U.S. Department of Health & Human Services
Education and Training
PATIENT SAFETY PRIMERS
2014 ANNUAL PERSPECTIVES
Device-related Complications (50)
Diagnostic Errors (53)
Identification Errors (20)
Discontinuities, Gaps, and Hand-Off Problems (129)
Fatigue and Sleep Deprivation (51)
Medication Safety (203)
Medical Complications (96)
Nonsurgical Procedural Complications (22)
Surgical Complications (87)
Transfusion Complications (4)
Psychological and Social Complications (53)
Australia and New Zealand (36)
Central and South America (5)
North America (720)
Journal Article (633)
Newspaper/Magazine Article (77)
Press Release/Announcement (9)
Special or Theme Issue (27)
Web Resource (63)
Epidemiology of Errors and Adverse Events (169)
Active Errors (191)
Latent Errors (105)
Near Miss (19)
Approach to Improving Safety
Education and Training
Residents and Fellows (161)
Continuing Education (69)
Online Education (52)
Teamwork Training (85)
Patient Education (85)
Allied Health Services (5)
Complementary and Alternative Medicine (1)
Health Care Providers (679)
Health Care Executives and Administrators (747)
Non-Health Care Professionals (517)
Setting of Care
Psychiatric Facilities (2)
Residential Facilities (17)
Ambulatory Care (67)
Outpatient Surgery (7)
Patient Transport (8)
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A new frontier in patient safety.
McCannon J, Berwick DM. JAMA
Patient Safety Authority Annual Reports.
Harrisburg, PA: Patient Safety Authority; April 2015.
The Patient Safety Initiative at America’s Public Hospitals: The Year One Overview.
Research Brief. Washington, DC: National Association of Public Hospitals and Health Systems; January 2011.
BOOSTing Care Transitions Resource Room.
Project BOOST (Better Outcomes for Older adults through Safe Transitions), Society of Hospital Medicine.
African Partnerships for Patient Safety.
Geneva, Switzerland: WHO Patient Safety, World Health Organization.
The partnership with patients: a call to action for leaders.
Denham CR. J Patient Saf. 2011;7:113-121.
Creating a Culture of Patient Safety Workshop.
Virginia Mason Institute. October 26-28, 2015; Seattle, WA.
Agency information collection activities: Assessing the Impact of the National Implementation of TeamSTEPPS Master Training Program; comment request.
Federal Register. Rockville, MD: Agency for Healthcare Research and Quality. August 27, 2013;78:52927-52929.
Partnering to Heal: Teaming-Up Against Healthcare-Associated Infections.
Washington, DC: US Department of Health and Human Services; May 2011.
Advancing Patient Safety: A Decade of Evidence, Design, and Implementation.
Rockville, MD; Agency for Healthcare Research and Quality; November 2009. AHRQ Publication No. 09(10)-0084.
Health Care Leader Action Guide to Reduce Avoidable Readmissions.
Osei-Anto A, Joshi M, Audet AJ, Berman A, Jencks SF. New York, NY: The Commonwealth Fund, The John Hartford Foundation, Health Research and Educational Trust; January 25, 2010.
Exploring the causes of adverse events in hospitals and potential prevention strategies.
Smits M, Zegers M, Groenewegen PP, et al. Qual Saf Health Care. 2010;19:e5.
Responsibility for quality improvement and patient safety: hospital board and medical staff leadership challenges.
Goeschel CA, Wachter RM, Pronovost PJ. Chest. 2010;138:171-178.
What is patient safety culture? A review of the literature.
Sammer CE, Lykens K, Singh KP, Mains DA, Lackan NA. J Nurs Scholarsh. 2010;42:156-165.
Proper positioning of pharmacy label on Hospira PCA vials will avoid interference with scanning.
ISMP Medication Safety Alert! Acute Care Edition. August 14, 2008;13:1-3.
Improving heparin safety: a multidisciplinary invited conference.
Peterson C, Ham CW, Vanderveen T. Hosp Pharm. 2008;43:491-497.
Measurement for improvement: a survey of current practice in Australian public hospitals.
Brand CA, Tropea J, Ibrahim JE, et al. Med J Aust. 2008;189:35-40.
Resident Duty Hours: Enhancing Sleep, Supervision, and Safety.
Ulmer C, Wolman DM, Johns MME, eds. Committee on Optimizing Graduate Medical Trainee (Resident) Hours and Work Schedule to Improve Patient Safety, Institute of Medicine. Washington, DC: The National Academies Press; 2008. ISBN: 9780309127721.
Revisiting duty-hour limits — IOM recommendations for patient safety and resident education.
Iglehart JK. N Engl J Med. 2008;359:2633-2635.
Anticoagulant safety practices call for pharmacist supervision.
Scott A. Drug Topics (Health-System Edition). November 10, 2008.
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