構造化 · Why do medication errors keep happening?

問い

Why do medication errors keep happening?

一方は他方に大きく影響しますか？投じられた票の4分の3で決まります。

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理由

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閉じる ✕

The same error recurs on the same drug every few months → 影響する？ → Errors are discussed as individual mistakes, not as patterns

まだ発言はありません。

完了した段階です。ペアと投票の記録は上にあります。論理を確かめる ↗

Patients are moved between wards mid-treatment and the chart lags behind	→	Errors are discussed as individual mistakes, not as patterns	未決	議論する
…	→	Agency staff do not know the ward's conventions	未決	議論する
Pharmacy reviews charts a day after the first dose was given	→	Infusion pumps on the ward come from three manufacturers	未決	議論する
Agency staff do not know the ward's conventions	→	Interruptions during the drug round are constant	未決回付済み	議論する
Allergy information is in a different system from the prescribing one	→	The same look-alike drugs are stored next to each other	✓ はい	議論する
Allergy information is in a different system from the prescribing one	→	Alerts in the system are so frequent that they are clicked through	✓ はい	議論する
Patients are moved between wards mid-treatment and the chart lags behind	→	Discharge medication lists disagree with the inpatient chart	✓ はい	議論する
Near misses are not reported because the form takes twenty minutes	→	The same look-alike drugs are stored next to each other	✓ はい	議論する
Double-checking is signed without a second person actually looking	→	Patients are moved between wards mid-treatment and the chart lags behind	✓ はい	議論する
Errors are discussed as individual mistakes, not as patterns	→	The same error recurs on the same drug every few months	✓ はい	議論する
Errors are discussed as individual mistakes, not as patterns	→	Near misses are not reported because the form takes twenty minutes	✓ はい	議論する
Night shift has one nurse for the whole bay	→	Interruptions during the drug round are constant	✓ はい	議論する
Pharmacy reviews charts a day after the first dose was given	→	Night shift has one nurse for the whole bay	✓ はい	議論する
Infusion pumps on the ward come from three manufacturers	→	Agency staff do not know the ward's conventions	✓ はい	議論する
Handwritten charts are still used when the system is down, which is often	→	Infusion pumps on the ward come from three manufacturers	✓ はい	議論する
Double-checking is signed without a second person actually looking	→	Discharge medication lists disagree with the inpatient chart	✓ 推論	議論する
Double-checking is signed without a second person actually looking	→	Allergy information is in a different system from the prescribing one	✗ いいえ	議論する
New nurses are put on drug rounds in their first week	→	The same error recurs on the same drug every few months	✗ いいえ	議論する
The same look-alike drugs are stored next to each other	→	Double-checking is signed without a second person actually looking	✗ いいえ	議論する
Discharge medication lists disagree with the inpatient chart	→	Allergy information is in a different system from the prescribing one	✗ いいえ	議論する
The same look-alike drugs are stored next to each other	→	The same error recurs on the same drug every few months	✗ いいえ	議論する
Alerts in the system are so frequent that they are clicked through	→	New nurses are put on drug rounds in their first week	✗ いいえ	議論する
Discharge medication lists disagree with the inpatient chart	→	Near misses are not reported because the form takes twenty minutes	✗ いいえ	議論する
Double-checking is signed without a second person actually looking	→	Alerts in the system are so frequent that they are clicked through	✗ いいえ	議論する
Errors are discussed as individual mistakes, not as patterns	→	Patients are moved between wards mid-treatment and the chart lags behind	✗ いいえ	議論する
Alerts in the system are so frequent that they are clicked through	→	The same error recurs on the same drug every few months	✗ いいえ	議論する
The same error recurs on the same drug every few months	→	Patients are moved between wards mid-treatment and the chart lags behind	✗ いいえ	議論する
Allergy information is in a different system from the prescribing one	→	Discharge medication lists disagree with the inpatient chart	✗ いいえ	議論する
Discharge medication lists disagree with the inpatient chart	→	Patients are moved between wards mid-treatment and the chart lags behind	✗ いいえ	議論する
The same error recurs on the same drug every few months	→	New nurses are put on drug rounds in their first week	✗ いいえ	議論する
