AHRQ Patient Safety Network

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Insulin

Origin/Sponsor

•Australia and New Zealand (1)

Resource Types

•Journal Article (30)

•Newspaper/Magazine Article (11)

•Press Release/Announcement (3)

Error Types

•Epidemiology of Errors and Adverse Events (11)

•Active Errors (21)

•Latent Errors (4)

•Near Miss (2)

Approach to Improving Safety

•Quality Improvement Strategies (24)

•Error Reporting and Analysis (10)

•Communication Improvement (10)

•Human Factors Engineering (13)

•Teamwork (2)

•Specialization of Care (5)

•Logistical Approaches (1)

•Culture of Safety (3)

•Technologic Approaches (12)

•Education and Training (17)

Clinical Areas

•Medicine (33)

•Nursing (6)

•Pharmacy (16)

Target Audience

•Health Care Providers (41)

•Health Care Executives and Administrators (34)

•Non-Health Care Professionals (8)

•Patients (2)

Setting of Care

•Hospitals (28)

•Residential Facilities (1)

•Ambulatory Care (9)

1 - 20 of 46

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COMMENTARY

ISMP medication error report analysis.

Cohen MR. Hosp Pharm. 2008;43:696–698.

STUDY

Medication error reporting in nursing homes: identifying targets for patient safety improvement.

Greene SB, Williams CE, Pierson S, Hansen RA, Carey TS. Qual Saf Health Care. 2010;19:218-222.

NEWSPAPER/MAGAZINE ARTICLE

Misadministration of IV insulin associated with dose measurement and hyperkalemia treatment.

ISMP Medication Safety Alert! Acute Care Edition. August 11, 2011;16:1-3.

NEWSPAPER/MAGAZINE ARTICLE

Action needed to prevent dangerous heparin-insulin confusion.

ISMP Medication Safety Alert! Acute Care Edition. May 3, 2007;12:1-2.

COMMENTARY

ISMP medication error report analysis.

Cohen MC. Hosp Pharm. 2009;44:374-378.

COMMENTARY

ISMP medication error report analysis.

Cohen MR. Hosp Pharm. 2005;40:643-648.

STUDY

Identifying causes of adverse events detected by an automated trigger tool through in-depth analysis.

Muething SE, Conway PH, Kloppenborg E, et al. Qual Saf Health Care. 2010;19:435-439.

NEWSPAPER/MAGAZINE ARTICLE

An overlooked condition.

Nicholas L. Modern Healthc. November 14, 2005;35:24.

STUDY

Selected medical errors in the intensive care unit: results of the IATROREF study: parts I and II.

Garrouste-Orgeas M, Timsit JF, Vesin A, et al; OUTCOMEREA Study Group. Am J Respir Crit Care Med. 2010:181:134-142.

COMMENTARY

Addressing safety concerns about U-500 insulin in a hospital setting.

Samaan KH, Dahlke M, Stover J. Am J Health Syst Pharm. 2011;68:63-68.

STUDY

Unintentional therapeutic errors involving insulin in the ambulatory setting reported to poison centers.

Spiller HA, Borys DJ, Ryan ML, Sawyer TS, Wilson BL. Ann Pharmacother. 2011;45:17-22.

COMMENTARY

Avoiding errors associated with insulin therapy.

Cohen H. Medscape CME/CE. May 14, 2009.

STUDY

Reducing potentially fatal errors associated with high doses of insulin: a successful multifaceted multidisciplinary prevention strategy.

Dooley MJ, Wiseman M, McRae A, et al. BMJ Qual Saf. 2011;20:637-644.

NEWSPAPER/MAGAZINE ARTICLE

A clinical reminder about the safe use of insulin vials.

ISMP Medication Safety Alert! Acute Care Edition. February 21, 2013;18:1-3.

STUDY

Adverse drug events among hospitalized Medicare patients: epidemiology and national estimates from a new approach to surveillance.

Classen DC, Jaser L, Budnitz DS. Jt Comm J Qual Patient Saf. 2010;36:12-21, AP1-AP9.

COMMENTARY

It's All in the Syringe

Weingart SN. AHRQ WebM&M [serial online]. August 2006.

NEWSPAPER/MAGAZINE ARTICLE

Medication errors with the dosing of insulin: problems across the continuum.

PA-PSRS Patient Saf Advis. March 2010;7:9-17.

COMMENTARY

ISMP medication error report analysis.

Cohen MR. Hosp Pharm. 2008;43:618-621.

NEWSPAPER/MAGAZINE ARTICLE

Common cause analysis.

Clapper C, Crea K. Patient Saf Qual Healthc. May/June 2010;7:30-35.

COMMENTARY

A Mid-Summer Fog

Braddock CH. AHRQ WebM&M [serial online]. November 2008.

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