February 2020 Volume 18 Issue 2

Now Available from ISMP Errors associated with oxytocin use: A multi- Expanded Smart Pump Guidelines organization analysis by ISMP and ISMP Canada We have just released revised and expanded Guidelines for Optimizing Safe ntravenous (IV) oxytocin used antepartum is indicated to induce labor in patients Implementation and Use of Smart Infusion with a medical indication, to stimulate or reinforce labor in selected cases of uterine Pumps to provide strategies for address - Iinertia, and as an adjunct in the management of incomplete or inevitable abortion. ing potential barriers and integrating this Used postpartum, IV oxytocin is indicated to produce uterine contractions during technology with other electronic systems. expulsion of the placenta and to control postpartum bleeding or hemorrhage. However, The expanded guidelines cover a broad improper administration of oxytocin can cause hyperstimulation of the uterus, which in scope of smart infusion pump usage in turn can result in fetal distress, the need for an emergency cesarean section, or uterine both inpatient and ambulatory settings, rupture. Sadly, a few maternal, fetal, and neonatal deaths have been reported. including perioperative, procedural, and radiology locations. The expanded guide - In October 2019, ISMP Canada published a multi-incident analysis 1 to identify oppor - lines also include recommendations to tunities to improve the safe use of this high-alert medication. A total of 144 reports of employ smart infusion pumps with dose incidents associated with oxytocin were analyzed from voluntary reports submitted error-reduction systems for plain IV fluid to ISMP Canada and the Canadian National System for Incident Reporting (NSIR) infusions. Also, there is a new set of guide - between 2000 and 2019. Maternal, fetal, or neonatal harm was reported in 12% of the lines associated with bi-directional smart oxytocin reports to ISMP Canada and 29% of the oxytocin reports to NSIR. Most of pump interoperability with the electronic the incidents reported in both data sets occurred during drug administration. health record. For recommendations on reducing risks involving infrastructure, In February 2020, ISMP analyzed an additional 52 voluntary reports associated with drug libraries, continuous quality improve - oxytocin submitted to the ISMP National Medication Errors Reporting Program (ISMP ment data, clinical workflow, and interop - MERP) between 1999 and 2019. About 10% of the reports described more than one erability, visit: www.ismp.org/node/972 . oxytocin error that had occurred. About 44% of the reported events originated during dispensing, with many relating to mix-ups between oxytocin and look-alike product vials. About a quarter (23%) originated during administration, and 13% during prescribing. Overall, about 8% of the reports were hazards that did not result in errors. A quarter (25%) of all events resulted in maternal, fetal, or neonatal harm. Form an interdisciplinary team and Analysis of the 144 incidents reported to ISMP Canada and NSIR revealed 3 main consider the following recommendations themes, some with multiple subthemes. Analysis of the 52 reports submitted to ISMP as you plan, implement, and monitor the revealed similar themes along with a few additional themes. The five themes from effectiveness of strategies to mitigate the both ISMP Canada and ISMP analysis of oxytocin incidents are presented below. risk of oxytocin errors and associated maternal, fetal, or neonatal harm. THEME 1 PRESCRIBING ERRORS Selection of wrong drug on order entry screen. Oxytocin errors related to pre - Increase the number of drug name let - scribing were associated with selecting the wrong drug from a computerized pre - ters required in electronic searches. scriber order entry (CPOE) screen when searching using only 3 letters, “PIT,” “OXY,” ISMP recommends requiring a minimum or “OXY10.” Most recently, two errors were reported in which physicians had entered of 5 letters when searching for a drug “PIT” for PITOCIN (oxytocin) in the CPOE system but accidentally selected name in electronic systems (see #19 in the PITRESSIN (discontinued brand name for vasopressin still found in some CPOE ISMP Guidelines for Safe Electronic Com- systems). When entering “OXY10” into the CPOE system, the following error occurred: munication of Medication Information, www.ismp.org/ext/329 ), resulting ideally in A physician intended to prescribe oral OXYCONTIN (oxy CODONE ) 10 mg every 12 only one drug name appearing in the hours as needed for pain for a postpartum patient. He entered “OXY10” into the results field. Indication-based prescribing CPOE search field but accidentally selected “oxytocin 10 units IV” from the menu, could also support the correct selection resulting in an order for oxytocin 10 units IV every 12 hours as needed for pain. The and appropriate use of medications. continued on page 2 — Oxytocin > continued on page 2 — check it out >

