Effective Teamwork in Healthcare, Exams of Public Health

Download Effective Teamwork in Healthcare and more Exams Public Health in PDF only on Docsity! PS103, PS104, and PS102 – Reviewer Questions And Answers Which statement best describes a team? a) A group of people who work together b) A group of people who try to accomplish the same goal c) A group of people who work together in a coordinated way, which maximizes each team member's strengths, to achieve a common goal - correct answer c) A group of people who work together in a coordinated way, which maximizes each team member's strengths, to achieve a common goal A team is more than just a group of people who work side by side. A team is a group of people who work together in a coordinated way, which maximizes each team member's strengths, to achieve a common goal. Such a group can anticipate mistakes, overcome obstacles, and navigate difficult situations. When teams communicate poorly in health care, consequences can sometimes include: a) Providing care with incomplete or missing information b) Confusion during transitions in care c) Team members not speaking up about their concerns d) All of the above - correct answer d) All of the above PS103, PS104, and PS102 – Reviewer Questions And Answers A critical element in effective teamwork is communication. Teams that do not communicate well are not truly teams, but merely groups of individuals working side by side. According to The Joint Commission, communication failures between care providers or between care providers and patients and families is consistently the main underlying cause of serious adverse events.1 All of the above choices are some of the potential consequences of poor communication. When health care teams do not communicate effectively, bad things can happen. It's a Tuesday morning, and you and your colleagues are waiting in the OR for the arrival of the surgeon. She is running 30 minutes late. As you prepare for the surgery, you chat with your colleagues about their weekend. The surgeon enters the room and all talking stops. She smiles briefly and walks toward the patient. She turns to the team and says, "I am late, and we have a patient waiting here, people. Let's get moving and get this done." The team is mostly silent during the procedure. The surgeon has loud music playing and indicates she would rather listen to the music than talk with the team. At the close of the surgery, the surgeon says a brief thank you to the team and leaves the OR. PS103, PS104, and PS102 – Reviewer Questions And Answers Mohammed: Mr. Niemeyer in 411, lung cancer with postobstructive pneumonia, oxygen dependent... Sofia: Right. Do you believe the scenario described above is an effective patient hand-over? a) Yes b) No - correct answer b) No The best answer is no. Transitions in care are inherently risky, and ineffective hand-overs can increase the likelihood of error and patient harm. To be effective, a hand-over communication should take place in a quiet area where participants cannot be interrupted. It should involve structured communication techniques. Communication should be two- way and involve active participation from both parties. Effective health care teams have several important characteristics, including: a) The ability to rehearse procedures together, like a choir or a sports team. PS103, PS104, and PS102 – Reviewer Questions And Answers b) Stable membership; that is, they have the same people on the team from day-to-day. c) Effective communication techniques. d) The ability to achieve good results without strong communication. - correct answer c) Effective communication techniques. Effective health care teams have a shared goal and effective two-way communication. The membership of the team may change frequently (Answer B), and it's quite possible for a health care team to consist of people who have never worked together before (Answer A). That makes strong, two-way communication a critical part of delivering safe care. Which of the following is likely to be the most immediate result of building an effective health care team? a) Less costly health care b) Safer care c) Fewer delays in care d) Elimination of waste in the system - correct answer b) Safer care The best answer is that care will be safer. For example, according to The Joint Commission, an estimated 80 percent of serious medical errors PS103, PS104, and PS102 – Reviewer Questions And Answers can be linked to miscommunication between caregivers when patients are transferred or "handed-over." One of the hallmarks of effective health care teams is frequent, two-way communication — a characteristic that would likely have an immediate and positive effect on care transitions and safety. While better teamwork can lead to fewer delays, elimination of waste, and even less costly care, these results would likely be secondary to an increase in safety. As a nurse practitioner in a small, rural urgent care clinic, you believe that your clinic team works well