IMSN members publications

Click to have a look on the publications issued by each IMSN member

Centrale Medicatie-incidenten Registratie (CMR)

  • CMR Praktijkprikkel
    A dynamic way on involving pharmacist into patient safety attention so-called “CMR incentives about practice”. With the consent of the reporter, case reports are presented by PvP/CMR with a short analysis. The described problem, selected to be obvious, is submitted to a specific survey on the problem and ways of preventing it.
    Periodicity: as needed
    Publication langage: Dutch
    No Subscription. Available for free download or sent by e-mail to registered users.
    Access to CMR Praktijkprikkel: Read on...

    What are the last CMR Praktijkprikkel?

    25 September 2018 – Mix-up between epidural and intravenous lines during medication administration
    17 September 2018 - Stop or continue anticoagulation: who controls?
    28 June 2018 - Medication administration records are not suitable for transfert of medication data
    13 March 2018 - Pay attention! Removing incorrect entries in pharmacy system does not lead to stop message via Edifact Results of the survey published on 16 July 2018
    5 February 2018 - Changes between strengths of insulin degludec (Tresiba°) 100 units/mL and 200 units/mL Results of the survey published on 16 July 2018
    10 January 2018 - Starting a new medicine with individual dispensing: chronic or not?
    22 December 2017 - Change of dosing syringe Depakine° oral liquid 300 mg / ml: graduation only in MILLIGRAM
    12 December 2017 - Important: check the indication of patients using modafinil (Aspendos°/Modiodal°)!
    27 November 2017 - Allergy entered under 'Other': no monitoring!
    Results of the survey published on 22 February 2018
    18 September 2017 - Wrong choice of medicine product after generic prescribing
    12 June 2017 - Amiodarone: Avoid Repeating High Start Dose!
    28 May 2017 - Again reported: dispensing 100 overdose Atropine eye drops
    8 May 2017 – Prescription Code (PRK) Depo-Provera° as of April 1, 2017, adjusted in G-Standard (Change of standardized names used in electronic prescribing)
    10 April 2017 - Issue 6: Reported again: unintentionally supply of phenprocoumon via automated dose dispensing (ADD)
    27 March 2017 – Issue 5: Serious overdose with Dipiperon°- drops
    Results of the survey published on 26 June 2017
    13 March 2017 – Issue 4: Who is in charge of gentamicin dose adjustment in your hospital? Results of the survey published on 20 July 2017
    27 February 2017 – Issue 3: Unintentional supply also via automated dose dispensing (ADD) leads to double intake of phenprocoumon
    13 February 2017 – Issue 2: Monitoring excipients not possible in software systems
    26 January 2017 – Issue 1: Inadvertently prolonged use of Brilique°

  • CMR Signaal
    A short message which CMR want to raise a risk in the medication use process, when the recurrence rate is high.
    Periodicity: as needed
    Publication langage: Dutch
    No Subscription. Available for free download or sent by e-mail to registered users.
    Access to CMR Signaal: Read on...

    What's the last CMR Signaal?

    22 December 2016 - Linking wrong Social Security Number leads to incorrect medication list Read on (in Dutch)...

  • CMR Alerts
    Serious incidents with a high risk of recurrence, educational potential for other healthcare providers and actual or potential risk of serious harm to the patient (CMR three basic criteria for the relevance of the error).
    Periodicity: as needed
    Publication langage: Dutch
    No Subscription. Available for free download or sent by e-mail to registered users.
    Access to CMR Alerts: Read on...

    What's the last CMR Alert?

    1st November 2017 - Possibility of merging two different medicines in supply software : risk of persistent use of not intended medicine for patients using automated dose dispensing Read on ...
    12 December 2016 - Important interactions missed due to poor computer date management leading to an erroneous date of the end of treatment Read on ...
    7 December 2016 - Ignorance of overfilled ampoule leads to possibly 50% higher dosage Read on ...
    17 November 2016 - Note Thyrax° dosage for conversion !! Read on ...
    12 May 2016 - Wrong choice in electronic prescribing list leads to pregnancy Read on ...
    23 December 2015 - “End date” in the current medication list leads to stop necessary medications Read on ...
    5 November 2015 - First confusion between Spiolto Respimat and Spiriva Respimat reported to CMR Read on ...
    16 July 2015 - Miscalculation in cabazitaxel preparation software Read on ...
    13 september 2013 - Error in drug preparation specification leads to excessively high dose of cabazitaxel (Jevtana®) Read on (English translation)...

