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September 8, 2005

  • Be aware of false glucose results with point-of-care testing
  • Hidden information
    Look-alike packaging of ceftriaxone vials may lead to errors.
  • TOPic for discussion
    A dispensing error involving a mix-up between TOPAMAX (topiramate) and TOPROL-XL (metoprolol) results in adverse consequences for a patient.
  • Don’t let this “flu” get you
    A prescribing error involving fluvoxamine and fluoxetine is uncovered through medication reconciliation.
  • Bigger is better
    Changes are made to improve the unit-dose package labels for RISPERDAL (risperidone) M-Tab tablets.
  • Location, location, location
    Mayne Pharma makes changes to improve the labeling of their morphine sulfate product.

September 22, 2005

  • Paralyzed by mistakes: Preventing errors with neuromuscular blocking agents
  • Hmmm.Think about this.
    Unintended consequences can occur from the misinterpretation of sliding scale insulin orders.
  • Be prepared for interruptions when outsourcing services
    Central Admixture Pharmacy Service recalled some injectable products due to concerns regarding the sterility. Were you ready?
  • Look- and sound-alike names
    Confusion between SALAGEN (pilocarpine) and selegiline leads to medication errors.
  • Bigger is better
    Changes are made to improve the unit-dose package labels for RISPERDAL (risperidone) M-Tab tablets.
  • ISMP errata
    Precision Xtra was incorrectly listed in the text of the September 8th 2005 newsletter as a brand that provided false glucose reading in patients receiving maltose or icodextrin products.
  • ISMP Teleconference
    Our next teleconference will be October 27, 2005, on "Just Culture- an Emerging Safety-Centered Accountability Model".

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