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The alarming reality of medication error: a patient case and review of Pennsylvania and national data. | AHRQ Patient Safety Network

The alarming reality of medication error: a patient case and review of Pennsylvania and national data. | AHRQ Patient Safety Network
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  • Commentary
  •  
  • Published September 2016

The alarming reality of medication error: a patient case and review of Pennsylvania and national data.

    Despite efforts to improve medication safety, it remains a persistent challenge in health care. This commentary describes an incident involving a medication error to illustrate how the Swiss cheese model can be used to explain why small missteps can result in failure. The authors review estimated incidence of medication errors at both local and national levels.





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