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Cohen MR, ed. Washington, DC: American Pharmacists Association; 2006. ISBN: 9781582120927.
Cohen, executive director of the Institute for Safe Medication Practices (ISMP), combined 25 years of experience as a leader in medication safety with stories and reports collected by ISMP to craft a primary text in 1999 on medication errors and their causes, prevention, and mitigation through risk management. This second edition builds on the success of the first one with an expanded text and new features. In addition to existing chapters on high-risk medications, cancer chemotherapy, and pediatric medicines, this edition offers added content on root cause analysis, drug delivery, disclosing errors, and managing risks through a culture of safety. The book continues to provide tools and insights for pharmacists and other practitioners trying to reduce medication errors, in both their practices and that of their institutions.
Committee on Identifying and Preventing Medication Errors, Aspden P, Wolcott J, Bootman JL, Cronenwett LR, eds. Washington, DC: The National Academies Press; 2007.
A major report by the Institute of Medicine (IOM) on medication errors suggests that, despite all the progress in patient safety since To Err is Human, medication errors remain extremely common, and the health care system can do much more to prevent them. Among the startling statistics from this report: more than 1.5 million Americans are injured every year in American hospitals, and the average hospitalized patient experiences at least one medication error each day. The report emphasizes actions that health care systems, providers, funders, and regulators can take to improve medication safety. These actions include having all US prescriptions written and dispensed electronically by 2010, more widespread use of medication reconciliation, and additional research on drug errors and how to prevent them. Importantly, the report also emphasizes actions that patients can take to prevent medication errors, such as maintaining active medication lists and bringing their medications to appointments. Support for the IOM report came from the Centers for Medicare & Medicaid Services.
Leape LL, Kabcenell A, Berwick DM, Roessner J. Boston, MA: Institute for Healthcare Improvement; 1998.
This application-oriented book provides the results of the Institute for Healthcare Improvement (IHI) Breakthrough Series program focusing on decreasing adverse drug events in health care facilities. More than 40 organizations share their collective learning experience, from planning for improvement, testing ideas, studying what they learned, and implementing change. The book’s numerous case studies, descriptions of step-wise improvement processes, and strategies for breaking down organizational barriers help illustrate the experience and methods that led to the group’s success. The book will be valuable to individuals and institutions attacking the problem of medication errors or seeking insight into collaborative learning models.