Ch. 4 Health Care Quality & Safety Terms Flashcards
Tall man lettering
the practice of writing part of a drug’s name in upper case letters to help distinguish sound-alike, look-alike drugs from one another in order to avoid medication errors
Main Purpose of Incident Report Involving Client
The main purpose of incident reports is to provide data that can lead to systems improvements. Incident reports are not included in clients’ health records and they are not completed anonymously. The purpose of an incident report is not for the nurse to justify her response to an adverse incident.
Best way to promote client safety
Regular assessment and early detection of changes in the client’s status are critical in preventing adverse outcomes. Informatics and therapeutic relationships are appropriate, and important, aspects of care but frequent assessment is paramount. Assigning the client to an easily accessible room is not a guarantee of frequent assessment.
Who analyzes incident reports?
The hospital’s health and safety committee
Incident reports are primarily used by internal safety review boards. State boards of nursing are not privy to them. They are not submitted to OSHA under most circumstances. The client’s primary care provider would be made aware of the incident, but this person is not the ultimate recipient of the report
Normal Hemoglobin Range
13.8 - 17.2
Use of a Checklist
a useful tool that serves as a prompt, as well as creating accountability for the care that is provided
When should the Joint Commission be informed?
when the situation is an acute threat to safety
When are care bundles generally used?
for more complex and multidimensional aspects of care.
QSEN competency
The QSEN model specifies the integration of best current evidence with clinical expertise, along with client and family preferences and values, for delivery of optimal health care. Researching current practices for prevention of the spread of infection demonstrates this competency. Working with others to provide care demonstrates collaboration of care. The nurse manager holding an in-service demonstrates education of the staff. Use of computer-generated plans for client care demonstrates the use of nursing informatics
Reporting Near Misses
Near misses must be reported so that systems improvements can be made and weaknesses identified. It is not sufficient to address this verbally or in a debriefing session, though these may be supplementary responses. There is no obvious need for the two clients to interact with each other
What would prevent errors and enhance safety when it comes to the administration of drugs?
A major contributor to medication errors is interruptions during the medication administration process
eliminating interruptions to nurses while they are preparing medications
Which action is most likely a violation of Occupational Safety and Health Administration (OSHA) regulations?
Excessive manual lifting is a violation of OSHA regulations
Just Culture
an approach to error evaluation that examines the nature of the error in order to assist in determining the appropriate response to the individual who made the error. Documentation, support, and the needs of the client do not determine whether this action was just
What is the most appropriate response if a nurse notices a change in a dosage of medicine for her patient?
Changes in dosage are common in all health care settings, and do not necessarily signal an error. However, it is the nurse’s responsibility to ensure that a change has in fact been ordered. The health record will include this change, and personal contact with the care provider is not normally necessary.
Which action is most likely to prevent adverse incidents?
Ensure clear, accurate communication between each of the team members.
Evidence suggests that poor communication contributes to approximately 66% of health care errors; the importance of high-quality communication is heightened during an urgent event
What may result in a reduction in reimbursement under the VBP program?
The rate of postoperative complications is significantly higher than national average
Under the value-based purchasing program, CMS may withhold a small percentage of reimbursement to hospitals that do not meet the national standards on key measures and outcomes, such as infection rates and complication rates.
CMS classifies suicide as a “near event” what does this mean for the hospital?
The hospital will have to bear the cost of treating the client’s brain injury.
If “never events” occur while a client is hospitalized, the cost of the care associated with that event will not be paid by CMS, but will be borne by the hospital. However, this does not mean that the hospital will never be reimbursed for the care of other Medicare and Medicaid clients. A “never event” is very rarely a criminal matter, and staff members’ malpractice insurance is not normally nullified by this event.
What requires a check by 2 nurses?
Administration of blood products requires two checks by nurses.
Mass trauma
caused by bombs and other explosives that are used to inflict mass trauma and cause multiple fatalities
Bioterrorism
involves the deliberate spread of pathogenic organisms into the community
Chemical Terrorism
involves the deliberate release of a chemical compound for the purpose of causing mass destruction
Nuclear Terrorism
involves the dispersal of radioactive materials into the environment for the purpose of causing injury and death
What principle should guide the hospital’s waste-reduction efforts?
Much hospital waste is considered a biohazard, but much other waste can be conventionally recycled.
Hospitals are changing their waste management strategies in the knowledge that much waste can be recycled in conventional ways. Biohazards can be easily diverted and disposed of appropriately and separately. Sorting can take place on-site, but recycling takes place off-site.
Which action best promotes environmental sustainability in a hospital setting?
Implementing a system to sort recyclables from waste that contains toxins or body fluids.
In which of these nursing situations would the nurse be likely to implement TeamSTEPPS tools?
informing a client’s physician that the client’s pain is not being adequately treated with the current analgesia orders
phoning a client’s primary care provider to report the client’s steady and unprecedented drop in blood pressure
TeamSTEPPS focuses primarily on communication, especially communication between members of different health disciplines. Medication administration, documentation, and safety planning are not the major focus of TeamSTEPPS
Best example of an at risk behavior
A nurse brings two clients’ medications into their room to save time and makes a drug error
Human error example
Forgetting to do an ordered intervention
Reckless behavior example
Falsifying records to cover up lapses in care is a serious violation
Debriefing
Debriefs typically are held after an event, for example an emergency code. Common issues discussed during a debrief are what went well, what didn’t go well, and what should be done differently next time
** Key word: event **
What skill best demonstrates QSEN?
selecting an appropriate vein and establishing access aseptically
What nursing action best demonstrates the QSEN competencies?
A nurse regularly asks clients and their families about their preferences for care
Patient-centered care is one of the six QSEN competencies. Advanced education and a broad experience base are congruent with high-quality care, but these are not as directly related to the six specific QSEN competencies.
The allergy status of a client who was diagnosed with suspected cellulitis was not documented and the client received a dose of an antibiotic that caused an allergic reaction. Root cause analysis (RCA) is consequently being performed. What goal should the team who is performing RCA prioritize?
identifying processes that may have made it possible for a client to receive a drug without having allergy status documented
RCA focuses on systemic factors that make is possible for errors to occur. This broad perspective supersedes questions of individual responsibility or the relationship to previous events.
Root cause analysis does NOT focus on education
During which of the following nursing activities would a checklist be most appropriate for enhancing client safety?
inserting a client’s indwelling urinary catheter
A standardized checklist can help ensure that all of the necessary elements of a procedure are performed. Addressing a client’s questions is not something that is adaptable to a list. Assisting with client hygiene or performing hand hygiene are not tasks that are sufficiently complex as to require a checklist.
Which of the following is the most likely cause for this increase in funding?
exceeding the safety targets that the CMS specifies
Keyword: exceeding
Endocarditis
An infection of the heart lining
A nurse makes a medication error and fills out an incident report. What will the nurse do with the incident report once it is filled out?
Maintain it according to agency policy.
An unintentional injury incident in a health care agency requires filling out an incident report, a confidential document that objectively describes the circumstances of the event. The incident report is not a part of the medical record and should not be mentioned in the documentation. The report is maintained by the agency.
Root cause analysis would identify an active error in which adverse event?
A nurse drew up 20 units of insulin rather than 2 units by misreading the lines on the syringe
Active errors are most often one-time events that are attributable to an individual’s actions.
Latent errors
errors may be due to equipment design issues, faulty maintenance, or poor organizational structure
The nurse should be most aware of the potential for safety violations when providing what aspect of the client’s care?
Medication administration is known to make up the largest proportion of safety violations in many care settings.
