L26, L28, L29, L30- Healthcare & Patient Care Flashcards
about how many people will be harmed while receiving health care
1 in 10: 43 mil worldwide per yr, 8th leading cause of wrongful death in the US
list the common adverse patient effects
1) medication errors
2) HAIs (hospital acquired infections)
3) pt falls in hospital (1/3 of Pts > 65)
4) unplanned readmission
5) surgical/anesthesia errors
6) unsafe injection practices
7) unsafe blood products
describe common causes of medication errors
- poor handwriting
- incorrect dosing or route of administration
- look-alike drugs
describe the prevalence of HAIs
- 5-15% of all hospitalized Pts
- 40% ICU Pts
- 40% catheter Pts (UTIs)
- 70% central line Pts (blood infection)
- HAP (hospital acquired pneumonia)- 2nd most common nosocomial infection
- SSI (surgical site infection)
what are the three factors that contribute to unsafe care
- structural
- human
- process
describe the structural factors that contribute to unsafe care
- lack of structural accountability
- non-existent safety culture
- lack of training, education of human resources
describe the human factors that contribute to unsafe care
- communication/teamwork failure
- errors at transition times
- stress, fatigue
- poor working conditions
describe process factors that contribute to unsafe care
- misdiagnosis
- poor test f/u
- counterfeit/substandard drugs
- no teamwork training
list the types of medical errors
-slips
-lapses
-mistakes
(-violations)
define slip
action not carried out as intended/planned
define lapses
missed actions/omissions
define mistakes
wrong intended action (faulty plan, incorrect intention)
define violation
deliberate action, known to be against the rules (failing to follow proper procedures)
NOT AN ERROR
list the outcomes of errors
1) adverse event
2) near-misses
3) sentinel event
( 4) violation)
define adverse event
harm/injury resulting directly from management of disease by provider, rather than underlying disease
define near-misses
errors that occur, but do not result in injury or harm to Pts b/c caught in time or by luck
define sentinel event
adverse event with death or detrimental harm occurs
list the diagnostic errors
- No-fault: happens when there are masked or unusual Sxs of disease, or if Pt is not fully cooperative
- Systems-related: technical/equipment failure, organizational flaws
- Cognitive errors: wrong, missed, delayed Dx due to clinician error
list the common cognitive errors
- Anchoring bias: wrong Dx due to clinician holding onto particular Dx (dismisses other Sxs pointing to alt. Dx)
- Confirmation bias: evidence to support pre-conceived opinion rather than evidence that refutes (or greater support to other Dx)
- Availability bias: assuming Dx based on recent Pt encounters or memorable cases
define safety culture
- environment where everyone can bring up errors freely
- facilitates error identification
- data collected for internal and external monitoring
differentiate the two types of medical errors in Reason’s ‘swiss cheese’ metaphor
Active factors: mistakes, procedural violations –> immediate impact
Latent factors: faulty equipment, lack of training –> accident waiting to occur
describe Human Factors (Ergonomic) Design
- Forcing functions: prevent undesirable actions
- Standardization: improves reliability; guidelines/checklists
- Simplification: reduce wasteful activities
what are the methods of analysis of medical errors
1) Root Cause Analysis: retrospective, how did it happen (not whose fault)
2) Failure Mode and Effects Analysis: forward looking approach
describe a PDSA
Plan-Do-Study-Act Cycle: continuous, on-going, rapid evaluation of safety procedures with incremental changes always occurring
define detectable pre-clinical phase (DPCP)
time interval between possible detection by screening and later detection after Sxs
what is the organization makes the ‘gold standard’ recommendations on screening tests
USPSTF (US preventive services task force)
list the grades from the USPSTF
A- strongly recommend B- recommends C- no recommendation (either way) D- recommends against I- insufficient evidence
what screenings are performed in infants (usually shortly after birth)
- PKU
- congenital hypothyroidism
define vaccine, vaccination, immunization
- Vaccine- biologically derived substance that elicits protective immune response (when administered to susceptible host)
- Vaccination- administration of vaccine
- Immunization- development of immunity after vaccination
define herd immunity
if a large percentage of population is immune (via vaccination) then entire population is protected
-i.e. measles has 94% immunity, enough to interrupt chain of transmission
what are the 4 conditions needed for herd immunity
- disease restricted to humans
- transmission must be relatively direct (human to human)
- random-mixing in population
- infections induce solid immunity
active immunity
-protection via one’s own immunity
-long-lasting
(immunity via natural infection)
passive immunity
- transfer of immunity products from another person / animal to susceptible host
- temporary protection that wanes over time
live attenuated vaccines
- vaccine with weakened ‘wild’ virus via chemical/physical processing
- produces immune response without clinical disease
- induces cell/humoral mediated immunity
- usually fewer doses needed and lasts longer
define narcotics (give exs)
- chemical agent to relieve acute and chronic pain by binding opioid receptors
- ex: opiates/opioids
anabolic steroids are considered _____ type of drugs
psychotropic
list licit and illicit drugs
Licit (legal): EtOH, cannabis, Rx opioids, tobacco
Illicit (illegal): heroin, cocains, cannabis, amphetamines, Rx opioids/benzos
injection drug users are at risk for (1) and (2)
1- HIV (10%)
2- Hep C (majority)
drug dependence/disease is highest in this group
Men, 20-29 y/o
list the effects alcohol has on organ systems
- CV- arrhythymias, cardiomyopathy
- GI- gastritis, bleeding, hepatitis, fatty liver, cirrhosis
- Neuro- neuropathy, dementia, cerebellar degeneration
- Immune- suppression => inc infections
- NeuroEndo- ED, testicular atrophy, feminization
- GYN- fertility, fetal alcohol syndrome
what are the 3 categories of risk factors for drug use and addiction
-Individual: genetics, sex
-Family: parental supervision / involvement, FHx
-Environmental: peer pressure, access, SES
(NOTE- the same categories with opposite components are protective factors)
list the three prevention theories
- Transtheoretical Model (stages of change theory)- continuous measures taken to change behavior
- Health Belief Model- based on Pt’s personal beliefs
- Community Organization Theory
CRAFFT screening tool
(everyone < 21 y/o) C- car with high driver R- drug use to relax A- drug use alone F- forget things while using drugs F- family/friends tell you to cut back T- trouble due to use
list the 3 principals of substance abuse Tx programs
1) adverse physical Sxs must be minimal
2) motivation to give up use > motivation to continue use
3) avoid places, activities, situations associated with substance use
define the 3 Tx approaches for substance use disorder
- Detoxification: acute, 5-21 days
- Rehab: short-term, 28 days
- Residential: long-term, 6-24 mos
what are the 3 causes for concern in the US health care system
- Outcomes: americans not healthiest among developed nations
- Access: americans more likely to have unmet health needs
- Inequalities: significant disparities in access/care
list the 4 parts of Medicare
A- contributory hospital insurance
B- supplementary medical insurance
C- incentives for managed care
D- optional drug coverage
