U.S. Department of Health & Human Services
Institutional Patient Safety Plan
PATIENT SAFETY PRIMERS
2014 ANNUAL PERSPECTIVES
Device-related Complications (3)
Discontinuities, Gaps, and Hand-Off Problems (1)
Medication Safety (7)
Medical Complications (9)
Surgical Complications (2)
North America (26)
Journal Article (18)
Newspaper/Magazine Article (2)
Web Resource (2)
Epidemiology of Errors and Adverse Events (5)
Active Errors (2)
Latent Errors (1)
Approach to Improving Safety
Institutional Patient Safety Plan
Health Care Providers (15)
Health Care Executives and Administrators (26)
Non-Health Care Professionals (6)
Setting of Care
Residential Facilities (1)
Ambulatory Care (2)
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The power of collaboration with patient safety programs: building safe passage for patients, nurses, and clinical staff.
Kerfoot KM, Rapala K, Ebright P, Rogers SM. J Nurs Adm. 2006;36:582-588.
Improving America's Hospitals: The Joint Commission's Report on Quality and Safety 2008.
Oakbrook Terrace, IL: The Joint Commission; November 2008.
On the CUSP: Stop HAI.
Health Research & Educational Trust, MHA Keystone Center.
Maintaining and sustaining the
On the CUSP: Stop BSI
model in Hawaii.
Lin DM, Weeks K, Holzmueller CG, Pronovost PJ, Pham JC. Jt Comm J Qual Patient Saf. 2013;39:51-60.
Eradicating central line–associated bloodstream infections statewide: the Hawaii experience.
Lin DM, Weeks K, Bauer L, et al. Am J Med Qual. 2012;27:124-129.
AHRQ Projects to Prevent Healthcare-Associated Infections, Fiscal Year 2011.
Rockville, MD: Agency for Healthcare Research and Quality; October 2011. AHRQ Publication No. 09-P013-4-E.
A resident-led institutional patient safety and quality improvement process.
Stueven J, Sklar DP, Kaloostian P, et al. Am J Med Qual. 2012;27:369-376.
Hospital responses to the Leapfrog Group in local markets.
Scanlon DP, Christianson JB, Ford EW. Med Care Res Rev. 2008;32:548-556.
The Leapfrog Group Announces the 2008 Leapfrog Top Hospitals.
Washington, DC: Leapfrog Group; September 24, 2008.
Critical Incident Reviews, Significant Adverse Event Reports and Action Plans.
St Andrews, Scotland: Scottish Information Commissioner; February 21, 2012. Reference No: 201100433.
Keeping Kidney Patients Safe.
Renal Physicians Association.
Rockville, MD: Agency for Healthcare Research and Quality; September 10, 2012.
Building and sustaining a systemwide culture of safety.
Yates GR, Bernd DL, Sayles SM, Stockmeier CA, Burke G, Merti GE. Jt Comm J Qual Patient Saf. 2005;31:684-689.
The Institute for Safe Medication Practices and poison control centers: collaborating to prevent medication errors and unintentional poisonings.
Vaida AJ. J Med Toxicol. 2015 Apr 4; [Epub ahead of print].
Health-care industry agrees on patient safety rules.
Landro L. Wall Street Journal (Eastern Edition). November 1, 2006:D1. [reprinted on Post-gazette.com].
Risk reduction for adverse drug events through sequential implementation of patient safety initiatives in a children's hospital.
Leonard MS, Cimino M, Shaha S, McDougal S, Pilliod J, Brodsky L. Pediatrics. 2006;118:e1124-e1129.
The TRANSFORM patient safety project: a microsystem approach to improving outcomes on inpatient units.
Braddock CH III, Szaflarski N, Forsey L, Abel L, Hernandez-Boussard T, Morton J. J Gen Intern Med. 2015;30:425-433.
Prioritizing patient safety interventions in small and rural hospitals.
Casey MM, Wakefield M, Coburn AF, Moscovice IS, Loux S. Jt Comm J Qual Patient Saf. 2006;32:693-702.
Implementation of a surgical comprehensive unit-based safety program to reduce surgical site infections.
Wick EC, Hobson DB, Bennett JL, et al. J Am Coll Surg. 2012;215;193-200.
A comprehensive obstetric patient safety program reduces liability claims and payments.
Pettker CM, Thung SF, Lipkind HS, et al. Am J Obstet Gynecol. 2014;211:319-325.
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