메뉴 건너뛰기




Volumn 36, Issue 3, 2006, Pages 181-184

Preventing potassium problems permanently: Eliminating concentrated potassium chloride errors

Author keywords

[No Author keywords available]

Indexed keywords

POTASSIUM CHLORIDE;

EID: 33750022271     PISSN: 1445937X     EISSN: None     Source Type: Journal    
DOI: 10.1002/j.2055-2335.2006.tb00602.x     Document Type: Article
Times cited : (4)

References (17)
  • 1
    • 0003413171 scopus 로고    scopus 로고
    • Kohn LT, Corrigan JM, Donaldson MS, editors. Institute of Medicine: Washington DC
    • Kohn LT, Corrigan JM, Donaldson MS, editors. To err is human: building a safer health system. Institute of Medicine: Washington DC; 2000.
    • (2000) To Err Is Human: Building a Safer Health System
  • 2
    • 0031039114 scopus 로고    scopus 로고
    • Dispensing with the KCl dispensing problem
    • Kelly DJ, Walsh F, McGann A. Dispensing with the KCl dispensing problem [letter]. Anesth Analg 1997; 84: 467.
    • (1997) Anesth Analg , vol.84 , pp. 467
    • Kelly, D.J.1    Walsh, F.2    McGann, A.3
  • 3
    • 85039242830 scopus 로고    scopus 로고
    • Potassium chloride for injection concentrate errors table
    • Accessed 13 March 2005. Available from
    • US Pharmacopeia. Potassium chloride for injection concentrate errors table. Qual Rev 1996; No. 56. Accessed 13 March 2005. Available from 〈www.usp.org/patientSafety/newsletters/qualityReview/qr561996-10-01d. html〉.
    • (1996) Qual Rev , vol.56
  • 4
    • 85039252684 scopus 로고    scopus 로고
    • Mum dies in drug mix-up
    • 26 September, Melbourne
    • Hunt E. Mum dies in drug mix-up. The Herald Sun. 26 September 2003, Melbourne.
    • (2003) The Herald Sun
    • Hunt, E.1
  • 5
    • 85039247515 scopus 로고    scopus 로고
    • 19 March. Accessed 13 March 2005. Available from
    • Canadian Broadcasting Corporation. Drug error kills 2 Alberta hospital patients. 19 March 2004. Accessed 13 March 2005. Available from 〈www.cbc.ca/stories/print/2004/03/18/canada/dialysis_deaths040318〉.
    • (2004) Drug Error Kills 2 Alberta Hospital Patients
  • 7
    • 0041498215 scopus 로고    scopus 로고
    • London: National Patient Safety Agency. Accessed 6 June 2005. Available from
    • National Patient Safety Agency. Patient safety alert. London: National Patient Safety Agency; 2002. Accessed 6 June 2005. Available from 〈www.npsa.nhs.uk/site/media/documents/486_riskalertpsa01.pdf〉.
    • (2002) Patient Safety Alert
  • 8
    • 32244438776 scopus 로고    scopus 로고
    • Canberra: The Council; Accessed 13 March 2005. Available from
    • Australian Council for Safety and Quality in Health Care. Medication alert 1-potassium chloride, intravenous. Canberra: The Council; 2003. Accessed 13 March 2005. Available from 〈www.safetyandquality.org〉.
    • (2003) Medication Alert 1-potassium Chloride, Intravenous
  • 9
    • 20644463486 scopus 로고    scopus 로고
    • Evaluation of the implementation of the alert issued by the UK National Patient Safety Agency on the storage and handling of potassium chloride concentrate solution
    • Lankshear AJ, Sheldon TA, Low son KV, Watt IS, Wright J. Evaluation of the implementation of the alert issued by the UK National Patient Safety Agency on the storage and handling of potassium chloride concentrate solution. Qual Saf Health Care 2005; 14: 196-201.
    • (2005) Qual Saf Health Care , vol.14 , pp. 196-201
    • Lankshear, A.J.1    Sheldon, T.A.2    Low Son, K.V.3    Watt, I.S.4    Wright, J.5
  • 10
    • 19344376242 scopus 로고    scopus 로고
    • Melbourne: Bayside Health Service; Accessed 23 July 2005. Available from
    • Bayside Health Service. Annual report 2003/2004. Melbourne: Bayside Health Service; 2004. Accessed 23 July 2005. Available from 〈www.bayside health.org.au/uploads/general/AnnualReport0304.pdf〉.
    • (2004) Annual Report 2003/2004
  • 12
    • 0025924692 scopus 로고
    • Incidence of adverse events and negligence in hospitalized patients: Results of the Harvard Medical Practice Study I
    • Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, et al. Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I. N Engl J Med 1991; 324: 370-6.
    • (1991) N Engl J Med , vol.324 , pp. 370-376
    • Brennan, T.A.1    Leape, L.L.2    Laird, N.M.3    Hebert, L.4    Localio, A.R.5    Lawthers, A.G.6
  • 13
    • 33750021103 scopus 로고    scopus 로고
    • Root cause analysis: Simplified tools and techniques
    • Andersen B, Fagerhaug T. Root cause analysis: simplified tools and techniques. Am Soc Qual 1999.
    • (1999) Am Soc Qual
    • Andersen, B.1    Fagerhaug, T.2
  • 14
    • 0028097184 scopus 로고
    • Error in medicine
    • Leape LL. Error in medicine. JAMA 1994; 272: 1851-7.
    • (1994) JAMA , vol.272 , pp. 1851-1857
    • Leape, L.L.1
  • 15
    • 0004223940 scopus 로고
    • New York: Cambridge University Press
    • Reason J. Human error. New York: Cambridge University Press; 1990.
    • (1990) Human Error
    • Reason, J.1
  • 16
    • 0032507502 scopus 로고    scopus 로고
    • Framework for analysing risk and safety in clinical medicine
    • Vincent C, Taylor-Adams S, Stanhope N. Framework for analysing risk and safety in clinical medicine. Br Med J 1998; 316: 1154-7.
    • (1998) Br Med J , vol.316 , pp. 1154-1157
    • Vincent, C.1    Taylor-Adams, S.2    Stanhope, N.3
  • 17
    • 0002324201 scopus 로고
    • Leading change: Why transformation efforts fail
    • Kotter JP. Leading change: why transformation efforts fail. Harvard Bus Rev; 1995: 59-67.
    • (1995) Harvard Bus Rev , pp. 59-67
    • Kotter, J.P.1


* 이 정보는 Elsevier사의 SCOPUS DB에서 KISTI가 분석하여 추출한 것입니다.