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| 1. |  Book/Report: Preventing Medication Errors: Quality Chasm Series. |
| | Committee on Identifying and Preventing Medication Errors, Aspden P, Wolcott J, Bootman JL, Cronenwett LR, eds. Washington, DC: The National Academies Press; 2007. |
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| 2. | Organizational Policy/Guidelines: Preventing errors relating to commonly used anticoagulants. |
| | Sentinel Event Alert. September 24, 2008;41:1-4. |
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| 3. | Study: The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before-and-after study. |
| | Franklin BD, O'Grady K, Donyai P, Jacklin A, Barber N. Qual Saf Health Care. 2007;16:279-284. |
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| 4. | Study: Dispensing errors in community pharmacy: perceived influence of sociotechnical factors. |
| | Szeinbach S, Seoane-Vazquez E, Parekh A, Herderick M. Int J Qual Health Care. 2007;19:203-09. |
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| 5. | Study: Pharmacist workload and pharmacy characteristics associated with the dispensing of potentially clinically important drug-drug interactions. |
| | Malone DC, Abarca J, Skrepnek GH, et al. Med Care. 2007;45:456-462. |
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| 6. | Study: Assessing and monitoring override medications in automated dispensing devices. |
| | Kowiatek JG, Weber RJ, Skledar SJ, Frank S, DeVita M. Jt Comm J Qual Patient Saf. 2006;32:309-317. |
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| 7. | Study: Errors associated with medications removed from automated dispensing machines using override functions. |
| | Kester K, Baxter J, Freudenthal K. Hosp Pharm. 2006;41:535-537. |
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| 8. | Book/Report: MEDMARX 5th Anniversary Data Report: A Chartbook of 2003 Findings and Trends 1999-2003. |
| | Rockville, MD: United States Pharmacopeial Convention, Inc.; 2004. |
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| 9. | Study: Frequency, types, and potential clinical significance of medication-dispensing errors. |
| | Bohand X, Simon L, Perrier E, Mullot H, Lefeuvre L, Plotton C. Clinics. 2009;64:11-16. |
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| 10. | Study: Impact of barcode medication administration technology on how nurses spend their time providing patient care. |
| | Poon EG, Keohane CA, Bane A, et al. J Nurs Adm. 2008;38:541-549. |
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| 11. | Press Release/Announcement: 20 mEq Potassium Chloride in 5% Dextrose and 0.45% Sodium Chloride Injection. |
| | MedWatch Safety Alert [US Food and Drug Administration Web site]. December 9, 2008. |
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| 12. | Commentary: Implementing a bar-code medication administration system. |
| | Weber RJ. Hosp Pharm. 2008;43:1016-1023. |
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| 13. | Commentary: ISMP medication error report analysis. |
| | Smetzer JL, Cohen MR. Hosp Pharm. 2008;43;788-792. |
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| 14. | Commentary: The Role of Bar Coding and Smart Pumps in Safety |
| | Jeffrey M. Rothschild, MD, MPH; Carol Keohane, RN, BSN AHRQ WebM&M [serial online]. September 2008. |
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| 15. | Newspaper/Magazine Article: Don't underestimate the impact of change on risk potential. |
| | ISMP Medication Safety Alert! Acute Care Edition. September 11, 2008;13:1-3. |
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| 16. | Study: Severity of medication administration errors detected by a bar-code medication administration system. |
| | Sakowski J, Newman JM, Dozier K. Am J Health Syst Pharm. 2008;65:1661-1666. |
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| 17. | Newspaper/Magazine Article: Medication errors associated with documented allergies. |
| | PA-PSRS Patient Safety Advisory. Sept 2008;5:75-80. |
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| 18. | Study: Effectiveness of a barcode medication administration system in reducing preventable adverse drug events in a neonatal intensive care unit: a prospective cohort study.
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| | Morriss FH Jr, Abramowitz PW, Nelson SP, et al. J Pediatr. 2008 Sep 27; [Epub ahead of print].
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| 19. | Commentary: ISMP medication error report analysis. |
| | Cohen MR. Hosp Pharm. 2008;43:618-621. |
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| 20. | Newspaper/Magazine Article: Misprogramming PCA concentration leads to dosing errors. |
| | ISMP Medication Safety Alert! Acute Care Edition. August 28, 2008;13:1-3. |
