Errors in the Operating Room

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Relevant Article Depot:

Tweetorial: Learning from Errors in the OR

Preventing Medication Errors in Pediatric Anesthesia: A Systematic Scoping Review

Incidence and characteristics of errors detected by a short team briefing in pediatric anesthesia

The German guidelines for medication safety in pediatric emergencies

Medication safety in pediatric anesthesia: An educational review and a call to action

Outcomes of a Failure Mode and Effects Analysis for medication errors in pediatric anesthesia

Evaluation of Perioperative Medication Errors and Adverse Drug Events

APSF hosts medication safety conference: consensus group defines challenges and opportunities for improved practice

Medication Errors in Pediatric Anesthesia: A Report From the Wake Up Safe Quality Improvement Initiative

Independent Double-check of Infusion Pump Programming: An Anesthesia Improvement Effort to Reduce harm

Assessing the Impact of the Anesthesia Medication Template on Medication Errors During Anesthesia: A Prospective Study

Integration of the Codonics Safe Label System(®) and the Omnicell XT(®) Anesthesia Workstation into Pediatric Anesthesia Practice: Utilizing Technology to Increase Medication Labeling Compliance and Decrease Medication Discrepancies While Maintaining User Acceptability

Institute of Medicine (US) Committee on Quality of Health Care in America: To Err is Human: Building a Safer Health System

Highly S. An Encounter with an Error Trap

Cognitive errors detected in anaesthesiology: a literature review and pilot study

Educational Review: Error traps in anesthesia for pediatric liver transplantation

Clinical impact of task interruptions on the anaesthetic team and patient safety in the operating theatre

Handling injectable medications in anaesthesia - Guidelines from the Association of Anaesthetists

Hensley NB, Koch CG, Pronovost PJ, et al. Wrong-patient blood transfusion error: leveraging Technology to overcome human error in intraoperative blood component administration. Jt Comm J Qual Patient Saf. 2019 Mar; 45(3): 190-198. PMID: 30389466

The Joint Commission. Sentinel Events (SE). Comprehensive Accreditation Manual for Hospitals. Updated July 2021.

Posner KL, Kent CD, Mincer SL, Domino KB. Anesthetic risk, quality improvement, and liability. In: Barash PG, Cullen BF, Stoelting RK, et al., eds. Clinical Anesthesia. 8th ed. Philadelphia, PA: Wolters Kluwer; 2017: 101.

The impact of using prefilled syringes on a standard operating procedure for preparing injectable medicines in clinical areas

WFSA Tutorial: Distractions in the OR

WFSA: Introduction to the Morbidity & Mortality Tool Kit for LMICs

A Quality Improvement Initiative to Reduce Adverse Effects of Transitions of Anesthesia Care on Postoperative Outcomes: A Retrospective Cohort Study

The vial can help: Standardizing vial design to reduce the risk of medication errors

Institute for Safe Medication Practices