Supported by educational grants from Novartis and Fresenius Kabi February 2020 Volume 18 Issue 2 Page 2

> Oxytocin — continued from page 1 continued from page 1 pharmacist was concerned about the order but dispensed the medication as prescribed because the nurse was waiting for the medication. The nurse also ques - Employ standard order sets. Require the tioned the pharmacist about the order, stating that she had never given a patient “IV use of standard order sets for prescribing oxytocin” to treat pain. But by the time the pharmacist followed up with the prescriber oxytocin antepartum and/or postpartum and corrected the error, the patient had received one dose of IV oxytocin. that reflect a standardized clinical approach to labor induction/augmentation and control THEME 2 LOOK-ALIKE DRUG PACKAGING AND NAMES of postpartum bleeding. Include adminis - Look-alike vials. Not unexpected, 40% of all oxytocin-related reports submitted to tration requirements, patient monitoring, ISMP described look-alike vials that had led to, or could have led to, mix-ups between standard treatment of oxytocin-induced oxytocin and another product. The most common, recent reports involved both uterine tachysystole, 2 and other safety generic (oxytocin) and brand (Pitocin) vials (10 units/mL) that looked similar to measures. (Use of standard order sets will ondansetron vials (4 mg/2 mL) from various manufacturers. The oxytocin/Pitocin also reduce drug selection errors during and ondansetron vials are available in similar sized, clear vials with green caps (and prescribing.) sometimes green lettering on both labels). The risk of a mix-up between these prod - ucts is heightened because they are often stored alphabetically near each other on Standardize concentration/bag size. pharmacy shelves and used for the same patient population, especially during Standardize to a single concentration/bag cesarean sections. In some cases, a shortage of ondansetron was a factor requiring size for both antepartum and postpartum purchase of an available product from a different manufacturer in vials that looked oxytocin infusions (e.g., 30 units of oxytocin similar to oxytocin/Pitocin vials. Many of the reported errors involved dispensing or in 500 mL of Lactated Ringer’s 2,3 ). stocking automated dispensing cabinets (ADCs) with the wrong product. Reports of other medications packaged in vials that look similar to oxytocin/Pitocin within the Provide oxytocin in ready-to-use form . past 5 years included clindamycin and metoclopramide. Have pharmacy provide patient care units with ready-to-use IV bags of oxytocin in a Look-alike drug names. About 12% of oxytocin errors reported to ISMP described standardized concentration that are name confusion between Pitocin and Pitressin, a long-discontinued brand of vaso - pharmacy-prepared or from an outsourced pressin originally manufactured by Parke-Davis (now a division of Pfizer). While sterile compounding service to avoid the some of these reports were received more than a decade ago, errors have persisted need for drug manipulation at the bedside. because vasopressin is sometimes still referred to as “PIT” or “Pitressin,” and the Before distribution of the bags to patient drug name can still be found in some order entry systems (see THEME 1 ). Most of care units, boldly label both sides of the bags the reported errors involved verbal orders or requests to the pharmacy for “Pitressin” to differentiate them from plain hydrating that were misheard as Pitocin. The few errors in which “Pitressin” infusions were solutions and magnesium infusions. If oxy - dispensed instead of the intended Pitocin infusion resulted in harm (e.g., pulmonary tocin infusions must be prepared on patient edema). care units during an emergency, require an independent double check of the pre- THEME 3 PREPARATION CHALLENGES paration and provide preprinted labels to Preparation and/or labeling problems. Nurses may prepare oxytocin infusions affix to prepared bags. on the patient care unit, just before use, by withdrawing the medication from a vial and adding the appropriate volume to a bag of IV solution (e.g., 0.9% sodium Standardize dosing units. Standardize chloride). The diluted solution is then administered IV via an infusion pump. Nursing how oxytocin doses, concentrations, and admixture on a patient care unit risks sterility and preparation errors. Also, if a nurse- rates are expressed. Always communicate prepared IV infusion bag is not labeled legibly, completely, and accurately, it can be oxytocin infusion orders in terms of the dose indistinguishable from bags containing plain IV solutions. This multi-organization rate (e.g., milliunits/minute) to lessen the op - analysis highlighted cases in which incomplete or omitted labels on nurse-prepared portunity for misinterpretation. Align oxytocin infusions led to patient safety issues. These labeling problems were typically due to dosing units and concentration with the interruptions, distractions, or competing priorities on the patient care unit. smart pump dose error-reduction system.

