|
|
2008
|
| 08/28/2008 |
Misprogramming PCA concentration leads to dosing errors |
| 08/14/2008 |
Proper positioning of pharmacy label on Hospira PCA vials will avoid interference with scanning |
| 07/31/2008 |
Use of tall man letters is gaining wide acceptance |
| 07/17/2008 |
Heparin errors continue despite prior, high-profile, fatal events |
| 07/03/2008 |
Epidural-IV route mix-ups: Reducing the risk of deadly errors |
| 06/19/2008 |
FDA Advise-ERR: Prevent dangerous drug-device interaction causing falsely elevated glucose levels |
| 06/05/2008 |
Benefits and risks of including patients on RCA teams |
| 05/22/2008 |
Managing visits from pharmaceutical sales representatives |
| 05/08/2008 |
Considering insulin pens for routine hospital use? Consider this... |
| 04/24/2008 |
Some red rules shouldn't rule in hospitals |
| 04/10/2008 |
FDA Advise-ERR: Medication errors associated with Cerebyx |
| 03/27/2008 |
There's more to the 60 Minutes story on heparin errors |
| 03/13/2008 |
Resolving human conflicts when questions about the safety of medical orders arise |
| 02/28/2008 |
USA Today news series: Clarifying the issues and embracing community pharmacy safety |
| 02/14/2008 |
Keeping patients safe from iatrogenic methadone overdoses |
| 01/31/2008 |
Fatal overdose uncovers need to rethink where pediatric IV medications are dispensed and administered |
| 01/17/2008 |
ADC survey shows some improvements, but unnecessary risks still exist |
|
|
2007
|
| 12/13/2007 |
Celebrating 10 years of ISMP CHEERS awards |
| 11/29/2007 |
Another heparin error: Learning from mistakes so we don't repeat them |
| 11/15/2007 |
Errors with injectable medications: Unlabeled syringes are surprisingly common! |
| 11/01/2007 |
Product-related issues make error potential enormous with investigational drugs |
| 10/18/2007 |
Error-prone conditions that lead to student-nurse related errors. |
| 10/04/2007 |
Potassium may no longer be stocked on patient care units, but serious threats still exist! |
| 09/20/2007 |
Fluorouracil error ends tragically, but application of lessons learned will save lives |
| 09/06/2007 |
Fatal 1,000-fold overdoses can occur, particularly in neonates, by transposing mcg and mg |
| 08/23/2007 |
Lack of standard dosing methods contributes to IV errors |
| 08/09/2007 |
Progress with preventing name confusion errors |
| 07/26/2007 |
Failure to cap IV tubing and disinfect IV ports place patients at risk for infections |
| 07/12/2007 |
Requirement #1-Patch should stick to the patient! |
| 06/28/2007 |
Ongoing, preventable fatal events with fentanyl transdermal patches are alarming! |
| 06/14/2007 |
Infusion free-flow apparently still a risk |
| 05/31/2007 |
Remote CPOE error-a situation that's more than remotely possible |
| 05/17/2007 |
ISMP 2007 survey on HIGH-ALERT medications
Differences between nursing and pharmacy perspectives still prevalent
|
| 05/03/2007 |
Action needed to prevent dangerous heparin-insulin confusion |
| 04/19/2007 |
Smart pumps are not smart on their own |
| 04/05/2007 |
Failure to clearly link TYLENOL products to acetaminophen poses serious threat to safety |
| 03/22/2007 |
If safety is your yardstick, measuring culture from the top down must be a priority |
| 03/08/2007 |
Criminal prosecution of human error will likely have dangerous long-term consequences |
| 02/22/2007 |
HIGH ALERT Medication Feature
Reducing patient harm from opiates
|
| 02/08/2007 |
Heed this warning! Don't miss important computer alerts |
| 01/25/2007 |
The five rights: A destination without a map
|
| 01/11/2007 |
High-Alert Medication Feature:
Anticoagulant safety takes center stage in 2007
|
|
|
2006
|
| 12/14/2006 |
The 9th Annual ISMP CHEERS Awards: And The Winners Are... |
| 11/30/2006 |
PEN injectors: Technology is not without imPENding risks
|
| 11/16/2006 |
Pharmaceutical industry medical device companies:
Part of the solution?
|
| 11/02/2006 |
Promethazine conundrum: IV can hurt more than IM injection!
