U.S. flag

An official website of the Department of Health & Human Services

AHRQ: Agency for Healthcare Research and Quality
Provide Feedback |
Patient Safety Network

All Content

Advanced Search
Search Tips
Save
Download citations
Selection
Format
Download
Published Date
Original Publication Date
Original Publication Date
PSNet Publication Date
Narrow Results By
PSNet Original Content
Commonly Searched Resource Types
Additional Filters
All Resource Types
Approach to Improving Safety
Safety Target
Setting of Care
Clinical Area
Target Audience
Error Types
Origin/Sponsor
1 - 8 of 8
Lessons Learned about Human Fallibility, System Design, and Justice in the Aftermath of a Fatal Medication Error.
Save to Library
  • Facebook
  • Twitter
  • Linkedin
  • Copy URL

    • Institute for Safe Medication Practices and the Just Culture Company. May 6, 2022.

    Organizational factors can contribute to the occurrence of patient safety events and how health systems respond to such events. This webinar highlighted lessons learned in the aftermath of a fatal medication error, and strategies to improve patient safety at the organizational level through system design and accountability.
    Medication safety issues with newly authorized PAXLOVID.
    Save to Library
  • Facebook
  • Twitter
  • Linkedin
  • Copy URL

    • Institute for Safe Medication Practices. Medication Safety Alerts. January 3, 2022.

    Emerging care practices can produce unsafe situations due to the newness of the approaches involved. This alert highlights safety considerations with an oral antiretroviral COVID treatment that include medication administration problems. Safety recommendations are provided for prescribers and pharmacists.
    Disrespectful behavior in healthcare: has it improved? Please take our survey!
    Save to Library
  • Facebook
  • Twitter
  • Linkedin
  • Copy URL

    • ISMP Medication Safety Alert! Acute care edition. September 9, 2021;26(18);1-5.

    Disrespectful behavior is a persistent contributor to failures in medical care. This article summarizes influences that enable the acceptance and perpetuation of unprofessional behaviors and calls for data to assess its presence and impact in health care environments. The deadline for survey participation is now closed.
    Mix-ups between the influenza (Flu) vaccine and COVID-19 vaccines.
    Save to Library
  • Facebook
  • Twitter
  • Linkedin
  • Copy URL

    • ISMP Medication Safety Alert! Acute care edition. October 7, 2021;26(20):1-4.

    Production pressure and low staff coverage can result in medication mistakes in community pharmacies. This article shares reported vaccine errors and factors contributing to mistaken administration of flu and COVID vaccines. Storage, staffing and collaboration strategies are shared to protect against vaccine mistakes.
    COVID-19 Content. ISMP Medication Safety Alert!
    Save to Library
  • Facebook
  • Twitter
  • Linkedin
  • Copy URL

    • March 2020--January 2021.

    Medication safety is improved through the sharing of frontline improvement experiences and concerns. These articles share recommendations to reduce risks associated with distinct areas of the medication use process. The topics discuss areas that require specific attention during the COVID-19 pandemic such as the use of smart pumps and automated dispensing cabinets.
    Medication Safety During the COVID-19 Pandemic: What Have We Learned in the United States.
    Save to Library
  • Facebook
  • Twitter
  • Linkedin
  • Copy URL

    • Institute for Safe Medication Practices and US Food and Drug Administration Division of Drug Information. June 23, 2020.

    The COVID-19 pandemic response is creating a need for care delivery adjustments that include changes in pharmacy and medication practices. This webinar discussed process alterations that have the potential to impact safe medication administration and provide context for the changes to help ensure they are effectively implemented.
    ISMP Guidelines for Optimizing Safe Implementation and Use of Smart Infusion Pumps.
    Save to Library
  • Facebook
  • Twitter
  • Linkedin
  • Copy URL

    • Institute for Safe Medication Practices. Horsham, PA: Institute for Safe Medication Practices; 2020.

    Smart pumps are widely available as a medication safety tool yet there are challenges affecting their reliable use. This guideline expands on earlier recommendations  to support smart pump use in both hospitals and the ambulatory setting. The material provides recommendations that address infrastructure, drug libraries, quality improvement data, workflow and electronic health record interoperability concerns.
    Back To Top
    Terms and Conditions | Privacy Policy | External Link Disclaimer

    Connect With Us

    Facebook Twitter You Tube LinkedIn

    Sign up for Email Updates

    Agency for Healthcare Research and Quality

    5600 Fishers Lane
    Rockville, MD 20857
    Telephone: (301) 427-1364