Ronald S. Litman, D.O., ISMP's medical director, discusses his investigation into the cause of a fatal medication error during surgery that involved accidental administration of the wrong drug by an anesthesiologist and describes prevention strategies that could prevent similar mistakes, such as bar-coding systems and the use of pre-filled drug syringes.
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ADCs currently are being used for medication distribution in the majority of U.S. hospitals and health systems, and ISMP believes healthcare organizations have an obligation to ensure that this technology is being optimized to promote safe patient outcomes.
Healthcare Leaders Urged to Avoid Severity Bias, Establish Just Culture In the wake of recent criminal charges being filed against a registered nurse in Tennessee who was involved in a fatal medication error, the Institute for Safe Medication Practices (ISMP) is emphasizing that the focus should be
This article appeared on the HealthLeaders website on January 28, 2019.