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Each question has 5 possible answers from which to choose. Only one choice is the most correct answer. Each choice may be accompanied by an explanation.

A 75-year-old man with acute cholangitis secondary to cholelithiasis is admitted to hospital in the evening and scheduled for endoscopic retrograde cholangiopancreatography the following morning. An order for IV antibiotics every 6 hours is made at 20:00 using the computerized provider order entry (CPOE) system. The physician is unaware the computer automatically assigns each order so as to align with regularly timed dosing regimes, in this case, 00:00 the following day. A pharmacist notes the delay, overrides the system, and enters 21:00. However, the computer programs the first dose for 21:00 the following day, and the pharmacist does not notice the date.

The patient does not receive any antibiotics until a full day later.

Which one of the following best explains this adverse event (accident in Québec)?


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