An unlabeled bag of what was presumed to be a plain IV solution was administered Employ barcode scanning technology. to a patient. Staff later noted maternal cramping and fetal heart rate deceleration. Despite a fast-paced environment of care, An investigation revealed that the bag contained oxytocin. The patient required an require the scanning of barcodes on oxy - emergency cesarean section. tocin vials and infusion bags prior to prepa - ration, dispensing, stocking (e.g., in ADCs), THEME 4 ADMINISTRATION-ASSOCIATED ERRORS and administration to help ensure that the Infusion pump or IV line mix-ups. Mix-ups of IV lines and misconnections to the right product has been selected. wrong infusion pump have resulted in drug or dose errors and omissions. Contributing factors included the need for multiple IV lines, a fast-paced work environment, heavy Use smart infusion pumps. Deliver all workload, failure to trace lines, inexperienced staff, and distractions. IV oxytocin via smart infusion pumps with continued on page 3 — Oxytocin > continued on page 3 — check it out >

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> Oxytocin — continued from page 2 continued from page 2 During augmentation of labor, IV oxytocin was to be administered at a controlled, prescribed rate via an infusion pump, while IV Lactated Ringer’s was to be adminis - an engaged dose error-reduction system. tered rapidly via gravity. During the set-up process, the lines were mixed up, and the Bi-directional smart pump interoperability oxytocin solution was inadvertently left to run freely without a pump. As a result, with the electronic health record will also the patient received a larger-than-intended dose of oxytocin, an error that led to the reduce the risk of programming errors. need for a cesarean section. Label and trace lines. Label the IV tubing Infusion bag swaps. Similar to line mix-ups, numerous errors were reported in on oxytocin infusions just above the injection which an oxytocin infusion bag was mixed up with either a hydrating fluid or port closest to the patient and just above magnesium infusion, leading to significant under- or overdoses. A common con - the pump. When setting up an infusion, trace tributing factor included availability of an oxytocin infusion during labor that was the line from the infusion bag to the pump, intended for use postpartum. and from the pump to the patient (and/or vice versa), to ensure the correct line For a laboring mother who was progressing well, a nurse selected what she thought attachment. Independent double checks was an infusion bag containing 500 mL of Lactated Ringer’s but was actually oxytocin can be used to verify the setup of IV lines. (30 units/500 mL). The mother received an unspecified amount of oxytocin prior to delivery at an infusion rate normally used for hydrating fluids. The oxytocin infusion Conduct vial/infusion bag packaging had been prepared for use after delivery and had been brought into the labor room assessment. Prior to use (or purchase) of by a second nurse. Shortly after oxytocin administration began, the mother’s medication vials or premixed infusion bags, contractions intensified, and fetal monitoring demonstrated significant heart rate conduct an assessment to ensure they do decelerations. The baby was delivered as soon as possible and had a low Apgar not look similar to other vials or bags used score without spontaneous breathing, requiring admission to the neonatal intensive in the facility and that the label is clear care unit. regarding the amount