together. Which of the following facts would best support your belief? a) Not a single complaint about unprofessional behavior has been filed by clinic members over the past year. b) The providers work in rotating shifts and rarely need to transmit information from one shift to the next. c) The team routinely takes a moment to discuss the plan and voice concerns before doing a procedure. d) All of the above. - correct answer c) The team routinely takes a moment to discuss the plan and voice concerns before doing a procedure. One of the main characteristics of strong health care teams is effective and frequent communication. The absence of unprofessional behavior (Answer A) does not necessarily mean the team is effective. And the PS103, PS104, and PS102 – Reviewer Questions And Answers see anything that is helpful or see me getting off in the weeds, please speak up." He then went around the room and introduced himself to everyone by his first name. Is the surgeon showing good leadership? a) Yes b) No - correct answer a) Yes By introducing himself, encouraging participation, and valuing everyone's role, the surgeon creates a collaborative, open environment where people can participate and speak up easily. This allows the group to navigate problems, anticipate issues, and respond effectively to the ever-changing dynamics of surgery. A circulating nurse had performed many tasks flawlessly during a very complicated, seven-hour operation, when a surgeon observed a small piece of lint in the patient's belly button as they were closing the incision. Without stopping to think, he wheeled around, pointed at the nurse, and said, "If this patient gets infected, it will be your fault!" The nurse was devastated. Is the surgeon showing good leadership? a) Yes PS103, PS104, and PS102 – Reviewer Questions And Answers b) No - correct answer b) No By criticizing her publicly and blaming her for the piece of lint, the surgeon eradicated any possibility of teamwork with the nurse. Not only will the relationship between the surgeon and the nurse be different in the future, but this nurse will be far less likely to go out of her way to help the surgeon and much less likely to speak up if she sees him getting into trouble. Any other team members witnessing this episode will also be negatively affected by the surgeon's tone and reaction. They, too, will be hesitant to speak up in the future. You are a pharmacy student, and this month you are doing a clinical rotation in a pharmacy located just outside of town. This is a very different experience from working in a hospital pharmacy, and you are enjoying the time immensely. However, you notice that your preceptor (instructor), whom you respect and who has been practicing and teaching for many years, has been losing his train of thought unusually often when talking with patients. And while filling a prescription recently, he grabbed the wrong strength of pills — and then he barked at the pharmacy technician who corrected him. As he begins to fill another order this morning, you see that once again, he seems to be using the wrong pills. Which of the following is a factor that might make it difficult for you to say something to this pharmacist? PS103, PS104, and PS102 – Reviewer Questions And Answers a) You're just a student, and health care is hierarchical by design. b) The pharmacist got annoyed when someon - correct answer d) A and B The best answer is A and B. While challenging authority figures requires courage in any field, the hierarchical nature of health care can make speaking up particularly difficult. This is especially true when senior practitioners get upset with junior staff who voice concerns about safety. Other reasons it may be hard to say something in this case include your respect for the pharmacist, concern that you are mistaken, and fear of being yelled at or mistreated. For learners, there's the additional worry that your evaluations and grades may be affected. However, it is always your place to speak up where safety is concerned, even if you're not certain you're right. You are a pharmacy student, and this month you are doing a clinical rotation in a pharmacy located just outside of town. This is a very different experience from working in a hospital pharmacy, and you are enjoying the time immensely. However, you notice that your preceptor (instructor), whom you respect and who has been practicing and teaching for many years, has been losing his train of thought unusually often when talking with patients. And while filling a prescription recently, he grabbed the wrong strength of pills — and then he barked at the pharmacy technician who corrected him. As he begins to fill PS103, PS104, and PS102 – Reviewer Questions And Answers at the pharmacy technician who corrected him. As he begins to fill another order this morning, you see that once again, he seems to be using the wrong pills. After you speak up, which of the following responses by the pharmacist would best indicate that this