Information technology cannot guarantee patient safety.

Saskia N de Wildt; Ron Verzijden; John N van den Anker; Matthijs de Hoog

Commentary

Information technology cannot guarantee patient safety.

May 2, 2007

de Wildt SN, Verzijden R, van den Anker JN, et al. BMJ. 2007;334(7598):851-2.

View more articles from the same authors.

The authors provide a case report of an infant who received a seven-fold overdose due to problems with a spreadsheet used for dosing calculations.

PubMed citation

Available at

Free full text

Related Resources From the Same Author(s)

Safety of the Manchester Triage System to detect critically ill children at the emergency department.

August 17, 2016

Improving handoff by deliberate cognitive processing: results from a randomized controlled experimental study.

April 28, 2021

The impact of type of manual medication cart filling method on the frequency of medication administration errors: a prospective before and after study.

February 23, 2011

Experiences with Lean Six Sigma as improvement strategy to reduce parenteral medication administration errors and associated potential risk of harm.

July 26, 2017

Drug administration errors in an institution for individuals with intellectual disability: an observational study.

August 29, 2007

Medication reconciliation performed by pharmacy technicians at the time of preoperative screening.

July 29, 2009

Cognitive diagnostic error in internal medicine.

April 24, 2013

Prescribing errors with low-molecular-weight heparins.

October 13, 2021

Maternal mortality: near-miss events in middle-income countries, a systematic review.

November 24, 2021

Systematic literature review on the effectiveness and safety of paediatric hospital-at-home care as a substitute for hospital care.

May 17, 2023

Preventing home medication administration errors.

March 14, 2022

The effect of prescriber education on medication-related patient harm in the hospital: a systematic review.

March 8, 2017

Do patients' disruptive behaviours influence the accuracy of a doctor's diagnosis? A randomised experiment.

March 23, 2016

The effect of a transitional pharmaceutical care program on the occurrence of ADEs after discharge from hospital in patients with polypharmacy.

April 27, 2022

Effect of medication reconciliation on patient reported potential adverse events after hospital discharge.

September 8, 2021

The use of "lives saved" measures in nurse staffing and patient safety research: statistical considerations.

March 30, 2011

'Providing good and comfortable care by building a bond of trust': nurses views regarding their role in patients' perception of safety in the intensive care unit.

November 11, 2015

Classification of medication incidents associated with information technology.

October 9, 2013

Self-reported uptake of recommendations after dissemination of medication incident alerts.

August 22, 2012

Safety perceptions of health care leaders in 2 Canadian academic acute care centers.

June 7, 2017

Validating a decision tree for serious infection: diagnostic accuracy in acutely ill children in ambulatory care.

August 19, 2015

Improving medical residents’ self-assessment of their diagnostic accuracy: does feedback help?

February 2, 2022

Effect of a pharmacy-based centralized intravenous admixture service on the prevalence of medication errors: a before-and-after study.

August 10, 2022

May 26, 2021

Why do doctors make mistakes? A study of the role of salient distracting clinical features.

December 11, 2013

January 19, 2011

Do malpractice claim clinical case vignettes enhance diagnostic accuracy and acceptance in clinical reasoning education during GP training?

September 20, 2023

Time-dependent drug–drug interaction alerts in care provider order entry: software may inhibit medication error reductions.

December 2, 2009

How would final-year medical students perform if their skill-based prescription assessment was real life?

February 22, 2023

Effect of automated unit dose dispensing with barcode scanning on medication administration errors: an uncontrolled before-and-after study.

December 1, 2021

The $17.1 billion problem: the annual cost of measurable medical errors.

April 20, 2011

How does audit and feedback influence intentions of health professionals to improve practice? A laboratory experiment and field study in cardiac rehabilitation.

April 12, 2017

Prescribing errors in post-COVID-19 patients: prevalence, severity, and risk factors in patients visiting a post-COVID-19 outpatient clinic.

March 23, 2022

Risk factors for clinically relevant deviations in patients' medication lists reported by patients in personal health records: a prospective cohort study in a hospital setting.

March 2, 2022

Validation of hospital administrative dataset for adverse event screening.

June 30, 2010

The effect of medication reconciliation via a patient portal on medication discrepancies: a randomized noninferiority study.

January 26, 2022

Safety of telephone triage in general practitioner cooperatives: do triage nurses correctly estimate urgency?

June 27, 2007

Exposure to media information about a disease can cause doctors to misdiagnose similar-looking clinical cases.

March 12, 2014

A checklist to improve patient safety in interventional radiology.

June 27, 2012

Effect of availability bias and reflective reasoning on diagnostic accuracy among internal medicine residents.

October 6, 2010

Where are my instruments? Hazards in delivery of surgical instruments.

August 10, 2016

Effect of a comprehensive surgical safety system on patient outcomes.

