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Search results for "Administration Errors"
Journal Article > Study
The impact of traditional and smart pump infusion technology on nurse medication administration performance in a simulated inpatient unit.
Trbovich PL, Pinkney S, Cafazzo JA, Easty AC. Qual Saf Health Care. 2010;19:430-434.
Errors at the administration stage are common for intravenous medications. Programmable or smart infusion pumps are widely used as a means of preventing such errors. However, prior studies have found that smart pumps alone may not significantly reduce errors, as they do not eliminate wrong-patient errors and may be prone to workarounds. This study compared three types of pumps—traditional pumps, smart pumps, and smart pumps combined with bar-code technology—in a simulated inpatient unit. The results indicate that smart pumps may reduce administration errors when combined with bar-coding or when only "hard" (unchangeable) dosing limits are used. Ultimately, creation of a "closed-loop" system that integrates technological solutions to prescription and administration errors represents the optimal solution for eliminating medication errors.
Journal Article > Commentary
Morphine overdose from error propagation on an acute pain service: [Une surdose de morphine resultant de multiples erreurs dans un service de douleur aigue].
Syed S, Paul JE, Hueftlein M, Kampf M, McLean RF. Can J Anaesth. 2006;53:586-590.
The authors provide a case study involving patient-controlled analgesia (PCA) pump errors that contributed to an accidental morphine overdose. They discuss how the case illustrates that small mistakes can combine to create major problems.