  • CMR Nieuwsbrief
    This newsletter discusses major risks, provides alerts and recommendations and informs about news from the Centrale Medicatie-incidenten Registratie (CMR).
    Periodicity: four issues by year
    Publication langage: Dutch
    No Subscription. Available for free download or sent by e-mail to registered users.
    Access to CMR Nieuwsbrief: Read on...

    What's new in the last issue?

    - News from PvP / CMR: ‘NOOTgeval’ naming case reviews from ambulance safety incidents; 17th National Emergency Congress
    - From the CMR database: patient mix-ups
    - Striking reports: Delivery problems with Thyrax°: conversion leads to 10fold error; Dosage control of dabigatran requires the mention of the indication on the prescription; Alert: omeprazole suspension by extemporaneous preparation
    - Incentives about practice: First use of insulins: what guidance for the patient? Anticoagulants: Who is in charge?

    What's new in the last community pharmacy issue?

    - News from the CMR: Collaboration between Boots and PvP/ CMR
    - Striking reports: Mix-up between leflunomide and lenalidomide; Alert: confusions between strengths of atropine eye drops; Reported again twice: Invalid conversion to Thyrax° levothyroxine 10x too high!
    - Incentives about practice: Prescriptions stopping treatments: important information for communities pharmacies and call to report similar incidents; Mix-up between insulins of different duration

  • CMR Regular columns in professional journals
    Het Pharmaceutisch Weekblad

    The Pharmaceutisch Weekblad (PW) is the official journal of the Royal Dutch Society for the Advancement of Pharmacy (KNMP), distributed every week to all the members of the KNMP: community pharmacists, hospital pharmacists and pharmacy industry.
    Publication langage: Dutch
    Access to CMR column in the Pharmaceutisch Weekblad: Read on...

    UA

    UA is a glossy magazine for pharmacy technicians, aiming to provide background information and practical facts and figures in an easily readable form.
    Publication langage: Dutch
    Access to CMR column in UA: Read on...

Danish Patient Safety Authority - Styrelsen for Patientsikkerheds læringsenhed


The Danish Patient Safety Authority is responsible for the administration of the system for reporting inadvertent incidents within the health service, and helps to make sure that the knowledge gained from these incidents and complaints and liability suits is used preventatively. The incidents are administrated in the Danish Patient Safety Database.

  • Newsletter from the Learning Unit
    The Newsletter from the Learning Unit is published by the Learning Unit of the the Danish Patient Safety Database.
    Periodicity: quaterly
    Publication langage: Danish
    No Subscription. Available for free download.
    Access to the Danish Patient Safety Authority’ Newsletter from the Learning Unit: Read on...

    What's new in the last Newsletter from the Learning Unit?

    - Annual Report 2016: Stable number of reported unintended events
    - Ombudsman Decision
    - Visit from the IT Provider of the Danish Patients Safety Database
    - Regional meetings on mandatory reporting
    - Law change regarding patient data
    - New employees in Knowledge Communication and Learning

  • Attention notes
    The Attention notes are issued when serious or fatal incidents are registered by the Danish Patient Safety Authority in the Danish Patient Safety Database.
    Periodicity: as needed
    Publication langage: Danish
    No Subscription. Available for free download.
    Access to the Danish Patient Safety Authority’ Attention notes: Read on...

    What are the last medication attention notes?

    12 September 2017 - Bupivacaine must not be given intravascularly Read on...
    7 September 2017 - Observe correct dosage of methotrexate Read on...
    30 June 2017 - Be aware of the interaction between warfarin and miconazole oral gel Read on...
    16 December 2016 - Risk of confusion between Gardasil° and the MMR vaccine Read on...
    9 March 2016 - Dement patients and patches Read on... ; It goes wrong when the patch must be changed Read on...
    15 June 2015 - Pradaxa® capsules should remain in the blister pack until use Read on...

  • Other publications
    Other publications are issued on request or when serious, fatal or repeated incidents are registred by the Danish Patient Safety Authority in the Danish Patient Safety Database.
    Periodicity: not applicable
    Publication langage: Danish
    No Subscription. Available for free download.
    Access to the Danish Patient Safety Authority’ other publications: Read on...

    What are the last other publications?

    2014 - Insulin use - identification of adverse events and proposals for preventive measures Read on...
    2014 - Thematic Report on the observation of patients in hospitals Read on...
    2013 - Thematic Report on dose dispensing Read on...
    2013 - Medication in housing and other services for people with disabilities Read on...

