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Search results for "Latent Errors"
- Drug shortages
- Latent Errors
ISMP Medication Safety Alert! Acute Care Edition. November 1, 2018;23:1-5. November 15, 2018;23:1-5.
Errors in the administration of intravenous medications can result in patient harm. This set of articles discusses the results of a nationwide IV push medication survey. The first article reviews unsafe practices in care delivery as defined by inpatient clinicians. The second article recommends ways to improve practice such as assessment of current practices, use of prefilled syringes, and heightened attention to effective labeling.
Journal Article > Review
Fox ER, Sweet BV, Jensen V. Mayo Clin Proc. 2014;89:361-373.
Drug Shortages: Public Health Threat Continues, Despite Efforts to Help Ensure Product Availability.
Washington, DC: United States Government Accountability Office; February 10, 2014. Publication GAO-14-194.
Legislation/Regulation > Organizational Policy/Guidelines
DeCamp M, Joffe S, Fernandez CV, Faden RR, Unguru Y; Working Group on Chemotherapy Drug Shortages in Pediatric Oncology. Pediatrics. 2014;133:e716-e724.
Thomas K. New York Times. November 17, 2012:A1.
This newspaper article reports on the concerns of patients and health care workers associated with the continuing drug shortages in the United States.
Silver Spring, MD: Food and Drug Administration; October 2013.
This report outlines the FDA's plans to address drug shortages, including streamlining tracking processes and developing early warning signals to identify potential shortages.
Talsma J. Drug Topics. June 15, 2013.
Discussing the current state of and efforts to address drug shortages, this news article notes a reduction in chemotherapy delays and reveals persistent barriers to improvement.
Tampa, FL: International Society for Pharmaceutical Engineering; June 2013.
Journal Article > Review
Rider AE, Templet DJ, Daley MJ, Shuman C, Smith LV. J Pharm Pract. 2013;26:183-191.
Drug shortages have been shown to have serious clinical consequences for affected patients. This review article outlines a systematic approach for managing drug shortages.
Murray C, Rycek W, Johnson D, Sifuentes-Tovar F. Pharm Purch Prod. January 2013;10:12.
This magazine article details how one academic medical center used a collaborative approach and implemented policies and procedures to address perioperative drug shortages.
Journal Article > Study
Metzger ML, Billett A, Link MP. N Engl J Med. 2012;367:2461-2463.
The nationwide unavailability of certain prescription medications has posed a potential patient safety problem, as these shortages have been increasingly common over the past few years. This study shows clear evidence that drug shortages can result in patient harm. In 2009, a shortage of mechlorethamine (a standard component of chemotherapy regimens for childhood leukemia) forced oncologists to treat patients with an alternative agent, cyclophosphamide (which was thought to be equally effective). This article demonstrates that children who received cyclophosphamide clearly had a higher rate of treatment failure, resulting in the need for further chemotherapy and bone marrow transplantation. This finding adds to other recent studies documenting clinical consequences directly related to drug shortages.
Journal Article > Commentary
Rochon PA, Gurwitz JH. Arch Intern Med. 2012;172:1499-1500.
This article comments on the patient safety implications of drug shortages and a proposed approach to guide clinical decision-making when distributing medications during shortages.
Neergaard L. San Francisco Chronicle; November 1, 2011:A6.
This newspaper article reports on an executive order directing the Food and Drug Administration to take steps to prevent and mitigate drug shortages.
Legislation/Regulation > Congressional Testimony
Hearings before the Subcommittee on Health of the Committee on Energy and Commerce Committee, 112th Cong, 1st Sess (September 23, 2011).
This hearing focused on the problem of medication shortages and its impact on patients, hospitals, and providers.