Survey spurs interest in renewing efforts to prevent serious tissue damage
|
| 10/19/2006 |
"And the 'EYES' have it": Eardrops, that is... |
| 10/05/2006 |
Harmful errors: How will your facility respond? |
| 09/21/2006 |
Our long journey towards a safety-minded Just Culture
Part II: Where we're going |
| 09/07/2006 |
Our long journey towards a safety-minded Just Culture
Part I: Where we’ve been |
| 08/24/2006 |
Your attention please. Designing effective warnings |
| 08/10/2006 |
Action needed to prevent serious tissue injury with IV promethazine |
| 07/27/2006 |
ISMP comments on IOM report, Preventing Medication Errors |
| 07/13/2006 |
Practitioners agree on medication reconciliation value, but frustration and difficulties abound |
| 06/29/2006 |
Vincristine therapy: days "4-11" misunderstood as days 4 through 11 |
| 06/15/2006 |
Preventing accidental IV infusion of breast milk in neonates |
| 06/01/2006 |
Rapid response team activation by patients can mitigate errors
|
| 05/18/2006 |
Tablet splitting: Do it only if you "half" to, and then do it safely
|
| 05/04/2006 |
Pump design flaws demonstrate need for practitioner involvement in FMEA |
| 04/20/2006 |
Original document needed to scan orders to pharmacy |
| 04/06/2006 |
IV potassium given epidurally: getting to the "route" of the problem |
| 03/23/2006 |
Safety requires a state of "mindfulness" (Part II) |
| 03/09/2006 |
Safety requires a state of "mindfulness" (Part I) |
| 02/23/2006 |
IV vincristine survey shows safety improvements needed |
| 02/09/2006 |
Pump up the volume - Tips for increasing error reporting |
| 01/26/2006 |
What does your patient safety brochure really say about safety? |
| 01/12/2006 |
Infusion pump double key bounce and double keying errors |
|
|
2005
|
| 12/15/2005 |
The 8th Annual ISMP CHEERS Awards: And the winners are... |
| 12/01/2005 |
Fatal misadministration of IV vincristine |
| 11/17/2005 |
Mail service and community pharmacies must work in tandem |
| 11/03/2005 |
Propofol sedation: Who should administer? |
| 10/20/2005 |
Preventing magnesium toxicity in obstetrics |
| 10/06/2005 |
Unfortunately, this time it wasn't the equipment |
| 09/22/2005 |
Paralyzed by mistakes. Preventing errors with neuromuscular blocking agents |
| 09/08/2005 |
Be aware of false glucose results with point–of-care testing |
| 08/25/2005 |
Safety still compromised by computer weaknesses
Comparing 1999 and 2005 pharmacy computer field test results |
| 08/11/2005 |
New fentanyl warnings: more needed to protect patients |
| 07/28/2005 |
High-reliability organizations (HROs):
What they know that we don't (Part II) |
| 07/14/2005 |
High-reliability organizations (HROs):
What they know that we don't (Part I) |
| 06/30/2005 |
Two steps forward and one step back for patient safety?
Two groups focus on improved outcomes, another on Rx "vending" machines |
| 06/16/2005 |
Symlin insulin adjunct presents safety issues |
| 06/02/2005 |
An exhausted workforce increases the risk of errors |
| 05/19/2005 |
Practitioners anticipate punitive action from licensing bodies |
| 05/05/2005 |
End the ice age-Is glacial acetic acid really needed? |
| 04/21/2005 |
Building a case for medication reconciliation |
| 04/07/2005 |
Patient's watchful eye and Internet lead to pump tampering |
| 03/24/2005 |
Medication orders: Don't put me on hold
Joint Commission and use of the Broselow tape
Sterile cockpit |
| 03/10/2005 |
Measuring up to medication safety |
| 02/24/2005 |
Welcome to the State Board of (Nursing, Pharmacy, Medicine) Inquisitions |
| 02/10/2005 |
The truth about hospital formularies
Survey shows many myths still exist 15 years later |
| |
|
| 01/27/2005 |
New dangers in the drug reimportation
process: Will we know what our patients are taking?
|
| 01/13/2005 |
Looking forward: Make "pro-change"
your New Year's Resolution |
|
|
2004
|
| 12/16/2004 |
Fatal gas line mix-up: How to avoid
making this "gastly" mistake
2004 ISMP CHEERS for medication
safety: Celebrating excellence |
| 12/02/2004 |
Loud wake-up call: Unlabeled containers
lead to patient's death |
| 11/18/2004 |
The truth about hospital formularies:
We've come a long way, or have we? |
| 11/04/2004 |
FDA and the pharmaceutical industry
must be more responsive for a safer healthcare system |
| 10/21/2004 |
Hazard Alert!
