Environmental Scan of Patient Safety Education and Training Programs

Appendix E

Content Area

Taxonomy ID Content Area Frequency
403 Device-related Complications 6
404  -- Indwelling Tubes and Catheters 0
405  -- Infusion Pumps 1
406  -- Prostheses and Implants 0
451  -- Restraints 6
407 Diagnostic Errors 18
408  -- Clinical Misdiagnosis 0
410  -- Diagnostic Test Interpretation Error 2
409  -- Radiograph Interpretation Error 1
412 Discontinuities, Gaps, and Hand-Off Problems 4
452  -- Missed or Critical Lab Results 0
413 Fatigue and Sleep Deprivation 13
411 Identification Errors 18
443  -- Wrong Patient 7
444  -- Wrong-Site Surgery 12
426 Medical Complications 26
429  -- Delirium 2
427  -- Nosocomial Infections 3
450  -- Patient Falls 11
428  -- Pressure Ulcers 5
430  -- Venous Thrombosis and Thromboembolism 0
414 Medication Safety 126
416  -- Medication Errors/Preventable Adverse Drug Events 96
420  ---- Administration Errors 14
419  ---- Dispensing Errors 11
448  ---- Monitoring Errors and Failures 23
417  ---- Ordering/Prescribing Errors 6
418  ---- Transcription Errors 5
415  -- Side Effects/Adverse Drug Reactions 17
421  -- Specific to High-Risk Drugs 18
422  ---- Anticoagulants 3
424  ---- Chemotherapeutic Agents 0
423  ---- Insulin 0
425  ---- Look-Alike, Sound-Alike Drugs 9
449  ---- Opiates/Narcotics 0
431 Nonsurgical Procedural Complications 15
432  -- Bedside Procedures 1
433  -- Cardiology 2
434  -- Gastroenterology 0
435  -- Interventional Radiology 0
436  -- Pulmonary Complications 0
445 Psychological and Social Complications 21
446  -- Privacy Violations 2
437 Surgical Complications 25
439  -- Intraoperative Complications 12
440  ---- Retained Surgical Instruments and Sponges 0
447  ---- Wrong-Site Surgery 12
441  -- Postoperative Surgical Complications 9
453  ---- Surgical Site Infections 9
438  -- Preoperative Complications 0
442 Transfusion Complications 4
630 Communication Improvement 179
631  -- Communication between Providers 30
632  ---- Read Back Protocols 3
633  ---- Structured Hand-offs 10
680  ---- SBAR 7
681  ---- Medication Reconciliation 2
634  -- Provider-Patient Communication 57
636  ---- Health Literacy Improvement 31
635  ---- Informed Consent 11
656 Culture of Safety 151
657  -- Learning Organization 36
682  -- Red Rules 1
686  -- Institutional Patient Safety Plan 53
689  -- Just Culture 18
668 Education and Training 0
671  -- Continuing Education 0
672  ---- Conferences and Workshops 0
673  ---- Educational Outreach/Academic Detailing 0
674  -- Online Education 0
677  -- Patient Education 0
670  -- Residents and Fellows 0
675  -- Simulators 0
669  -- Students 0
676  -- Teamwork Training 0
619 Error Reporting and Analysis 206
625  -- Error Analysis 185
627  ---- Failure Mode Effects Analysis 34
628  ---- Morbidity and Mortality Conferences 0
629  ---- Narrative/Storytelling 27
626  ---- Root Cause Analysis 73
688  ---- Patient Safety Indicators 3
620  -- Error Reporting 91
621  ---- Governmental Reporting 1
622  ---- Institutional Reporting 2
690  ---- Never Events 12
623  ---- Nongovernmental Reporting 0
685  ---- Patient Complaints 2
624  ---- Patient Disclosure 3
637 Human Factors Engineering 109
641  -- Checklists 22
638  -- Forcing Functions 0
640  -- Medical Alarm Design 0
639  -- Medical Device Design 0
611 Legal and Policy Approaches 57
612  -- Credentialing, Licensure, and Discipline 5
613  -- Incentives 11
614  ---- Financial 3
615  ---- Public Reporting 8
617  -- Malpractice Litigation 3
616  -- Regulation 33
618  -- Role of the Media 3
651 Logistical Approaches 56
655  -- Duty Hour Limitation 4
652  -- Laboratory Result Tracking Improvement 2
653  -- Nurse Staffing Ratios 0
654  -- Scheduling Changes 3
603 Quality Improvement Strategies 186
604  -- Audit and Feedback 1
605  -- Benchmarking 12
606  -- Continuous Quality Improvement 87
607  -- Critical Pathways 5
610  -- Patient Self-Management 3
608  -- Practice Guidelines 14
609  -- Reminders 0
683  -- Six Sigma 12
645 Specialization of Care 10
650  -- Clinical Pharmacist Involvement 3
648  -- Hospitalists 0
647  -- Intensivists and Other ICU Strategies 1
646  -- Specialized Teams 2
684  ---- Unit-Based Safety Team 0
687  ---- Rapid-Response Teams 2
649  -- Volume-Based Referral 0
643 Teamwork 112
644  -- Teamwork Training 71
658 Technologic Approaches 73
659  -- Automatic drug dispensers 4
660  -- Bar Coding and Radiofrequency ID Tagging 8
678  -- Clinical Information Systems 25
663  ---- Computerized Decision Support 2
662  ---- Computerized Provider Order Entry (CPOE) 3
679  ---- Electronic Health Records 13
664  -- Computer-Assisted Therapy 2
666  ---- Computer- or Robotic-Assisted Surgery 0
665  ---- Computer-Assisted Radiotherapy 0
661  -- Computerized Adverse Event Detection 6
667  -- Telemedicine 0
691 Driving Change 56
692 Risk Analysis 114
693 Triage Questions 2
694 Specific Patient Care Issues 52