Errors are discussed as individual mistakes, not as patterns	→	Discharge medication lists disagree with the inpatient chart	✗ いいえ	議論する
Discharge medication lists disagree with the inpatient chart	→	The same look-alike drugs are stored next to each other	✗ いいえ	議論する
The same error recurs on the same drug every few months	→	Double-checking is signed without a second person actually looking	✗ いいえ	議論する
The same error recurs on the same drug every few months	→	Alerts in the system are so frequent that they are clicked through	✗ いいえ	議論する
The same error recurs on the same drug every few months	→	Allergy information is in a different system from the prescribing one	✗ いいえ	議論する
The same look-alike drugs are stored next to each other	→	New nurses are put on drug rounds in their first week	✗ いいえ	議論する
Near misses are not reported because the form takes twenty minutes	→	The same error recurs on the same drug every few months	✗ いいえ	議論する
Near misses are not reported because the form takes twenty minutes	→	Errors are discussed as individual mistakes, not as patterns	✗ いいえ	議論する
The same look-alike drugs are stored next to each other	→	Discharge medication lists disagree with the inpatient chart	✗ いいえ	議論する
Errors are discussed as individual mistakes, not as patterns	→	Double-checking is signed without a second person actually looking	✗ いいえ	議論する
Alerts in the system are so frequent that they are clicked through	→	Double-checking is signed without a second person actually looking	✗ いいえ	議論する
Discharge medication lists disagree with the inpatient chart	→	Alerts in the system are so frequent that they are clicked through	✗ いいえ	議論する
The same error recurs on the same drug every few months	→	Near misses are not reported because the form takes twenty minutes	✗ いいえ	議論する
Double-checking is signed without a second person actually looking	→	The same error recurs on the same drug every few months	✗ いいえ	議論する
New nurses are put on drug rounds in their first week	→	Patients are moved between wards mid-treatment and the chart lags behind	✗ いいえ	議論する
Errors are discussed as individual mistakes, not as patterns	→	Alerts in the system are so frequent that they are clicked through	✗ いいえ	議論する
The same look-alike drugs are stored next to each other	→	Patients are moved between wards mid-treatment and the chart lags behind	✗ いいえ	議論する
The same look-alike drugs are stored next to each other	→	Alerts in the system are so frequent that they are clicked through	✗ いいえ	議論する
New nurses are put on drug rounds in their first week	→	Discharge medication lists disagree with the inpatient chart	✗ いいえ	議論する
Near misses are not reported because the form takes twenty minutes	→	Allergy information is in a different system from the prescribing one	✗ いいえ	議論する
New nurses are put on drug rounds in their first week	→	Near misses are not reported because the form takes twenty minutes	✗ いいえ	議論する
Double-checking is signed without a second person actually looking	→	Near misses are not reported because the form takes twenty minutes	✗ いいえ	議論する
The same look-alike drugs are stored next to each other	→	Errors are discussed as individual mistakes, not as patterns	✗ いいえ	議論する
Near misses are not reported because the form takes twenty minutes	→	Alerts in the system are so frequent that they are clicked through	✗ いいえ	議論する
Errors are discussed as individual mistakes, not as patterns	→	Allergy information is in a different system from the prescribing one	✗ いいえ	議論する
Patients are moved between wards mid-treatment and the chart lags behind	→	The same error recurs on the same drug every few months	✗ いいえ	議論する
New nurses are put on drug rounds in their first week	→	Alerts in the system are so frequent that they are clicked through	✗ いいえ	議論する
Double-checking is signed without a second person actually looking	→	The same look-alike drugs are stored next to each other	✗ いいえ	議論する
The same error recurs on the same drug every few months	→	Discharge medication lists disagree with the inpatient chart	✗ いいえ	議論する
The same look-alike drugs are stored next to each other	→	Allergy information is in a different system from the prescribing one	✗ いいえ	議論する
Double-checking is signed without a second person actually looking	→	Errors are discussed as individual mistakes, not as patterns	✗ いいえ	議論する
Near misses are not reported because the form takes twenty minutes	→	Discharge medication lists disagree with the inpatient chart	✗ いいえ	議論する
Patients are moved between wards mid-treatment and the chart lags behind	→	The same look-alike drugs are stored next to each other	✗ いいえ	議論する
