ISMP medication error report analysis.
Approach to Improving Safety
- Communication between Providers
- Human Factors Engineering
- Medical Device Design
- Bar Coding and Radiofrequency ID Tagging
Setting of Care
This monthly selection reports on pump programming errors that led to overdoses of patient-controlled analgesia (PCA), miscommunication regarding dose and indication for alteplase, and a warning to not use empty prelabeled syringes.