Improving reporting of outpatient pediatric medical errors

Pediatrics

Volumn 128, Issue 6, 2011, Pages

  Neuspiel, Daniel R ^a   Stubbs, Erin H ^a   Liggin, Lori ^a  

^a Levine Children s Hospital   (United States)

Author keywords

Ambulatory care; Medical error; Safety

Indexed keywords

VACCINE;

ARTICLE; CLINICAL PRACTICE; HEALTH CARE PERSONNEL; HUMAN; LABORATORY TEST; MEDICAID; MEDICAL ERROR; MEDICATION ERROR; NURSE; OUTPATIENT; PATIENT CARE; PATIENT INFORMATION; PATIENT REFERRAL; PATIENT SAFETY; PEDIATRICS; PHYSICIAN; PRESCRIPTION; PRIORITY JOURNAL; SYSTEM ANALYSIS; TEACHING HOSPITAL; UNITED STATES; VOLUNTARY REPORTING;

EID: 83155176156     PISSN: 00314005     EISSN: 10984275     Source Type: Journal    
DOI: 10.1542/peds.2011-0477     Document Type: Article

References (22)

1. Institute of Medicine, Committee on Quality of Health Care in America. To Err Is Human: Building a Safer Health System. Kohn KT, Corrigan JM, Donaldson MS, eds. Washington, DC: National Academies Press; 2000
2. Institute of Medicine, Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001
3. Institute of Medicine, Committee on Identifying and Preventing Medication Errors. Preventing Medication Errors. Aspden P, Wolcott JA, Bootman JL, Cronenwett LR, eds. Washington, DC: National Academies Press; 2007
4. Plews-Ogan ML, Nadkarni MM, Forren S, et al. Patient safety in the ambulatory setting: a clinician-based approach. J Gen Intern Med. 2004;19(7):719-725
5. Cullen DJ, Bates DW, Small SD, Cooper JB, Nemeskal AR, Leape LL. The incident reporting system does not detect adverse drug events: a problem for quality improvement. Jt Comm J Qual Improv. 1995;21(10):541-548
6. Institute of Medicine, Committee on the Health Professions Education Summit, Board on Health Care Services. Health Professions Education: A Bridge to Quality. Greiner AC, Knebel E, eds. Washington, DC: National Academies Press; 2003
7. Weingart SN, Callanan LD, Ship AN, Aronson MD. A physician-based voluntary reporting system for adverse events and medical errors. J Gen Intern Med. 2001;16(12):809-814
8. Weingart SN, Ship AN, Aronson MD. Confidential clinician-reported surveillance of adverse events among medical inpatients. J Gen Intern Med. 2000;15(7):470-477
9. Chaudhry S, Olfinboba K, Krumholz H. Detection of errors by attending physicians on a general medicine service. J Gen Intern Med. 2003;18(8):595-600
10. Neuspiel DR, Guzman M, Harewood C. Improving error reporting in ambulatory pediatrics with team approach. Advances in Patient Safety: New Directions and Alternative Approaches. Vol 1. Henriksen K, Battles JB, Keyes MA, et al., eds. Agency for Healthcare Research and Quality. Available at: http://www.ncbi.nlm.nih.gov/books/NBK43643/. Accessed October 18, 2011
11. Fox LA, Thierry P. Process improvement: tools and methodologies for the 21st century. Available at: http://health-information.advanceweb.com/Editorial/ Content/PrintFriendly.aspx?CC=60881. Accessed September 8, 2010
12. Tague NR. The Quality Toolbox. 2nd ed. Milwaukee, WI: ASQ Quality Press; 2005:178-182
13. Neuspiel DR, Hyman D, Lane M. Quality improvement and patient safety in the pediatric ambulatory setting: current knowledge and implications for residency training. Pediatr Clin North Am. 2009;56(4):935-951
14. McPhillips HA, Stille CJ, Smith D, et al. Potential medication dosing errors in outpatient pediatrics. J Pediatr. 2005;147(6):761-767
15. Dill JL, Generali JA. Medication sample labeling practices. Am J Health Syst Pharm. 2000;57(22):2087-2090
16. Mohr JJ, Lannon CM, Thoma KA, et al. Learning from errors in ambulatory pediatrics. In: Henriksen K, Battles JB, Marks ES, et al., eds. Advances in Patient Safety: From Research to Implementation. Washington, DC: Agency for Healthcare Research and Quality; 2005:355-368
17. Kaushal R, Goldmann DA, Keohane CA, et al.Adverse drug events in pediatric outpatients. Ambul Pediatr. 2007;7(5):383-389
18. Zandieh SO, Goldmann DA, Keohane CA, Yoon C, Bates DW, Kaushal R. Risk factors in preventable adverse drug events in pediatric outpatients. J Pediatr. 2008;152(2):225-231
19. Kaushal R, Goldmann DA, Keohane CA, et al. Medication errors in paediatric outpatients. Qual Saf Health Care. 2010;19(6):e30
20. Gurwitz JH, Field TS, Harrold LR, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA. 2003;289(9):1107-1116
21. Gandhi T, Weingart S, Borus B, et al. Adverse drug events in primary care. N Engl J Med. 2003;348(16):1556-1564
22. Agency for Healthcare Research and Quality. Medical Office Survey on Patient Safety Culture. Available at: www.ahrq.gov/qual/patientsafetyculture/ mosurvindex.htm. Accessed October 18, 2011