ISMP urges immediate replacement of Brethine ampuls
with vials!
|
| 10/07/2004 |
Reducing "at-risk behaviors"
Part II of Patient safety should NOT be a priority in
healthcare!
|
| 09/23/2004 |
Patient safety should NOT be
a priority in healthcare!
Part I: Why we engage in "at-risk behaviors"
|
| 09/09/2004 |
Inflated risk: Inadvertent
drug injections into inflation port
Potential confusion with AMARYL
(glimepiride) and REMINYL (galantamine)
|
| 08/26/2004 |
Root causes: A roadmap to action |
| 08/12/2004 |
Hospital and medical staff leadership
is key to compliance with JC dangerous abbreviation
list |
| 07/29/2004 |
Misprogram a PCA pump? It's easy! |
| 07/15/2004 |
Lowdown on lomustine: We’d
hate CeeNU make this mistake |
| 07/01/2004 |
An omnipresent risk of morphine-hydromorphone
mix-ups |
| 06/17/2004 |
Problems persist with life-threatening
tubing misconnections |
| 06/03/2004 |
Oops, sorry, wrong patient!Applying
the JC “two-identifier” rule beyond the patient’s
room |
| 05/20/2004 |
The high cost of medications: A
bitter pill to swallow |
|
05/06/2004
|
Bicillin products: Syringe enhancements
may help to prevent IV administration |
|
04/22/2004
|
Improvised
drug delivery: A cause for concern
Hazard warning with BRETHINE
and METHERGINE.
|
|
04/08/2004
|
Burns in MRI patients
wearing transdermal patches
Confusion caused by several different
products with DULCOLAX brand name.
|
|
03/25/2004
|
Intimidation:
Practitioners speak up about this unresolved problem
(Part II)
|
|
03/11/2004
|
Intimidation:
Practitioners speak up about this unresolved problem
(Part I)
|
|
02/26/2004
|
Broselow
tape: Measuring the changes from 1998 to today
|
|
02/12/2004
|
Safety issues with adding lidocaine to IV potassium infusions
|
|
01/29/2004
|
Evidence-based
medicine doesn’t preclude common sense
|
|
01/15/2004
|
Template for
disaster? Fatal injection into wrong port of implanted
infusion pump
|
|
|
2003
|
|
12/18/2003
|
2003 CHEERS
for medication safety: Celebrating excellence
ISMP's
list of high-alert medications
|
|
11/27/2003
|
Intrathecal
injection of ionic contrast media may be fatal
|
|
11/13/2003
|
A spectrum of
problems with using color
|
|
10/30/2003
|
Double-checks
for endogenous and exogenous errors
|
|
10/16/2003
|
Survey on high-alert
medications
Differences between nursing and pharmacy perspectives
revealed
|
|
10/02/2003
|
Helping to remove
the barriers to patient education
|
|
09/18/2003
|
How sterile water
bags show up on nursing units
|
|
09/04/2003
|
Cultural diversity
and medication safety
|
|
08/21/2003
|
Is an antithyroid
or antimetabolite needed?
|
|
08/07/2003
|
How are you
preventing acetaminophen overdoses?
|
|
07/24/2003
|
Part II - How
to prevent errors - Safety issues with patient-controlled
analgesia
|
|
07/10/2003
|
Safety issues with
patient-controlled analgesia Part I - How errors occur
|
|
06/26/2003
|
New data monitoring
technology offers real-time reporting of impending adverse
events
|
|
06/12/2003
|
Blood pressure
monitor tubing may connect to IV ports
|
|
05/29/2003
|
Mind your “Medrols”
|
|
05/15/2003
|
How fast is too fast
for IV push medications?
|
|
05/01/2003
|
Nix the quick fix:
Drug protocols require groundwork
|
|
04/17/2003
|
"Looks"
like a problem: ephedrine - epinephrine
|
|
04/03/2003
|
U cnt
abbrv “Patient Safety”
|
|
03/20/2003
|
Last week was National
Patient Safety Week – and what a week it was!
