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- Culture of Safety 1
- Education and Training 6
- Error Reporting and Analysis 8
- Human Factors Engineering
- Legal and Policy Approaches 3
- Quality Improvement Strategies 6
- Specialization of Care 1
- Technologic Approaches 2
- Transparency and Accountability 1
- Device-related Complications
- Medication Safety 7
- MRI safety 1
- Nonsurgical Procedural Complications 3
- Allied Health Services 1
- Internal Medicine 6
- Pediatrics 3
- Nursing 1
- Pharmacy 1
- Family Members and Caregivers 2
- Health Care Executives and Administrators 11
Health Care Providers
- Nurses 5
Non-Health Care Professionals
- Engineers 10
- Patients 8
Search results for "Newspaper/Magazine Article"
Jewett C. Kaiser Health News. May 3, 2019.
Transparency has been heralded as a cornerstone to improvement in health care. This news article reports on a government alternative summary reporting program that allowed medical device makers to conceal safety events and malfunction reports associated with medical devices. A new program that expands access to information about device-related failures will be put in place.
Mohr H, Weiss M. Associated Press. November 27, 2018.
ISMP Medication Safety Alert! Acute Care Edition. May 31, 2018;23:1-4.
Smart pumps offer both benefits and drawbacks that can affect medication safety. This newsletter article explores missteps related to lack of compliance with setting hard stops to protect patients when using unique intravenous medication concentrations. Recommendations to prevent errors include using standardized dosing concentrations as often as possible, adhering to metric unit dosing requirements, and verifying pump programming settings.
Multifaceted initiative to reduce "alarm fatigue" on cardiac unit reduces alarms and increases nurse and patient satisfaction.
Agency for Healthcare Research and Quality. Health Care Innovations Exchange. June 18, 2014.
Clinical alarms have been described as a serious patient safety issue. This article relates how one hospital implemented a series of actions reduce nuisance alarms in a cardiac unit and reports a substantial decrease in audible alerts with no subsequent adverse effects. Interventions included expanding limits for triggering heart rate alarms and collaboration between two nurses to design customized alarm parameters for individual patients.
ISMP Canada Safety Bulletin. July 31, 2011;11:1-2.
This announcement reports on mistaken intravenous administration of breast milk and provides recommendations to prevent parenteral administration of enteral nutrition.
Harasim P. Las Vegas Review-Journal. November 21, 2010;News:1B.
This article discusses how the organizational system of one hospital delayed an investigation into catheter line malfunctions.
ISMP Medication Safety Alert! Acute Care Edition. July 15, 2010;15:1-2.
This piece describes reports of tubing misconnections and discusses upcoming standards for connectors that will prevent such errors.
ISMP Medication Safety Alert! Acute Care Edition. April 8, 2010;15:1-3.
Kowalczyk L. Boston Globe. February 21, 2010.
This news account discusses a patient death after a heart monitor alarm was inadvertently turned off. Hospital and device safety experts weigh in on strategies to prevent these types of errors.
Bogdanich W. New York Times. January 24, 2010:A1.
First in a series on medical radiation, this news feature and accompanying video investigate patient deaths and injuries following mistakes related to radiation treatment. The journalists discuss the number of radiation therapy errors in New York and reveal that state law does not require public reporting of such mistakes.
ISMP Medication Safety Alert! Acute Care Edition. August 14, 2008;13:1-3.
This article reports on an overdose caused by improper label placement on a patient controlled analgesia (PCA) pump and provides recommendations for preventing pump-related medication errors.
ISMP Medication Safety Alert! Acute Care Edition. May 8, 2008;13:1-3.
This article describes common problems associated with insulin pen injectors and provides recommendations for their safe use.
Landro L. Wall Street Journal. June 27, 2007:D3.
This article discusses errors associated with tubing misconnections in hospital-based care. A previous WebM&M commentary discussed a tubing error that led to administration of the wrong gas.
ISMP Medication Safety Alert! Acute Care Edition. November 16, 2006;11:1, 3.
This article discusses the high percentage of reported errors that are related to product or device problems and advocates that the pharmaceutical industry and medical device companies should also be accountable for safety.
ISMP Medication Safety Alert! Acute Care Edition. April 6, 2006;11:1-2.
This article outlines systems failures that can contribute to the inadvertent misadministration of IV medications and provides several recommendations to support safe practices.
Sentinel Event Alert. April 3, 2006;(36):1-3.
This alert summarizes types of tubing misconnections reported to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and recommends 10 strategies to prevent their occurrence.
Gehlot V, Sloane EB. Computer. April 2006;39:54-60.
The authors discuss clinical alarm systems from a technical perspective and propose a toolkit to help make complex clinical IT systems more technically reliable.
ISMP Medication Safety Alert! Acute Care Edition. January 12, 2006;11:1-2.
This article describes problems involving the keys on infusion pumps and includes recommendations to help prevent errors when programming infusion pumps.
McNeil DG Jr. New York Times. August 19, 2005;National Desk section:1.
This front page article in The New York Times reviews flying object incidents in magnetic resonance imaging (MRI) scanners. A number of dramatic cases are described (including several that were fatal), as are some of the challenges, both technological and procedural, in preventing this safety hazard.
Kerber R. The Boston Globe. June 23, 2005;Business section:E1.
This article reports on problems with medical devices and discusses whether manufacturers should directly notify patients regarding defects.