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Cases & Commentaries
- Web M&M
Clarence H. Braddock III, MD, MPH; November 2008
A woman with diabetes is admitted to a teaching hospital in July. An intern, who received training at a hospital where only paper orders were used, mistakenly chose the wrong form for the insulin order. As a result, the insulin dose was not adjusted for the patient's NPO (nothing by mouth) status, and she became unresponsive.
Journal Article > Study
Characteristics of medication errors made by students during the administration phase: a descriptive study.
Wolf ZR, Hicks R, Serembus JF. J Prof Nurs. 2006;22:39-51.
The authors analyzed reports of drug administration errors by nursing students. They found that omission errors were most common and that student inexperience and distraction were contributing factors.
Journal Article > Commentary
Rule AM, Drincic A, Galt KA. Jt Comm J Qual Patient Saf. 2007;33:155-162.
The authors share a case report of errors associated with the introduction of new equipment in an ambulatory setting and discuss the importance of device selection and user training to minimize these failures.
ISMP Medication Safety Alert! Acute Care Edition. October 18, 2007;12:1-2.
Reporting on survey results that identified common errors that student nurses make, this article offers recommendations for both educators and students.