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Danger in Disruption
Fontaine DK. AHRQ WebM&M [serial online]. October 2009.
A toddler admitted for severe dehydration requires a femoral IV. The anesthesiologist ignores a nurse's reminder that hospital policy requires monitoring if a child is to receive sedation in the unit. When the nurse attempts to stop the procedure, the anesthesiologist throws the needle to the floor.
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Resource Type
Commentary
Setting of Care
Hospitals
Target Audience
Health Care Providers
Health Care Executives and Administrators
Organizational Behaviorists
Clinical Area
Anesthesiology
Gastroenterology
Pediatric Gastroenterology
Nursing
Safety Target
Medication Safety
Nonsurgical Procedural Complications
Psychological and Social Complications
Approach to Improving Safety
Communication between Providers
Teamwork