|
|
03/06/2003
|
The virtues of independent
double checks – they really are worth your time!
|
|
02/20/2003
|
It’s time
for standards to improve safety with electronic communication
of medication orders
|
|
02/06/2003
|
The reports are
in…or are they? Awareness of medication error
reporting programs needs a boost
|
|
01/23/2003
|
Water,
water, everywhere, but please don't give IV
|
|
01/09/2003
|
Success with
New Year's resolutions requires more than personal resolve
|
|
|
2002
|
|
12/18/2002
|
"Cheers"
for medication safety: Celebrating those who made a
difference in 2002
|
|
11/24/2002
|
Watch out for this
turkey - Complacency
|
|
11/13/2002
|
Face it! Intimidation
presents serious safety issues
|
|
10/30/2002
|
Tricks but no
treats: Illusions and medication errors
|
|
10/16/2002
|
It doesn't pay to
play the percentages
|
|
10/03/2002
|
Benzocaine-containing
topical sprays and methemoglobinemia
|
|
09/18/2002
|
Bad "marks"
for order communication
|
|
09/04/2002
|
Involving non-clinical
departments in patient safety discussions can reduce
the risk of serious errors
|
|
08/21/2002
|
The road less traveled
|
|
08/07/2002
|
Accidental
childhood acetaminophen overdoses illustrate our responsibility
to educate parents
|
|
07/24/2002
|
Pain scales don't
weigh every risk
|
|
07/10/2002
06/26/2002
|
Pharmacy interventions
- Part I and II from ISMP survey
|
|
06/12/2002
|
What's
in a name? Ways to prevent dispensing errors linked
to name confusion
A medication error trifecta!
|
|
05/29/2002
|
More
on avoiding opiate toxicity with PCA by proxy
|
|
05/15/2002
|
Atrocious
labeling of plastic ampuls
needs action now by FDA and manufacturers
|
|
05/01/2002
|
Annenberg Conference
sends a patient's message: "Nothing about me without
me"
|
|
04/17/2002
|
Remote
order entry: Innovative practice to reduce distractions
and offer 24-hour pharmacy service
|
|
04/03/2002
|
Beware of erroneous
daily oral methotrexate dosing
|
|
03/20/2002
|
Practitioner
access to the Internet: A necessity in a modern hospital
|
|
03/06/2002
|
ISMP survey shows
drug companies providing fewer unit dose packaged medications
|
|
02/20/2002
|
Eliminating
dangerous abbreviations and dose expressions in the
print and electronic world
|
|
02/07/2002
|
"Smart"
infusion pumps join CPOE and bar coding as important
ways to prevent medication errors
|
|
01/23/2002
|
Shortsighted
JC standard lacks understanding of pharmacist's role
in prospective order review
|
|
01/09/2002
|
Messages in
our mailbox
|
|
|
2001
|
|
12/12/2001
|
The
year 2001 at a glance: ISMP's medication safety "Cheers"
|
|
11/28/2001
|
IV connection
to tracheostomy cuff inflation port reflects larger problem
|
|
11/14/2001
|
Supervision
often a weak link in error prevention
|
|
10/31/2001
|
To promote understanding,
assume every patient has a health literacy problem
|
|
10/17/2001
|
Failure
Mode and Effects Analysis can help guide error prevention
efforts
|
|
10/03/2001
|
Systems thinking:
Tap into staff creativity to unleash innovation
|
|
09/19/2001
|
ISMP survey
on perceptions of a nonpunitive
culture produces some surprising results
|
|
08/08/2001
|
It's time for
a new model of accountability
|
|
07/25/2001
|
The supermarkets
do it - so why can't we raise the "bar" in
health care?
|
|
07/11/2001
|
Patient safety
is all about taking that extra step
|
|
06/28/2001
|
Insights into
people will improve our safety systems.
|
|
06/13/2001
|
Medication
error or professional judgement?
|
|
05/30/2001
|
New official
interpretation of JC standard bans open access to
pharmacy after hours
|
|
05/02/2001
|
Please Don't
Sleep Through this Wake-Up Call
Includes ISMP's table of
dangerous medical abbrevations
|
|
04/18/2001
|
Lessons
Lost by the Global Pharmaceutical Industry
|
ISMP Canada | 
ISMP Spain | Pennsylvania Patient Safety Authority