Hong Kong Hospital Authority

  • Medication Safety Bulletin
    The Medication Safety Bulletin (MSB) is published biannually (May and November) to serve as an educational publication to share issues related to medication safety.
    Periodicity: twice a year
    Publication langage: English
    No subscription. Available for free download.
    Access to Medication Safety Bulletin: Read on...

    What's new in the last issue?

    - Update of “Lists of HA wide Approved / Standard Abbreviations in Prescribing”
    - Highlights of The Annual Medication Safety Forum 2017
    - Look-alike Sound-alike medications: From risk to improvement
    - Kowloon Central Cluster’s experience on Continuous Quality Improvement from Near Miss

  • Risk Alert
    A risk management newsletter for Hong Kong Hospital Authority healthcare professionals
    Periodicity: four issues by year
    Publication langage: English
    No subscription. Available for free download.
    Access to Risk Alert: Read on...

    What's new in the last issue?

    - History will repeat itself
    - Sentinel Events (SEs) (Q1 2018) Retained instruments / material, Patient suicide, Baby Abduction
    - Serious Untoward Events (SUEs) (Q1 2018) Medication Error: Known Drug Allergy

Irish Medication Safety Network

  • IMSN Safety Alerts
    IMSN medication safety briefings and alerts are published in the Pharmacy Journal and Clinical Indemnity Scheme Newsletter
    Periodicity: as needed
    Publication langage: English
    No Subscription. Available for free download.
    Access to IMSN Safety Alerts: Read on...

    What's the last alert?

    21 November 2017 - IMSN Safety Alert: Safe Use of Prostaglandin Analogues in Obstetrics Read on...
    7 April 2017 - IMSN Safety Alert: Risks associated with High-Strength Insulin Preparations Read on...
    October 2016 - IMSN Safety Alert on Allergy and Anaphylaxis to Known Drug Allergens (update of original alert published in October 2012) Read on...
    July 2016 - IMSN Safety Alert: Risk of Cross-contamination with Insulin Pens (update of original alert published in November 2013) Read on...
    July 2016 - IMSN Safety Alert: Confusion Risk with trastuzumab EMTANSINE (Kadcyla®) and trastuzumab (update of original alert published in July 2014) Read on...
    October 2015 - IMSN Safety Alert: IV Magnesium Sulphate in Obstetrics Read on...
    May 2015 - IMSN Safety Alert on Novel Oral Anticoagulants (NOACs) Read on...

ISMP Brasil

  • Boletim ISMP Brasil
    The ISMP Brasil Newsletter aims to disseminate relevant information on medication errors at all levels of health care. In each edition, topics of interest for institutions, health professionals and society are addressed.
    Periodicity: four to five issues by year
    Publication langage: Portuguese
    No Subscription. Available for free download or sent by e-mail to registered users.
    Access to Boletim ISMP Brasil: Read on...

    What's new in the last issue?

    Safe use of medicines in surgery

  • Safety Alerts
    Periodicity: as needed
    Publication langage: Portuguese
    No Subscription. Available for free download.

    What's the last alert?

    April 2017 - Mix-up risk between vaccine vials Read on...
    August 2016 - Mix-up risk with vials of injectable potassium chloride Read on...
    28 April 2016 - Mix-up risk with flu vaccine vials Read on...

ISMP Canada

  • ISMP Canada Safety Bulletin
    The purpose of the bulletins is to confidentially share the information received about medication incidents which have occurred and to suggest medication system improvement strategies for enhancing patient safety. The bulletins will also share alerts and warnings specific to the Canadian market place.
    Periodicity: 10 to 13 issues by year
    Publication langages: English and French
    No Subscription (excepted for commercial corporations or Government agencies).
    Available for free download or sent by e-mail to registered users.
    Access to the ISMP Canada Safety Bulletin: Read on...
    Access to the Bulletin de l’ISMP Canada: Read on...

    What's new in the last issue?

    - Injecting Standardization into Vaccine Clinics
    - SafeMedicationUse.ca Consumer Newsletter Synopsis: Keep Your Medications Organized
    - Med Safety Exchange Webinar Series

  • ISMP Canada Alerts
    Periodicity: as needed
    Publication langage: English and French
    Available for free download or sent by e-mail to registered users.
    Access to ISMP Canada Alerts: Read on...

    What's the last alert?

    7 December 2017 - ALERT: Polyethylene Glycol and Propylene Glycol Mix-up Causes Harm Read on...
    9 September 2015 - ALERT: Methylene Blue Interaction Leads to Serotonin Syndrome Read on...
    31 March 2015 - ALERT: Shortage of Topical Epinephrine 1:1000 Poses Safety Risks Read on...

