Overdose of intravenous intralipid in a premature neonate [2]

Joint Commission Journal on Quality and Patient Safety

Volumn 33, Issue 10, 2007, Pages 588-589

  Low, Evonne ^a   Ryan, C Anthony ^b  

^a Irish Centre for Fetal and Neonatal Translational Research   (Ireland)

^b UNIVERSITY COLLEGE CORK   (Ireland)

Author keywords

[No Author keywords available]

Indexed keywords

LIPID EMULSION;

CASE REPORT; CESAREAN SECTION; EXTREMELY LOW BIRTH WEIGHT; HUMAN; HYPONATREMIA; MALE; MEDICATION ERROR; NEWBORN; NEWBORN INTENSIVE CARE; NOTE; OUTCOME ASSESSMENT; PARENTERAL NUTRITION; PREMATURITY; STANDARD; UNITED STATES;

CESAREAN SECTION; FAT EMULSIONS, INTRAVENOUS; HUMANS; HYPONATREMIA; INFANT, EXTREMELY LOW BIRTH WEIGHT; INFANT, NEWBORN; INTENSIVE CARE UNITS, NEONATAL; MALE; MEDICATION ERRORS; OUTCOME ASSESSMENT (HEALTH CARE); PARENTERAL NUTRITION; PREMATURE BIRTH; UNITED STATES;

EID: 35348992122     PISSN: 15537250     EISSN: None     Source Type: Journal    
DOI: 10.1016/s1553-7250(07)33064-x     Document Type: Article

References (7)

1. Chuo J., Lambert G., Hicks R.W.: Intralipid medication errors in the neonatal intensive care unit. Jt Comm J Qual Patient Saf 33:104-111, Feb. 2007.
2. Marino P.L.: The ICU Book. Philadelphia: Lea & Febiger, 1991.
3. The Joint Commission: Sentinel Events; Evaluating Cause and Planning Improvement. Oak Brook Terrace, IL: Joint Commission Resources, 1998.
4. Flynn F., Mohr L., Lawlor-Klean P.: Right programming of pumps to prevent errors in the infusion process. Jt Comm J Qual Safety 29:37-40, Jan. 2003.
5. Toft B., Mascie-Taylor H.: Involuntary automaticity: A work-system induced risk to safe health care. Health Serv Manage Res 18:211-216, Nov. 2005.
6. Toft B.: Independent Review of the Circumstances Surrounding Four Adverse Events That Occurred in the Reproductive Medicine Units at the Leeds Teaching Hospitals. Leeds, U.K.: National Health Service Trust, West Yorkshire, Department of Health, 2004.
7. Spear S.J.: Why complex systems fail. Paper presented at the Harvard Macy Program for Leaders in Healthcare Education, Boston, Jun. 13-14, 2004.