Narrow Results Clear All
- Communication Improvement 5
- Culture of Safety 2
- Education and Training 3
- Error Reporting and Analysis 3
- Human Factors Engineering 6
- Legal and Policy Approaches 3
- Logistical Approaches 3
- Quality Improvement Strategies 4
- Specialization of Care 4
- Teamwork 1
- Technologic Approaches 6
- Device-related Complications 2
- Discontinuities, Gaps, and Hand-Off Problems 1
- Medical Complications 4
- Medication Errors/Preventable Adverse Drug Events 9
- Nonsurgical Procedural Complications 1
- Psychological and Social Complications 1
- Second victims 1
- Surgical Complications 3
Search results for "Newspaper/Magazine Article"
Partnering with families and patient advocates: another line of defense in adverse event surveillance.
ISMP Medication Safety Alert! Acute Care Edition. August 1, 2019;24.
Having family members or patient advocates present during hospitalizations can help prevent errors. This newsletter article suggests that utilizing this risk prevention strategy in peripheral care areas such as radiology and other testing units could also prevent patient harm. Recommendations to ensure success of this approach include communicating with advocates, encouraging them to speak up, and activating a rapid response to patient deterioration.
Safety enhancements every hospital must consider in wake of another tragic neuromuscular blocker event.
ISMP Medication Safety Alert! Acute Care Edition. January 17, 2019;24.
This newsletter article reports on the findings of a government investigation into the death of a patient during a positron emission tomography scan. A neuromuscular blocking agent was mistakenly administered instead of an anti-anxiety medication with a similar name. The investigation determined various individual and system failures that contributed to the incident, such as misuse of automated dispensing cabinets, wrong picklist medication selection, workarounds of override protections, and lack of patient monitoring. Recommendations for preventing similar incidents include use of barcoding verification, automated dispensing cabinet stocking changes, and labeling improvements.
ISMP Medication Safety Alert! Acute Care Edition. July 14, 2011;16:1-3.
Graham J, Dizikes C. Chicago Tribune. June 27, 2011.
This newspaper article reports on an order entry error that resulted in a 60-fold overdose and raised concerns about the safety of electronic medication data systems.
ISMP Medication Safety Alert! Acute Care Edition. April 21, 2011;16:1-3.
This article analyzes a fatal error involving parenteral nutrition and makes recommendations to prevent such incidents.
Grant M. AARP The Magazine. September/October 2010;53:48-51,90-91.
Luby R. KETV. Omaha, NE. March 31, 2010.
This news piece focuses on a heparin overdose that resulted in the death of a toddler.
ISMP Medication Safety Alert! Acute Care Edition. March 12, 2009;14:1-3.
This article provides screening, dosing, and monitoring recommendations for using basal opioid infusions and patient-controlled analgesia (PCA) in patients at risk for developing respiratory depression.
Feinmann J. BMJ. 2009;338:b420.
This news article highlights a National Patient Safety Agency campaign to achieve safer care through five interventions.
Parents sue over babies' heparin overdoses: infants were given too much heparin at Methodist Hospital.
Higgins W. Indianapolis Star. September 13, 2008;News section:A1
Families whose infants died from or were harmed by heparin overdoses are suing the drug manufacturer and the hospital.
ISMP Medication Safety Alert! Acute Care Edition. September 11, 2008;13:1-3.
This article discusses a medication error associated with a new smart pump system and describes strategies to prevent errors when well-established processes are changed.
Berwick DM, Leape LL. Newsweek. October 16, 2006:70-71.
As part of the "Health for Life" series, Drs. Berwick and Leape discuss the notion of completely eliminating medical errors and share stories about several hospitals' efforts to raise safety standards.
Fischman J. US News and World Report. August 1, 2005;139:45,49-50,52.
This article reports on activities at several hospitals that illustrate how information technology can help improve the safety of health care.
Saving lives: hospitals have signed on to a six-part plan to avoid a multitude of unnecessary deaths.
Comarow A. US News & World Report. July 18, 2005;139:74,76,79.
This article, accompanying the widely read ranking of "America's Best Hospitals," describes the Institute for Healthcare Improvement's 100,000 Lives Campaign. Focusing on the six practices promoted by the campaign, it reviews the progress to date, with a particular focus on two participating hospitals' (Hackensack University Medical Center in New Jersey and McLeod Regional Medical Center in South Carolina) experiences in implementing the practices.