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- Communication Improvement 1
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- Technologic Approaches 3
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Ostrov BF. San Jose Mercury News. October 26, 2007;Local section:1B.
This article reports that, despite facing state sanctions and fines for its role in three fatal medication errors since 2004, a violating hospital was slow to retrain its pharmacy technicians.
Vonfremd M, Ibanga I. ABC News.com. July 10, 2008.
Several infants in a neonatal unit at a Texas hospital received overdoses of heparin. Authorities are investigating whether the error contributed to the deaths of two infants.
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.
Journal Article > Study
Sauberan JB, Dean LM, Fiedelak J, Abraham JA. Am J Health Syst Pharm. 2010;67:49-57.
This study reports on a quality improvement effort to eliminate errors due to look-alike, sound-alike medications.