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HI: PS 104: TEAMWORK AND

COMMUNICATION COMPLETE EXAM NEW

UPDATE SOLUTION

Lesson 1 Referring to the video on the previous page, in your opinion, what was the underlying cause of the adverse event?

• The culture of the hospital did not promote safety as the highest priority.
• The surgeon failed to listen to the scrub technician student and the nurses. The charge nurse failed to insist on an X-ray. The scrub technician student and the circulating nurse failed to insist on an X-ray.
• The charge nurse failed to insist on an X-ray. A healthy 45-year-old athlete is scheduled for a knee arthroscopy to clean up her knee so that she can ski better in the coming winter. This is a low-risk, straightforward procedure.The chief of orthopedics will perform the procedure. After two complex and time-consuming procedures, this is his final surgery of the day.Because of a staffing issue, two nurses are pulled from another operating room (OR) to help. They are experienced nurses but have never worked in orthopedics before, and they don't know any of their colleagues.The surgery begins with limited introductions or discussion about the case, and the surgeon has loud music playing. He asks one of the two "new" nurses for 20 mL of local anesthetic with dilute epinephrine to put in the knee. The nurse hears only, "Give me the epi." Not knowing what it is for, she hands him a syringe with 20 mL of concentrated epinephrine, which is 1,000 times too much.As a result, the patient suffers a massive heart attack, a near fatal event. If the team had taken time for a short conversation prior to the procedure, what do you think they could have accomplished?
• Acquainted the team members
• Verified the experience and comfort level of the team members to provide the care

• Identified what drugs were going to be used
• Outlined the plan
• Prevented the adverse event - All of these answers could be correct. There are many factors that increased the risk for error in this example: The surgeon is fatigued, the nurses are unfamiliar with their environment, and the environment is distracting. (See PS 103: Human Factors and Safety for a review of the internal and external factors that contribute to error.) Yet, if the members of the surgical team had taken time before the start of the procedure to acquaint themselves with one another and the procedure and express any concerns, and if the team had communicated effectively during the procedure — reconfirming critical points and functioning as a more cohesive unit — it is likely the same error would not have occurred. A one-minute conversation could have:
• Acquainted the team members.
• Verified the experience and comfort level of the team members to provide the care.
• Identified what drugs were going to be used.
• Outlined the plan. It's perhaps all they needed to mitigate the factors that contributed to this nearly lethal event. Post-Lesson Assessment: PS 104 Lesson 1 Effective health care teams have several important characteristics, including:
• Stable membership; that is, they have the same people on the team from day to day
• Effective communication techniques
• The ability to rehearse procedures together, like a choir or a sports team
• The ability to achieve good results without strong communication - - Effective communication techniques Post-Lesson Assessment: PS 104 Lesson 1

One reason it's critical for caregivers to improve their teams' effectiveness is:

• Ineffective teams can contribute to unsafe events and situations.
• Effective teams limit the number of caregivers patients have to speak with, reducing confusion among patients and families.
• Effective teams rely less on technology and more on human capabilities, thus leading to better care.
• All of the above - - Ineffective teams can contribute to unsafe events and situations. Post-Lesson Assessment: PS 104 Lesson 1 When teams communicate poorly in health care, consequences can sometimes include:
• Providing care with incomplete or missing information
• Team members not speaking up about their concerns
• Appropriate treatments not being considered
• All of the above - - All of the above Post-Lesson Assessment: PS 104 Lesson 1 Which of the following is likely to be the most immediate result of building an effective health care team?
• Safer care
• Elimination of waste in the system
• Fewer delays in care
• Less costly health care - - Safer care Post-Lesson Assessment: PS 104 Lesson 1 One reason it's critical for caregivers to improve their teams' effectiveness is:
• Effective teams reduce the risk of errors by providing a "safety net" for individual caregivers.

• Effective teams limit the number of caregivers patients have to speak with, reducing confusion among patients and families.
• Effective teams rely less on technology and more on human capabilities, thus leading to better care.
• All of the above - Effective teams reduce the risk of errors by providing a "safety net" for individual caregiver Lesson 2: Your Turn: Hospital Admission

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?

• I have Mr. Chan, a 62-year-old man whom I believe has acute myelogenous leukemia.
• Mr. Chan has a two-week history of fatigue, shortness of breath, and easy bruising. He was seen yesterday with lab revealing a hematocrit of 24 and numerous immature white cells in the peripheral smear.
• Mr. Chan needs admission and a hematologic workup.
• I'd like to send Mr. Chan to you. He has agreed to admission and can be there in about 30 minutes. #2 In the question above, does the physician give a complete SBAR through his statements?
• Yes
• No - - Mr. Chan needs admission and a hematologic workup.
• No

Post-Lesson Assessment: PS 104 Lesson 2 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?

