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You are educating clinical managers in your healthcare facility on how to identify appropriate events for conducting a Root Cause Analysis. Which event provides the best opportunity for an RCA? - a. A post-op patient removes his own TV causing a skin tear from the tape b, A patient with no known allergies experiences an anaphylactic reaction to an antibiotic requiring transfer to ICU, 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 4 months related to sedation 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 instrament. 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 instrament 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 The answer is 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 BCMA compliance rates of the unit d. Ask the nurse what was occurring at the time, and why she chose to bypass the policy The Board of Hospital A wants to know how Hospital A's safety performance in central line associated. blood stream infection (CLABSI) compares to that of other hospitals in their region. Which data display would best inform them for that decision? - a, Control charts of overall infection rate by quarter for the past two years for each hospital in the region b. A table indicating the CLABST infection rates of all hospitals in the region relative to the National Healthcare Safety Network benchmark for CLABST infections for the past 2 years c. A written report summarizing the current CLABSI prevention protocols of each hospital in the region d. A table showing the number of CLABST infections in each hospital in the region by quarter for the past 2 years A new cath lab is under construction in our hospital, and the medical director contacts you to express concerns related to the transport of patients from the cath lab to the ICU, You agree to assist in the design ofan FMEA. Components of the FMEA will include: - a. Assembling a multidisplinary team whose members will brainstorm potential failures b. Conducting the 5 "whys" to figure out what could go wrong c. Listing potential root causes of adverse events in the current cath lab d, Asking the medical director to participate in leadership rounds in the current cath lab to identify potential safety risks A new medication administrative safety process was implemented in a hospital. A team convened to perform a failure mode effects analysis and calculate a risk priority number (RPN). After a targeted medication safety program on the new process was delivered to nurses, the same team convened to perform another FMEA, The team would be happy to see: - a. The detectability increased and RPNs were lower b. The detectability decreased and RPNs were lower c. The frequency numbers decreased and RPNs were higher d, The frequency numbers increased and RPNs were lower Sharing lessons learned from RCA's does what? - a. exposes the fallibility of the involved clinician(s) b. Allows others to introduce work arounds to avoid the same situation c. Allows co-workers to learn the rationale for why an event occurred and incorporate new lessons learned into practice d, Sharing these events allows for exposure from litigation perspective and should not be encouraged Which of the following descriptions best reflects principles of safe system design? - a. Hospital A routinely reviews and updates policies and procedures every 2 years b, Hospital B routinely studies close calls c. Hospital C routinely provides trainings on the use of newly introduced medical equipment d. Hospital D routinely utilizes control charting to report safety performance Which of the following descriptions is true about human factors? - a. human factors science represents the intersection of medicine and engineering b, Human factors science consists of a set of principles that can be learned during training c. Human factors science addresses problems by modifying the design of the system to better aid people The patient safety team reviewed a sample of patients who had been readmitted within 48 hours of discharge and noticed that the patient's discharge medication lists had not been accurately reconciled. The appropriate next steps for the team to take include: - a. Reprimand the discharging provider b, Ask nursing to be responsible for all medication reconciliation c. Gather a team of key stakeholders to flow map the medication reconciliation process d. Gather data on the accuracy and timeliness of medication reconciliation You have been asked to present an overview of safety events to the board of trustees. IN order to best represent safety issues, you should: - a, highlight system-wide improvements that have been implemented in the past year b. Present cases of harm with contributing root causes and actions taken c. display a graph of the numbers and types of safety events reported in the past year d, Lead an open discussion of board members’ safety concerns and recommendations When setting organizational safety priorities, it is best for you to: - a. determine priorities based on pay for performance measurements b. Focus primarily on accreditation standards and requirements c. develop a mechanism to gather input from a variety of sources d, review the current literature to identify areas of concern You are meeting with the CFO to determine return on investment (ROT) for multiple patient safety initiatives, Which project is most likely to receive approval based on the determined ROT: - a. Procurement of new beds with built-in alarms to reduce falls with a 
