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ISMP medication error report analysis.
ISMP medication error report analysis. Cohen MR, Smetzer JL. Hosp Pharm. 2009;44(10):847-853.
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December 30, 2014
Cohen MR, Smetzer JL. Hosp Pharm. 2009;44(10):847-853.
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This monthly selection reports on two pediatric deaths due to severe hyponatremia following postoperative fluid administration. Errors involving a missing dose clarification request, a related near miss, and medication name confusion are also described.