pharmacy has a culture of safety? a) "Thanks! I'll tell your supervisor that you helped me today." b) "If you know wha - correct answer a) "Thanks! I'll tell your supervisor that you helped me today." In a culture of safety, all individuals value safety. Those who help prevent errors should be rewarded, not punished or told not to repeat their behavior. If this were an especially strong culture of safety, the pharmacist would also suggest sharing his error with the rest of the staff and changing the system to make medication mix-ups less likely. Answer B is threatening and Answer C is likely to be confusing to the learner. Answer D shows that although this pharmacist may value safety, the rest of the group does not. What is a culture of safety? a) A place where errors never happen b) A place where errors are always caught PS103, PS104, and PS102 – Reviewer Questions And Answers c) A place where all staff can talk freely about safety problems without fear d) A place where all staff feel comfortable reporting errors only if they're guaranteed anonymity - correct answer c) A place where all staff can talk freely about safety problems without fear Humans, even humans using technology, are fallible. In health care, there will always be errors and near-misses. In a culture of safety, however, people feel comfortable discussing errors and are rewarded for their focus on patient safety. Although an anonymous reporting system may be useful, the fact that it needs to be anonymous may indicate that people don't feel comfortable discussing errors openly. A 62-year-old man with a two-week history of fatigue, shortness of breath, and easy bruising is seen at a primary care clinic on a Saturday morning. Lab work drawn the day before shows the patient to be anemic and having abnormalities with white blood cells. The patient is pleasant, but fatigued, and becomes short of breath walking to the exam room. A blood smear shows numerous abnormal white blood cells. The clinic physician tells the patient that something is wrong with his blood and recommends admission to the hospital. The patient agrees, and the physician calls his colleague in the hospital emergency room. The clinic physician makes the following statements. Which part of the statement is the background? PS103, PS104, and PS102 – Reviewer Questions And Answers a) I have Mr. Chan, a 62-year-old man whom I believe has acute myelogenous leukemia. b) Mr. Chan has a two-week history of fatigue, shortness of breath, and easy bruising. He was seen yesterday with lab reve - correct answer b) Mr. Chan has a two-week history of fatigue, shortness of breath, and easy bruising. He was seen yesterday with lab revealing a hematocrit The correct answer is B, in which the speaker shares history that is relevant to the current situation. A 62-year-old man with a two-week history of fatigue, shortness of breath, and easy bruising is seen at a primary care clinic on a Saturday morning. Lab work drawn the day before shows the patient to be anemic and having abnormalities with white blood cells. The patient is pleasant, but fatigued, and becomes short of breath walking to the exam room. A blood smear shows numerous abnormal white blood cells. The clinic physician tells the patient that something is wrong with his blood and recommends admission to the hospital. The patient agrees, and the physician calls his colleague in the hospital emergency room. Clinic Physician, " Mr. Chan has a two-week history of fatigue, shortness of breath, and easy bruising. He was seen yesterday with lab revealing a hematocrit" PS103, PS104, and PS102 – Reviewer Questions And Answers You are a member of an intensive care unit team in a regional hospital. This morning, a patient had an unexpected severe allergic reaction (anaphylaxis) after being given a penicillin derivative. There was a significant delay in getting the physician involved and beginning treatment for this life-threatening condition. Fortunately, the patient is now stable and does not seem to be experiencing any lasting effects. At this point, what would an effective team leader do? a) Report this adverse event in the anonymous reporting system so that it can be investigated b) Ask administrators to launch an investigation immediately to find out who was responsible for this adverse event c) Add this medication to the patient's allergy list d) Conduct a debriefing - correct answer d) Conduct a debriefing Debriefings occur after events to find out what happened and what could be done better next time. The most effective debriefings happen soon after the event, while memories are fresh. However, the first priority is the patient's health - so debriefings should only occur after the patient is stabilized. PS103, PS104, and PS102 – Reviewer Questions And Answers You are a member of an intensive care unit team in a regional hospital. This morning, a patient had an unexpected severe allergic reaction (anaphylaxis) after being given a penicillin derivative. There was