• Stop using nursing assistants in the ICU.
• Implement mandatory debriefings after the team works together on a patient.
• Implement the use of critical language in the ICU.
• Fire the physician who failed to respond in a timely way. - Implement the use of critical language in the ICU. Post-Lesson Assessment: PS 104 Lesson 2 In health care, briefings:
• Need to take place as soon after an event as possible, to maximize learning for the entire group.
• Involve only doctors and nurses.
• Are of limited effectiveness
• Are a type of structured communication - Are a type of structured communication. Which of the following actions is essential for closed-loop communication? (A) The sender gives a great deal of detailed information to the receiver, making sure not to leave anything out (B) The receiver responds to all information, even if it is only with an "okay" or "uh-huh," to acknowledge that he has heard the sender (C) The receiver repeats to the sender what he has heard

(D) None of the above is essential. - (C) The receiver repeats to the sender what he has heard. Post-Lesson Assessment: PS 104 Lesson 2 What is "SBAR"? a) A system for delivering information b) A system for identifying areas for improvement c) A system for confirming receipt of information d) A system for assessing patient values - a) A system for delivering information Post-Lesson Assessment: PS 104 Lesson 2 When you arrived at the unit today and listened to the change of shift report, you heard about a patient named Jane W. According to the tape-recorded signout, Jane "is a 57-year-old woman with abdominal pain and vomiting. She has pain medications ordered p.r.n. [as needed]." During your shift, Jane does not request pain medications. Near the end of your shift, however, you get a call from Jane's daughter. Distraught, she asks why nobody is treating her mother's pain. When you explain that Jane has not requested any pain medications, her daughter exclaims, "But she's had a stroke! She can't use the call light! What kind of place are you running over there?" How might the transition between providers ("hand-over") have contributed to this situation?

• You had no opportunity for verbal repeat back.
• The handoff was hard to understand.
• The handoff was too brief and failed to include important information.
• You weren't paying close attention to the information you were being given - The handoff was too brief and failed to include important information. Post-Lesson Assessment: PS 104 Lesson 2 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?

• Apply the two-challenge rule.
• Conduct a debriefing.
• Ask administrators to launch an investigation immediately to find out who was responsible for this adverse event.
• Report this adverse event in the anonymous reporting system so that it can be investigated. - Conduct a debriefing. Post-Lesson Assessment: PS 104 Lesson 2 Linda, a pharmacist at an outpatient pharmacy for a medium-sized medical group, receives a call from John, a nurse practitioner in the cardiology clinic. John tells Linda he needs to call in a new prescription for hydrochlorothiazide at 50 mg once a day for Ms. Krane. At the end of the conversation Linda says to John, "Okay, so you want Ms. Joanne Krane to have a new prescription for hydrochlorothiazide at 50 mg by mouth once a day. Thirty pills and six refills." What has Linda just done?
• Increased the likelihood of error by repeating an order
• Provided a read back
• Used SBAR in communication
• Provided a read back AND used SBAR in communication - Provided a read back Post-Lesson Assessment: PS 104 Lesson 2 SBAR stands for:
• Situation, Background, Assessment, Recommendation
• Situation, Brief, Assessment, React
• Stop, Breathe, Act, Reflect
• Stop, Brief, Alert, React - - Situation, Background, Assessment, Recommendation

Post-Lesson Assessment: PS 104 Lesson 3 According to US studies, approximately what portion of serious adverse events can be linked to miscommunication between caregivers when patients are transferred or handed over?

• 5 percent
• 30 percent
• 50 percent
• 80 percent - - 80 percent Post-Lesson Assessment: PS 104 Lesson 3 Which is the following statements best describes the role of patients in ensuring safety across the continuum of care?
• Patients have the responsibility to ensure their own safety.
• Patients should always use a designated medication manager.
• Patients often need to be able to act out precise recommendations when they leave the health care setting for home.
• All of the above - Patients often need to be able to act out precise recommendations when they leave the health care setting for home. Post-Lesson Assessment: PS 104 Lesson 3 When speaking with a patient who has limited understanding of health care terminology, which of the following words would you likely want to avoid?
• "Adverse"
• "Lipids"
• "Abdomen"
• All of the above - all of the above Post-Lesson Assessment: PS 104 Lesson 3 A patient's primary care provider (PCP) prescribes him a new diuretic because of a change in his insurance. It is intended to replace his previous medication.

However, when he gets home, he is confused and takes both the previous and the new diuretic. He becomes dehydrated and ends up in the hospital. Which of the following process improvements would have been the best option for the PCP to prevent this adverse event?

• Using an electronic medication reconciliation tool
• Using teach-back to confirm patient understanding
• Closing the loop on test results
• Calling the pharmacist to confirm the patient's medication list - - Using teach- back to confirm patient understanding Post-Lesson Assessment: PS 104 Lesson 3 Which of the following is NOT always a key part of the medication reconciliation process?
• Following up with the patient to ensure he or she takes the medication as prescribed
• Collecting the list of the patient's medications and dosing information
• Documenting any changes
• Confirming that the list makes sense - Following up with the patient to ensure he or she takes the medication as prescribed