ISMP Safety Briefs: Inhalation Medication Entered Incorrectly Causes Error
This column was prepared by the Institute for Safe Medication Practices (ISMP), an ECRI affiliate. A pharmacist reported that a medication was entered incorrectly into their pharmacy dispensing system from an electronic prescription. The prescriber had ordered “mometasone 100 mcg-formoterol 5 mcg inhalation.” However, the pharmacy technician entered “mometasone 100 mcg inhalation.” Fortunately, a pharmacist […]
Read More ›ISMP Safety Briefs: PRIORIX Diluent Administered Without Vaccine
This column was prepared by the Institute for Safe Medication Practices (ISMP), an ECRI affiliate. PRIORIX® is a measles, mumps, and rubella vaccine manufactured by GSK. It is available in cartons containing 10 single-dose vials of lyophilized antigen component and 10 single-dose prefilled ungraduated syringes of sterile water diluent. The prefilled diluent syringes have luer […]
Read More ›Guidance for Imported Fluid Products Published by ISMP
Following Food and Drug Administration’s approval of a temporary importation list for fluid products in response to Hurricane Helene, the Institute for Safe Medication Practices (ISMP) has released guidelines to help health care organizations evaluate safety and assess potential risks when using these imported products. ISMP’s Imported Fluid Product Checklist outlines factors that should be […]
Read More ›ISMP: Manage the Ordering and Dispensing of Loading and Maintenance Medication Doses to Avoid Errors
This column was prepared by the Institute for Safe Medication Practices (ISMP), an ECRI affiliate. A health system specialty pharmacy recently reported errors related to choosing the incorrect refill dose (eg, maintenance vs loading dose) of a self-injectable medication within an integrated pharmacy software system. When the specialty pharmacy system integrated into an electronic health […]
Read More ›ISMP: Practitioners Can Reduce and Prevent Errors Involving ‘Look-Alike’ Bottles by Using Purchasing Decisions and Barcode Scanning
This column was prepared by the Institute for Safe Medication Practices (ISMP), an ECRI affiliate. The Institute for Safe Medication Practices (ISMP) has recently received multiple reports of different manufacturer bottles with similar appearances that have contributed to errors. In one case, a mix-up occurred between prasugrel 10 mg tablets and flecainide 100 mg tablets, […]
Read More ›Tranexamic Acid Injection Added to ISMP’s List of High-Alert Medications
Tranexamic acid injections have been added to the Institute for Safe Medication Practices’ (ISMP’s) 2024 List of High-Alert Medications in Acute Care Settings. “High-alert” medications have an increased risk of causing significant harm to patients when they are incorrectly administered. ISMP recommends that practitioners implement safeguarding measures to minimize the risk of error when dispensing […]
Read More ›ISMP Safety Brief: Prevent Additional Patient Harm and Deaths From Accidental Daily Methotrexate Dosing
This column was prepared by the Institute for Safe Medication Practices (ISMP), an ECRI affiliate. Methotrexate is a folic acid antagonist that was originally approved to treat a variety of cancers. Used for oncologic indications, methotrexate is administered in cyclical frequencies and in variable doses based on body surface area and the type of cancer […]
Read More ›ISMP Safety Brief: Unintentional Ingestion of Boric Acid Vaginal Suppositories
This column was prepared by the Institute for Safe Medication Practices (ISMP), an ECRI affiliate. A doctor told a woman with a vaginal infection to use boric acid suppositories to help relieve symptoms that often accompany vaginitis, such as a bad odor. Boric acid (a pesticide that is harmful when taken orally) suppositories are sold […]
Read More ›ISMP Launches the 2023-24 Targeted Medication Safety Best Practices for Community Pharmacy
This column was prepared by the Institute for Safe Medication Practices (ISMP), an ECRI affiliate. The Institute for Safe Medication Practices (ISMP) has launched the 2023-24 Targeted Medication Safety Best Practices for Community Pharmacy (Best Practices). The purpose of these Best Practices is to identify, inspire, and mobilize widespread, national adoption of consensus-based best practices […]
Read More ›ISMP Safety Brief: Confusion Among the Many Humira Products With More Biosimilars on the Horizon
This column was prepared by the Institute for Safe Medication Practices (ISMP), an ECRI affiliate. A specialty pharmacy reported concerns with look-alike packaging with the many presentations of Humira® (adalimumab), which is used for nine different autoimmune indications in both pediatric and adult populations. The manufacturer produces 20 different prefilled syringe and pen carton configurations. […]
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