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A hospital is using the AHRQ Hospital Survey on Patient Safety Culture. There were 80 employees who responded. Responses to the survey item that states "we have patient safety problems in this unit" were as follows: Response # of Respondents Strongly Agree 16 Agree 32 Neither Agree nor Disagree 12 Disagree 17 Strongly Disagree 3 What is the Percent Positive Score that should be reported for this item? A. 75% B. 60% C, 25% D. 20%- V Answer ¥ -C. 25% To improve culture of safety survey results, an organization should: a) Offer coaching and apply Just Culture principles to leaders in lower performing areas b) Acknowledge and celebrate high performing areas in front of leadership c) Perform root cause analysis on underperforming units to better understand their results d) Identify best practice in high performing units and disseminate to other settings- V Answer ¥ -d) Identify best practice in high performing units and disseminate to other settings The human resource department asked the patient safety specialist for recommendations on new policies to help support safety culture. The recommendation that best promotes a culture of safety is: a) Sending human resources all event data so they can record involyement in adverse events in personnel files b) Including human resources in all root cause analyses so they can provide guidance on recommended training updates for staff c) Implementation of routine use of a tool to determine which events are attributed to human error, at risk behavior, and reckless behavior d)} Implementation of routine use of a tool to determine which events are attributed to human error, at risk behavior, and reckless behavior and consult with human resources on risk and reckless behavior cases- ¥ Answer ¥ -d} Implementation of routine use of a tool to determine which events are attributed to human error, at risk behavior, and reckless behavior and consult with human resources on risk and reckless behavior cases 4. In which of the following activities would a patient safety specialist engage to promote a culture of safety? a) Review annual data on defects and successes b) Instruct team members to act in a safe and respectful manner c) Apply best evidence with the goal of failure free operation over time d) Focus on a list of projects identified by senior stakeholders- Y Answer ¥ -c) Apply best evidence with the goal of failure free operation over time 5. A staff murse administers a high alert medication requiring a double check, per policy, to the incorrect patient and the patient suffers an arrhythmia, When reviewing James Reason’s unsafe acts algorithm, what is a strategy to use prior to holding the nurse personally accountable? a) Have the chief nursing officer interview the nurse b) Hold a root cause analysis c) Perform the substitution test with three other nurses d) Ask other nurses if the staff nurse is trastworthy- / Answer JV -c) Perform the substitution test with three other nurses c) A training on reporting d) Situational awareness training- J Answer ¥ -a) Psychological safety A staff member discovered a medication with an incorrect label. The staff immediately notified the pharmacist, and the correct label was sent prior to medication administration. Then, the staff completed an event report through the organization's reporting tool, Which of the following actions should the unit manager take in response to this event? a) Document the incident in the employee's performance review b) Investigate system failures and recognize the employee for reporting a near miss event c) Notify the director of pharmacy about the pharmacist's error d) No action since the incident did not cause patient harm- Y Answer V -b) Investigate system failures and recognize the employee for reporting a near miss event . The graph shows the teamwork climate results from the Safety Attitudes Questionnaire (SAQ) for your organization, Your response would be to: a) Initiate teamwork development in all the departments below the 50th percentile b) Initiate teamwork development in all the departments below the 25th percentile c) Do nothing, more than 75% of departments scored above the desired threshold of 60% d)} Consider the other domains of the survey before defining actions- ¥ Answer ¥ -d) Consider the other domains of the survey before defining actions You are educating clinical managers in your healthcare facility on how to identify appropriate events for conducting a root cause analysis (RCA). Which event provides the best opportunity for an RCA? a) A post-operative patient removes his own IV causing a skin tear from the tape b) A patient with no known allergies experiences an anaphylactic reaction to an antibiotic requiring transfer to TCU c) The biopsy samples from a colonoscopy are never received by pathology after the procedure d) There have been 3 occurrences of depressed respirations in the same department in the last four months related to sedation- Y Answer ¥ -c) The biopsy samples from a colonoscopy are never received. by pathology after the procedure The instrument count is incorrect at the conclusion of a surgical procedure. The hospital policy does not stipulate that the surgeon remain on the premises until an x-ray is obtained. The surgeon leaves the hospital to catch a flight. The x-ray reveals a retained instrument, Another surgeon is contacted to remove the retained instrument, What should leadership do next? a) Create a process map of how instruments are managed during surgery looking for latent flaws b) Revise the hospital policy to make it clear that surgeons must stay in the OR until instrument count issues are resolved. c) Counsel the surgeon about customary clinical standards for a surgeon using appropriate accountability system d)} Reeducate the OR nursing staff on keeping track of instruments on the sterile field- V Answer V -c) Counsel the surgeon about customary clinical standards for a surgeon using appropriate accountability system A nurse on a medical-surgical unit does not comply with barcode medication administration (BCMA) while caring for one of her patients, What should her supervisor do? a) Ask staff if there are adequate scanners to meet their needs b) Counsel the nurse on the importance of following policy c) Request that the pharmacy run a report of the BCMA compliance rates of the unit d) Ask the nurse what was occurring at the time, and why she chose to bypass the policy- / Answer JV -d) Ask the nurse what was occurring at the time, and why she chose to bypass the policy 
