The “sharp end” individuals refers to those who come into contact with the patients.

How to respond to this? 

The “sharp end” individuals refers to those who come into contact with the patients. They are the ones actually doing the task such as the nurses administering medications. The errors and violations committed by the “sharp end individuals are possibly not checking the labels against the orders transcribed for the patient before administration. Prior to the administration of medications, the nurse must check and validate the medication order, and also apply their critical thinking skills to the ordered medication and the status and condition of the patient in respect to the contraindications, pertinent lab results, pertinent data like vital signs, etc. This could’ve helped them catch the oxygen-nitrogen discrepancy. The “blunt end” refers to the many layers of the health care system that is not in direct contact with patients. These are decisions made away from the bedside that impact care. In this case, the nursing home’s supplier, BOC Gases, are considered the “blunt end” individuals. The errors and violations committed by them are possibly not properly checking and verifying the order. The case mentions that the supplier delivered one tank of pure nitrogen in addition to three tanks of pure oxygen which had been ordered. To me it seems like an extra tank was delivered – which was the pure nitrogen. No one noticed that 4 tanks were being delivered instead of the 3 ordered? To minimize medication error, staff must be sure to always repeat orders back for accuracy. This is something that the supplier could’ve possibly failed to do. Also, the order should’ve been double checked upon loading the tanks and delivering them to the nursing home. Both tanks likely had the word “pure” on it which is why it’s imperative to check the labels before delivering. I believe there was negligence on both ends – sharp and blunt. Negligence is usually defined by some variation on the theme of failing to have and to use reasonable knowledge, skill and care.