Bulletins

Click on the links below to read each bulletin.

Broken Endoscope Tip- this bulletin, with manufacturer advisory, alerts to a potential risk with use of the Olympus Lens Cleaning Sheath-MAJ 1537; the tip can break off in the patient during use.

Bone Cement Mix-up - this bulletin notes problem that can result from packaging similarities between Osteoset and Allomatrix (August 2010)

Confusing Labels - this bulletin discusses risks posed by confusing medication labels (August 2008)

Case Notes - this review highlights a hidden risk—newborn babies who fall while being held by family or friends (August 2008)

Innovation and Safety – “low tech” surgical innovation with unanticipated results (July 2008)

Siderails and Bed Safety – information about entrapment and bed safety (March 2008)

Retained Objects – recommendations to avoid unintentionally retained objects during surgery (November 2007)

Case Study – a ‘good culture” nevertheless results in harm: lessons learned (November 2007)

INR Monitor – devices for testing levels of blood thinners are not all the same (November 2007)

Implanted Pain Pumps – adding medication to the pump requires precision (July 2007)

Sandbags & MRI – not all sandbags contain sand (May 2007)

Show Me the Mark – a quick second check of the surgical site before anesthesia (January 2007)

Ticket to Ride – information for patients transitioning in the hospital (November 2006)

Kinked Tubing – plastic tubing with a kink cannot be straightened (July 2006)

MRI Upgrade – more powerful MRI prompts re-evaluation of all equipment in MRI suite (June 2006)