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Block 4 - CritCareSurg > Clin Lab - Patient Safety > Flashcards

Clin Lab - Patient Safety Flashcards

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1
Q

What is the estimated deaths/year are from medical accidents or medical errors?

A

250,000 - 400,000

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2
Q

What is the 3rd leading cause of death for adults?

A

medical accidents or medical error

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3
Q

What are the 1st two causes of death?

A

1st - MI
2nd - stroke

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4
Q

What is included in the statistics of medical accidents/errors?

A

Hospital-based errors
–> doesn’t account for outpatient errors

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5
Q

Types of errors

A
  • Diagnostic
  • Surgical
  • Medications
  • Systems issues
  • Communication issues
    Preventable adverse outcomes - healthcare-associated infections (HAI), falls, pressure ulcers, venous thromboembolism, delirium
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6
Q

What % of dx errors may affect total deaths?

A

10%

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7
Q

What % of dx errors are preventable?

A

20%

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8
Q

What is the leading type of malpractice case?

A

Diagnostic errors

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9
Q

Types of diagnostic errors

A
  • Failure to diagnose
  • Misdiagnosis
  • Delay in diagnosis
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10
Q

What are the big 3 diagnostics that are missed?

A
  • Cancer
  • Vascular events - stroke, MI, dissection
  • Infx
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11
Q

What is more seen in outpt for diagnostic errors?

A

not sending someone for FU & condition worsens

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12
Q

What is more seen in the ER for diagnostic errors?

A

stroke/MI

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13
Q

What are the factors that incr the likelihood of diagnostic error?

A
  • Communication
  • Cognitive shortcuts (“heuristics”)
  • Unlikely presentation
  • External stressors
  • Bias
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14
Q

Examples of Communication factors that incr diagnostic error.

A
  • Between providers
  • Between patient & provider(s)
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15
Q

Examples of Cognitive shortcuts “heuristics” that incr diagnostic errors.

A

Anchoring
Availability bias
Premature closure
Context error

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16
Q

Describe anchoring

A

Hooked on a diagnosis & you have tunnel vision

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17
Q

Describe availability bias

A

Whatever we’ve recently seen we tend to dx other pts w/ those same sx (influenced)

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18
Q

Describe premature closure

A

Don’t make broad differential before considering all possibilities

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19
Q

Describe context error

A

Demographics, hx, social situation

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20
Q

Some studies have shown surgical errors may account for___ of all adverse events. How many pts?

A
  • almost half
  • 1 in 20 pts
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21
Q

Types of surgical errors

A
  • surgery (practice makes perfect)
  • preventable infx
  • injuries
  • wrong procedure
  • retained surgical objects
  • patient awareness during surgery
22
Q

Examples of preventable infxs

A
  • Surg site
  • central line
  • catheter assoc.
23
Q

Examples of surgical error injuries?

A
  • Positional – nerve damage, compartment syndrome, pressure sore
  • Burns – electrocautery
  • Sharp object / puncture
  • Equipment malfunction
24
Q

Describe wrong procedure errors during surg

A

wrong patient, wrong side, wrong nerve block, etc.

25
Q

Prevention of surgical errors:

A
  • Informed consent
  • Checklists
  • Time-out
  • Infx prevention measures – abx, change of gloves/gowns, maintenance of temp/blood glucose levels, etc..
  • Equipment check-outs
  • 2-person checks
  • Structured communication
  • Strict counts
26
Q

of prescription meds

A

10,000

27
Q

of OTC meds

A

300,000

28
Q

Most med errors are in the ___ and ___ of meds?

A

ordering & administration

29
Q

What things can cause medication errors & it’s administration?

A
  • Handwritten prescriptions
  • Sound alike drugs
  • Look-alike drugs / vials
30
Q

What can increase the possibility of systems issues?

A
  • Medical devices
  • working environments
  • EMRs
  • system protocols
31
Q
A
32
Q
A
33
Q
A
34
Q
A
35
Q
A
36
Q

How have Human factor engineering system issues been lessened?

A
  • Usability
  • Standardization (color coding)
  • Forced functions – things happen in a particular way
37
Q

What are the 2 key areas of error dealing w/ transitions in care?

A
  • patient related transitions (pt moves)
  • Provider-related transitions (pt stationary, providers change)
38
Q

Examples of Patient-related transitions (pt moves)

A
  • ER to hospital floor
  • Room to imaging center
  • Surgery OR/PACU to hospital floor
  • Hospital to home or rehab
  • Primary care to specialist consultant
39
Q

Examples of provider-related transitions (pt stationary, providers change)

A
  • Shift change – day/week
  • Specialist weekend coverage
  • Nursing meal breaks
40
Q

Types of Healthcare-assoc. conditions

A
  • Infx
  • Pressure wounds
  • Venous thromboembolism
  • Injuries form preventable falls
  • Adverse effects from meds
41
Q

Examples of healthcare-assoc. infxs

A
  • Catheter assoc. UTI (CAUTI)
  • Central line assoc. bloodstream (CLABSI)
  • Ventilator assoc. pneumonia (VAP)
  • Surgical site infxs
  • C. difficile
  • Multi-drug resistant organisms (MDRO) – MRSA, VRE
42
Q

Ways to prevent HC assoc. infx in surgery

A
  • Surgical prep / wash
  • Prophylactic abx
  • Wound care
43
Q

Ways to prevent HC assoc. - catheter assoc. UTI.

A
  • Reduction in use of catheters
  • Sterile technique
  • Nursing protocols for early removal
44
Q

Ways to prevent HC assoc. - central line assoc. bloodstream infx

A
  • Aseptic technique / hand hygiene
  • US guided insertion
  • Avoid femoral artery
  • Daily antiseptic baths
  • Antiseptic or Abx impregnated dressings
  • Disinfect hub each time prior to accessing
  • Remove ASAP
45
Q

When can pressure wound occur?

A
  • pre-hospitalization
  • during surg
  • during hospitalization
46
Q

Stages of Pressure ulcers.

A

Unstageable - eschar formed
I - skin is unbroken but inflamed
II - skin broken to epidermis or dermis
III - extends to subcutaneous layer
IV - extends to muscle or bone

47
Q

Prevention of pressure wounds

A
  • Frequent repositioning
  • Cushioning
  • Daily skin checks
  • Adequate nutrition
48
Q

Illnesses/conditions assoc. w/ VTE in the hospital

A
  • Infx
  • Stroke
  • Inflammatory dz
  • Malignancy
  • Surgery
49
Q

Prevention of thromboembolism

A
  • Low risk – ambulate, compression pumps
  • Moderate / high risk – meds (Lovenox or heparin [kidneys])
50
Q

Causes of falls

A
  • Patients forget
  • wet floors
  • wires/cords
  • meds - opioids/benzos/anesthesia - lack of glasses
51
Q

Prevention of falls

A
  • Bed alarms
  • fall risk bracelet
  • sign on door
  • make things easily assessable
  • gripper socks
  • camera
  • make sure call button is working
52
Q

List quality improvement processes

A
  • Mandatory reporting & public disclosure
  • Financial consequences
  • System-wide practices
  • Education
  • Monitoring

Block 4 - CritCareSurg (2 decks)

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