Our Blog

March 18, 2019

The Unforgivable Error

In order to reduce medication errors, it is essential that they first be identified and reported, a key component of Root Cause Analysis. This process helps […]
March 11, 2019

Assessing Probability

There are a number of methods used to assess the probability of an event resulting from medication administration. The Naranjo Scale is perhaps the most common […]
March 4, 2019

Serotonin Syndrome: Are we missing it?

Serotonin syndrome can often go overlooked even though it can be lifethreatening if not detected in time and properly treated. The condition is caused by excessive […]
February 25, 2019

Avoiding Medication Errors

An unfortunate part of healthcare involves medication errors which can occur during any phase of the distributive process. Healthcare providers are encouraged to practice Continuous Quality […]
February 18, 2019

Errors with Volume of Distribution

In my experiences with dosing, antibiotics tend to offer the greatest challenge, especially in septic patients. The reason this is a challenge is because septic patients […]
February 12, 2019

Revisiting Once Daily Dosing

  Recently we were asked to evaluate a patient  who was administered gentamicin 440 mg IV q24 hr. The patient received 5 doses prior to obtaining […]
February 5, 2019

The Swiss Cheese Model

The human error problem can be viewed in two ways: the person approach and the system approach. Each has its model of error causation and each […]
January 29, 2019

Errors with Half Life Determination

Calculating elimination rate constants and half lives can be challenging in patients that are unstable. For drugs that are eliminated renally, it is important to ensure […]
January 21, 2019

Reducing Medication Errors

Most hospitals practice continuous quality improvement and therefore have some type of medication error program in place. In many instances, we find that hospitals have an […]
January 14, 2019

First Dose Levels

In an effort to achieve accuracy, oftentimes clinicians are hesitant to check first dose peak and trough levels for aminoglycosides. The tendency is to obtain peak […]
January 7, 2019

Practical steps to reduce med errors

 By focusing on five key rules of medication therapy, clinicians can reduce the occurrence of medication errors and improve patient safety. These key rules include the […]
December 31, 2018

Pharmacokinetic Dosing Errors

Medication errors associated with pharmacokinetics can sometimes get overlooked. Oftentimes, dosing errors occur but may go unreported. This can be especially true when dealing with aminoglycosides. […]
December 24, 2018

Medication Error Reporting

“Between January and December 1990, the number of medication error reports received per month ranged from 73 to 141. In that year the number of errors […]