of drug per total volume. This process should occur even Failure to scan the barcode on the infusion bag, often due to a sense of urgency, for a drug that is used temporarily during a was another contributing factor. drug shortage or other reason. If similarities are noticed, and the drug/solution cannot After a precipitous birth, a mother was prescribed a bolus dose and continuous be purchased from a different manufac - infusion of oxytocin to alleviate postpartum bleeding. A nurse quickly gathered what turer/supplier, implement strategies to avoid she thought was an oxytocin infusion but did not scan the bag’s barcode prior to confusion (e.g., auxiliary labeling on vials, hanging the infusion. An hour after starting the infusion, the mother experienced infusion bags, bins, ADC screens) and warn hypotension, weakness, and vomiting and was given a dose of IV ondansetron. all users about the risk. Later, when the nurse was hanging a replacement bag of oxytocin, she noticed that the initial infusion bag contained magnesium (20 g/500 mL), not oxytocin Store separately. Separate the storage (30 units/500 mL). The mother’s magnesium toxicity was treated with IV calcium of look-alike oxytocin and ondansetron vials gluconate with improvement in symptoms. (and other look-alike vials) in the pharmacy and patient care storage locations. Try to Infusion rate confusion. Inconsistent terminology used to express an oxytocin obtain one of the products from a different infusion rate in the medication order, administration record, and/or pump library led manufacturer and utilize barcode scanning. to several errors. The concentration of oxytocin in an IV infusion solution is usually expressed in milliunits per mL or units per L. The administration rate for the solution Reduce access to unneeded medica - is typically expressed as the amount of drug (milliunits/minute) and as the volume tions. Whenever possible, avoid bringing of solution to be infused (e.g., mL/hour). As a result of confusion between the units any medication or solution to the patient’s of measure, infusion pump programming errors were made, which resulted in the bedside until it is prescribed and needed. delivery of more than the intended dose of oxytocin. Restricting access to unneeded medications is a key error-reduction strategy, particularly Inadvertent bolus doses from leftover drug in tubing. One reported event in birthing units where emergent circum - reminded us how residual oxytocin (or other drugs) in IV tubing can have severe stances may require rapid changes in the adverse effects when other medications or infusions are administered through the plan of care. same line. If IV lines are not changed, the length of the IV tubing may contain 10 mL or more of uninfused drug. Additionally, needleless ports and stopcocks also have dead Avoid outdated brand names and drug space where the drug can accumulate. name abbreviations. Remove outdated brand names, including Pitressin, from CPOE Residual oxytocin left in an obstetrical patient’s IV line caused hypertonic, tetanic uterine systems. Avoid using abbreviations such as contractions leading to deceleration of the fetal heart rate and fetal hypoxia, when a “PIT” for either Pitocin or Pitressin or “OXY” Lactated Ringer’s hydrating solution was rapidly infused through the same IV line. for oxytocin or oxy CODONE/Oxy CONTIN. continued on page 4 — Oxytocin > continued on page 4 — check it out >

Newsletter also partially supported by an educational grant from February 2020 Volume 18 Issue 2 Page 4

