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Errors During Resuscitation: The Impact of Perceived Authority on Delivery of Care

Nicole Jane Delaloye1, Kathy Tobler2, Thomas O'Neill3

  • 1From the Medical Education Specialization, Departments of Community Health Sciences.

Journal of Patient Safety
|July 4, 2017
PubMed

Insights

Pediatric resuscitation teams often followed incorrect medication orders from superiors, highlighting a critical need for improved communication and challenging behaviors in high-stress medical scenarios. This impacts patient safety.

Area of Science:

  • Medical Education
  • Patient Safety
  • Healthcare Communication

Background:

  • Hierarchical structures in healthcare can impede effective communication.
  • Pediatric resuscitation requires precise adherence to medication protocols.
  • Challenging authority figures, even when incorrect, is difficult for medical teams.

Purpose of the Study:

  • To investigate how perceived authority influences pediatric resuscitation teams' responses to incorrect medical orders.
  • To determine the impact of a senior physician's incorrect order on team actions.
  • To analyze factors contributing to the acceptance of erroneous medical directives.

Main Methods:

  • 48 interprofessional pediatric resuscitation teams participated in a simulated resuscitation scenario.
  • A confederate actor posing as a senior physician issued an incorrect medication order.
  • Video recordings were analyzed using the Advocacy Inquiry Scale and a hierarchical demeanor rating.

Main Results:

  • 50% of teams followed the incorrect medication order.
  • Teams' ability to challenge the order and the physician's demeanor significantly influenced order acceptance.
  • Variations in following incorrect orders were noted across different study sites.

Conclusions:

  • Reluctance to challenge incorrect orders led to significant medication administration errors.
  • The perceived authority and demeanor of superiors strongly correlated with order acceptance.
  • Institutional factors may play a role in the rate of medication errors.
Abstract

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