Examkin

Soru

Zorluk: OrtaInterprofessional Teamwork and Conflict Resolution

A 42-year-old man is hospitalized for the treatment of acute myeloid leukemia. He develops a temperature of 39.1°C (102.4°F) and has an absolute neutrophil count of 150/mm³. The covering night-shift hospitalist orders empirical intravenous vancomycin and cefepime. The clinical pharmacist reviews the patient's electronic health record and notes a documented history of severe, IgE-mediated anaphylaxis to all cephalosporins. The pharmacist pages the hospitalist to recommend an alternative antipseudomonal agent. The hospitalist, who is currently managing a cardiac arrest on another floor, answers the call and states, 'I do not have time to review the allergy history right now. The febrile neutropenia protocol requires this regimen, so please verify the order immediately,' and abruptly hangs up. Which of the following is the most appropriate next step for the pharmacist?

  1. Withhold the cephalosporin and immediately escalate the safety concern to the supervising attending physician.Cevap
  2. B
    Dispense the medication as ordered but include a prominent warning label regarding the potential for anaphylaxis.
  3. C
    Verify the ordered regimen to ensure rapid treatment, assuming the hospitalist has weighed the risks.
  4. D
    Delay all empirical antibiotic therapy until the hospitalist is available to discuss alternative agents.
  5. E
    Recommend transferring the patient to the intensive care unit so the medication can be administered under continuous monitoring.

Cevap

The pharmacist should withhold the contraindicated medication and activate the chain of command by escalating the concern to the supervising attending physician.
The correct action is to withhold the medication and escalate the concern. In high-reliability healthcare organizations, any team member has the authority and professional obligation to 'stop the line' if a critical patient safety threat is identified. Because the prescribing physician is dismissive and unavailable for further discussion (due to managing a separate clinical emergency), the pharmacist cannot safely resolve the conflict directly with the prescriber at this moment. The most appropriate action to prevent patient harm, while ensuring the patient eventually receives the correct alternative treatment, is to activate the formal chain of command by contacting the supervising attending physician.

Adım Adım Çözüm

1
Identify the critical safety threat.
The prescribed medication (cefepime) is absolutely contraindicated due to a history of IgE-mediated anaphylaxis.
Administering the medication would cause immediate, severe harm to the patient.
2
Recognize the communication breakdown.
The prescribing physician is cognitively overloaded with an emergency and is unable/unwilling to process the safety warning.
Standard peer-to-peer conflict resolution (like the Two-Challenge Rule) cannot be completed effectively in this immediate context.
3
Apply the appropriate systemic safety framework.
The pharmacist must 'stop the line' and utilize the chain of command to escalate the issue to the attending physician.
Patient safety supersedes hierarchy; when a direct provider cannot correct a critical error, the concern must be escalated upward until resolved.

Anahtar Kavram

Chain of Command and Escalation in Patient Safety
Bu soruyu puanla

Konular

Interprofessional Teamwork and Conflict Resolution

Bu konudan daha fazla soru