complication rates and risk data, even for rare surgical procedures, such as bariatric surgery. in 2005, ahrq provided links to a compendium of 140 research articles, implementation programs and tools and products used to improve patient safety, sponsored jointly with the department of defense (dod)-health affairs. in 2008, ahrq launched the ahrq health care innovations exchange site that contains profiles of hundreds of patient safety programs that have been implemented in hospitals and other health care settings across the united states. the goal of the site is to document and share these innovations with other organizations that can adapt them in different settings, allowing the adopters to base their quality improvement plans on previously tested methods. food and drug administration the food and drug administration is an agency of the united states government that regulates food, drugs, medical devices and biological products for human use. the fda receives medication error reports on marketed human drugs from direct contacts and manufacturer's reports, and in 1992, began monitoring medication error reports that are forwarded from the united states pharmacopeia (usp) and the institute for safe medication practices (ismp). the effectiveness of the fda's drug safety monitoring procedures was called into question after several approved drugs were shown to have serious side effects. in september 2006, an institute of medicine report commissioned by the fda found that its drug safety system is limited by inadequate funding, insufficient regulatory authority, and a lack of oversight by experts free of pharmaceutical industry ties. the fda launched a new program in 2005 to provide drug risk information directly to the public through internet-accessible drug sheets and bulletins. the enactment of the food and drug administration amendments act of 2007 (fdaaa), expanded the authority of the fda over drug safety monitoring after approval and introduction for use by the public. in 2008, the fda established a single website for both the public and the healthcare profession with access to drug safety information, including warnings, recalls, and reporting of adverse reactions, using medwatch. independent organizations australian patient safety foundation the apsf is a non-profit independent organization founded in 1989 for anesthesia error monitoring, and expanded to patient incident reporting and monitoring after results from the quality in australian health care study (qahcs) in 1995 prompted reaction from the public. adverse medical events, both sentinel events (patient death and injury) and near misses (medical errors with potential harm), are reported and analyzed through its subsidiary, patient safety international (psi), using a software tool, the advanced incident management system (aims). aims is used in over half of australia's hospitals, and was adopted in 2005 by the new zealand accident compensation corporation and the university of miami medical group in florida. data remains confidential is protected from legal discovery under australian commonwealth quality assurance legislation. patient safety information is provided by electronic newsletters. canadian patient safety institute the canadian patient safety institute (cpsi, institut canadien pour la sécurité des patients) was developed in 2003 after consultations among canadian healthcare professional organizations, provincial and territorial ministries of health and health canada. an independent non-profit corporation, the cpsi promotes solutions and collaboration among governments and stakeholders to improve patient safety, and has a five-year mandate. areas of improvement are education, system innovation, communication, regulatory affairs and research. together with the institute for safe medication practices canada and saskatchewan health, a canadian root cause analysis framework is offered to healthcare organizations to analyze the contributing factors that led to a critical incident or close call. in april 2005, cpsi launched the safer healthcare now! campaign, aimed at reducing error-related injuries by focusing on six evidence-based measures and through over 200 local organizations, based on the 100,000 lives campaign. institute for safe medication practices canada the institute for safe medication practices canada (ismp) is an independent national non-profit agency that reviews and analyzes medication incident and near-miss reports. in collaboration with the canadian institute for health information (cihi), and health canada, ismp established the canadian medication incident prevention and reporting system (cmirps) in 2003. ismp takes the lead role in collecting reports from health practitioners, analyzing incidents, and disseminating preventative methods. egyptian neonatal safety training network the egyptian neonatal safety training network (enstn) originated from a 2013 project funded by tempus. the main objective was to develop and support an organization that would establish high standards of practice in neonatal intensive care units (nicus), inform and train the whole range of health care workers dealing with infants (neonatologists, pediatricians, nurses, medical students, and others), and promote a culture of patient safety. more detailed goals included formulating protocols and guidelines to enhance continuity of care in nicus, conducting research on specific aspects of patient safety, and reporting adverse events. german agency for quality in medicine based in berlin, the german agency for quality in medicine is a not-profit organization, which coordinates healthcare quality programs. in the field of patient safety aqumed was one of the first german organizations calling for effective patient safety programs. the agency was co-founder of the german coalition for patient safety. aqumed established a national network of critical incident reporting systems. the institution is partner of the international high 5 project. german coalition for patient safety the german coalition for patient safety (aps), established in 2005 and located in bonn is a german non-profit association of organizations and individuals interested and involved in promotion of patient safety. aps' multidisciplinary working groups develop recommendations for patient safety activities in in- and outpatient healthcare institutions. the recommendations are available as open-access documents and distributed in healthcare institutions for free. aps acting together with the german agency for quality in medicine is a lead technical agency of the high 5 project. the health foundation based in london, england, the health foundation is an independent charity that aims to improve the quality of health care for the people of the united kingdom. the safer patients initiative, one of the foundation's quality and performance improvement programs, targets reducing medication-related adverse events and errors, reducing infections associated with intensive care units or surgery and improving organizational culture, leadership and expertise