Like most of the IMSN's founders, David Cousins was a busy hospital pharmacist. As chief pharmacist of Derby Hospitals (September 1983–August 2002), he commissioned a new pharmacy department and provided a range of new pharmacy services:
- full intravenous additive service; pump and syringe driver library service;
- aseptic satellite pharmacies in intensive care, paediatrics, cancer care, operating theatres and, palliative care/hospice;
- pharmacists as full members of the cardiopulmonary resuscitation team.
He developed a substantial commercial aseptic dispensing business as income generation for the hospital, selling total parenteral nutrition, antibiotics, chemotherapy and other intravenous infusions to home care companies and hospitals.
He also introduced new postgraduate pharmacy training courses in the UK with the University of Derby: DPharm, MSc and Postgraduate diploma for pharmacists and validated training courses for pharmacy technicians.

His colleagues abroad knew David Cousins mainly as Head of Safe Medication Practice and Medical Devices, National Patient Safety Agency (NPSA) and further NHS England (September 2002 – October 2014), where he helped to develop and implement the NHS National Reporting and Learning System (NRLS).
This tireless analyst of tens of thousands of incident reports, NHS complaints and evidence data has published over 50 Patient Safety Alerts and other national guidance intended to minimize preventable deaths and serious harm to patients from the unsafe use of medicines and medical devices including guidance on: the safer use of concentrated potassium chloride Injection; reducing harms from injectable medicines; minimizing wrong route errors including oral liquid medicines, intrathecal vincristine, intravenous bupivacaine; reducing harm from omitted and delayed medicines.
So many treasures now only accessible in NHS archives.

At the end of 2007, in collaboration with the National Institute for Health and Clinical Excellence (NICE), he introduced in the UK medicines reconciliation on hospital admission to ensure that any medication patients are taking prior to admission to hospital is properly documented on admission. He also authored a 2014 Patient Safety Alert requiring every NHS organization in England to appoint a Medication Safety Officer. His most enduring legacy is the national network of Medication Safety Officers he launched.

During this period of national responsibility, and on behalf of the UK NPSA, David Cousins was also particularly active at European and international level. As member of the Expert Group on Safe Medication Practices established in 2003 by the Council of Europe Committee of Experts on Pharmaceutical Questions, he played a decisive role in including a specific strategy to promote medication safety in the Council of Europe Recommendation Rec(2006)7 of the Committee of Ministers to member states on management of patient safety and prevention of adverse events in health care adopted 24 May 2006. It is regrettable that the report approved on November 7, 2006, to which he contributed and that he presented on many occasions, is no longer available on the European Directorate for the Quality of Medicines & HealthCare (EDQM) website.

Still on a global scale, David Cousins has been one of the driving forces behind a WHO project under the Seventh Framework Programme of the European Union (EU-FP7), aiming to increase the capacity of pharmacovigilance (PV) centres in identifying and understanding the root causes of preventable adverse drug reactions (ADRs) (2009 - 2013).

David Cousins also tried to orient the European Medicine Agency’s (EMA) policy on preventing medication errors.

David Cousins was convinced, determined and pugnacious, as shown by his positions in reaction to what he saw as resignations. He became recipient of the RPS Lifetime Achievement Award, the 2015 UKCPA Lifetime Achievement Award and the 2020 ISMP Lifetime Achievement Cheers Award, pleased to receive recognition from peers.

Mike Cohen, Chair of the IMSN told : "David is known world-wide for his important work in medication safety over many years. He was one of the organizers of the International Medication Safety Network and will be remembered for his life-saving work and the many contributions he made to the work we all share."
June 2023

Intravenous (IV) oxytocin is used antepartum to induce labor in patients with a medical indication, to stimulate or reinforce labor in selected cases of uterine inertia, and as an adjunct in the management of an incomplete, inevitable, or elective abortion. Used postpartum, IV oxytocin is indicated to produce uterine contractions during the expulsion of the placenta, and to prevent or control postpartum bleeding or hemorrhage. Therefore, oxytocin is needed in all obstetric care areas with consistency of practice amongst all provider types (e.g., anesthesia, obstetrics, midwives, perinatal nursing) whether using low doses for labor induction or augmentation, commonly measured in milliunits, or at higher doses to prevent or treat postpartum hemorrhage (PPH), commonly measured in units.

