A nurse receives a verbal order which was understood to be for Avert 6

Question

The physician actually ordered Antivert 25 mg daily. The patient is also taking Prozac®/Sarafem® (fluoxetine), which when taken with Avert can be life threatening. The patient's condition stabilizes and an interdisciplinary team meets to perform a root cause analysis hoping to learn from the mistake. The nurse was part of the group formed to help identify ways the system could be changed to prevent similar errors. This situation describes:
a. just culture.
b. standard of care.
c. a call-out.
d. benchmarking.

Answer 1

ANS: A
Correct: Just culture is an organizational culture that promotes patient safety by acknowledging that competent health care professionals may make mistakes; incidents are analyzed through root cause analysis to determine where system changes can prevent future occurrences.
Incorrect:
b. Standard of care is the expected level and type of care based on the knowledge and skill the average prudent clinician would possess and exercise in the same or similar circumstances based on evidence; standards are based on expert consensus derived from research or documentation in scientific literature.
c. In a call-out the provider calls out critical information during urgent situations so all team members can hear to help anticipate next steps.
d. Benchmarking is using an attribute or achievement that serves as a standard for other providers or institutions to emulate.