  • SafeMedicationUse.ca Safety Newsletter for Consumers
    SafeMedicationUse.ca provides a better way for consumers to report medication incidents and to get information about using medication safely.
    Periodicity: 8 to 10 issues by year
    Publication langages: English and French
    No Subscription. Available for free download or sent by e-mail to registered users.
    Access to the SafeMedicationUse.ca Safety Newsletter for Consumers: Read on...
    Access to the Bulletin de Médicamentssécuritaires.ca: Read on...

    What's new in the last issue?

    - Have Unused Medications Overstayed Their Welcome?

  • SafeMedicationUse.ca Safety Alert for Consumers
    SafeMedicationUse.ca provides a better way for consumers to report medication incidents and to get information about using medication safely.
    Periodicity: 8 to 10 issues by year
    Publication langages: English and French
    No Subscription. Available for free download or sent by e-mail to registered users.
    Access to SafeMedicationUse.ca Safety Alert for Consumers: Read on...
    Access to Médicamentssécuritaires.ca Alerte: Read on...

    What's the last alert?

    31 March 2014 - More Reports of Eye Injuries Involving Clear Care Read on...

  • Ontario Critical Incident Learning Bulletin
    Funding for this bulletin and the associated knowledge translation project is provided by the Ontario Ministry of Health and Long-Term Care.
    Periodicity: four to five issues by year
    Publication langage: English
    No subscription. Available for free download.
    Access to Ontario Critical Incident Learning: Read on...

    What's new in the last issue?

    - Strengthening Medication Reconciliation (MedRec) at Discharge

  • Regular columns in professional journals
    From 1999 to 2010, ISMP Canada articles were published in regular columns that appear in the Canadian Journal of Hospital Pharmacy (CJHP), in Hospital News, and less frequently in the Canadian Pharmacists Journal, the official publication of the Canadian Pharmacists Association.

    CACCN Dynamics

    CACCN Dynamics is a journal published by the Canadian Association of Critical Care Nurses.
    Publication langage: English
    Access to ISMP Canada column in CACCN Dynamics: Read on...

    Healthcare Quarterly

    Healthcare Quarterly' objectives are to document and disseminate leading practices in health service delivery and policy development and to help Canadian health system managers anticipate and respond to changing environments, demands and mandates. Healthcare Quarterly’s target audience is decision and policy makers in governments, regions, networks, hospitals and facilities across Canada and internationally.
    Publication langage: English
    Access to ISMP Canada articles in Healthcare Quarterly: Read on...

    Pharmacy Connection

    Pharmacy Connection is the official publication of the Ontario College of Pharmacists.
    Publication langage: English
    Access to ISMP Canada column in Pharmacy Connection: Read on...

ISMP España

  • ISMP España Boletin
    The contents of this newsletter with recommendations for prevention of medication errors have been made from the reports sent by health professionals to the medication errors reporting and learning programme financed by the Spanish Ministry of Health, Social Services and Equality.
    Periodicity: 1 to 6 issues by year
    Publication langage: Spanish
    No subscription. Available for free download.
    Access to ISMP España Boletin: Read on...

    What's new in the last issue?

    - Prevention of medication errors in pediatric patients

  • ISMP España Alertas
    Periodicity: as needed
    Publication langage: Spanish
    No subscription. Available for free download.
    Access to ISMP España Alertas: Read on...

    What's the last alert?

    April 2016 - Change in the presentation of Methotrexate Wyeth° 2.5 mg tablets to prevent medication errors Read on...
    12 July 2012 - Risk of error in the preparation of cabazitaxel (Jevtana°) Read on...

  • Labeling/packaging prone to errors
    Periodicity: as needed
    Publication langage: Spanish
    No subscription. Available for free consultation.
    Access to ISMP España Labeling/packaging prone to errors: Read on...

    What are the last alerts?