However, improper administration of oxytocin can cause hyperstimulation of the uterus, which in turn can result in fetal distress, the need for an emergency cesarean section, or uterine rupture. Multiple International Medication Safety Network (IMSN) member countries have identified that there are substantial risks involved with the use of oxytocin and have reported significant patient harm from related errors

Building a Response to Oxytocin-Related Errors

In a series of OxytocinSIG meetings held in 2022, IMSN members shared firsthand experience with a variety of risks, close calls, errors, and adverse events associated with the use of oxytocin. These included:

• Inappropriate/unnecessary use in labor induction in low-risk patient populations
• Lack of a standardized dosing regimen
• Confusion with look-alike and sound-alike medications
• Inappropriate use of brand names or unsafe abbreviations
• Non-standardized or non-centralized preparation of oxytocin infusions
• Use of multiple oxytocin infusion concentrations/preparations
• Insuficient monitoring of beyond-use dates of pre-prepared solutions
• Reliance on manually programmed infusion pumps without automated safeguards in place
• Mix-ups with infusion tubing
• Mix-ups with dosing/infusion rates
• Use/availability of oxytocin in the direct patient care area without appropriate orders and communication among healthcare providers

IMSN Oxytocin SIG Recommendations for Global Implementation of Safe Oxytocin Use Practices

These selected risk-reduction strategies include recommendations that can help avoid errors and significant patient harm related to the use of oxytocin through all phases of the medication-use process.

Implementing and moving forward

IMSN acknowledges that healthcare organizations in different parts of the world vary in the availability of technologies (e.g., electronic health records, infusion pumps, automated dispensing cabinets) and resources (e.g., central pharmacy compounding programs). While the recommendations may not all be achievable everywhere, organizations should work to identify those that can be implemented at each step of the medication-use process and consider the remaining recommendations as future goals to work towards.

• Continue to report errors involving oxytocin through your normal reporting programs and to the International Medication Error Reporting Portal, so that we may continue to evaluate the safe use of oxytocin and other medications around the world.
• Premixed solutions are currently not available globally except from outsourced compounding pharmacies in some countries. IMSN urges the global pharmaceutical industry to make premixed oxytocin solutions available everywhere, as soon as possible.

May 2023

During the fall of 2020, as the world waited in anticipation for the emergency use/conditional marketing authorization of COVID-19 vaccines, members of the International Medication Safety Network (IMSN) began to discuss safety issues that might impact global immunization roll out efforts with regard to the knowledge on vaccination errors already gathered by the IMSN.

Building a Response to the Different Types of Vaccine-Related Errors

In a series of CVSIG meetings in mid-2021, as vaccination campaigns rolled out, IMSN members shared firsthand experience with a variety of risks, near-misses, errors, and adverse events following immunization with COVID-19 vaccines on the basis of aggregated analysis by CVSIG members. These included issues with:

• screening (e.g., wrong age, patients with contraindicated conditions),
• storage (e.g., inappropriate storage temperature, confusion and mis-selection resulting from storage near other vaccines or monoclonal antibodies),
• preparation (e.g., serial errors for vaccines needing a two-step reconstitution process, diluent errors including incorrect diluent volume or no dilution, dosing errors including wrong dose, no dose, expired dose),
• administration (e.g., shoulder injury related to vaccine administration, wrong time interval for second dose or third dose, syringe and/or needle malfunction or misuse leading to underdose, wrong vaccine, wrong drug, wrong route of administration, accidental exposure),
• and monitoring (e.g., missed second or third doses).

In addition, the approach to errors has evolved over the course of COVID-19 vaccination campaigns (for example, intervals between doses, authorized ages, authorized doses, and recommended vaccines).

IMSN CVSIG Recommendations for Global Implementation of Safe COVID-19 Immunization Practices - January 2022

The recommendations follow the vaccine use process and address errors occurring during each stage.

Moving Forward: during the development of these recommendations, several topics were identified that will receive special attention from IMSN

• Promoting packaging vaccines in prefilled unit-dose syringes as a global standard
• Addressing issues related to COVID-19 vaccine safety for pediatrics as COVID-19 vaccines are being authorized for use in more countries
• Addressing risks during overlapping COVID-19 immunizations and other immunization campaigns
• Involving IMSN in review of a globally standardized schema and pathways for adverse events following immunization reporting