AHRQ Patient Safety Network

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Insulin

Origin/Sponsor

•Australia and New Zealand (1)

Resource Types

•Journal Article (31)

•Newspaper/Magazine Article (11)

•Press Release/Announcement (3)

Error Types

•Epidemiology of Errors and Adverse Events (11)

•Active Errors (21)

•Latent Errors (4)

•Near Miss (2)

Approach to Improving Safety

•Quality Improvement Strategies (22)

•Error Reporting and Analysis (10)

•Communication Improvement (10)

•Human Factors Engineering (15)

•Teamwork (2)

•Specialization of Care (5)

•Logistical Approaches (1)

•Culture of Safety (3)

•Technologic Approaches (12)

•Education and Training (16)

Clinical Areas

•Medicine (31)

•Nursing (5)

•Pharmacy (17)

Target Audience

•Health Care Providers (41)

•Health Care Executives and Administrators (33)

•Non-Health Care Professionals (7)

•Patients (2)

Setting of Care

•Hospitals (27)

•Residential Facilities (2)

•Ambulatory Care (9)

1 - 20 of 47

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NEWSPAPER/MAGAZINE ARTICLE

Common cause analysis.

Clapper C, Crea K. Patient Saf Qual Healthc. May/June 2010;7:30-35.

COMMENTARY

ISMP medication error report analysis.

Cohen MR. Hosp Pharm. 2008;43:696–698.

STUDY

Medication error reporting in nursing homes: identifying targets for patient safety improvement.

Greene SB, Williams CE, Pierson S, Hansen RA, Carey TS. Qual Saf Health Care. 2010;19:218-222.

COMMENTARY

A Mid-Summer Fog

Braddock CH. AHRQ WebM&M [serial online]. November 2008.

NEWSPAPER/MAGAZINE ARTICLE

Action needed to prevent dangerous heparin-insulin confusion.

ISMP Medication Safety Alert! Acute Care Edition. May 3, 2007;12:1-2.

STUDY

Unintentional therapeutic errors involving insulin in the ambulatory setting reported to poison centers.

Spiller HA, Borys DJ, Ryan ML, Sawyer TS, Wilson BL. Ann Pharmacother. 2011;45:17-22.

STUDY

Adverse drug events among hospitalized Medicare patients: epidemiology and national estimates from a new approach to surveillance.

Classen DC, Jaser L, Budnitz DS. Jt Comm J Qual Patient Saf. 2010;36:12-21, AP1-AP9.

COMMENTARY

ISMP medication error report analysis.

Cohen MC. Hosp Pharm. 2009;44:374-378.

NEWSPAPER/MAGAZINE ARTICLE

Misadministration of IV insulin associated with dose measurement and hyperkalemia treatment.

ISMP Medication Safety Alert! Acute Care Edition. August 11, 2011;16:1-3.

STUDY

Reducing potentially fatal errors associated with high doses of insulin: a successful multifaceted multidisciplinary prevention strategy.

Dooley MJ, Wiseman M, McRae A, et al. BMJ Qual Saf. 2011;20:637-644.

STUDY

A multifaceted program for improving quality of care in intensive care units: IATROREF study.

Garrouste-Orgeas M, Soufir L, Tabah A, et al; Outcomerea Study Group. Crit Care Med. 2012;40:468-476.

COMMENTARY

Are Two Insulin Pumps Better Than One?

Cook CB. AHRQ WebM&M [serial online]. January 2009.

NEWSPAPER/MAGAZINE ARTICLE

Medication errors common for hospital diabetes.

Nursing Times. April 1, 2011.

STUDY

Selected medical errors in the intensive care unit: results of the IATROREF study: parts I and II.

Garrouste-Orgeas M, Timsit JF, Vesin A, et al; OUTCOMEREA Study Group. Am J Respir Crit Care Med. 2010:181:134-142.

NEWSPAPER/MAGAZINE ARTICLE

A clinical reminder about the safe use of insulin vials.

ISMP Medication Safety Alert! Acute Care Edition. February 21, 2013;18:1-3.

COMMENTARY

ISMP medication error report analysis.

Cohen MR, Smetzer JL. Hosp Pharm. 2010:45;352-355.

COMMENTARY

ISMP medication error report analysis.

Cohen MR. Hosp Pharm. 2007;42:498-499.

COMMENTARY

ISMP medication error report analysis.

Cohen MR, Smetzer JL. Hosp Pharm. 2007;42:884–888.

COMMENTARY

Addressing safety concerns about U-500 insulin in a hospital setting.

Samaan KH, Dahlke M, Stover J. Am J Health Syst Pharm. 2011;68:63-68.

COMMENTARY

ISMP medication error report analysis.

Cohen MR. Hosp Pharm. 2008;43:618-621.

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