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40 of K.
Lesar TS. AHRQ WebM&M [serial online]. November 2003.
An unclear verbal order leads to administration of the wrong drug.
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Resource Type
Commentary
Setting of Care
Hospitals
Target Audience
Health Care Providers
Organizational Behaviorists
Clinical Area
Medicine
Cardiology
Geriatrics
Nursing
Hospital Pharmacy
Safety Target
Discontinuities, Gaps, and Hand-Off Problems
Ordering/Prescribing Errors
Error Types
Noncognitive Errors ("Slips & Lapses")
Approach to Improving Safety
Communication Improvement
Read Back Protocols
Clinical Pharmacist Involvement
Culture of Safety
Automatic drug dispensers
Origin/Sponsor
Agency for Healthcare Research and Quality (AHRQ)