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Root cause system failure — USMLE Step 3 MCQ

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HardEthics, Patient Safety, Quality Improvement, Systems-Based PracticeRoot cause system failureUSMLE Step 3

A patient receives a drug despite a documented allergy. Review shows the allergy alert was hidden by low-value alerts, medication reconciliation was incomplete, and clinicians assumed someone else had checked. What is the best corrective action?

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Correct answer: C — Redesign alerts for clinical relevance and require reliable allergy reconciliation

The failures are system failures: poorly calibrated alerts, incomplete reconciliation, and ambiguous ownership. Redesigning the alert workflow and reconciliation process is stronger than reminders or shifting blame.

Reference: AHRQ, Patient Safety Primer: Medication Errors: https://psnet.ahrq.gov/primer/medication-errors