A 72-year-old man is admitted to the hospital with a severe exacerbation of chronic obstructive pulmonary disease. He has a history of moderate Alzheimer dementia and permanent atrial fibrillation. His daughter accompanies him and provides documentation establishing her as his legally appointed healthcare proxy due to his lack of clinical decision-making capacity.
During admission, a resident physician inadvertently prescribes the patient's home warfarin at 10 mg daily instead of the correct 1 mg daily dose. The hospital's electronic health record fails to generate a dose-warning alert. Over the next three days, the patient receives the incorrect dose.
On hospital day 4, the attending physician discovers the prescribing error. The patient's INR is 7.5. He has no evidence of bleeding, and his neurological exam remains at his baseline. Warfarin is withheld, oral vitamin K is administered, and the INR normalizes within 24 hours without any adverse clinical consequences.
The attending physician prepares to address this event. Which of the following is the most appropriate course of action?
- Disclose the dosing error to the patient's daughter, explain the corrective clinical measures taken, and commit to a systemic investigation of the event.Cevap
- BDisclose the medication error exclusively to the patient himself rather than his daughter, as he has not been declared legally incompetent by a court of law.
- CInform the daughter that the supratherapeutic INR was an unavoidable adverse event caused by a pharmacokinetic interaction between warfarin and his acute COPD therapies.
- DApologize to the daughter for administering warfarin, as therapeutic anticoagulation is absolutely contraindicated during the acute phase of a respiratory exacerbation.
- EDisclose the error to the daughter and conclude the root cause analysis by formally documenting the resident's negligence as the sole etiology of the event.