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Richard H. White, MD ; July-August 2005
An intern increases a patient's warfarin dosage nightly based on subtherapeutic INR levels drawn each morning; after several days, the patient develops potentially life-threatening bleeding.
Journal Article > Commentary
Cassano AT. Hosp Pharm. 2006;41:151-156.
The authors describe the implementation of intravenous medication administration software interfaced with "smart" infusion pumps.
Journal Article > Study
Hsu KY, DeLaurentis P, Bitan Y, Degnan DD, Yih Y. J Patient Saf. 2019;15:e8-e14.
Smart infusion pumps store drug safety information, but this data must be periodically updated. This study demonstrated significant delays in updating the drug information for smart infusion pumps. These delays resulted in failure to alert for two high-risk medication cases, but neither case led to patient harm.