Pediatric patients are particularly vulnerable to medication errors. This review explores efforts to reduce risks of medication mistakes in this patient population and safety improvement strategies such as smart pumps, barcoding systems, and workflow management systems.

The Joint Commission requires hospitals to have antimicrobial stewardship programs to prevent harm from antimicrobial overuse. The authors interviewed antimicrobial stewardship program leaders to delineate the qualities of successful programs and future directions for the field. A past WebM&M commentary described the harms associated with inappropriate antibiotic use.

Inaccurate medication reconciliation leads to medication discrepancies and places patients at risk for adverse drug events. Health information exchange can enhance medication safety through improved access to prescribing information. In this cluster-randomized trial, a pharmacist performed medication reconciliation with access to a regional health information exchange for patients admitted to a single hospital in the intervention arm and without such information access for patients in the control arm. In the first 10 months of the study, the health information exchange provided access to prescribing information from large hospitals and a pharmacy insurance plan, but only hospital prescribing information was available during the last 21 months because the insurance plan began charging for data. Although researchers found no significant difference between the intervention and control groups with regard to the number of medication discrepancies, patients who underwent medication reconciliation with access to pharmacy insurance data had a higher number of medication discrepancies identified than control patients. They conclude that charging for pharmacy data interrupted the positive effect of health information exchange on medication reconciliation in the study. A past WebM&M commentary described how lack of access to prescribing information led to an adverse drug event.

Alarm fatigue is an increasingly recognized safety concern. This retrospective cohort study found that primary care clinicians were more likely to override alerts when there were multiple alerts per patient, but overrides were not related to overall workload or repeated exposure to the same alert. The authors recommend reducing the number of alerts per patient to address alarm fatigue.

… of the American Medical Informatics Association : JAMIA … J Am Med Inform Assoc … Health information technology (IT) …

… Jt Comm J Qual Patient Saf … Jt Comm J Qual Patient Saf … Computerized provider order entry (CPOE) …

… of the American Medical Informatics Association : JAMIA … J Am Med Inform Assoc … Many institutions are now moving from …

In this study, better safety climates in emergency departments were associated with more intercepted near misses but not with fewer preventable adverse events.

Pediatric nurses reported frequently violating medication administration policies, especially in emergency situations. The impact of these protocol violations on patient safety was unclear.

… of the American Medical Informatics Association : JAMIA … J Am Med Inform Assoc … This commentary presents a model …

This study, one of the first to analyze prescribing errors in community primary care practices, found a remarkably high rate of errors. Nearly one in four prescriptions contained at least one error in dosing, frequency, or patient instructions, and a startling proportion of prescriptions had illegibility errors as well. Computerized provider order entry (CPOE) could have prevented a large proportion of these errors, and recent studies have shown that CPOE can decrease prescribing errors in community-based office practices. A Patient Safety Primer discusses outpatient medication prescribing errors and other pressing safety issues in outpatient practice.

… Journal of general internal medicine … J Gen Intern Med … The implementation of new computerized …

… Journal of General Internal Medicine … J Gen Intern Med … Few ambulatory practices use electronic …

… Journal of patient safety … J Patient Saf … The majority of adverse drug events in …

… Ann Emerg Med . 2009;53(6):715-23.e1. doi:10.1016/j.annemergmed.2008.10.007 …

… Commission journal on quality and patient safety … Jt Comm J Qual Patient Saf … This study describes the development of …

… Journal of general internal medicine … J Gen Intern Med … Adoption and implementation of electronic …