November 24, 2010

2019 Novel Coronavirus (COVID-19) pandemic: built environment considerations to reduce transmission.

May 6, 2020

Medication administration errors in nursing homes using an automated medication dispensing system.

July 15, 2009

The relationship between inpatient cardiac surgery mortality and nurse numbers and educational level: analysis of administrative data.

April 8, 2009

Sleep and errors in a group of Australian hospital nurses at work and during the commute.

November 19, 2008

Inappropriate prescriptions of direct oral anticoagulants (DOACs) in hospitalized patients: a narrative review.

May 10, 2023

Preventable hospital admissions related to medication (HARM): cost analysis of the HARM study.

March 1, 2011

Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands.

October 1, 2008

Nature and timing of incidents intercepted by the SURPASS checklist in surgical patients.

May 2, 2012

Prevalence of medication transfer errors in nephrology patients and potential risk factors.

November 6, 2019

Effect of medication reconciliation with and without patient counseling on the number of pharmaceutical interventions among patients discharged from the hospital.

August 19, 2009

Effect on diagnostic accuracy of cognitive reasoning tools for the workplace setting: systematic review and meta-analysis.

September 14, 2022

Differences in medication reconciliation interventions between six hospitals: a mixed method study.

June 29, 2022

Preventable and non-preventable adverse drug events in hospitalized patients: a prospective chart review in the Netherlands.

November 9, 2011

Access to prescription opioids—Primum Non Nocere: a teachable moment.

July 27, 2016

The effect of a clinical pharmacist-led training programme on intravenous medication errors: a controlled before and after study.

April 2, 2014

Reliability of the assessment of preventable adverse drug events in daily clinical practice.

April 2, 2008

Medication errors: the impact of prescribing and transcribing errors on preventable harm in hospitalised patients.

March 4, 2009

Association between workarounds and medication administration errors in bar-code-assisted medication administration in hospitals.

April 25, 2018

Comparison of potential risk factors for medication errors with and without patient harm.

August 18, 2010

The influence that electronic prescribing has on medication errors and preventable adverse drug events: an interrupted time-series study.

December 2, 2009

Anticoagulant medication errors in hospitals and primary care: a cross-sectional study.

November 14, 2018

Development and validation of the SURgical PAtient Safety System (SURPASS) checklist.

April 22, 2009

The incidence and nature of in-hospital adverse events: a systematic review.

June 18, 2008

Expanded surgical time out: a key to real-time data collection and quality improvement.

April 18, 2007

Teamwork, clinical leadership skills and environmental factors that influence missed nursing care - a qualitative study on hospital wards.

May 3, 2023

Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19 disease.

July 29, 2020

Important factors for effective patient safety governance auditing: a questionnaire survey.

January 30, 2019

Review of medication errors that are new or likely to occur more frequently with electronic medication management systems.

July 17, 2019

Prevention of surgical malpractice claims by a surgical safety checklist.

January 26, 2011

Results of a survey among GP practices on how they manage patient safety aspects related to point-of-care testing in every day practice.

April 22, 2015

Impact of interactions between drugs and laboratory test results on diagnostic test interpretation—a systematic review.

November 21, 2018

Diagnostic error as a result of drug-laboratory test interactions.

March 6, 2019

Overall performance of a drug-drug interaction clinical decision support system: quantitative evaluation and end-user survey.

April 13, 2022

Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study.

April 23, 2014

Surgical patient safety officers in the United States: negotiating contradictions between compliance and workplace transformation.

February 24, 2021

Surgical adverse outcomes and patients’ evaluation of quality of care: inherent risk or reduced quality of care?

December 12, 2007

Physician prescribing of opioids to patients at increased risk of overdose from benzodiazepine use in the United States.

May 16, 2018

The problem with using patient complaints for improvement.

January 17, 2018

Learning from morbidity and mortality conferences: focus and sustainability of lessons for patient care.

April 28, 2021

Can preventable adverse events be predicted among hospitalized older patients? The development and validation of a predictive model.

September 10, 2014

The barriers and enhancers to trust in a just culture in hospital settings: a systematic review.

August 17, 2022

The association between complications, incidents, and patient experience: retrospective linkage of routine patient experience surveys and safety data.

March 27, 2019

Identifying adverse events: reflections on an imperfect gold standard after 20 years of patient safety research.

March 25, 2020

Temporal trends in patient safety in the Netherlands: reductions in preventable adverse events or the end of adverse events as a useful metric?

August 5, 2015

Diagnostic accuracy of emergency nurse practitioners versus physicians related to minor illnesses and injuries.

August 4, 2010

Moving beyond the weekend effect: how can we best target interventions to improve patient care?

June 30, 2021

Design and implementation of an ICU incident registry.

November 1, 2006

Physician communication when prescribing new medications.

October 11, 2006

Supervision, interprofessional collaboration, and patient safety in intensive care units during the COVID-19 pandemic.

