Match each clinical scenario to the most accurate patient safety or error classification term.
- A hospital purchasing department switches medication suppliers, resulting in neuromuscular blocker vials that are identical in size and cap color to the hospital's standard insulin vials.Latent error
- A physician prescribes a standard therapeutic dose of enoxaparin. A clinical pharmacist notes the patient's severe renal impairment and correctly reduces the dose prior to dispensing.Near miss
- A physician writes a prescription for 'methotrexate 2.5 mg daily' instead of 'weekly' for rheumatoid arthritis, resulting in the patient developing severe myelosuppression.Active error
- A patient admitted for routine management of a chronic obstructive pulmonary disease exacerbation dies by suicide in the medical-surgical unit bathroom.Sentinel event
Cevap
The look-alike vials represent a Latent error; the intercepted enoxaparin dose is a Near miss; the improper methotrexate prescription is an Active error; and the inpatient suicide is a Sentinel event.
Each clinical scenario corresponds to a distinct categorization within the standard patient safety error taxonomy. Systemic vulnerabilities created away from the point of care are latent errors; mistakes intercepted prior to patient contact are near misses; frontline operator mistakes that reach the patient are active errors; and severe, unexpected harms such as inpatient suicide or wrong-site surgery are sentinel events.
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Anahtar Kavram
Error Classification and Patient Safety Definitions