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Difficulty: EasyInterprofessional Teamwork and Conflict Resolution

A 5-year-old boy is brought to the emergency department with status epilepticus. The attending physician verbally orders an intravenous loading dose of phenytoin. The administering nurse calculates the requested dose based on the patient's weight and realizes it is ten times the recommended maximum, which could be fatal. The nurse politely brings this discrepancy to the physician's attention, but the physician appears distracted by another critically ill patient and quickly replies, 'I know what I am doing, just give the dose I ordered.' Which of the following is the most appropriate immediate next action for the nurse?

  1. Explicitly state the safety concern using standardized communication terminology and refuse to administer the unsafe dose.Answer
  2. B
    Administer the prescribed dose immediately because the patient requires rapid stabilization for an acute neurological emergency.
  3. C
    Assume the physician has diagnosed a refractory condition requiring a massive dose and proceed with the administration.
  4. D
    Transfer the patient to another nurse without detailing the dose conflict in order to maintain unit workflow and avoid further argument.
  5. E
    Leave the bedside to file an immediate mandatory report with the state medical board regarding physician impairment.

Answer

Explicitly state the safety concern using standardized communication terminology and refuse to administer the unsafe dose.
The correct action applies established interprofessional teamwork principles, specifically the Two-Challenge Rule and structured communication tools like CUS (I am Concerned, I am Uncomfortable, this is a Safety issue). When a team member discovers a potential safety event, they have a professional obligation to 'stop the line' and unequivocally state their concern. If the initial concern is ignored, they must challenge the decision a second time and, if necessary, escalate the issue through the clinical chain of command rather than administering a harmful dose.

Step-by-Step Solution

1
Identify the patient safety threat.
A lethal dose of medication has been ordered, and the physician has dismissed the initial correction.
Recognizing an immediate threat to life is the first step in interprofessional conflict resolution.
2
Apply a standardized conflict resolution framework.
The nurse must use a tool like the CUS framework (Concerned, Uncomfortable, Safety) or the Two-Challenge Rule.
Standardized frameworks empower team members to stop the line and overcome hierarchical intimidation to prevent medical errors.

Key Concept

Interprofessional Teamwork and the Two-Challenge Rule / CUS Framework
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Topics

Interprofessional Teamwork and Conflict Resolution

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