> Oxytocin — continued from page 3 continued from page 3

THEME 5 COMMUNICATION GAPS Limit verbal orders. Limit verbal orders Incomplete hand-offs at transitions of care. The lack of clear communication to emergencies or under sterile conditions. and/or documentation during transitions of care was a key contributor to oxytocin When they are needed, readback (or repeat incidents. Reporters attributed poor communication/documentation to heavy work - back under sterile conditions) is a must. load, a fast-paced environment, inexperience, and involvement of many individuals in the patient’s care. Discard discontinued bags and change oxytocin tubing. When an oxytocin infu - Administration of oxytocin was put on hold when staff noted a deceleration in the sion is discontinued, promptly remove and fetal heart rate. Fifteen minutes later, the physician examined the patient and gave a discard any unused portion of the infusion verbal order to restart the oxytocin infusion, but at a lower rate. A few minutes later, a and change the IV line to ensure no residual second physician, who was taking over for the first, gave an order to restart the drug is left in the tubing. oxytocin at the original dose. The lack of documentation and communication regarding the decision to lower the rate of infusion was considered to be a factor in this incident. Support clear communication/docu - mentation. Use standardized communi - To help prevent errors with oxytocin, consider the recommendations listed in the cation strategies (e.g., SBAR) and docu - Check it out! column to the right starting on page 1. mentation tools during transitions of care to promote clear, timely, and efficient References exchange of patient information. 1) ISMP Canada. Errors associated with oxytocin use: a multi-incident analysis. ISMP Canada Safety Bulletin . 2019;19(8):1-5. www.ismp.org/ext/342 2) Simpson KR, Knox GE. Oxytocin as a high-alert medication: implications for perinatal patient safety. Engage patients. Encourage questions MCN Am J Matern Child Nurs . 2009;34(1):8-15. about oxytocin to further engage patients/ 3) McKenna DS, Rudinsky K, Sonek J. Effects of a new patient safety-driven oxytocin dosing protocol on postpartum hemorrhage. J Pregnancy . 2014;2014:157625. www.ismp.org/ext/347 families in the birth planning process.

ISMP thanks ISMP Canada for providing the analysis of oxytocin events reported in Canada. 1

Confusion over antiretroviral therapy abbreviation. A patient received the wrong The “-afil” drug name stem antiretroviral drug due to confusion with a drug name abbreviation. Like vaccine Medications with the suffix “-afil” belong to a class of drugs known as abbreviations, antiretroviral drugs have phosphodiesterase type 5 (PDE5) inhibitors with vasodilator action. 1 This class been assigned drug name abbreviations of medications is most commonly used for the treatment of erectile dysfunction that can increase the risk of confusion in males. Some of the medications are also approved for benign prostatic (www.ismp.org/ext/306 ). In this case, the hyperplasia (BPH) with or without erectile disfunction and pulmonary arterial physician intended to prescribe PIFELTRO hypertension in adults ( Table 1 , page 5). (doravirine), which is commonly abbrevi - ated as DOR in most literature on therapies These drugs selectively block PDE5, an enzyme found primarily in the corpus used to treat human immunodeficiency cavernous of the penis and the vasculature of lung. PDE5 is responsible for the virus (HIV) infections. During order entry, breakdown of cyclic guanosine monophosphate (cGMP). By preventing the the prescriber was thinking DOR but acci - breakdown of cGMP, PDE5 inhibitors prolong the activity of vasodilators such dentally selected DOVATO(dolutegravir and as nitric oxide, which promotes relaxation of the blood vessels and increases lami VUDine), which starts with DOV, as the blood circulation in the penis and lungs, and to a lesser degree, systemically. 2-10 prescribed antiviral medication.

There are currently four PDE5 inhibitors approved by the US Food and Drug Both drugs are taken once daily and are Administration (FDA) for use in the US ( Table 1 , page 5). These drugs are available in a single strength (Pifeltro avail able as oral tablets, oral disintegrating tablets, powder for oral suspension, 100 mg, Dovato 50 mg/300 mg). Thus, when and intravenous injection. The oral suspension and intravenous injection are prescribing either drug, the strength does only approved for the treatment of pulmonary arterial hypertension. 2-9 not require selection, and the prescriber did not notice the difference between the For erectile dysfunction, these medications are usually dosed as needed prior intended 100 mg dose of Pifeltro and the to sexual activity. They are recommended to be taken 15 minutes to 4 hours 50 mg/300 mg dose of Dovato. Because before sexual activity. 2- 9 There are significant differences in the onset of action, both antiretroviral medications are used to elimination half-life, duration of activity, and target affinity that should be con - treat HIV infection, the pharmacist was not sidered when initiating therapy with PDE5 inhibitors for erectile dysfunction. able to identify the prescribing error without continued on page 5 — what’s in a Name ? > continued on page 5 — SAFETY wire > February 2020 Volume 18 Issue 2 Page 5