a significant delay in getting the physician involved and beginning treatment for this life-threatening condition. Fortunately, the patient is now stable and does not seem to be experiencing any lasting effects. The unit leaders are trying to figure out what changes they should make to prevent this treatment delay from happening again. Given what you know about the incident, what change would you recommend? a) Implement mandatory debriefings after the team works together on a patient. b) Fire the physician who failed to respond in a timely way. c) Stop using nursing assistants in the ICU. d) Implement the use of critical language in the ICU. - correct answer d) Implement the use of critical language in the ICU. Critical language (such as "I need some clarity") is an agreed-upon phrase or set of words that indicates to all members of a patient care team that there is a problem. It helps individuals who need to call attention to a problem but don't know what to say, especially if the patient is awake and listening; and it also serves as a red flag to team members that they need to stop and pay attention. Critical language might have helped the nursing assistant speak up more quickly when he PS103, PS104, and PS102 – Reviewer Questions And Answers observed problems with the patient's breathing. Debriefings, which occur after the event, would be a valuable source of learning, but they would not be sufficient to prevent an event like this one in the future. Effective team leaders: a) Have multiple degrees. b) Are usually physicians. c) Seek input from all members of the team. d) Know the correct answer in any given situation. - correct answer c) Seek input from all members of the team. Effective team leaders are not necessarily the ones with the most training, the most degrees, or the highest salary. And they don't always have all the answers. They do, however, seek feedback from all team members, recognizing that one person can't provide safe care alone. In Margaret's case, Peter, Amy, Jorge, and Teddy came to work planning to do a good job. They didn't intend for Margaret to die, and neither did anyone else in the hospital. Each of these individuals was known as a smart, well-trained person. But somehow, things went horribly wrong. PS103, PS104, and PS102 – Reviewer Questions And Answers his pocket when his supervising attending isn't looking. He takes them home for his own use. Later, his roommate finds him passed out and not breathing on the couch in their apartment. Would an RCA be useful in this case? a) Yes b) No - correct answer b) No No. An RCA is not appropriate in cases of negligence or willful harm. These cases are better investigated by the police. This case is an example of criminal activity (stealing controlled substances) and gross professional misconduct (illegal drug use). While an RCA might be helpful to improve the way that medications are kept secure, the overall situation is one best left to the authorities. It is important to note that an error is rarely the result of criminal activity. Dr. Jones is having a very busy day in the internal medicine clinic. The printer that he uses to print computerized prescriptions for his patients is out of ink. He is already running 45 minutes behind but is trying to take good care of Mr. Diaz, who has hypertension and diabetes. Dr. Jones quickly hand-writes a prescription for an antihypertensive and gives it to Mr. Diaz. The pharmacy misreads the prescription and PS103, PS104, and PS102 – Reviewer Questions And Answers dispenses a dose 10 times greater than Dr. Jones intended. Later that evening, Mr. Diaz gets dizzy and falls down the stairs. Would an RCA be useful in this case? a) Yes b) No - correct answer a) Yes Yes. This case is a series of small steps that led to an unfortunate and unintended event. Dr. Jones wanted to provide good medical care for Mr. Diaz. The pharmacist wanted to make sure that Mr. Diaz got his medicine. Mr. Diaz wanted to stay healthy, so he took his pills as prescribed, but somehow he ended up injured instead. This would be a good situation for a root cause analysis. Firing Dr. Jones or blaming Mr. Diaz won't prevent this mistake from happening again. An RCA could help prevent falls in the future. In Margaret's case, Peter, Amy, Jorge, and Teddy came to work planning to do a good job. They didn't intend for Margaret to die, and neither did anyone else in the hospital. Each of these individuals was known as a smart, well-trained person. But somehow, things went horribly wrong. Would an RCA be useful in this case? a) Yes PS103, PS104, and PS102 – Reviewer Questions And Answers b) No - correct answer a) Yes Yes. In this case, a tragic event happened even though everyone involved in Margaret's care was trying to do the right thing. In this situation, a series of factors contributed to Margaret's death. Consequently, a retrospective, systematic analysis of the event would be warranted to help identify the causes that could be addressed. Root cause