 

Clinical Area

Taxonomy ID Clinical Area Frequency
303 Allied Health Services 8
304  -- Nutrition/Dietetics 0
305  -- Physical and Occupational Therapy 0
306 Complementary and Alternative Medicine 0
307 Dentistry 1
308 Medicine 323
309  -- Anesthesiology 0
310  -- Critical Care 3
311  -- Dermatology 0
312  -- Emergency Medicine 16
313  -- Family Medicine 5
314  -- Gynecology 0
315  -- Hospital Medicine 31
316  -- Internal Medicine 24
317  ---- Allergy & Immunology 1
318  ---- Cardiology 2
319  ---- Emergency Medicine 16
320  ---- Endocrinology 0
321  ---- Gastroenterology 0
322  ---- General Internal Medicine 0
323  ---- Geriatrics 0
324  ---- Hematology 2
372  ---- Infectious Diseases 3
325  ---- Medical Oncology 0
326  ---- Nephrology 0
327  ---- Pulmonology 0
328  ---- Rheumatology 0
330  -- Mental Health Care (Psychiatry & Clinical Psychology) 3
331  -- Neurology 1
332  -- Obstetrics 0
333  -- Ophthalmology 0
334  -- Pathology & Laboratory Medicine 1
335  -- Pediatrics 22
341  ---- General Pediatrics 8
344  ---- Neonatology and Intensive Care 0
336  ---- Pediatric Allergy & Immunology 1
337  ---- Pediatric Cardiology 0
338  ---- Pediatric Emergency Medicine 2
339  ---- Pediatric Endocrinology 0
340  ---- Pediatric Gastroenterology 0
342  ---- Pediatric Hematology 2
343  ---- Pediatric Medical Oncology 0
345  ---- Pediatric Nephrology 0
346  ---- Pediatric Pulmonology 0
347  ---- Pediatric Rheumatology 0
348  -- Physical Medicine and Rehabilitation 0
314  -- Primary Care 13
349  -- Public Health 28
350  -- Radiology 3
351  -- Surgery 37
352  ---- Cardiothoracic Surgery 0
353  ---- General Surgery 1
354  ---- Neurosurgery 0
356  ---- Orthopedic Surgery 1
355  ---- Otolaryngology 0
357  ---- Pediatric Surgery 1
358  ---- Plastic Surgery 0
359  ---- Surgical Oncology 0
360  ---- Urology 0
371  ---- Vascular Surgery 0
361 Nursing 45
364  -- Anesthesia Nursing 2
363  -- Critical Care Nursing 2
366  -- Emergency Nursing 2
367  -- Home Nursing 1
362  -- Medical/Surgical/Psychiatric Nursing 0
365  -- Obstetrical Nursing 0
368 Pharmacy 34
370  -- Community Pharmacy 0
369  -- Hospital Pharmacy 1

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Page last reviewed June 2013
Internet Citation: Appendix E. June 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/environmental-scan-programs/envscan-program-ape.html