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Table 1. List of phosphodiesterase type 5 (PDE5) inhibitors available in the US. knowing the patient’s resistance profile and Generic Name Brand Formulations Indications specific intended therapy. As the intended drug, Pifeltro, may be paired with lami- avanafil STENDRA Tablets Erectile dysfunction VUDine, it is also unknown if the patient sildenafil REVATIO Tablets, powder for Erectile dysfunction; pulmonary was already taking lami VUDine, which VIAGRA oral suspensions and arterial hypertension intravenous injection might have led to a duplicate therapy warn - ing since the erroneously prescribed drug, tadalafil ADCIRCA Tablets Erectile dysfunction ; BPH with/ Dovato, contains lami VUDine. Mix-ups are ALYQ without erectile dysfunction; CIALIS pulmonary arterial hypertension also possible between other antiretrovirals with commonly used drug name abbrevia - vardenafil LEVITRA Tablets and disinte - Erectile dysfunction tions (e.g., TAF [tenofovir alafenamide] and STAXYN grating tablets TDF [tenofovir disoproxil fumarate]). Tadalafil has the longest duration of action (24-36 hours, maximum of 72 hours); avanafil has a quick onset (from 20 minutes post-dose); and sildenafil and var - This is a prime example of why drug name denafil have similar duration of action (4-6 hours). Avanafil has a greater selec - abbreviations should be prohibited. Check tivity for PDE5, which may decrease the potential for adverse effects. your order entry system, clinical guidelines, and electronic medication administration For pulmonary arterial hypertension, the medications are either taken once record to ensure that the given abbreviations daily (tadalafil) or three times daily (sildenafil). 2-9 All PDE5 inhibitors may be for antiretroviral medications are not auto - taken with or without food. However, the absorption of PDE5 inhibitors, except matically populated or included in the drug tadalafil, may be delayed if taken together with high-fat meals and patients name fields. Also, it is safest if drug name should be advised of this effect. 10-11 searches, using technology, require entry of at least the first 5 letters of the actual drug PDE5 inhibitors are generally well tolerated with mild to moderate side effects name, and not an abbreviated drug name. including headache, facial flushing, nasal congestions, dyspepsia, and dizzi - ness. However, rare but serious adverse effects of prolonged erections lasting more than 4 hours, priapism (painful erections lasting more than 6 hours), vision disturbances/loss, and hearing loss have been reported. Patients should be advised to seek immediate care if they experience any of these symptoms and to discontinue the drug in the event of vision or hearing loss. 2-9

