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Checklists and the Hierarchy of Effectiveness

In HiQuiPs by Alex ChanLeave a Comment

You are working a particularly busy overnight solo coverage shift when a very sick 4-year old patient with respiratory distress begins desatting requiring urgent intubation. A team is quickly assembled and preparation is completed for the procedure. You begin attempting endotracheal tube insertion but after two failed attempts with direct laryngoscopy you ask for a bougie, and none is delivered. You ask again, and nothing. As you momentarily take your eyes off of …

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Reporting Patient Safety Events in the Emergency Department

In Education & Quality Improvement, HiQuiPs by Alex ChanLeave a Comment

You are a physician caring for a 4-year-old patient in the Emergency Department (ED) presenting with a fever. Before ordering Acetaminophen for the patient, you check the patient’s weight on the emergency record, which you read as 17kg. You then write an order based on this weight. The ED nurse checks the order to see if the medication dose is safe using the hospital medication formulary. After that, the nurse approaches you and …