title: Near-infrared spectroscopy monitors: a novel tool for patient safety in the intensive care unit.
abstract: Medication errors due to adverse incidents with medical devices are a significant contributor to the total number of hospital errors. Unfortunately, there may be no warning when a device fails, and caregivers may not have an opportunity to prevent patient harm as a result. An error of unrecognized interruption of infusions of cardiac medications can cause rapid patient deterioration. In the case presented, near-infrared spectroscopy monitoring alerted caregivers to an otherwise clinically silent error with infused cardiac medications in the intensive care unit and permitted recognition and intervention before patient harm occurred.
authors.affiliation: Department of Pediatrics, Section of Critical Care/Medicine/Cardiac Intensive Care, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60614, USA. jkane@childrensmemorial.org
authors.forename: Jason M
authors.initials: JM
authors.lastname: Kane
mesh_terms: D004059:Diffusion of Innovation; D016503:Drug Delivery Systems; D004868:Equipment Failure; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis; D015278:Intensive Care Units, Pediatric; D008508:Medication Errors / Q000517:prevention & control*; D017751:Safety Management; D019265:Spectroscopy, Near-Infrared / Q000295:instrumentation*