analyses can be useful in health care because: a) They help to assign blame. b) They help to identify system failures that can be corrected. c) They are often quick and simple to perform. - correct answer b) They help to identify system failures that can be corrected. Root cause analyses are systematic approaches to understanding an error (or a near miss), with the hopes of identifying systems failures that can be addressed. They are not used to assign blame, nor are they necessarily quick. They are retrospective, occurring only after an error has happened. Mr. Reynolds, a 75-year-old man, recently suffered from a wrong-site surgery. His left ankle was operated upon rather than his right ankle. PS103, PS104, and PS102 – Reviewer Questions And Answers d) An administrator needs to develop a balanced budget. - correct answer c) A social worker catches a patient who is falling out of bed. RCAs can be very useful in health care to address both errors as well as near misses, such as the near-fall in answer choice C. Which is an important approach when conducting an RCA? a) Use categories to organize events that led to errors. b) Focus on a single process in order to consider it in depth. c) Consider the costs involved in addressing the problems found during the process. d) Avoid focusing on patterns. - correct answer a) Use categories to organize events that led to errors. In an RCA, we group the events that led to the error (or near miss) into categories, so that the most important and crucial work processes can be addressed. Discerning patterns of this kind is important, as is considering a broad range of processes from which problems might have arisen. Although costs may need to be considered later on, this is not part of an RCA. Quinn is a three-year-old boy with a congenital heart malformation. While recovering in the pediatric intensive care unit after surgical PS103, PS104, and PS102 – Reviewer Questions And Answers correction, he is accidentally given a tenfold dose of heparin. Although he suffers no permanent injuries, the leadership of the hospital rightly decides to conduct a root cause analysis. As they assemble the team, it is crucial that they do the following: a) Include Quinn's parents. b) Put together a team of mostly nurses and physicians. c) Create a team of members who fulfill several roles. d) Include the health care providers involved in Quinn's care. - correct answer c) Create a team of members who fulfill several roles. Root cause analysis teams need to be diverse in order to be able to see as many viewpoints as possible. While patients and families, as well as the providers involved, may be included in the teams, there is by no means consensus about whether to include these individuals. Interprofessional teams are strongly encouraged, but there is no hard- and-fast prescription for which professions should be included or what the balance of the professions should be. Ideally, the team will include people with a strong understanding of the areas and processes involved in the case. What else should the leadership do as they plan for the RCA? a) Wait to conduct the RCA for a period of time, in order to let the emotions surrounding the incident subside. PS103, PS104, and PS102 – Reviewer Questions And Answers b) Make sure that the team conducting the RCA is clear about what they can and cannot review from the records. c) Make sure the team has time and resources to conduct the RCA, including access to advisors when necessary. d) Make sure there is at least one member of the senior leadership on the team. - correct answer c) Make sure the team has time and resources to conduct the RCA, including access to advisors when necessary. Conducting a high-quality RCA takes time and resources, and it is important that leadership makes sure these are both available to the team members. Senior leadership does not need to be on the team itself, and senior leaders may even be an impediment to drawing candid answers out of front-line staff. RCAs should be conducted quickly, before memories fade and attention is turned to newer problems. The team conducting Quinn's RCA begins work. What should their first step be? a) Review the medical literature. b) Review Quinn's medical records and interview providers. c) Develop causal statements using Charles Vincent's framework. d) Review anonymous opinions from providers as to the reasons for this incident, and then construct a list of the most common. - correct answer b) Review Quinn's medical records and interview providers. PS103, PS104, and PS102 – Reviewer Questions And Answers a) Team factors, institutional context, and organizational factors b) Budget, human nature, and organizational factors c) Team factors, human nature, and PDSA cycles d) Psychology, PDSA cycles, and management factors - correct answer a) Team factors, institutional context, and organizational factors In his papers on this topic, Charles Vincent lists seven categories of factors that influence medical practice