CPPS IHI PRACTICE EXAM 2026 TEST PAPER
SOLVED RESPONSES
◉ You are educating clinical managers in your health care facility on
how to identify appropriate events for conducting a root cause
analysis (RCA). Which event provides the BEST opportunity for an
RCA?
A. A post-operative patient removes his own IV, 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. In the last four months, there have been three occurrences of
depressed respirations related to sedation in the same department.
Answer: C. The biopsy samples from a colonoscopy are never
received by pathology after the procedure.
Although a one-time event, the missing biopsy samples are the
strongest contender for RCA because the problem may result in very
significant harm (e.g., if there is no option for additional biopsy and
a diagnosis cannot be made) and because the situation clearly
represents deviation from practice standards, in this case related to
chain of custody of a specimen. An RCA would identify the potential
,for this to happen again and define actions to close the gaps in the
management of specimens.
A possible contender for RCA is the fact that there have recently
been three occurrences of depressed respirations related to sedation
in the same department. Although a single event of this type would
probably not trigger RCA because of the inherent risk of invasive
procedures, the pattern of events seems to warrant some kind of
investigation. The group of events need to be analyzed, such as by
peer review, to look for common causes and assess the best course
of action, including whether to proceed with RCA.
◉ At the conclusion of a surgical procedure at your hospital, the
instrument count is incorrect. The hospital policy does not stipulate
that the surgeon must remain on the premises until an x-ray is
obtained to check for retained foreign objects. By the time the x-ray
results come in to reveal that there is, in fact, a retained instrument,
the original surgeon has left the hospital to catch a flight. Another
surgeon is contacted to remove the retained instrument. How should
leadership respond to this event?
A. Re-educate the OR nursing staff on keeping track of instruments
on the sterile field.
B. Revise the hospital policy to make it clear that surgeons must stay
in the operating room (OR) until instrument count issues are
resolved.
C. Using an appropriate accountability system, counsel the surgeon
about customary clinical standards.
,D. Create a process map of how instruments are managed during
surgery, looking for la Answer: C. Using an appropriate
accountability system, counsel the surgeon about customary clinical
standards.
The surgeon made a choice to leave for personal reasons before
receiving confirmation that his patient was safe. In the substitution
test, other surgeons would likely consider it their responsibility to
stay and assure the patient was object-free.Although the policy could
clearly outline that a surgeon must stay until counts are confirmed,
it is unrealistic for leaders to regulate every step of every process
and practice: As health care professionals, surgeons already have a
pre-existing, overarching duty to avoid causing unjustifiable risk or
harm.
In this case, counseling the surgeon likely does not mean pulling his
privileges; it means having a conversation with him about the
inappropriateness of the action he took and the potential impact on
his patient. Sometimes individuals do share the responsibility for a
deviation, and we need to hold professionals accountable for their
portion of a situation even when system factors may also need
improvement.
◉ The human resources department at your organization has asked
your patient safety specialist for recommendations on new policies
to help support safety culture. Which recommendation sounds best?
A. Sending human resources all event data so that they can record
involvement in adverse events in personnel files
, B. Including human resources in all root cause analyses so that they
can provide guidance on recommended training updates for staff
C. Implementing routine use of a tool to determine which events are
attributed to human error, at-risk behavior, and reckless behavior
D. Implementing routine use of a tool to determine which events are
attributed to human error, at-risk behavior, and reckless behavior
AND consulting with human resources on at-risk and reckless
behavior cases Answer: C. Implementing routine use of a tool to
determine which events are attributed to human error, at-risk
behavior, and reckless behavior AND consulting with human
resources on at-risk and reckless behavior cases
The first answer (sending human resources all event data so that
they can record involvement in adverse events in personnel files) is
incorrect because including all events in personnel files regardless
of blame worthiness does not support a just culture.
The second answer (including human resources in all root cause
analyses so that they can provide guidance on recommended
training updates for staff) is interesting but incorrect because
recommendations for staff training could come out of the RCA
process without the involvement of HR.
The third answer (implementing routine use of a tool to determine
which events are attributed to human error, at-risk behavior, and
reckless behavior) is not correct because, while it makes the good
suggestion of using a tool to distinguish among human error, at-risk
behavior, and reckless behavior, it does not address what to do with
that information; human resources should be consulted to help
SOLVED RESPONSES
◉ You are educating clinical managers in your health care facility on
how to identify appropriate events for conducting a root cause
analysis (RCA). Which event provides the BEST opportunity for an
RCA?
