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Kelman B. Kaiser Health News. April 29, 2022.
This WebM&M describes an adverse event due to mislabeling or “syringe swap” in a preoperative patient. The commentary outlines several recommendations and safeguards to ensure that medications administration is safe.
Rockville, MD: Agency for Healthcare Research and Quality; April 2022.
London UK: Crown Copyright; March 30, 2022. ISBN: 9781528632294.
National Academies of Sciences, Engineering, and Medicine. Washington, DC: The National Academies Press; 2022. ISBN: 9780309686259
ISMP Medication Safety Alert! Acute care edition. April 7, 2022; 27(2):1-6.
Checklists are used in many clinical settings to improve patient safety. This pediatric intensive care unit updated a static checklist, eSIMPLE, to a dynamic, decision-support enhanced checklist, eSIMPLER.
Famolaro T, Hare R, Tapia A, et al. Rockville, MD: Agency for Healthcare Research and Quality; March 2022. AHRQ Publication No. 22-0017.
This Spotlight Case describes an older man incidentally diagnosed with prostate cancer, with metastases to the bone. He was seen in clinic one month after that discharge, without family present, and scheduled for outpatient biopsy. He showed up to the biopsy without adequate preparation and so it was rescheduled. He did not show up to the following four oncology appointments.
Kelman B. Kaiser Health News. March 22, 2022
Stein L, Fraser J, Penzenstadler N et al. USA Today. March 10, 2022.
Rockville, MD: Agency for Healthcare Research and Quality; March 2022.
ISMP Medication Safety Alert! Acute care edition. February 24, 2022; 27(4):1-5; March 10, 2022; 27(5):1-5.