    5 June 2018 - Risk of dosing errors associated with the labeling change of Ranitidine Normon° 50 mg / 10 mL ampoules
    10 April 2018 - Risk of confusion between the capsules of Revlimid° 15 mg and Revlimid° 25 mg (lenalidomide)
    26 February 2018 - Risk of confusion between MicardisPlus° (telmisartan/hydrochlorothiazide) tablets 40 mg/12.5 mg and 80 mg/12.5 mg
    15 February 2018 - "We said yesterday": omission in the administration of trimethoprim when using Soltrim° injectable (sulfamethoxazole + trimethoprim)
    29 January 2018 - Recall of the risk of incorrect storage of vials of Zerbaxa° 1 g/0.5 g (ceftozolan/tazobactam)
    22 January 2018 - Dosage errors due to confusion between budesonide nebulizing ampoules of 0.5 mg / 2 mL and 1 mg / 2 mL (Budesonide Aldo-Unión° or Pulmicort°)
    9 January 2018 - "We said yesterday": confusion between Sandostatin° ampoules 0.05 mg (octreotide) and Sandimmun° 50 mg (ciclosporin)
    23 November 2017 - Confusions continue between the ampuls of Tramadol Normon° 100 mg / 2 mL and Mepivacaine Normon° 2% solution for injection 2 mL
    18 November 2017 - Risk of confusion between the packages of Etoposide Tevagen° 100 mg / 5 mL and Fludarabine Teva° 50 mg / 2 mL
    10 November 2017 – Risk of confusion between vials of CellCept° 500 mg (mycophenolate mofetil) and Meropenem Aurovitas° 1000 mg
    28 October 2017 - Confusion between oral ampuls of Hydroferol° (calcifediol) 0.266 mg and injectable ampoules of Furosemide Gesfur° 20 mg
    30 June 2017 - Confusion between the packs and the blisters of Misofar° vaginal tablets of 25 and 200 micrograms
    22 June 2017 - Risk of dosing errors with Sprycel (dasatinib) coated tablets 50 and 70 mg
    6 June 2017 - Confusion between IV Minibags Levobupivacaine Normon° 0.625 mg/mL 100 mL and Levofloxacin Normon° 5 mg/mL 100 mL
    16 February 2017 - Risk of confusion between ampuls of Ropivacaine GES° 2 mg/mL 10 mL and Magnesium Sulfate Genfarma° 1.5 g/10 mL
    26 January 2017 - Confusion between 10 mL plastic ampoules of Lidocaine B Braun° and Glucocemin° 33% Braun
    22 December 2016 - Confusion of Diclofenac Llorens° ampuls 75 mg / 3 mL with those of Metamizol Normon° 2 g / 5 mL and Flumil® 300 mg / 3 mL (acetylcysteine)
    12 October 2016 - Risk of dosage errors with Aspegic° injectable
    26 August 2016 - Risk of dosage errors with Nexavar° (sorafenib) tablets 200 mg
    5 August 2016 - Risk of inappropriate storage of vials Zerbaxa° 1 g / 0.5 g (ceftozolane / tazobactam)
    2 August 2016 - Continuing confusion between Alkeran° 2 mg (melphalan) and Leukeran° 2 mg (chlorambucil)
    1 August 2016 - Confusion between packages of Remifentanil Sala° vials 1 and 5 mg
    21 July 2016 - Risk of incorrect conservation Mekinist° 0.5 mg, 1 mg and 2 mg coated tablets (trametinib)

ISMP USA

  • ISMP Medication Safety Alert! Acute Care edition
    The Acute Care edition newsletter has been in circulation since 1996. It is a compilation of medication and device related errors, prevention recommendations and editorial content. It alerts practitioners and managers in a timely fashion to potentially hazardous situations that may contribute to adverse drug events.
    Periodicity: biweekly
    Publication langage: English
    On subscription only. Sent by e-mail to subscribers.
    Access to ISMP Medication Safety Alert! Acute Care edition: Read on...

    What's new in the last issue?

    - Mix-up between epidural analgesia and IV antibiotics in labor and delivery units continue to cause harm
    - Safety briefs: FDA draft guidance clarifies requirements for barcodes and expiration dates; Label format used by some outsourcers; FDA cautions on misuse of pen needles
    - Acute Care Action Agenda (July-September 2018)

  • ISMP Alerts
    In addition to a full suite of medication safety newsletters for healthcare professionals and consumers, ISMP makes available urgent medication advisories. These Safety Alerts address serious medication errors or information requiring immediate attention by healthcare practitioners.
    Periodicity: as needed
    Publication langage: English
    No Subscription.
    Access to ISMP Alerts: Read on...

    What are the last alerts?

    6 September 2018 - Check for Proper Nucala Dose Preparation Read on...
    24 April 2018 - Verapamil-Naloxone Look-Alike Vials Read on...
    23 April 2018 - Packaging Could Lead to Acetaminophen Overdoses Read on...

  • National Alert Network (NAN) Alert
    ISMP joined with the other members of the National Coordinating Council on Medication Error Reporting and Prevention (NCC MERP) to create a National Alert Network (NAN) that broadens the reach of alerts. The NAN warns healthcare providers through several national distribution channels of the risk for medication errors that have recently caused serious harm or death.
    Periodicity: as needed
    Publication langage: English
    No Subscription. Available for free download or sent by e-mail to ISMP bulletins subscribers.
    Access to National Alert Network (NAN) Alert: Read on...