and error. These include patient characteristics, task factors, individual staff member characteristics, team factors, work environment, organizational and management factors, and institutional context. Prathibha, a 29-year-old woman, is recovering from same-day knee surgery. While in the post-anesthesia care unit (PACU), she unexpectedly goes into acute respiratory failure and requires intubation. Because she is a young, healthy woman with no medical problems and this was a very unexpected outcome, the charge nurse convenes a team to conduct a root cause analysis. Which of the following is an example of the type of causal statement that this team might expect to develop? a) Prathibha hid her diagnosis of asthma, so the team was not aware of her respiratory risks. b) The nurse responsible for Prathibha was unqualified to monitor complex medical patients. PS103, PS104, and PS102 – Reviewer Questions And Answers c) Respiratory compromise can occur in patients with underlying conditions post-operatively. It is unlikely that this outcome could have been prevented. d) The patient was unattended for 30 minutes because the nurse was busy caring for other patients, and this - correct answer d) The patient was unattended for 30 minutes because the nurse was busy caring for other patients, and this contributed to the outcome. RCAs are about identifying systems-based issues that contributed to an error, so that these issues can be corrected. Blame, such as in A and B, is not part of RCAs. Answer C is also incorrect, as there are almost always other factors that contributed to the error. Strong action - correct answer A strong action is likely to eliminate or greatly reduce the likelihood of an event. It uses physical plant or systemic fixes with application of human factors principles. intermediate action - correct answer An intermediate action is likely to control the root cause or vulnerability. It employs human factors principles, but it also relies upon individual action such as a checklist or cognitive aid. weak action - correct answer A weak action by itself is less likely to be effective. It relies on policies, procedures, and individual action. PS103, PS104, and PS102 – Reviewer Questions And Answers Remove unnecessary and dangerous steps from a process. a) Strong b) Intermediate c) Weak - correct answer a) Strong This simplifies the process and thus makes it less prone to error. Train staff in IV pump use. a) Strong b) Intermediate c) Weak - correct answer c) Weak Training, while beneficial, only impacts staff members who participate. People can also forget their training and revert back to old ways of doing things, so as a recommended action, this may be a bit weak. Add more nurses to a unit. a) Strong b) Intermediate c) Weak - correct answer b) Intermediate PS103, PS104, and PS102 – Reviewer Questions And Answers results, so that 99% of patients receive calls within two days of their results. c) Patients need to have their INRs checked more frequently. d) Patients awaiting lab results should be given access to MyChart, a part of the electronic health record that allows them to access their lab results themselves. - correct answer b) Have the phlebotomy lab automatically generate a list of patients all patients who had INRs drawn that day and email them to the nurse, with space to note if the nurse has reached the patient with their results, so that 99% of patients receive calls within two days of their results. Good recommendations contain ideas for improving the system, as well as ideas for measuring that improvement. Answer B has both of these characteristics. A is punitive and not systems-based, and C does not directly address the problem of the lack of follow-up by the clinic. D, although a good idea, does not contain a measurable outcome. The RCA team working on Peter's case develops several recommended actions. Which of the following is likely to have the strongest impact? a) Assign more staff to the job of calling patients with their INR results. b) Post signs reminding the staff to call patients with their INR results. c) Work with the phlebotomy lab to automatically generate the names of all patients who had INRs drawn that day and send them in an email to the nurse responsible for patient follow-up. PS103, PS104, and PS102 – Reviewer Questions And Answers d) Create a policy that specifies that patients with INRs must be called with their results within one week. - correct answer c) Work with the phlebotomy lab to automatically generate the names of all patients who had INRs drawn that day and send them in an email to the nurse responsible for patient follow-up. Actions that are likely to have a strong impact rely on systemic fixes, such as creating a new process where none existed before. A process in which multiple departments work together to identify patients needing a phone call would likely have a strong impact. Posting signs may be a useful cognitive aid with intermediate impact; however, creating a policy