Allergy information is in a different system from the prescribing one	→	Near misses are not reported because the form takes twenty minutes	✗ いいえ	議論する
Discharge medication lists disagree with the inpatient chart	→	Errors are discussed as individual mistakes, not as patterns	✗ いいえ	議論する
Allergy information is in a different system from the prescribing one	→	Errors are discussed as individual mistakes, not as patterns	✗ いいえ	議論する
Discharge medication lists disagree with the inpatient chart	→	The same error recurs on the same drug every few months	✗ いいえ	議論する
Patients are moved between wards mid-treatment and the chart lags behind	→	Allergy information is in a different system from the prescribing one	✗ いいえ	議論する
Allergy information is in a different system from the prescribing one	→	Patients are moved between wards mid-treatment and the chart lags behind	✗ いいえ	議論する
New nurses are put on drug rounds in their first week	→	Double-checking is signed without a second person actually looking	✗ いいえ	議論する
Patients are moved between wards mid-treatment and the chart lags behind	→	New nurses are put on drug rounds in their first week	✗ いいえ	議論する
Alerts in the system are so frequent that they are clicked through	→	Allergy information is in a different system from the prescribing one	✗ いいえ	議論する
Errors are discussed as individual mistakes, not as patterns	→	New nurses are put on drug rounds in their first week	✗ いいえ	議論する
Near misses are not reported because the form takes twenty minutes	→	New nurses are put on drug rounds in their first week	✗ いいえ	議論する
New nurses are put on drug rounds in their first week	→	The same look-alike drugs are stored next to each other	✗ いいえ	議論する
Alerts in the system are so frequent that they are clicked through	→	The same look-alike drugs are stored next to each other	✗ いいえ	議論する
Patients are moved between wards mid-treatment and the chart lags behind	→	Alerts in the system are so frequent that they are clicked through	✗ いいえ	議論する
Allergy information is in a different system from the prescribing one	→	The same error recurs on the same drug every few months	✗ いいえ	議論する
Double-checking is signed without a second person actually looking	→	New nurses are put on drug rounds in their first week	✗ いいえ	議論する
New nurses are put on drug rounds in their first week	→	Errors are discussed as individual mistakes, not as patterns	✗ いいえ	議論する
Near misses are not reported because the form takes twenty minutes	→	Double-checking is signed without a second person actually looking	✗ いいえ	議論する
Alerts in the system are so frequent that they are clicked through	→	Patients are moved between wards mid-treatment and the chart lags behind	✗ いいえ	議論する
Alerts in the system are so frequent that they are clicked through	→	Errors are discussed as individual mistakes, not as patterns	✗ いいえ	議論する
Discharge medication lists disagree with the inpatient chart	→	New nurses are put on drug rounds in their first week	✗ いいえ	議論する
New nurses are put on drug rounds in their first week	→	Allergy information is in a different system from the prescribing one	✗ いいえ	議論する
Alerts in the system are so frequent that they are clicked through	→	Discharge medication lists disagree with the inpatient chart	✗ いいえ	議論する
Near misses are not reported because the form takes twenty minutes	→	Patients are moved between wards mid-treatment and the chart lags behind	✗ いいえ	議論する
Patients are moved between wards mid-treatment and the chart lags behind	→	Near misses are not reported because the form takes twenty minutes	✗ いいえ	議論する
Errors are discussed as individual mistakes, not as patterns	→	The same look-alike drugs are stored next to each other	✗ いいえ	議論する
Alerts in the system are so frequent that they are clicked through	→	Near misses are not reported because the form takes twenty minutes	✗ いいえ	議論する
Patients are moved between wards mid-treatment and the chart lags behind	→	Double-checking is signed without a second person actually looking	✗ いいえ	議論する
Allergy information is in a different system from the prescribing one	→	Double-checking is signed without a second person actually looking	✗ いいえ	議論する
Discharge medication lists disagree with the inpatient chart	→	Double-checking is signed without a second person actually looking	✗ いいえ	議論する
The same error recurs on the same drug every few months	→	The same look-alike drugs are stored next to each other	✗ いいえ	議論する
