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LeurLocking the wrong things together (ie_ivf line to ng tube)....

Read a jcaho sentinel events newsletter. talked about errors of hooking the wrong connections together. some of it was unbelieveable!!

some examples it mentioned

IVF hooked to ng tube.

blood pressure machine tubing connected to iv port (as oppsed to the cuff)

ivf to the trach cuff port:eek:

fluids going into foleys,

tube feedings going in IV's

etc, etc etc.

Seriously, the little port that you use to inflate/deflate the cuff on the trach. It's so close to teh trach. how could you hook up fluids to it???

to quote grey's anatomy-

Seriously! that's nuts.

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When I think about the possibility of these things, I don't think of incredibly stupid nurses. What I imagine is that a combination of factors (fatigue, poor pt ratios, rushing, etc) leads to disaster.

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