or simply giving a job to more people without a clear process is likely to have a weak impact. The RCA team prepares and shares a summary of their work. What should it contain? a) A clear description of what happened, root causes, and recommendations for prevention. Team members and methods should be included. b) A clear description of what happened, root causes, and recommendations for prevention. Estimated costs for implementation should be included. c) A general description of what happened, root causes, and recommendations for prevention. Team members and methods should be included. PS103, PS104, and PS102 – Reviewer Questions And Answers d) A general description of what happened, root causes, and recommendations for prevention. Estimated costs for implementation should be included. - correct answer a) A clear description of what happened, root causes, and recommendations for prevention. Team members and methods should be included. Communicating the findings of an RCA is a crucial step towards improving patient safety. A presentation (or report) should include a clear description of what happened, the root causes of the event, and recommendations for how to prevent the error from occurring again - mirroring the goals of the RCA itself. It should also describe who was on the RCA team and what methods they used to gather and interpret information. With whom should the team share the report? a) All providers in the hospital and the public relations office b) The public relations office c) Practice leadership and the hospital leadership d) Hospital leadership and the public relations office - correct answer c) Practice leadership and the hospital leadership When communicating about the RCA, a final report or presentation to administrators and stakeholders is the minimum. Some of the individuals who should receive the report include organization leadership, department heads of those departments involved in the PS103, PS104, and PS102 – Reviewer Questions And Answers caused him to lose sleep at night and feel fatigue during the day, as well as long work hours, contributed to the incident.3 In this scenario, an illness and fatigue (and possibly boredom) were internal factors that contributed to the error. Can you identify the external factor that contributed to the error in this scenario? - correct answer long work hours were a factor related the individuals' environment that contributed to the error. Karen is a pediatric nurse with more than seven years of experience. She cares for many sick children: Some cases are simple, others complex. Working in this environment, Karen and her colleagues experience emotions ranging from joy to pain. It has been a particularly hectic week for Karen. Not only are three staff nurses out on leave, but the float and per diem nurses brought in to help have little pediatric experience. Earlier in the week, Karen switched shifts with another nurse and worked an evening shift and then the following morning shift. On the final shift for this long week, Karen is on the evening shift again. Karen checks the electrodes taped to the chest of a four-year-old girl. After pulling up the bed sheet and helping the little girl get comfortable, she intends to reconnect the lead into the cord from the heart monitor machine located at the bedside. With the machine connected, the staff PS103, PS104, and PS102 – Reviewer Questions And Answers can monito - correct answer A, B, and D are correct. Karen is tired after her multiple shifts, stressed out and distracted by her daughter's sudden illness, and interrupted by the phone call from her daughter. After the phone call, Karen remembers she needs to reconnect the heart monitor machine. She returns to the bedside and looks down to find a cable hanging near the side of the heart monitor. She grasps the cable with her right hand. In her left hand, she holds the lead connected to the electrodes on the patient's body. This cable terminates in a circular six-point connector used on EKG leads. In order to connect the cable to the monitor, the cable has to be held in the proper orientation. Just as Karen is about to trace the origin of the line in her right hand, Joan, the per diem nurse, sticks her head in the doorway to ask for the telephone number to call to have the bed in the next patient room repaired. Karen looks up. Always willing to help, she explains who to call and what forms need to be filled out. "By the way, the forms are on the intranet. The secretary is gone. I will have to help you print one out." Afte - correct answer The correct answer is C and D. As we have discussed in this lesson, just trying harder and paying closer attention won't mitigate the effects of contributory factors both internal and external — such as fatigue and distraction. Any nurse could have made this same mistake, given the circumstances. To prevent this type of mistake in the future, the organization must design an environment that mitigates the effects of these factors and reduces the likelihood of making a mistake. PS103, PS104, and PS102 – Reviewer 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 - correct answer d) All of the above Human factors is an established science that uses many disciplines to understand how people perform under different circumstances. This engineering discipline deals with the interface of people, equipment, and the environment. 