The same error recurs on the same drug every few months	→	Errors are discussed as individual mistakes, not as patterns	✗ いいえ	表示中 ↑ · 閉じる ✕
Allergy information is in a different system from the prescribing one	→	New nurses are put on drug rounds in their first week	✗ いいえ	議論する
The same look-alike drugs are stored next to each other	→	Near misses are not reported because the form takes twenty minutes	✗ いいえ	議論する
…	→	Infusion pumps on the ward come from three manufacturers	✗ いいえ	議論する
Reporting an error has led to disciplinary action in the past	→	Handwritten charts are still used when the system is down, which is often	✗ いいえ	議論する
Infusion pumps on the ward come from three manufacturers	→	…	✗ いいえ	議論する
…	→	…	✗ いいえ	議論する
Interruptions during the drug round are constant	→	Infusion pumps on the ward come from three manufacturers	✗ いいえ	議論する
…	→	Handwritten charts are still used when the system is down, which is often	✗ いいえ	議論する
…	→	Night shift has one nurse for the whole bay	✗ いいえ	議論する
Weight-based doses are calculated by hand at the bedside	→	Infusion pumps on the ward come from three manufacturers	✗ いいえ	議論する
Agency staff do not know the ward's conventions	→	…	✗ いいえ	議論する
Weight-based doses are calculated by hand at the bedside	→	Night shift has one nurse for the whole bay	✗ いいえ	議論する
Night shift has one nurse for the whole bay	→	Reporting an error has led to disciplinary action in the past	✗ いいえ	議論する
Agency staff do not know the ward's conventions	→	Weight-based doses are calculated by hand at the bedside	✗ いいえ	議論する
Interruptions during the drug round are constant	→	Agency staff do not know the ward's conventions	✗ いいえ	議論する
Pharmacy reviews charts a day after the first dose was given	→	Handwritten charts are still used when the system is down, which is often	✗ いいえ	議論する
Handwritten charts are still used when the system is down, which is often	→	Pharmacy reviews charts a day after the first dose was given	✗ いいえ	議論する
Interruptions during the drug round are constant	→	…	✗ いいえ	議論する
Agency staff do not know the ward's conventions	→	Handwritten charts are still used when the system is down, which is often	✗ いいえ	議論する
…	→	Pharmacy reviews charts a day after the first dose was given	✗ いいえ	議論する
Weight-based doses are calculated by hand at the bedside	→	Handwritten charts are still used when the system is down, which is often	✗ いいえ	議論する
…	→	Night shift has one nurse for the whole bay	✗ いいえ	議論する
Reporting an error has led to disciplinary action in the past	→	Agency staff do not know the ward's conventions	✗ いいえ	議論する
Interruptions during the drug round are constant	→	Handwritten charts are still used when the system is down, which is often	✗ いいえ	議論する
Agency staff do not know the ward's conventions	→	…	✗ いいえ	議論する
Weight-based doses are calculated by hand at the bedside	→	Agency staff do not know the ward's conventions	✗ いいえ	議論する
Agency staff do not know the ward's conventions	→	Infusion pumps on the ward come from three manufacturers	✗ いいえ	議論する
Infusion pumps on the ward come from three manufacturers	→	Handwritten charts are still used when the system is down, which is often	✗ いいえ	議論する
…	→	Interruptions during the drug round are constant	✗ いいえ	議論する
Handwritten charts are still used when the system is down, which is often	→	Interruptions during the drug round are constant	✗ いいえ	議論する
Agency staff do not know the ward's conventions	→	Pharmacy reviews charts a day after the first dose was given	✗ いいえ	議論する
Handwritten charts are still used when the system is down, which is often	→	Agency staff do not know the ward's conventions	✗ いいえ	議論する
Reporting an error has led to disciplinary action in the past	→	…	✗ いいえ	議論する
Night shift has one nurse for the whole bay	→	…	✗ いいえ	議論する
…	→	Handwritten charts are still used when the system is down, which is often	✗ いいえ	議論する
Infusion pumps on the ward come from three manufacturers	→	Pharmacy reviews charts a day after the first dose was given	✗ いいえ	議論する
Interruptions during the drug round are constant	→	Weight-based doses are calculated by hand at the bedside	✗ いいえ	議論する
…	→	Weight-based doses are calculated by hand at the bedside	✗ いいえ	議論する
Infusion pumps on the ward come from three manufacturers	→	…	✗ いいえ	議論する
Infusion pumps on the ward come from three manufacturers	→	Interruptions during the drug round are constant	✗ いいえ	議論する
Pharmacy reviews charts a day after the first dose was given	→	Interruptions during the drug round are constant	✗ いいえ	議論する
Reporting an error has led to disciplinary action in the past	→	Weight-based doses are calculated by hand at the bedside	✗ いいえ	議論する
