What is one example of a communication technique providers can use to improve
communication with patients?
A.) SBAR
B.) Teach-back
C.) CUSP
D.) Two-Challenge Rule
Give this one a try later!
, B.) Teach-back
In the context of failure modes and effects analysis (FMEA), how is the risk priority
number (RPN) used?
A.)It calculates the failure modes that will create the most errors.
B.) It specifies the failure modes that have been shown to cause harm.
C.) It identifies the highest priority failure modes to address.
D.) It prioritizes the failure modes that do not require action.
Give this one a try later!
C.) It identifies the highest priority failure modes to address.
The Risk Priority Number (RPN) is a score that provides the team a way to
identify the highest risk failure modes in descending order. If the team does
not have the resources to address all the identified risks, this number can
be used to filter out failure modes that are acceptable in the current
state.In regard to the other answer options: The RPN does not determine
that an action is not required; that determination comes from the team
evaluating the issue at hand, and, to some degree, may be decided based
on time and resources available. The RPN does not identify error potential
or represent harm that has already occurred; it identifies the impact of a
failure mode if it does occur.
Which of the following statements best describes the science of human factors?
A.) It is applied to address problems by modifying the design of the system to better
aid the people in it.
B.) It is about eliminating human error.
C.) It consists of a set of principles that can be learned during training.
D.) It represents the intersection of medicine and engineering.
Give this one a try later!
, A.) It is applied to address problems by modifying the design of the system
to better aid the people in it.
Human factors science can't eliminate errors, but it can be applied to help
modify the design of the system to aid people in performing better, given
their limitations as human beings.
A medication error is self-reported by a nurse to the risk manager. The manager tells
the nurse to complete an incident report. Upon review of the patient safety event, the
manager notices that the nurse overrode a safety check on the barcode scan system.
Further review of the "override" report reveals that several other nurses have also
overridden the system. The risk manager further investigates and finds out that there
was an issue with the printer in registration on that day, which meant that the barcode
scanner could not read the patient ID bracelets.
This is an example of what type of analysis?
A.) Failure mode and effects analysis
B.) Root cause analysis
C.) Event report analysis
D.) Process analysis
Give this one a try later!
B.) Root cause analysis
Correct Answer:Root cause analysis-Root cause analysis is a methodical
investigation of the error/event by continuously asking why until you come
to the actual cause of the error. Failure mode and effects analysis is usually
performed when rolling out something new. Event report analysis is a
description of what happened, not necessarily the cause. Process analysis
looks at how something is done, rather than why something happened.
A hospital's patient safety team is exploring strategies to reduce the number of patient
identification errors in the lab specimen collection process. Which of the following
strategies will provide the highest impact in reduction of errors?
, A.) Educate all nurses and phlebotomists to ask about patient identifiers before
obtaining specimen.
B.) Revise the process to allow only one specimen label on the nurse/phlebotomist
tray at a time.
C.) Standardize the process to require the nurse/phlebotomist to ask the patient to
state their name prior to the specimen collection.
D.) Utilize barcode scanners to generate a specimen label at the bedside.
Give this one a try later!
D.) Utilizing bar code scanners is the correct answer because it entails a
forcing function at the bedside.
After scanning the armband, the correct label for that patient will print from
the scanner.In regard to the other options: Education is always the lowest
impact (soft fix) in any action plan. Changing processes is better but will
still rely on individuals to do the right thing, e.g., the nurse/phlebotomist
would need to make sure multiple labels were not on the tray, which is a
common shortcut to avoid having to walk back and forth between
specimen collections. Direct observation would be required to make sure
people didn't introduce workarounds.
A hospital board wants to know how its safety performance in central line-associated
blood stream infections (CLABSIs) compares to that of other hospitals in their region.
Which data display would best inform them for that decision?
A.) A written report summarizing the current CLABSI prevention protocols of each
hospital in the region
B.) A table showing the number of CLABSI infections in each hospital in the region by
quarter for the past two years
C.) A table indicating the CLABSI infection rates of all hospitals in the region relative
to the National Healthcare Safety Network benchmark for CLABSI infections for the
past two years
D.) Control charts of overall infection rate by quarter for the past two years for each
hospital in the region
Give this one a try later!
communication with patients?
