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Extensive initiatives are under way to improve the quality of patient care and to create safer patient care environments. Some of these efforts focus on creating a culture of safety that overtly encourages and supports reporting of any patient care circumstance that threatens the safety of patients or caregivers. Others focus on specific processes of care where patients are known to be at high risk for developing complications. In general these complications are viewed as adverse events, and efforts are directed toward identifying how they might be prevented from occurring. Various types of events have been identified and research is ongoing to analyze their possible root causes and to design and test interventions that might prevent their occurrence in the future.
Adverse events are defined as any patient injury caused by clinical care. An adverse event does not imply error or poor quality care, although in some situations this may be the case. The label of adverse event simply indicates that an undesirable clinical outcome has resulted from some aspect of diagnosis or therapy, which may be associated with an underlying disease process (Agency for Healthcare Research and Quality, 2006). These adverse events are equivalent to iatrogenic events.
An example to illustrate an adverse event due to different circumstances is anaphylactic reaction to penicillin. A serious allergic reaction to penicillin in a patient with no prior history of this allergy would be classified as an adverse drug event. Another example of an adverse event would be a patient with a known history...