AHRQ Patient Safety Network

The Collection > Active Errors

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Safety Target

•Device-related Complications (62)

•Diagnostic Errors (103)

•Identification Errors (66)

•Discontinuities, Gaps, and Hand-Off Problems (106)

•Fatigue and Sleep Deprivation (6)

•Medication Safety (409)

•Medical Complications (63)

•Nonsurgical Procedural Complications (31)

•Surgical Complications (132)

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•Psychological and Social Complications (33)

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•Africa (1)

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•Clinical Guideline (2)

•Journal Article (615)

•Legislation/Regulation (7)

•Meeting/Conference (3)

•Newspaper/Magazine Article (164)

•Press Release/Announcement (9)

•Special or Theme Issue (5)

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Error Types
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Active Errors

•Noncognitive Errors ("Slips & Lapses") (97)

•Cognitive Errors ("Mistakes") (98)

Approach to Improving Safety

•Quality Improvement Strategies (192)

•Legal and Policy Approaches (101)

•Error Reporting and Analysis (248)

•Communication Improvement (235)

•Human Factors Engineering (213)

•Teamwork (38)

•Specialization of Care (37)

•Logistical Approaches (54)

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•Technologic Approaches (199)

•Education and Training (167)

Clinical Areas

•Allied Health Services (5)

•Medicine (650)

•Nursing (112)

•Pharmacy (149)

Target Audience

•Health Care Providers (671)

•Health Care Executives and Administrators (646)

•Non-Health Care Professionals (267)

•Patients (105)

Setting of Care

•Hospitals (591)

•Psychiatric Facilities (3)

•Residential Facilities (15)

•Ambulatory Care (104)

•Outpatient Surgery (14)

•Patient Transport (12)

1 - 20 of 860

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STUDY

Empowering frontline nurses: a structured intervention enables nurses to improve medication administration accuracy.

Kliger J, Blegen MA, Gootee D, O'Neil E. Jt Comm J Qual Patient Saf. 2009;35:604-612.

STUDY

Association of interruptions with an increased risk and severity of medication administration errors.

Westbrook JI, Woods A, Rob MI, Dunsmuir WTM, Day RO. Arch Intern Med. 2010;170:683-690.

COMMENTARY

Implementing a safe and reliable process for medication administration.

Richardson B, Bromirski B, Hayden A. Clin Nurse Spec. 2012;26:169-176.

NEWSPAPER/MAGAZINE ARTICLE

Design for reliability: barcoded medication administration.

Hayden AC, Lanoue ET, Still CJ. Patient Saf Qual Healthc. July/August 2011;8:12-20.

STUDY

Medication safety initiative in reducing medication errors.

Nguyen EE, Connolly PM, Wong V. J Nurs Care Qual. 2010;25:224-230.

STUDY

The application of Aronson's taxonomy to medication errors in nursing.

Johnson M, Young H. J Nurs Care Qual. 2011;26:128-135.

REVIEW

Work interruptions and their contribution to medication administration errors: an evidence review.

Biron AD, Loiselle CG, Lavoie-Tremblay M. Worldviews Evid Based Nurs. 2009;6:70-86.

COMMENTARY

Using simulation to teach nursing students and licensed clinicians obstetric emergencies.

Alderman JT. MCN Am J Matern Child Nurs. 2012;37:394-400.

STUDY

A case of mistaken identity: staff input on patient ID errors.

Ortiz J, Amatucci C. Nurs Manage. April 2009;4:37-41.

COMMENTARY

Nursing student medication errors: a case study using root cause analysis.

Dolansky MA, Druschel K, Helba M, Courtney K. J Prof Nurs. 2013;29:102-108.

STUDY

A human factors framework and study of the effect of nursing workload on patient safety and employee quality of working life.

Holden RJ, Scanlon MC, Patel NR, et al. BMJ Qual Saf. 2011;20:15-24.

STUDY

The impact of traditional and smart pump infusion technology on nurse medication administration performance in a simulated inpatient unit.

Trbovich PL, Pinkney S, Cafazzo JA, Easty AC. Qual Saf Health Care. 2010;19:430-434.

STUDY

Patient perceptions of missed nursing care.

Kalisch BJ, McLaughlin M, Dabney BW. Jt Comm J Qual Patient Saf. 2012;38:161-167.

COMMENTARY

Medication errors: don't let them happen to you.

Anderson P, Townsend T. Amer Nurs Today. March 2010;5:23-27.

NEWSPAPER/MAGAZINE ARTICLE

Action needed to prevent dangerous heparin-insulin confusion.

ISMP Medication Safety Alert! Acute Care Edition. May 3, 2007;12:1-2.

STUDY

Relationship between systems-level factors and hand hygiene adherence.

Dunn-Navarra AM, Cohen B, Stone PW, Pogorzelska M, Jordan S, Larson E. J Nurs Care Qual. 2011;26:30-38.

STUDY

Characteristics of medication errors made by students during the administration phase: a descriptive study.

Wolf ZR, Hicks R, Serembus JF. J Prof Nurs. 2006;22:39-51.

STUDY

Bar code medication administration technology: characterization of high-alert medication triggers and clinician workarounds.

Miller DF, Fortier CR, Garrison KL. Ann Pharmacother. 2011;45:162-168.

NEWSPAPER/MAGAZINE ARTICLE

Don't underestimate the impact of change on risk potential.

ISMP Medication Safety Alert! Acute Care Edition. September 11, 2008;13:1-3.

REVIEW

A concept analysis of situational awareness in nursing.

Fore AM, Sculli GL. J Adv Nurs. 2013 Mar 25; [Epub ahead of print].

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