U.S. Department of Health and Human Services
Agency for Healthcare Research and Quality: Advancing Excellence in Health Care
Sign up for a Free Account
Mohr H, Weiss M. Associated Press. November 27, 2018.
Usability issues, poor design, and lack of effective instruction hinder safe use of medical equipment. This news article reports on problems associated with ambulatory use of insulin pumps submitted to a Food and Drug Administration database.
Considering insulin pens for routine hospital use? Consider this...
ISMP Medication Safety Alert! Acute Care Edition. May 8, 2008;13:1-3.
New technology, new errors: how to prime an upgrade of an insulin infusion pump.
Rule AM, Drincic A, Galt KA. Jt Comm J Qual Patient Saf. 2007;33:155-162.
United States marshals seize defective infusion pumps made by Alaris Products.
Rockville, MD: Center for Devices and Radiological Health, US Food and Drug Administration; August 29, 2006.
Doctors see flaw in device recalls.
Kerber R. The Boston Globe. June 23, 2005;Business section:E1.
Decisions about critical events in device-related scenarios as a function of expertise.
Laxmisan A, Malhotra S, Keselman A, Johnson TR, Patel VL. J Biomed Inform. 2005;38:200-212.
Views of nurses and other health and social care workers on the use of assistive humanoid and animal-like robots in health and social care: a scoping review.
Papadopoulos I, Koulouglioti C, Ali S. Contemp Nurse. 2018;54:425-442.
Reducing treatment errors through point-of-care glucometer configuration.
Estock JL, Pham IT, Curinga HK, et al. Jt Comm J Qual Patient Saf. 2018;44:683-694.
Smart pump custom concentrations without hard "low concentration" alerts can lead to patient harm.
ISMP Medication Safety Alert! Acute Care Edition. May 31, 2018;23:1-4.
Principles of automation for patient safety in intensive care: learning from aviation.
Dominiczak J, Khansa L. Jt Comm J Qual Patient Saf. 2018;44:366-371.
Intravenous smart pumps: usability issues, intravenous medication administration error, and patient safety.
Giuliano KK. Crit Care Nurs Clin North Am. 2018;30:215-224.
Intravenous smart pump drug library compliance: a descriptive study of 44 hospitals.
Giuliano KK, Su WT, Degnan DD, Fitzgerald K, Zink RJ, DeLaurentis P. J Patient Saf. 2018;14:e76-e82.
More than half a million heart surgery patients at risk of a dangerous infection.
Sun LH. The Washington Post. October 13, 2016.
The frequency of intravenous medication administration errors related to smart infusion pumps: a multihospital observational study.
Schnock KO, Dykes PC, Albert J, et al. BMJ Qual Saf. 2017;26:131-140.
Making healthcare safer by understanding, designing and buying better IT.
Thimbleby H, Lewis A, Williams J. Clin Med. 2015;15:258-262.
PCA safety data review after clinical decision support and smart pump technology implementation.
Prewitt J, Schneider S, Horvath M, Hammond J, Jackson J, Ginsberg B. J Patient Saf. 2013;9:103-109.
Tubing and Luer Misconnections: Preventing Dangerous Medical Errors.
US Food and Drug Administration.
A case study on the safety impact of implementing smart patient-controlled analgesic pumps at a tertiary care academic medical center.
Tran M, Ciarkowski S, Wagner D, Stevenson JG. Jt Comm J Qual Patient Saf. 2012;38:112-119.
Notre Dame students design to save lives.
McFadden M. WNDU. February 21, 2012.
Safety in numbers? Try connectivity.
Dyell D. Patient Saf Qual Healthc. January/February 2012;9:34-37.
Radiation risks of diagnostic imaging.
Sentinel Event Alert #47. August 24, 2011.
Tubing misconnections: normalization of deviance.
Simmons D, Symes L, Guenter P, Graves K. Nutr Clin Pract. 2011;26:286-293.
Preventing catheter/tubing misconnections: much needed help is on the way.
ISMP Medication Safety Alert! Acute Care Edition. July 15, 2010;15:1-2.
The impact of traditional and smart pump infusion technology on nurse medication administration performance in a simulated inpatient unit.
Trbovich PL, Pinkney S, Cafazzo JA, Easty AC. Qual Saf Health Care. 2010;19:430-434.
Latest heparin fatality speaks loudly—what have you done to stop the bleeding?
ISMP Medication Safety Alert! Acute Care Edition. April 8, 2010;15:1-3.
An engineered solution to the maladministration of spinal injections.
Lawton R, Gardner P, Green B, et al. Qual Saf Health Care. 2009;18:492-495.
PSNET: Patient Safety Network
PSNet is produced for the Agency for Healthcare Research and Quality by a team of editors at the University of California, San Francisco with guidance from a prominent Technical Expert/Advisory Panel. The AHRQ PSNet site was designed and implemented by Silverchair.
Agency for Healthcare Research and Quality
5600 Fishers Lane
Rockville, MD 20857
Telephone: (301) 427-1364