Human Factors in Healthcare: Improving Safety and Efficiency, Exams of Advanced Education

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IHI PS 103 PRACTICE EXAM WITH

COMPLETE QUESTIONS AND ANSWERS

Human factors is the study of: (A) Interactions among humans (B) Interactions between humans and machines (C) Interactions between humans and the environment (D) All of the above - (D) All of the above Which of the following is an example of unconscious processing by the brain? (A) Optical illusions (B) Skipping a step on a checklist to save time (C) Mistaking one drug for another because of look-alike packages (D) A and C - (D) A and C When attempting to decrease the risk of error, it's important to use human factors principles because: (A) If you understand the factors that cause people to make mistakes, you can hire safer providers. (B) If you understand human factors principles, you can ensure your system is perfectly safe. (C) If you understand the factors that affect human performance on critical tasks, you can design a safer system. (D) If you understand human factors principles, you can always justify using the latest technology at the bedside. - C) If you understand the factors that affect human performance on critical tasks, you can design a safer system. You visit the local convenience store looking for a refreshing drink on a pleasant day. You know that you want a new type of cola beverage you've heard advertised on the radio, and reach into the refrigerator for what you think is the caffeine-free version of that cola. After you pay, pop the can, and begin drinking, you find that you purchased the sugar-free version instead (whoops!). What most likely contributed to this error? (A) Look-alike cans/labels (B) The ad on the radio

(C) The cost of the beverage (D) The weather outside - (A) Look-alike cans/labels At the end of a double shift, an experienced nurse with an excellent track record gives a medication to the wrong patient. Based on human factors principles, what would you guess was the biggest contributor to this error? (A) The nurse's training was out-of-date. (B) The nurse was prone to error because she was tired. (C) The nurse had become complacent and stopped trying hard. (D) The nurse deliberately ignored protocol. - (C) The nurse had become complacent and stopped trying hard. Human factors is the study of: (A) All the factors that cause humans to make errors (B) All the factors that make it easier to do work in the right way (C) All the factors that differentiate humans from other species (D) A and B - (B) All the factors that make it easier to do work in the right way Which of the following factors can increase human risk for error? (A) Predisposing mental and physiological states (e.g., fatigue, stress, dehydration, hunger, and boredom) (B) Factors that directly enable decision making (e.g., perception, attention, memory, reasoning, and judgment) (C) Factors that directly enable decision execution (e.g., communication and being able to carry out the intended action) (D) All of the above - (D) All of the above At the end of a double shift, an experienced nurse with an excellent track record gives a medication to the wrong patient. Based on human factors principles, what would you recommend as the best way to prevent the same error from recurring? (A) Ensuring staff training is up-to-date (B) Incentivizing nursing staff to remain vigilant (C) Improving medication administration processes (D) A and B - (C) Improving medication administration processes Which of the following is a basic strategy for minimizing the opportunity for error in a process?

(A) Reducing reliance on technology (B) Standardizing how the process is completed (C) Trying harder to perform the process correctly (D) A and C - Which of the following statements about redundancies within processes is always true? (A) They are needlessly inefficient. (B) They remove the opportunity for error. (C) They require two people to do the work of one. (D) None of the above - (D) None of the above Your hospital is implementing an electronic health record (EHR) and is teaching all staff how to use it. As you go through the EHR training, you notice that it takes five clicks to bring up the vital signs for a patient. In the past, when you wanted to see a patient's vital signs, you could simply look at the sheet of paper clipped onto the end of the bed. Which of the following likely needs to be improved about the new process to review vital signs? (A) It needs to be simplified. (B) It needs to be standardized. (C) It needs redundancies added. (D) It needs to avoid reliance on memory. - (A) It needs to be simplified. At the end of your training session on the new EHR, you are handed a two-sided laminated card titled "Quick Start Guide." It provides step-by-step instructions for basic tasks such as entering orders and writing daily notes in the EHR. This is an example of: (A) Using forcing functions and constraints (B) Automating carefully (C) Simplifying (D) Avoiding reliance on memory - (D) Avoiding reliance on memory The first time you admit a patient to the hospital using the new EHR, you see a screen pop up as you are attempting to enter orders. At the top it says, "You must enter orders for DVT (blood clot) prevention before completion of this admission