Handwritten charts are still used when the system is down, which is often	→	…	✗ いいえ	議論する
Weight-based doses are calculated by hand at the bedside	→	…	✗ いいえ	議論する
Pharmacy reviews charts a day after the first dose was given	→	Weight-based doses are calculated by hand at the bedside	✗ いいえ	議論する
…	→	Pharmacy reviews charts a day after the first dose was given	✗ いいえ	議論する
Handwritten charts are still used when the system is down, which is often	→	…	✗ いいえ	議論する
Interruptions during the drug round are constant	→	Night shift has one nurse for the whole bay	✗ いいえ	議論する
Night shift has one nurse for the whole bay	→	…	✗ いいえ	議論する
…	→	Reporting an error has led to disciplinary action in the past	✗ いいえ	議論する
…	→	Weight-based doses are calculated by hand at the bedside	✗ いいえ	議論する
…	→	…	✗ いいえ	議論する
Handwritten charts are still used when the system is down, which is often	→	Reporting an error has led to disciplinary action in the past	✗ いいえ	議論する
Pharmacy reviews charts a day after the first dose was given	→	…	✗ いいえ	議論する
Agency staff do not know the ward's conventions	→	Reporting an error has led to disciplinary action in the past	✗ いいえ	議論する
Reporting an error has led to disciplinary action in the past	→	Pharmacy reviews charts a day after the first dose was given	✗ いいえ	議論する
Night shift has one nurse for the whole bay	→	Weight-based doses are calculated by hand at the bedside	✗ いいえ	議論する
Weight-based doses are calculated by hand at the bedside	→	…	✗ いいえ	議論する
Night shift has one nurse for the whole bay	→	Agency staff do not know the ward's conventions	✗ いいえ	議論する
Agency staff do not know the ward's conventions	→	Night shift has one nurse for the whole bay	✗ いいえ	議論する
Reporting an error has led to disciplinary action in the past	→	…	✗ いいえ	議論する
Handwritten charts are still used when the system is down, which is often	→	Weight-based doses are calculated by hand at the bedside	✗ いいえ	議論する
…	→	Interruptions during the drug round are constant	✗ いいえ	議論する
Interruptions during the drug round are constant	→	Pharmacy reviews charts a day after the first dose was given	✗ いいえ	議論する
Night shift has one nurse for the whole bay	→	Infusion pumps on the ward come from three manufacturers	✗ いいえ	議論する
Interruptions during the drug round are constant	→	…	✗ いいえ	議論する
Infusion pumps on the ward come from three manufacturers	→	Night shift has one nurse for the whole bay	✗ いいえ	議論する
Handwritten charts are still used when the system is down, which is often	→	Night shift has one nurse for the whole bay	✗ いいえ	議論する
…	→	Infusion pumps on the ward come from three manufacturers	✗ いいえ	議論する
Pharmacy reviews charts a day after the first dose was given	→	…	✗ いいえ	議論する
Weight-based doses are calculated by hand at the bedside	→	Interruptions during the drug round are constant	✗ いいえ	議論する
Infusion pumps on the ward come from three manufacturers	→	Weight-based doses are calculated by hand at the bedside	✗ いいえ	議論する
Night shift has one nurse for the whole bay	→	Pharmacy reviews charts a day after the first dose was given	✗ いいえ	議論する
Reporting an error has led to disciplinary action in the past	→	Night shift has one nurse for the whole bay	✗ いいえ	議論する
Pharmacy reviews charts a day after the first dose was given	→	Agency staff do not know the ward's conventions	✗ いいえ	議論する
…	→	Agency staff do not know the ward's conventions	✗ いいえ	議論する
Reporting an error has led to disciplinary action in the past	→	Infusion pumps on the ward come from three manufacturers	✗ いいえ	議論する
Weight-based doses are calculated by hand at the bedside	→	Reporting an error has led to disciplinary action in the past	✗ いいえ	議論する
Night shift has one nurse for the whole bay	→	Handwritten charts are still used when the system is down, which is often	✗ いいえ	議論する
Infusion pumps on the ward come from three manufacturers	→	Reporting an error has led to disciplinary action in the past	✗ いいえ	議論する
Weight-based doses are calculated by hand at the bedside	→	Pharmacy reviews charts a day after the first dose was given	✗ いいえ	議論する
Pharmacy reviews charts a day after the first dose was given	→	Reporting an error has led to disciplinary action in the past	✗ いいえ	議論する
…	→	Reporting an error has led to disciplinary action in the past	✗ いいえ	議論する
Interruptions during the drug round are constant	→	Reporting an error has led to disciplinary action in the past	✗ いいえ	議論する
Reporting an error has led to disciplinary action in the past	→	Interruptions during the drug round are constant	✗ いいえ	議論する