WebM&M Cases & Commentaries
WebM&M (Morbidity & Mortality Rounds on the Web) features expert analysis of medical errors reported anonymously by our readers. Spotlight Cases include interactive learning modules available for CME. Commentaries are written by patient safety experts and published monthly. Contribute by Submitting a Case anonymously.
Narrow Results Clear All
- Communication Improvement
- Culture of Safety 1
- Education and Training 1
- Error Reporting and Analysis 1
- Human Factors Engineering 2
- Logistical Approaches 1
- Quality Improvement Strategies 1
- Specialization of Care 1
- Teamwork 1
- Technologic Approaches 1
- Medication Errors/Preventable Adverse Drug Events
- Medication Safety
- Read Back Protocols
Timothy S. Lesar, PharmD; November 2003
An unclear verbal order leads to administration of the wrong drug.
- Spotlight Case
Matthew B. Weinger, MD; George T. Blike, MD; September 2003
An infant acutely desaturates following an ED nurse's premature administration of a paralytic medication.
Mary Caldwell, RN, PhD, MBA; Kathleen A. Dracup, RN, DNSc; September 2003
A patient given diltiazem rather than saline suffers severe bradycardia requiring temporary pacemaker.