in measuring improvement. the goal of the initiative is a 50 percent reduction in adverse events per 1,000 patient days for each site. in 2004, the health foundation selected four hospitals from across the uk to work on a £4.3 million patient safety improvement program. these four hospitals continue to show measurable improvements in their patient safety performance, and 16 more hospitals are being selected in 2006 to join the second phase. lancaster patient safety research unit the unit was founded in january 2008 and is a collaborative venture between the university hospitals of morecambe bay nhs trust and lancaster university. it is funded by the uk national health service through the national institute for health and care research (nihr). the unit has two aims. the first is to conduct research in patient safety. the second is to make sure that the unit's findings are used in practice, to improve the welfare of people in north lancashire and south cumbria and throughout the national health service. in june 2010 the unit's director, professor andrew smith, helped launch the helsinki declaration for patient safety in anaesthesiology, a practical manifesto aimed at improving the safety of anesthesia care throughout europe. he is now part of a joint european society of anesthesiology/european board of anesthesiology task force overseeing the implementation of the declaration. united states alliance for quality improvement and patient safety the alliance for quality improvement and patient safety fosters the efforts of federally-listed patient safety organizations under the patient safety and quality improvement act of 2005 to improve patient safety and the quality of patient care delivery. aqips is a nonprofit professional association for federally listed patient safety organizations and their member providers. aqips and its members are committed to implementing innovative improvement programs using the protections of the patient safety act to improve patient safety, quality, clinical performance and patient outcomes with the goal of encouraging a safety culture and minimizing patient risk. (see www.aqips.org) council on surgical and perioperative safety the council on surgical & perioperative safety (csps) was founded in august 2007 and is incorporated in the state of illinois. the csps is a unique coalition of seven professional organizations representing the entire spectrum of the surgical team. its voting member organizations include the american association of nurse anesthetists, the american association of surgical physician assistants, the american college of surgeons, the association of perioperative registered nurses, the american society of anesthesiologists, the american society of perianesthesia nurses, and the association of surgical technologists. the csps and its member organizations have a combined total of more than 250,000 members and represent more than two million healthcare practitioners. ecri institute patient safety organization on november 5, 2008, ecri institute pso was officially listed as a federal patient safety organization under the patient safety and quality improvement act of 2005. ecri institute patient safety organization serves nationwide as a pso directly for providers, hospitals, and health systems as well as provide support services to state and regional psos. institute for healthcare improvement the institute for healthcare improvement (ihi) is an independent not-for-profit organization helping to lead the improvement of health and health care throughout the world. founded in 1991 and based in boston, massachusetts, ihi works to accelerate improvement by building the will for change, cultivating promising concepts for improving patient care, and helping health care systems put those ideas into action. an important heuristic of ihi is the triple aim. ihi advocates for organizations and communities to aim to improve population health and the experience of care while reducing per capita cost. as of 2020, founder donald berwick continues to serve on the board of directors, kedar mate serves as president and ceo and michael dowling serves as board chair. institute for safe medication practices the institute for safe medication practices (ismp), based in suburban philadelphia, is a nonprofit organization devoted to preventing medication errors and the safe use of medications. its medication error prevention efforts began in 1975 with a column in hospital pharmacy to inform healthcare professionals and others about medication error prevention. ismp operates a voluntary practitioner error-reporting program to tabulate errors nationally, understand their causes, and share “lessons learned” with the healthcare community, known as the medication errors reporting program (merp), operated by the united states pharmacopeia (usp) in cooperation with ismp. in addition, ismp's corporate subsidiary, med-e.r.r.s. (medical error recognition and revision strategies), works directly and confidentially with the pharmaceutical industry to prevent errors that stem from confusing or misleading naming, labeling, packaging, and device design. the ismp list of error-prone abbreviations is distributed nationally. the joint commission founded in 1951, the joint commission (tjc, previously abbreviated as jcaho) is an independent, not-for-profit organization that evaluates and accredits nearly 15,000 healthcare organizations and programs in the united states. an organization must undergo an on-site survey by a joint commission survey team at least every three years. the scope of reviews by tjc is broad, including hospitals, home care agencies, medical equipment providers, nursing homes, rehabilitation facilities, surgical centers and medical laboratories. passing a survey is crucial for most organizations, since accreditation by tjc is required for participation in medicare and some state and private health care programs. since the accreditation rate is over 90%, there have been questions raised regarding the effectiveness of these surveys. in 1997, tjc began including outcomes and other performance data into the accreditation process (the "oryx initiative"). information gained allowed the joint commission to develop national patient safety goals to promote specific improvements in patient safety. the goals highlight problem areas in health care and describe evidence-based solutions. examples include prevention of falls, patient identification, reducing hospital infections and pressure ulcers, and improving hospital staff communication. in addition, the joint commission created a "do not use" list of abbreviations in 2004 to avoid acronyms and symbols that lead to misinterpretation. identifying sentinel events and analyzing the root causes has been a focus of tjc since 1996; the first eight alerts were published in 1998. the commission defines a sentinel event as "any unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof." the health care facility experiencing the sentinel event is expected to complete a thorough root cause analysis, make improvements