Medication Safety Alert! October 18, 2018
In this week's issue:
- Errors Due to the Presentation of Results on Accu-Chek Inform II and Possibly Other Glucometers
- Confusion when thinking about error-prone drug abbreviations
- Container label changes for vitamin A, D, and E
- Peel-off label on rocuronium vial leads to confusion
- Join us in celebrating American Pharmacists Month in October!
- New 2018-2019 FDA/ISMP Safe Medication Management Fellows
- Avani Bhalodia, PharmD
- Mona Hamman, PharmD
Problem: Glucose testing is one of the most frequent point-of-care (POC) tests performed in hospitals.1 While POC glucose testing offers immediate results that can be used to make important clinical decisions about the treatment of hypo- or hyperglycemia, errors can occur at any point in the testing process. For example, earlier studies have found that the most common types of errors associated with POC glucose testing are related to delays in testing due to the unavailability of trained staff2 and a failure to positively identify patients prior to testing.3 In the latter case, a study in a...