An ambulance was dispatched to attend a 55 year-old patient with heart failure in the community.

An ambulance was dispatched to attend a 55 year-old patient with heart failure in the community. While treating this patient, a paramedic mistakenly pushes 4 milligrams of intravenous norepinephrine instead of the intended lookalike vial of 1 milligram of bumetanide (Bumex®).

The patient immediately develops a supraventricular tachycardia, becomes hypertensive, and deteriorates into ventricular fibrillation. Resuscitative efforts are unsuccessful; the patient is pronounced dead on arrival at the ED.

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• Identify and outline, from a quality systems perspective, the errors made by the paramedic in this clinical scenario
• Analysethe contributing human and system error factors and apply your findings to this case.

• Describe the process and systems actions you would recommend to improve patient safety and prevent a similar error by another paramedic