Two Patients with Community-Acquired Pneumonia, Patient a and Patient B

question 1358

Multiple Choice

Two patients with community-acquired pneumonia, Patient A and Patient B, are admitted to the intensive care unit (ICU) of a small community hospital.  Blood cultures are ordered on both patients.  At the start of a 12-hour day shift, an on-call senior resident who is caring for both patients receives notification from the laboratory that Patient A's blood cultures are growing gram-positive cocci in clusters.  The resident enters an electronic order for intravenous vancomycin but mistakenly places the order for Patient B instead of Patient A.  Two days later, Patient B experiences acute kidney injury.  The nephrologist identifies the error, and vancomycin is immediately discontinued.  Which of the following changes would root cause analysis most strongly support to prevent future occurrences of this error?

• A)Increasing didactic training for residents on order entry in the electronic medical record
• B)Increasing time off between shifts and mandating sleep breaks for ICU residents
• C)Instituting daily team-based interprofessional rounds in the ICU
• D)Organizing intern and resident schedules to ensure fewer patient handoffs
• E)Requiring verbal approval by infectious disease specialist before ordering nephrotoxic antibiotics

---

Definitions:

Chromosomes

Rod-shaped structures that are composed of genes and found within the nuclei of cells.

Genes

Units of heredity made up of DNA that act as instructions to make molecules called proteins, crucial for the development, functionality, and regulation of the body's tissues and organs.

Cytosines

One of the four main nucleobases found in DNA and RNA, which pairs with guanine during the nucleic acids' synthesis.

Genes

Genes are units of heredity made up of DNA. They carry the information responsible for the development of organisms.