    What are the last alerts?

    May 24, 2018: Safe handling of concentrated electrolyte products from outsourcing facilities during critical drug shortages Read on...
    12 October 2017: Severe hyperglycemia in patients incorrectly using insulin pens at home Read on...
    15 September 2016: Observe for possible fluid leakage when preparing parenteral syringes Read on...
    30 June 2015 - Move toward full use of metric dosing: Eliminate dosage cups that measure liquids in fluid drams. Use cups that measure mL Read on...
    23 March 2015 - Potentially dangerous confusion between Bloxiverz (neostigmine) injection and Vazculep (phenylephrine) injection Read on...

  • ISMP Medication Safety Alert! Community/Ambulatory Care edition
    The Community/Ambulatory Care edition is targeted toward pharmacists, pharmacy technicians, nurses, physicians and other community health professionals. This newsletter provides timely information about medication-related errors and adverse drug reactions and their implications for community practice sites, and offers recommendations on how to improve medication safety within the community setting.
    Periodicity: montly
    Publication langage: English
    On subscription only. Sent by e-mail to subscribers.
    Access to ISMP Medication Safety Alert! Community/Ambulatory Care edition: Read on...

    What's new in the last issue?

    - QuarterWatch™ (2017 Annual report): Four Severe Adverse Events and the Leading Suspect Drugs
    - Safety briefs: Clear instructions and patient education key for Xarelto; Wrong resident errors; Look-alike benzodiazepine bottles
    - ISMP Medication Safety Alert! Action Agenda (May - August 2018)

  • ISMP Medication Safety Alert! Long-Term Care Advise-ERR
    The Long-Term Care Advise-ERR is a newsletter specifically tailored to the long-term care setting, which provides timely medication safety information to staff working with resident populations that are often elderly, frail, dependent, complex in nature, and fraught with many different illnesses and dysfunctions.
    Periodicity: monthly
    Publication langage: English
    On subscription only
    Access to ISMP Medication Safety Alert! Long-Term Care Advise-ERR: Read on...

    What's new in the last issue?

    - Right Medication, Wrong Resident
    - Worth reading… Medication reconciliation in long-term care: Getting Started Kit (version 3): Canadian Patient Safety Institute, ISMP Canada. March 2017
    - Safety wires: Suppository mix-up; Change in abbreviation definitions; Get your influenza vaccine; Video on safety culture

  • ISMP Medication Safety Alert! Nurse Advise-ERR
    The Nurse Advise-ERR is designed to meet the medication safety information needs of nurses who transcribe orders, administer medications, and monitor the effects of medications on patients. The newsletter offers detailed error reports and checklists of evidence-based error reduction strategies.
    Periodicity: monthly
    Publication langage: English
    On subscription only
    Access to ISMP Medication Safety Alert! Nurse Advise-ERR: Read on...

    What's new in the last issue?

    - Students Have a Key Role in a Culture of Safety: Analysis of Student-Associated Medication Incidents
    - Worth repeating…Flushing IV tubing with unrecognized residual drug leads to adverse effects
    - Safety wires: ISMP List of High-Alert Medications recently updated; Warning! Dilute sertraline oral concentrate; Video on safety culture; Influenza vaccine for healthcare workers

  • ISMP Safe Medicine
    Safe Medicine is the US consumer health education newsletter that focuses specifically on the prevention of medication errors. This ISMP newsletter teaches consumers to become active partners with their healthcare providers and assume a leading role in ensuring safe medication use.
    Periodicity: bimonthly
    Publication langage: English
    On subscription only
    Access to ISMP Safe Medicine: Read on...

    What's new in the last issue?

    - Understanding the Results on Your Blood Glucose Meter Screen
    - Advice from FDA: 5 health tips college students need to know
    - Safety Tips: First generic EpiPen and EpiPen Jr approved; Don’t get stuck with used sharps; Being a part of your healthcare team

  • Pennsylvania Patient Safety Advisory
    The Pennsylvania Patient Safety Advisory is published by the Pennsylvania Patient Safety Authority operating the The Pennsylvania Patient Safety Reporting System (PA-PSRS). This publication is produced by ECRI Institute and the Institute for Safe Medication Practices under contract to the Authority.
    Periodicity: quarterly, with periodic supplements
    Publication langage: English
    No Subscription. Available for free download or sent by e-mail to registered users.
    Access to Pennsylvania Patient Safety Advisory: Read on...

