Acute Care Volume 23, Issue 20

Medication Safety Alert! October 4, 2018

In this month's issue:

Featured article

Problem: Within weeks of each other, two hospitals have reported mix-ups between epidural analgesia and intravenous (IV) antibiotics in labor and delivery (L&D) units. These mix-ups mimic previously published events and have similar contributing factors including look-alike infusion bags, overlooked warning labels, and a point-of-care barcode medication administration (BCMA) system that was not fully engaged. However, unlike the prior events, drug shortages also played a role in the most recent errors.    

Recent Errors

Epidural fentaNYL with bupivacaine administered IV. An obstetrician...

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