"The exact same error, administering insulin instead of influenza vaccine, has been reported many times around the world, including several cases in the US. Some cases have been fatal."www.ismp.org/newsletters/acutecare/showarticle.aspx?id=1138
.."Many of these containers have little difference in shape or color. Even worse, the containers have the drug name, concentration, lot number, and expiration date embossed into the plastic using transparent, raised letters, which are virtually impossible to read." www.pharmacytimes.com/publications/issue/2006/2006-01/2006-01-5135
“In her haste to give the already-late medications, she fails to notice the “Do not crush” warning on the electronic medication administration record.” americannursetoday.com/medication-errors-dont-let-them-happen-to-you/
"Healthcare practitioners are repeatedly challenged by unexpected problems they encounter due to both large and small work system failures that hinder patient care. A medication needed for a patient is missing on a patient care unit; an order is never received in the pharmacy; access to the automated dispensing cabinet is crowded and time-consuming; the new barcode scanner has a high rate of scanning failures; a critical drug is in short supply—the list of failures is varied and quite long, often making it difficult or impossible to execute tasks as designed." www.ismp.org/newsletters/acutecare/showarticle.aspx?id=1139
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