Clinicians should be aware that PDE5 inhibitors have some significant drug contraindications, warnings, and precautions due to their systemic vasodilation March 8–14, 2020 effects. They can potentiate the hypotensive effects of nitrates and guanylate cyclase (GC) stimulators (e.g., riociguat) and should not be used concurrently. Similarly, PDE5 inhibitors should be used with caution in patients with cardio - vascular disease (CVD) and cardiovascular risk factors. It is recommended that clinicians evaluate the patient’s cardiac status prior to starting these drugs . Additionally, concomitant administration of PDE5 inhibitors with anti- To subscribe: www.ismp.org/node/138 hypertensive medications, especially alpha-blockers, may cause an additional decrease in blood pressure (orthostatic hypotension) and should be used ISMP Nurse Advise ERR (ISSN 1550-6304) © 2020 with caution. 2-11 Institute for Safe Medication Practices (ISMP). Subscribers References are granted permission to redistribute the newsletter or reproduce its contents within their practice site or facility 1) World Health organization. Guidance on the use of International Nonproprietary Names only. Other reproduction, including posting on a public- (INNs) for pharmaceutical substances. Switzerland: 2017:42. www.ismp.org/ext/26 access website, is prohibited without written permission 2) Cialis [package insert]. Indianapolis, IN: Eli Lilly and Company; 2018. from ISMP. This is a peer reviewed publication. 3) Adcirca [package insert]. Indianapolis, IN: Eli Lilly and Company; 2017. Report medication and vaccine errors to ISMP: 4) Alyq [package insert]. North Wales, PA: Teva Pharmaceuticals; 2019. Call 1-800-FAIL-SAF(E), or visit www.ismp.org/MERP or 5) Viagra [package insert]. New York, NY: Pfizer Inc.; 2017. www.ismp.org/VERP . ISMP guarantees the confidentiality 6) Revatio [package insert]. New York, NY: Pfizer Inc.; 2014. of information received and respects the reporters’ wishes 7) Levitra [package insert]. Research Triangle Park, NC: GlaxoSmithKline; 2014. regarding the level of detail included in publications. 8) Staxyn [package insert]. Whitehouse Station, NJ: Merck & Co., Inc.; 2010. 9) Stendra [package insert]. Mountain View, CA: Vivus, Inc.; 2012 Editors: Ann Shastay, MSN, RN, AOCN; Judy Smetzer, 10) Evans JD, Hill SR. A comparison of the available phosphodiesterase-5 inhibitors in the treat - BSN, RN, FISMP; Michael Cohen, RPh, MS, ScD (hon), ment of erectile dysfunction: a focus on avanafil. Patient Prefer Adherence. 2015;9:1159–64. DPS (hon), FASHP; Russell Jenkins, MD; Ronald S. Litman, 11) Huang SA, Lie JD. Phosphodiesterase-5 (PDE5) inhibitors in the management of erectile DO, ML. ISMP, 200 Lakeside Drive, Suite 200, Horsham, dysfunction. P T. 2013;38(7):407,414-9. PA 19044. Email: [email protected]; Tel: 215-947-7797; Fax: 215-914-1492. ismp.org consumermedsafety.org twitter.com/ISMP1 facebook.com/ismp1 medsafetyofficer.org ISMP Safe Medication Management Fellowships ISMP is now accepting applications for three unique Fellowship programs commencing in 2020

ISMP Safe Medication Management Fellowship

Location and Term : This 12-month Fellowship commences July/August 2020 at the Horsham, Pennsylvania (near Philadelphia) office of ISMP. Relocation to the Horsham/Philadelphia area is required.

Description : Now in its 28 th year, this Fellowship offers a nurse, pharmacist, or physician with at least 1 year of postgraduate clinical experience an unparalleled opportunity to work collaboratively with the nation’s experts in medication safety to assess and develop interdisciplinary medication error-prevention strategies. This Fellowship is open to US citizens (or applicants with a valid US visa).

FDA/ISMP Safe Medication Management Fellowship

Location and Term : This 12 -month Fellowship commences August/September 2020. The Fellow will spend 6 months at the Horsham, Pennsylvania (near Philadelphia) office of ISMP and 6 months at the Silver Spring, Maryland (near Washington, DC) office of the US Food and Drug Administration (FDA) . Relocation to the Horsham/Philadelphia and Silver Spring/Washington, DC, area is required.

Description: This Fellowship, open to a healthcare professional with at least 1 year of postgraduate clinical experience , is a joint effort between ISMP and FDA’s Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology, Division of Medication Error Prevention and Analysis. The Fellowship allows the candidate to benefit from ISMP’s years of medication safety experience along with FDA’s valuable regulatory experience focused on medication error prevention.

ISMP International Medication Safety Management Fellowship

Location and Term : This 12-month Fellowship commences July/August 2020 at the Horsham, Pennsylvania (near Philadelphia) office of ISMP. Relocation to the Horsham/Philadelphia area is required.

Description: This Fellowship, open to a healthcare professional with an advanced degree and at least 1 year of experience in an acute care setting , will help train a medication safety leader seeking a long-term career at an international level. The Fellow will be involved in global medication safety initiatives, address worldwide safety issues, and help increase global reporting of medication errors. All applicants must be fluent in written and spoken English and be a US citizen or gain official documentation to remain in the US for the duration of the Fellowship and to travel internationally.

A competitive stipend is provided with all Fellowship programs .

How to Apply Information and an application can be found at: www.ismp.org/profdevelopment/ . An application can also be requested by calling 215-947-7797.

The application deadline for all Fellowship Programs is March 31, 2020 .