    What's new in the last issue?

    - The Breakup: Errors when Altering Oral Solid Dosage Forms
    - Speaking Up for Safety—It’s Not Simple
    - Safety Stories: A Weighty Problem

  • Regular columns in professional journals
    Hospital Pharmacy

    Hospital Pharmacy is an independent, peer-reviewed journal, practitioner-focused and dedicated to the promotion of best practices and medication safety. This seminal column hosted since 1975 by Hospital Pharmacy was the first regular publication on medication errors analysis and prevention.
    Periodicity: monthly with the exception of a combined July/August issue
    Publication langage: English
    Access to ISMP Medication Error Report Analysis in Hospital Pharmacy: Read on...

    Journal of Emergency Nursing

    The Journal of Emergency Nursing is the official peer-reviewed journal of the Emergency Nurses Association (ENA), reaching emergency nurses, emergency/trauma departments and emergency department managers.
    Publication langage: English
    Access to Danger Zone column in Journal of Emergency Nursing: Read on...

    P&T° Pharmacy & Therapeutics

    P&T° is a peer-reviewed journal for managed care and hospital formulary management, aiming to provide pharmacy and therapeutics committee members with the latest information to help them manage their formularies and establish medication-related policies.
    Periodicity: monthly
    Publication langage: English
    Access to Medication errors column in P&T°: Read on...

    Pharmacy Times

    Pharmacy Times is a clinically-based, monthly journal providing practical information pharmacists can use in their everyday practice.
    Periodicity: monthly
    Publication langage: English
    Access to Medication Safety column in Pharmacy Times: Read on...

New Zealand Medication Safety Programme

  • Medication Safety Watch
    Medication Safety Watch is a bulletin for all health professionals and health care managers working with medicines or patient safety. Medication alerts and safety signals provide information and actions about high-risk medicines and situations. They are issued to health care staff, managers and organisations.
    Periodicity: four issues by year
    Publication langage: English
    No subscription. Available for free download.
    Access to Medication Safety Watch: Read on...

    What's new in the last issue?

    - Reducing the risk of error and patient harm with low-dose oral methotrexate
    - What’s new? Update on the safe use of opioids collaborative; Making strong opioids safer for patients
    - What to do with patients' own medicine in hospital?
    - Incidents and cautions: Sodium citrate or sodium chloride?
    - Upcoming alert: a draft alteplase/tenectaplase alert will be sent out in the near future

  • Alerts & Patient Safety Signal
    The alerts produced by the Commission are recommendations relating to either internationally recognised or locally identified high risk medicines or situations. Alerts are sent out directly to relevant health care providers with the latest information and advice on particular topics of concern.
    Periodicity: as needed
    Publication langage: English
    No Subscription. Available for free download or sent by e-mail to registered users.
    Access to Alerts & Patient Safety Signal: Read on...

    What's the last Alert or Safety Signal?

    19 July 2017 - Open Book ALERT: Prescribing error – dabigatran and enoxaparin Read on...
    6 July 2017 - Transdermal patches and burns: Commission’s transdermal patch medication Alert 15 published in 2013, updated list of transdermal patches available in New Zealand (June 2017) Read on...
    6 July 2017 - Injectable phenytoin incidents – risk of death and severe harm Read on...
    12 June 2017 - ALERT 17: Alteplase or tenecteplase? Read on...
    24 February 2017 – Pharmacy Council Safety Alert - Caution Required with Compounded Oral Liquid Formulations Read on…
    30 September 2015 - Safety Signal: Risk of serious adverse drug reactions Read on...
    3 September 2014 - ALERT: Transdermal patches Read on...
    5 August 2014 - ALERT: Metoprolol Read on...

NHS England

  • Patient Safety Alerts
    Patient safety alerts are issued via the Central Alerting System (CAS), a web-based cascading system for issuing alerts, important public health messages and other safety critical information and guidance to the NHS and other organisations, including independent providers of health and social care.
    Periodicity: as needed
    Publication langage: English
    No subscription. Available for free download.
    Access to NHS England Patient Safety Alerts: Read on...

    What are the last medication safety alerts?

