Patient Safety & Quality Improvement USMLE Step 1 Practice Question
A 45-year-old woman presents to the emergency department with fever (38.9°C), hypotension (88/52 mmHg), tachycardia (118 bpm), and altered mental status. Blood cultures are drawn and broad-spectrum antibiotics are ordered stat. The attending physician selects appropriate empiric coverage based on suspected sepsis source. However, the pharmacy is understaffed due to unexpected call-outs, and the antibiotics are not dispensed until 8 hours after the order is placed. During this interval, the patient's lactate rises from 3.2 to 5.8 mmol/L and she requires vasopressor support. Which type of medical error best characterizes the delay in antibiotic administration?
Answer choices
- AActive error in prescribing, as the physician selected antibiotics without confirming culture results first
- BDiagnostic error, as sepsis was not recognized early enough to warrant urgent intervention
- CLatent error involving system-based factors, as inadequate pharmacy staffing created conditions for delayed drug administrationCorrect answer
- DMedication error in drug selection, as empiric broad-spectrum coverage was not indicated without confirmed organism identification
- EAdverse drug event, as the prolonged interval between order and administration increased cumulative drug toxicity
- FPrescriber incompetence, as the physician should have anticipated pharmacy delays and written orders earlier in the patient's course
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