A.) SBAR
B.) Teach-back
C.) CUSP
D.) Two-Challenge Rule
Give this one a try later!
, B.) Teach-back
In the context of failure modes and effects analysis (FMEA), how is the risk priority
number (RPN) used?
A.)It calculates the failure modes that will create the most errors.
B.) It specifies the failure modes that have been shown to cause harm.
C.) It identifies the highest priority failure modes to address.
D.) It prioritizes the failure modes that do not require action.
Give this one a try later!
C.) It identifies the highest priority failure modes to address.
The Risk Priority Number (RPN) is a score that provides the team a way to
identify the highest risk failure modes in descending order. If the team does
not have the resources to address all the identified risks, this number can
be used to filter out failure modes that are acceptable in the current
state.In regard to the other answer options: The RPN does not determine
that an action is not required; that determination comes from the team
evaluating the issue at hand, and, to some degree, may be decided based
on time and resources available. The RPN does not identify error potential
or represent harm that has already occurred; it identifies the impact of a
failure mode if it does occur.
Which of the following statements best describes the science of human factors?
A.) It is applied to address problems by modifying the design of the system to better
aid the people in it.
B.) It is about eliminating human error.
C.) It consists of a set of principles that can be learned during training.
D.) It represents the intersection of medicine and engineering.
Give this one a try later!
, A.) It is applied to address problems by modifying the design of the system
to better aid the people in it.
Human factors science can't eliminate errors, but it can be applied to help
modify the design of the system to aid people in performing better, given
their limitations as human beings.
A medication error is self-reported by a nurse to the risk manager. The manager tells
the nurse to complete an incident report. Upon review of the patient safety event, the
manager notices that the nurse overrode a safety check on the barcode scan system.
Further review of the "override" report reveals that several other nurses have also
overridden the system. The risk manager further investigates and finds out that there
was an issue with the printer in registration on that day, which meant that the barcode
scanner could not read the patient ID bracelets.
This is an example of what type of analysis?
A.) Failure mode and effects analysis
B.) Root cause analysis
C.) Event report analysis
D.) Process analysis
Give this one a try later!
B.) Root cause analysis
Correct Answer:Root cause analysis-Root cause analysis is a methodical
investigation of the error/event by continuously asking why until you come
to the actual cause of the error. Failure mode and effects analysis is usually
performed when rolling out something new. Event report analysis is a
description of what happened, not necessarily the cause. Process analysis
looks at how something is done, rather than why something happened.
A hospital's patient safety team is exploring strategies to reduce the number of patient
identification errors in the lab specimen collection process. Which of the following
strategies will provide the highest impact in reduction of errors?
, A.) Educate all nurses and phlebotomists to ask about patient identifiers before
obtaining specimen.
B.) Revise the process to allow only one specimen label on the nurse/phlebotomist
tray at a time.
C.) Standardize the process to require the nurse/phlebotomist to ask the patient to
state their name prior to the specimen collection.
D.) Utilize barcode scanners to generate a specimen label at the bedside.
Give this one a try later!
D.) Utilizing bar code scanners is the correct answer because it entails a
forcing function at the bedside.
After scanning the armband, the correct label for that patient will print from
the scanner.In regard to the other options: Education is always the lowest
impact (soft fix) in any action plan. Changing processes is better but will
still rely on individuals to do the right thing, e.g., the nurse/phlebotomist
would need to make sure multiple labels were not on the tray, which is a
common shortcut to avoid having to walk back and forth between
specimen collections. Direct observation would be required to make sure
people didn't introduce workarounds.
A hospital board wants to know how its safety performance in central line-associated
blood stream infections (CLABSIs) compares to that of other hospitals in their region.
Which data display would best inform them for that decision?
A.) A written report summarizing the current CLABSI prevention protocols of each
hospital in the region
B.) A table showing the number of CLABSI infections in each hospital in the region by
quarter for the past two years
C.) A table indicating the CLABSI infection rates of all hospitals in the region relative
to the National Healthcare Safety Network benchmark for CLABSI infections for the
past two years
D.) Control charts of overall infection rate by quarter for the past two years for each
hospital in the region
Give this one a try later!