order set. Click here to complete this order." This pop-up box is an example of the use of: (A) A forcing function (B) Simplification (C) Redundancy (D) A and B - A forcing function Which of the following is a basic strategy for minimizing the opportunity for error in a process? (A) Reducing the number of steps (B) Making it more manual (i.e., less automated) (C) Adding workarounds to the process (D) None of the above - Which of the following is an important reason for checklists in health care? (A) The human brain can only remember approximately 22 pieces of information at once. (B) Completing checklists gives people a sense of accomplishment. (C) Checklists prompt providers to remember and appreciate the importance of tasks. (D) None of the above; checklists should not typically be used because they insult the intelligence of providers and staff. - You're working in an outpatient clinic that recently started using an electronic health record (EHR). You are entering a prescription for an antibiotic into the EHR to treat Mrs. Jones's urinary tract infection. As you enter the order, a warning screen pops up saying that she has chronic kidney disease, and the medication dose should be adjusted based upon her last recorded creatinine level (a measure of kidney function). However, you know that Mrs. Jones's most recent creatinine level — recorded at a different clinic and therefore not available in your EHR — came back normal. When you attempt to move past the warning, the system will not allow you to proceed. Which of the following concepts does this scenario demonstrate? (A) Technology can introduce unintended problems. (B) Technology should facilitate how you do your work, not dictate it. (C) Human beings must still be very present when interacting with technology to ensure its proper and effective use.

(D) All of the above - (D) All of the above Which of the following statements about computerized prescriber order entry systems (CPOEs) is true? (A) Several studies have disputed the claim that they reduce errors. (B) They eliminate the possibility for error by eliminating the reliance on human memory. (C) They typically interfere with workflow while providing few benefits. (D) A and C - (A) Several studies have disputed the claim that they reduce errors. Which of the following is the best example of using technology to improve safety and prevent errors? (A) Providing inpatients with electronic tablets so that they can keep in better touch with the outside world (B) Giving nursing assistants electronic tablets to ensure there's no delay in recording patients' vital signs (C) Switching to an electronic health record (EHR) platform that is of comparable quality but lower cost (D) Implementing redundancies, in which providers double-check each other's electronic inputs - (B) Giving nursing assistants electronic tablets to ensure there's no delay in recording patients' vital signs Effective ways for addressing defects in the human-technology interface include: (A) Providing in-person user training on using the technology (B) Testing the technology in real-world situations (C) Encouraging users to find workarounds (D) All of the above - (B) Testing the technology in real-world situations You're caring for a patient with diabetes who was admitted to your hospital with an elevated blood glucose level. She is on an insulin pump that is programmed to deliver one unit of insulin per hour through her intravenous (IV) line. How does this technology help make her care safer? (A) The pump eliminates the need for providers to be involved in her care. (B) The pump eliminates the possibility of a medication error. (C) The pump helps automate a complex care process. (D) All of the above - The pump helps automate a complex care process.

Which of the following statements about bar-cording systems is true? (A) They typically offer few benefits and merely promote workarounds. (B) They can completely prevent medication errors. (C) They can help providers keeps track of laboratory specimens, identify medications and medical equipment, and identify patients. (D) B and C - (C) They can help providers keeps track of laboratory specimens, identify medications and medical equipment, and identify patients. Effective ways for addressing defects in the human-technology interface include: (A) Involving the user in the design of the technology (B) Testing the technology under real-life conditions (C) Reducing the cost of the technology (D) A and B - (D) A and B You're working in an outpatient clinic that recently started using an electronic health record (EHR). You are entering a prescription for an antibiotic into the EHR to treat Mrs. Jones's urinary tract infection. As you enter the order, a warning screen pops up saying that she has chronic kidney disease, and the medication dose should be adjusted based upon her last recorded creatinine level (a measure of kidney function). However, you know that Mrs. Jones's most recent creatinine level — recorded at a different clinic and therefore not available in your EHR — came back normal. When you attempt to move past the warning, the system will not allow you to proceed. What does this block best exemplify? (A) How technology can be used to make patient care safer (B) How technology can be used to make care more efficient (C) How technology that dictates your work — rather than facilitates it — can introduce unintended problems (D) A and B - (C) How technology that dictates your work — rather than facilitates it — can introduce unintended problems You're caring for a patient with diabetes who was admitted to your hospital with an elevated blood glucose level. She is on an insulin pump that is programmed to deliver one unit of insulin per hour through her intravenous (IV) line. Which of the following is a risk of this technology? (A) The pump is dictating rather than facilitating your work. (B) The pump could malfunction.

(C) There is no risk associated with the pump. (D) A and B - (B) The pump could malfunction.