    9 August 2018 - Resources to support safe and timely management of hyperkalaemia. Read on…
    17 April 2018 - Risk of death or severe harm from inadvertent intravenous administration of solid organ perfusion fluids Read on...
    9 January 2018 - Risk of death and severe harm from failure to obtain and continue flow from oxygen cylinders Read on... (Updated on 19 June 2018)
    9 November 2017 - Confirming removal or flushing of lines and cannulae after procedures Read on...
    27 September 2017 - Risk of severe harm and death from infusing total parenteral nutrition too rapidly in babies Read on...
    11 August 2017: Resources to support safe transition from the Luer connector to NRFit for intrathecal and epidural procedures, and delivery of regional blocks Read on...
    5 July 2017 - Risk of death and severe harm from ingestion of superabsorbent polymer gel granules Read on...
    6 April 2017 - Supporting the safety of girls and women being treated with valproate Read on...
    16 November 2016 - Risk of severe harm and death due to withdrawing insulin from pen devices Read on...
    9 November 2016 - Risk of death and severe harm from error with injectable phenytoin Read on...
    3 October 2016 - Reducing the risk of oxygen tubing being connected to air flowmeters Read on...
    7 September 2016 - Restricted use of open systems for injectable medication Read on...
    17 August 2016 - Resources to support the care of patients with acute kidney injury Read on...
    20 April 2016 - Patient safety incident reporting and responding to Patient Safety Alerts Read on...
    8 February 2016 - Risk of severe harm or death when desmopressin is omitted or delayed in patients with cranial diabetes insipidus Read on...
    26 October 2015 - Support to minimise the risk of distress and death from inappropriate doses of naloxone Read on...
    18 August 2015 - Addressing antimicrobial resistance through implementation of an antimicrobial stewardship programme Read on...
    27 May 2015 - Risk of death or severe harm due to inadvertent injection of skin preparation solution Read on...
    1st April 2015 - Managing risks during the transition period to new ISO connectors for medical devices Read on...
    19 January 2015 - Harm from using Low Molecular Weight Heparins when contraindicated Read on...

Prescrire


Prescrire provides independent information, by and for healthcare professionals, about drugs and therapeutic and diagnostic strategies. A non-profit organisation, Prescrire is wholly financed by its subscribers, and accepts no advertising or other outside support. Read on...

  • Prescrire International
    Periodicity: 11 times a year
    Publication langage: English
    On subscription only, offering full access online to the entire database of reviews in English going back to the first issue of Prescrire International in 1992.
    Access to Prescrire International: Read on...
    From the editors of Prescrire International: "Top Texts of 2018" new sampling of texts selected to introduce to Prescrire International Free Special Edition
    Already subscriber? Refer a friend or colleague Become an ambassador

    What's new in the last issue?

    - Gastrointestinal surgery: altered absorption of oral drugs. Available information is poor, fragmented and difficult to access: Drug regulatory agencies and companies would better serve patients and healthcare professionals if the SPCs for orally administered drugs specified their site(s) of absorption

  • La revue Prescrire
    Periodicity: monthly plus a yearly supplement in French devoted to drug interactions
    Publication langage: French
    On subscription only, offering full access online to the entire database of reviews going back to the first issue of La revue Prescrire in 1981.
    Access to La revue Prescrire: Read on (in French)...

    What's new in the last issue?

    - Sevelamer Carbonate - Renvela° from the age of 6 years. Sachets of 2.4 g of powder but no dosing device suitable for an accurate measurement of 0.4 g, 0.8 g or 1.6 g
    - Etilefrin - Étiléfrine Serb°. Priapism: an option of choice but unsuitable packaging for a possible self-injection. No injection material in the packaging or details in the patient leaflet Read on (in French)…
    - Raltegravir - Isentress° tablets 600 mg once daily. Different bioavailability of 400 mg and 600 mg dosage forms
    - Oral solid forms labeling: ANSM encourages improved safety. Prominent INNs, and unit-dose blisters to be preferred: a progress, but without obligation for the compagnies. Read on (in French)…
    - Mycophenolic acid: modification of pregnancy prevention regulations, but unchanged teratogenic effects
    - Cutaneous retinoids: contraindicated in pregnant women. Do not neglect effective contraception during treatment, a precaution not yet included in the SPCs and leaflets
    - Effective marketing. Onivyde° (liposomal pegylated irinotecan), not to be confused with 'classical' irinotecan (Campto° or others)
    - Revestive° (téduglutide): incomplete packaging
    - Enantone° LP pre-filled syringe with two compartments for all dosages
    - Contraceptive implants with etonogestrel and enzyme inducers: pregnancies
    - Concentrated insulins: think and act in units of insulin to avoid errors. Reported to Preventing the Preventable Programme: unjustified conversions between concentrated insulins at 100 Units / ml and 200 Units / ml. Read on (in French)…

    Updated on October 4, 2018