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psnet.ahrq.gov/issue/follow-ismp-guidelines-safeguard-design-and-use-automated-dispensing-cabinets-adcs
May 07, 2018 - December 1, 2010
Medication errors associated with documented allergies.
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psnet.ahrq.gov/issue/ismp-updates-its-list-drug-name-pairs-tall-man-letters
June 10, 2018 - March 23, 2012
Medication errors associated with documented allergies.
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psnet.ahrq.gov/issue/my-medicines
January 13, 2016 - adverse drug events and provides a way to record important medication information such as a list of allergies
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psnet.ahrq.gov/node/846564/psn-pdf
March 29, 2023 - For example, one study looked
at drug allergy alerts and found that although 44.8% of alerts were overridden … , only 9.3% of those were
inappropriately overridden, and very few overrides led to an adverse allergic … reaction.
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psnet.ahrq.gov/perspective/technology-tool-improving-patient-safety
April 26, 2023 - For example, one study looked at drug allergy alerts and found that although 44.8% of alerts were overridden … , only 9.3% of those were inappropriately overridden, and very few overrides led to an adverse allergic … reaction.
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psnet.ahrq.gov/web-mm/fumbled-handoff-inpatient-rehab
December 21, 2018 - Expiration Complexity of patient condition prior to and during stay Major Treatments, Medications, Allergies
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psnet.ahrq.gov/node/33709/psn-pdf
July 01, 2011 - Administrative information,
diagnoses, current medications, and allergies, as well as an editable synopsis
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psnet.ahrq.gov/web-mm/hold-order
December 19, 2018 - January 3, 2017
WebM&M Cases
Patient Allergies and Electronic
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psnet.ahrq.gov/web-mm/who-nose-where-airway
May 01, 2016 - Perioperative Anaphylaxis After Insertion of a Latex Drain in a Patient with Known Latex Allergy
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psnet.ahrq.gov/web-mm/cvc-placement-speak-now-or-do-not-use-line
November 01, 2003 - Organizing Plight
September 1, 2016
WebM&M Cases
Allergy
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psnet.ahrq.gov/node/33842/psn-pdf
January 01, 2018 - IT fails during use or is otherwise not
working as designed.(15)
Network problem prevented remote allergy
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psnet.ahrq.gov/node/73456/psn-pdf
June 30, 2021 - J Allergy Clin Immunol Pract 2018; 6(2):570-8. Doi: 10.1016/j.jaip.2017.07.010
12.
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psnet.ahrq.gov/web-mm/one-dose-two-errors
September 29, 2017 - WebM&M Cases
Delayed Sepsis Management Due to Ambiguous Allergy
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psnet.ahrq.gov/web-mm/endotracheal-tube-fallout-patient-severe-obesity-during-eye-surgery
January 29, 2021 - Perioperative Anaphylaxis After Insertion of a Latex Drain in a Patient with Known Latex Allergy
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psnet.ahrq.gov/node/857260/psn-pdf
November 30, 2023 - preoperative assessment to gather information about the patient's medical
history, current medications, allergies
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psnet.ahrq.gov/perspective/conversation-withtroyen-brennan-md-jd-mph
December 21, 2022 - and, had we a system in place—such as an electronic medical record that reminded us of the patient's allergies—then
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psnet.ahrq.gov/web-mm/wrongful-resuscitation
October 12, 2012 - can include appropriate "flags" that make sure that important information such as DNR orders and drug allergies
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psnet.ahrq.gov/sites/default/files/2024-06/spotlight_case_hemorrhagic_shock_slides_final.pptx
January 01, 2024 - 4
Case Details (1)
A 67-year-old man weighing 175 pounds, in excellent health except for seasonal allergies
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psnet.ahrq.gov/web-mm/when-taking-sglt2-inhibitor-remember-sstop-stop-sglt2-inhibitor-three-days-bef-o-re
February 01, 2023 - preoperative assessment to gather information about the patient's medical history, current medications, allergies
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psnet.ahrq.gov/sites/default/files/2024-08/spotlight_case_a_fatal_twist_in_pseudohyperkalemia_slides.pptx
January 01, 2024 - 25
System Optimization (3)
Increasing awareness of long QT syndrome:
Similar to alerts for patient allergies