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 - correct answer d) A and C PS103, PS104, and PS102 – Reviewer Questions And Answers 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. - correct answer b) The nurse was prone to error because she was tired. The nurse was most likely fatigued after a double shift, which made her prone to error. We cannot sustain performance by merely trying hard and paying attention, and fatigue can affect performance no matter how hard you try or how excellent your training may be. When you are fatigued, you need processes that help prevent you from making an error, or mitigate the effects of an error if you do make one. Redundancies are needed in which of the following circumstances? Select all that apply a) When a secondary system is needed in the event a first system fails b) Within any process in health care c) Within a situation where a failure in the first step can result in serious harm d) Within processes in which redundancies will not take more time - correct answer Answer: A and C. Although not every process in health care requires a redundancy, it is important to have one when a primary system can fail and such failure would result in harm. PS103, PS104, and PS102 – Reviewer Questions And Answers Karen is a pediatric nurse with more than seven years of experience. She cares for many sick children: some cases are simple, others complex. Working in this environment, Karen and her colleagues experience emotions ranging from joy to pain. It has been a particularly hectic week for Karen. Not only are there three staff nurses out on leave, but the float and per diem nurses brought in to help have little pediatric experience. Earlier in the week, Karen switched shifts with another nurse, and she worked an evening shift and then the following morning shift. On the final shift for this long week, Karen is on the evening shift again. Karen checks the electrodes taped to the chest of a four-year-old girl. After pulling up the bed sheet and helping the little girl get comfortable, she meant to reconnect the lead into the cord from the heart monitor machine located at the bedside. With the machine connected, the staff c - correct answer Answer: A. The connection should be designed so that it is not possible to connect the two different cords. A constraint would have made it difficult to connect but not impossible. A double check could still fail if the individual double-checking made the same mistake. When the risk of failure or harm is high, forcing functions should be used. Promoting teamwork and effective communication may have mitigated this event by: PS103, PS104, and PS102 – Reviewer Questions And Answers a) Ensuring that the off-going nurse communicated with the oncoming nurse about the condition of the pump. b) Providing Karen with additional support or less stressful duties since she was fatigued from the unusual schedule. c) There was no need for additional communication, as the computer on the unit housed all of the information needed to provide safe care. d) a and b - correct answer Answer: D. Teamwork and communication can help improve the accuracy of patient handoffs and also provide support and backup for individuals when they are not functioning at their best. Would a checklist have been useful to lessen the opportunity for error? a) Yes b) No - correct answer Answer: A. A checklist at the nurse handoff would have reminded the nurses to discuss the condition of the pump. 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 - correct answer b) Standardizing how the process is completed PS103, PS104, and PS102 – Reviewer Questions And Answers 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 - correct answer d) Avoiding reliance on memory Checklists, such as the laminated guide, alleviate your reliance on memory to help make sure you perform a given process (which is not automated and relies on you) correctly. There is nothing forcing you to use this checklist, and it isn't simplifying the steps in the process — just helping you remember them. 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 - correct answer a) A forcing function PS103, PS104, and PS102 – Reviewer Questions And Answers Forcing functions make it impossible to skip a task. Just as you cannot put a car into reverse unless your foot is on the brake, you cannot complete this particular admission order in this EHR unless you address the prevention of blood clots. This is not an example of simplification, as it actually adds a step. At the same time, it's not repeating a step, so it's not an example of redundancy.