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USP releases first-ever case study book to advance medication error prevention

Rockville, Md., March 10, 2004 -- The United States Pharmacopeia (USP) today released Advancing Patient Safety in U.S. Hospitals: Basic Strategies for Success, a first-ever case study book featuring actual hospital medication errors and steps taken to prevent similar mistakes.

"This unique book was written to help hospitals and health care systems reduce medication errors and facilitate a culture change that embraces error reporting systems," explained Diane Cousins, R.Ph., vice president of the Center for the Advancement of Patient Safety (CAPS) at USP.

More than two dozen health care administrators and practitioners were interviewed for this book, representing large and small U.S. hospitals. Their telling accounts describe the steps they have taken to change their hospitals' cultures of blame; how they convinced staff members to report more medication errors; how error reports are analyzed to identify trends; and how their hospitals have instituted process changes to reduce medication errors.

"Without error reporting, we cannot identify and implement the system and process changes necessary to eliminate medication errors," Cousins said. "Many of the first-person accounts in this book offer situations familiar to many health care practitioners. We believe hospitals and health care institutions nationwide will find the book's information a valuable resource and tool for building a safer health care system."

In addition to first-person accounts, USP offers 10 recommendations to improve medication safety in health facilities. Among the recommendations: adopt a nonpunitive policy for reporting potential and actual medication errors; create open lines of communication among departments and disciplines; and provide incentives for participating in the medication safety reporting system.

USP operates MEDMARX, the national, Internet-accessible anonymous reporting database that hospitals and health care systems use to track and trend m
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Contact: Sherrie Borden
slb@usp.org
301-816-8268
US Pharmacopeia
10-Mar-2004


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