Medication Safety Flashcards
What are the error types coresponding to performance
knowledge
rule
skill
what is skill based level
familiar tasks
no conscious thought
What problem occur when there is lack of attentional checks
intention to depart from customary
interruption
delay in carrying out activity
what is a slip
performing the wrong function
what is a lapse
forgetting to perform a certain task
what is the rule based level
familiar task but not yet skilled
conscious decision to follow a series of tasks
what is knowledge based level
unfamiliar task
conscious action carefully thought through
no rules to match it
high concentration level
limited information can be received and interpreted
mistakes
what is the perfection myth
if we try hard enough we will not make any errors
what is the punishment myth
if we punish people when the may errors they will make fewer of them
what is a system
a set of inter related activities or entities with a joint purpose
what are the individual factors in the pharmacy that can cause an issue
tired hungry unfamiliar with task no self check procedure unfamiliar with formulations performance deficit
what are the task factors in the pharmacy that can cause an issue
interruptions
similar drugs adjacenet
drop down lists unavaible protocols
what is a person approach
individuals who make errors are careless at fault reckless
blame and punish
remove individual = improve safety
what is a system approach
poor organizational design sets people up to fail
focus on the individual
change the system = improve safety
