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Richard H. White, MD ; July-August 2005
An intern increases a patient's warfarin dosage nightly based on subtherapeutic INR levels drawn each morning; after several days, the patient develops potentially life-threatening bleeding.
Journal Article > Review
Adverse events associated with sedatives, analgesics, and other drugs that provide patient comfort in the intensive care unit.
Riker RR, Fraser GL. Pharmacotherapy. 2005;25:8S-18S.
This review outlines risks associated with use of sedatives and analgesics in the intensive care unit. The authors provide insights to help clinicians identify and respond sooner to adverse events.
Journal Article > Study
Sexton JB, Thomas EJ, Helmreich RL. BMJ. 2000;320:745-749.
This study describes self-reported perceptions of teamwork among operating room and intensive care unit staff as well as those of an airline cockpit crew. In the medical setting, investigators discovered tremendous variation in teamwork perceptions that followed traditional hierarchies. While surgical attendings and residents rated teamwork high, anesthesiology attendings rated it lower, as did surgical nurses and anesthesia residents in decreasing order. The authors also note that discussing errors seems to be a greater challenge in medicine than in aviation, which may derive from the fact that aviation participants acknowledged that fatigue and stress negatively impact job performance. While the findings draw only from survey results and make no connection to actual errors in practice, they do generate support for a safety culture in medicine similar to that of the aviation field.