Structuration · Why do medication errors keep happening?

LA QUESTION

Why do medication errors keep happening?

L’une influence-t-elle fortement l’autre ? Les trois quarts des votes exprimés décident.

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fermer ✕

Errors are discussed as individual mistakes, not as patterns → influence ? → New nurses are put on drug rounds in their first week

Rien n’a encore été dit.

Phase terminée — l’archive des paires et des votes figure ci-dessus.Vérifier la logique ↗

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