Discontinuity and disaster: gaps and the negotiation of culpability in medication delivery.

Sidney W A Dekker

Commentary

Discontinuity and disaster: gaps and the negotiation of culpability in medication delivery.

December 15, 2011

Dekker SWA. J Law Med Ethics. 2007;35(3):463-70.

View more articles from the same authors.

The author analyzes one Swedish medication error incident that resulted in criminal charges against the nurse involved and discusses how the media contorted the assignment of blame for the failure.

PubMed citation

Available at

Related Resources From the Same Author(s)

A systems approach to analyzing and preventing hospital adverse events.

June 24, 2020

Obstacles to research on the effects of interruptions in healthcare.

September 24, 2016

Benefactor or burden: exploring the professional identity of safety professionals.

October 24, 2018

Intervening in interruptions: what exactly is the risk we are trying to manage?

October 11, 2017

A just culture after Mid Staffordshire.

May 29, 2014

The systems approach to medicine: controversy and misconceptions.

December 9, 2014

Just culture: who gets to draw the line?

October 14, 2009

Laparoscopic bile duct injury: understanding the psychology and heuristics of the error.

February 11, 2009

Criminalization of medical error: who draws the line?

October 6, 2011

Doctors are more dangerous than gun owners: a rejoinder to error counting.

August 23, 2011

Related Resources

Interview

In Conversation with Jessica Behrhorst about The Evolution of Root Cause Analysis

February 26, 2025

Perspective

The Evolution of Root Cause Analysis

February 26, 2025

Interview

In Conversation With...Amy Helwig about Health Plan Patient Safety Initiatives

July 10, 2024

Perspectives on Safety

Health Plan Patient Safety Initiatives

July 10, 2024

Inside the preventable deaths that happened within a prominent transplant center.

June 28, 2023

Conflict of interest, Dr Charles Denham and the Journal of Patient Safety.

December 3, 2014

Interview

In Conversation with…Albert Wu, MD, MPH

May 1, 2011

New patient safety organizations lower roadblocks to medical error reporting.

August 13, 2008

Disruptive clinician behavior: a persistent threat to patient safety.

August 9, 2006

Perspective

Organizational Change in the Face of Highly Public Errors—I. The Dana-Farber Cancer Institute Experience

May 1, 2005

See More About The Topic

Organizational Behaviorists

Policy Makers

Discontinuities, Gaps, and Hand-Off Problems

Medication Safety

Credentialing, Licensure, and Discipline

Discontinuity and disaster: gaps and the negotiation of culpability in medication delivery.

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

Discontinuity and disaster: gaps and the negotiation of culpability in medication delivery.

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

Submit Your Innovations

Continue as a Guest

Continue Logged In

Submit Your Innovations

Continue as a Guest

Continue logged in

New Users to the PSNet site

Submit Your Training

Continue as a Guest

Continue Logged In

Submit Your Training

Continue as a Guest

Continue Logged In

New Users to the PSNet site

Submit Your Toolkit

Continue as a Guest

Continue Logged In

Submit Your Toolkit

Continue as a Guest

Continue Logged In

New Users to the PSNet site

Submit Your WebM&M Case

Continue as a Guest

Continue Logged In

Submit Your WebM&M Case

Continue as a Guest

Already have a PSNet

Account?

New Users