A. A post-operative patient removes his own IV, 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. In the last four months, there have been three occurrences of
depressed respirations related to sedation in the same department.
Answer: C. The biopsy samples from a colonoscopy are never
received by pathology after the procedure.
Although a one-time event, the missing biopsy samples are the
strongest contender for RCA because the problem may result in very
significant harm (e.g., if there is no option for additional biopsy and
a diagnosis cannot be made) and because the situation clearly
represents deviation from practice standards, in this case related to
chain of custody of a specimen. An RCA would identify the potential
,for this to happen again and define actions to close the gaps in the
management of specimens.
A possible contender for RCA is the fact that there have recently
been three occurrences of depressed respirations related to sedation
in the same department. Although a single event of this type would
probably not trigger RCA because of the inherent risk of invasive
procedures, the pattern of events seems to warrant some kind of
investigation. The group of events need to be analyzed, such as by
peer review, to look for common causes and assess the best course
of action, including whether to proceed with RCA.
◉ At the conclusion of a surgical procedure at your hospital, the
instrument count is incorrect. The hospital policy does not stipulate
that the surgeon must remain on the premises until an x-ray is
obtained to check for retained foreign objects. By the time the x-ray
results come in to reveal that there is, in fact, a retained instrument,
the original surgeon has left the hospital to catch a flight. Another
surgeon is contacted to remove the retained instrument. How should
leadership respond to this event?
A. Re-educate the OR nursing staff on keeping track of instruments
on the sterile field.
B. Revise the hospital policy to make it clear that surgeons must stay
in the operating room (OR) until instrument count issues are
resolved.
C. Using an appropriate accountability system, counsel the surgeon
about customary clinical standards.
,D. Create a process map of how instruments are managed during
surgery, looking for la Answer: C. Using an appropriate
accountability system, counsel the surgeon about customary clinical
standards.
The surgeon made a choice to leave for personal reasons before
receiving confirmation that his patient was safe. In the substitution
test, other surgeons would likely consider it their responsibility to
stay and assure the patient was object-free.Although the policy could
clearly outline that a surgeon must stay until counts are confirmed,
it is unrealistic for leaders to regulate every step of every process
and practice: As health care professionals, surgeons already have a
pre-existing, overarching duty to avoid causing unjustifiable risk or
harm.
In this case, counseling the surgeon likely does not mean pulling his
privileges; it means having a conversation with him about the
inappropriateness of the action he took and the potential impact on
his patient. Sometimes individuals do share the responsibility for a
deviation, and we need to hold professionals accountable for their
portion of a situation even when system factors may also need
improvement.
◉ The human resources department at your organization has asked
your patient safety specialist for recommendations on new policies
to help support safety culture. Which recommendation sounds best?
A. Sending human resources all event data so that they can record
involvement in adverse events in personnel files
, B. Including human resources in all root cause analyses so that they
can provide guidance on recommended training updates for staff
C. Implementing routine use of a tool to determine which events are
attributed to human error, at-risk behavior, and reckless behavior
D. Implementing routine use of a tool to determine which events are
attributed to human error, at-risk behavior, and reckless behavior
AND consulting with human resources on at-risk and reckless
behavior cases Answer: C. Implementing routine use of a tool to
determine which events are attributed to human error, at-risk
behavior, and reckless behavior AND consulting with human
resources on at-risk and reckless behavior cases
The first answer (sending human resources all event data so that
they can record involvement in adverse events in personnel files) is
incorrect because including all events in personnel files regardless
of blame worthiness does not support a just culture.
The second answer (including human resources in all root cause
analyses so that they can provide guidance on recommended
training updates for staff) is interesting but incorrect because
recommendations for staff training could come out of the RCA
process without the involvement of HR.
The third answer (implementing routine use of a tool to determine
which events are attributed to human error, at-risk behavior, and
reckless behavior) is not correct because, while it makes the good
suggestion of using a tool to distinguish among human error, at-risk
behavior, and reckless behavior, it does not address what to do with
that information; human resources should be consulted to help
