A 74-Year-Old Man Is Brought to the Emergency Department After

question 382

Multiple Choice

A 74-year-old man is brought to the emergency department after being found unconscious at home.  Emergency medical personnel report that he was in complete heart block when they arrived.  The patient's history is significant for a myocardial infarction 12 years ago, with subsequent congestive heart failure.  He has been admitted to the hospital twice over the past 3 months, once for decompensated heart failure and once for atrial fibrillation with rapid ventricular response.  In reviewing the home medications brought in by his wife, the physician notes that the patient is taking aspirin; dabigatran; furosemide; apixaban; lisinopril; extended-release metoprolol; and atenolol.  The wife reports that he takes these medications regularly and they were all prescribed by his doctors.  He sees a primary care physician and a cardiologist, who work within the same hospital system.  The patient's son, a pharmacist, expresses disappointment  after learning of his father's complete heart block and prescription for 2 different beta blockers and oral anticoagulants.  Which of the following actions would be most helpful in preventing the medical error that led to this patient's outcome from occurring again in the future?

• A)Arrange a meeting between the cardiologist and primary care physician
• B)Discuss the patient's situation with his wife
• C)Hire more pharmacists to oversee discharge planning
• D)Implement electronic prescribing
• E)Perform a root cause analysis

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Definitions:

Deindividuation

Process whereby people lose their sense of socialised individual identity and engage in unsocialised, often antisocial, behaviours.

Social Identity

An individual's sense of who they are based on their group memberships, such as nationality, religion, or social class, which shapes their behaviors and attitudes.

SIDE

The Social Identity model of Deindividuation Effects; a theory explaining how group identity and anonymity can influence behaviors in group settings.

Optimal Distinctiveness

People strive to achieve a balance between conflicting motives for inclusiveness and separateness, expressed in groups as a balance between intragroup differentiation and intragroup homogenisation.