Practices. November 7, 2006.
This teleconference discussed the 2006 FDA medication package insert design program and reviewed prescription drug labeling format changes. Handouts and an audio download of the presentation are available.
Web Resource > Course Material/Curriculum
The Systems Engineering Initiative for Patient Safety (SEIPS).
Center for Quality and Productivity Improvement; College of Engineering at the University of Wisconsin–Madison.
The project supports development of a multidisciplinary Developmental Center for Evaluation and Research in Patient Safety (DCERPS) through application of several approaches: systems engineering, human factors engineering, and industrial engineering approaches to promote patient safety, health care worker safety, and medical error reduction.
Book/Report
Report on the Safe Use of Pick Lists in Ambulatory Care Settings.
Rizk S, Oguntebi G, Graber ML, Johnston D. Research Triangle Park, NC: RTI International; 2016.
Standard term selection tools—like pick lists or drop-down menus—in information technology can create opportunities for user error due to human factors. This publication explores how mistakes such as selecting the wrong drug from an ordering pick list can occur in the ambulatory environment. The report includes recommendations and resources to help enhance medication safety when using these tools.
Newsletter/Journal
Innovations to improve patient safety.
Agency for Healthcare Research and Quality. Health Care Innovations Exchange. May 18, 2016.
This issue highlights innovations that can be applied in a variety of health care environments to prevent hospital-acquired conditions. The resources include the Chartbook on Patient Safety and checklist, decision support, and screening programs.
Book/Report
Safety Considerations for Product Design to Minimize Medication Errors: Guidance for Industry.
Rockville, MD: Center for Drug Evaluation and Research, US Food and Drug Administration; April 2016.
Strategies to prevent medication errors are a continuing focus of ongoing safety initiatives. This guidance outlines factors to consider when creating drug products to reduce design-associated medication errors.
Book/Report
Preventable tragedies: superbugs and how ineffective monitoring of medical device safety fails patients.
US Senate Health, Education, Labor, and Pensions Committee. January 13, 2016.
Insufficient sterilization of duodenoscopes and other medical equipment has been linked to health care–associated infection outbreaks. This report summarizes findings from a government investigation into existing methods for monitoring and reporting device problems and provides recommendations for Congress, hospitals, and the Food and Drug Administration to augment identification and prevention of safety issues associated with medical devices.
Book/Report
Environmental Cleaning for the Prevention of Healthcare-Associated Infections (HAIs).
Leas BF, Sullivan N, Han JH, Pegues DA, Kaczmarek JL, Umscheid CA. Rockville, MD: Agency for Healthcare Research and Quality; August 2015. Technical Brief No. 22. AHRQ Publication No. 15-EHC020-EF.
Exploring the evidence on hard surface cleaning techniques in hospital rooms, this report provides recommendations for continued monitoring of disinfection practices to reduce the spread of health care–associated infections and enhance cleanliness in hospitals.
Tools/Toolkit
Preventing Falls With Injury.
Oakbrook Terrace, IL: Joint Commission Center for Transforming Healthcare; August 2015.
Patient falls are preventable and can be addressed through quality and safety strategies. This toolkit provides a process to help health care organizations determine factors that contribute to falls in their facilities and design interventions to drive improvement.
Press Release/Announcement
FDA Drug Safety Communication: FDA warns about prescribing and dispensing errors resulting from brand name confusion with antidepressant Brintellix (vortioxetine) and antiplatelet Brilinta (ticagrelor).
MedWatch Safety Alert. Silver Spring, MD: US Food and Drug Administration; July 30, 2015.
Look-alike and sound-alike drug names can contribute to confusion and result in medication errors. To raise awareness of potential wrong-patient errors due to similarity between two proprietary names, this announcement describes near misses with the drugs at the prescribing and dispensing stage and suggests clinicians use the generic names for the medications to reduce risk of patient harm.
Book/Report
Examining the Relationship Between Health IT and Ambulatory Care Workflow Redesign.
Zheng K, Ciemins EL, Lanham HJ, Lindberg C. Rockville, MD: Agency for Healthcare Research and Quality; July 2015. AHRQ Publication No. 15-0058-EF.
Ineffective implementation of health information technology (IT) can result in workarounds and other workflow changes that disrupt care delivery. This report examines how health IT implementation can affect clinician and staff workload in the ambulatory care environment, including increase interruptions and multitasking, and recommends workload considerations to enable staff to adapt to changes in practice.
Web Resource > Multi-use Website
Injection Safety.
World Health Organization.
Poor injection practices contribute to health care–associated infections. This Web site provides resources related to a global campaign to enhance the safe use of injections through training, communication, policy development, and syringe design.