November 10, 2021

Speaking up about patient safety concerns: the influence of safety management approaches and climate on nurses' willingness to speak up.

July 18, 2018

Is culture associated with patient safety in the emergency department? A study of staff perspectives.

April 23, 2014

High-risk medication in home care nursing: a Delphi study.

September 7, 2022

Risky procedures by nurses in hospitals: problems and (contemplated) refusals of orders by physicians, and views of physicians and nurses: a questionnaire survey.

September 28, 2005

Changes in adverse event rates in hospitals over time: a longitudinal retrospective patient record review study.

February 13, 2013

Barriers and success factors to the implementation of a multi-site prospective adverse event surveillance system.

July 23, 2014

Checklists improve experts' diagnostic decisions.

April 17, 2013

Finding and fixing mistakes: do checklists work for clinicians with different levels of experience?

May 22, 2013

Twelve tips on engaging learners in checking health care decisions.

December 11, 2013

Related Resources

Patient safety of perioperative medication through the lens of digital health and artificial intelligence.

June 28, 2023

Patient Safety Innovations

Remote Response Team and Customized Alert Settings Help Improve Management of Sepsis

May 31, 2023

Annual Perspective

Improving Diagnostic Safety and Quality

April 26, 2023

Interview

In Conversation with Susan McGrath, PhD and George Blike, MD about Surveillance Monitoring

April 26, 2023

Perspective

Surveillance Monitoring to Improve Patient Safety in Acute Hospital Care Units

April 26, 2023

Perspectives on Safety

Annual Perspective

Technology as a Tool for Improving Patient Safety

March 29, 2023

Journal Article

Study

Reducing hospital harm: establishing a command centre to foster situational awareness.

March 29, 2023

Improving diagnostic decision support through deliberate reflection: a proposal.

November 9, 2022

Eight human factors and ergonomics principles for healthcare artificial intelligence.

November 2, 2022

Remote patient monitoring during COVID-19: an unexpected patient safety benefit.

March 23, 2022

Assessing the impact of virtual medication history technicians on medication reconciliation discrepancies.

December 1, 2021

Patient Safety Innovations

The generalizability of a medication administration discrepancy detection system: quantitative comparative analysis

September 29, 2021

Why and how to approach user experience in safety-critical domains: the example of health care.

September 8, 2021

COVID-19 and open notes: a new method to enhance patient safety and trust.

July 7, 2021

WebM&M Cases

Norepinephrine Dosing Error Associated with Multiple Health System Vulnerabilities

May 26, 2021

Considering the safety and quality of artificial intelligence in health care.

September 16, 2020

The impact of technology on prescribing errors in pediatric intensive care: a before and after study.

June 3, 2020

Medication errors during simulated paediatric resuscitations: a prospective, observational human reliability analysis.

December 18, 2019

Smart pumps improve medication safety but increase alert burden in neonatal care

December 4, 2019

Commissioning simulations to test new healthcare facilities: a proactive and innovative approach to healthcare system safety.

September 11, 2019

Patient Safety Primers

Patient Safety 101

September 7, 2019

Perceptual and interpretive error in diagnostic radiology—causes and potential solutions.

September 4, 2019

Interview

In Conversation With… Erik Hollnagel, PhD

June 1, 2019

Interview

In Conversation With… Jane Brice, MD, MPH

May 1, 2019

The wicked problem of patient misidentification: how could the technological revolution help address patient safety?

May 1, 2019

Medication safety in emergency medical services: approaching an evidence-based method of verification to reduce errors.

April 3, 2019

Assessing the use of Google Translate for Spanish and Chinese translations of emergency department discharge instructions.

March 20, 2019

Error and Uncertainty in Diagnostic Radiology.

March 20, 2019

WebM&M Cases

Duplicate Insulin Order

March 1, 2019

Usability testing of a mobile app to report medication errors anonymously: mixed-methods approach.

January 16, 2019

See More About The Topic

Hospitals

Health Care Providers

Health Care Executives and Administrators

Information Professionals

Emergency Medicine

Information technology cannot guarantee patient safety.

Remote Response Team and Customized Alert Settings Help Improve Management of Sepsis

Reducing hospital harm: establishing a command centre to foster situational awareness.

The generalizability of a medication administration discrepancy detection system: quantitative comparative analysis

Patient Safety 101

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

Information technology cannot guarantee patient safety.

Remote Response Team and Customized Alert Settings Help Improve Management of Sepsis

Reducing hospital harm: establishing a command centre to foster situational awareness.

The generalizability of a medication administration discrepancy detection system: quantitative comparative analysis

Patient Safety 101

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

PSNet Log in

Submit Your Innovations

Continue as a Guest

Continue Logged In

Submit Your Innovations

Continue as a Guest

Continue logged in

New Users to the PSNet site