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TERM 3- Premidterm > L26, L28, L29, L30- Healthcare & Patient Care > Flashcards

L26, L28, L29, L30- Healthcare & Patient Care Flashcards

1
Q

about how many people will be harmed while receiving health care

A

1 in 10: 43 mil worldwide per yr, 8th leading cause of wrongful death in the US

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2
Q

list the common adverse patient effects

A

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

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3
Q

describe common causes of medication errors

A
  • poor handwriting
  • incorrect dosing or route of administration
  • look-alike drugs
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4
Q

describe the prevalence of HAIs

A
  • 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)
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5
Q

what are the three factors that contribute to unsafe care

A
  • structural
  • human
  • process
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6
Q

describe the structural factors that contribute to unsafe care

A
  • lack of structural accountability
  • non-existent safety culture
  • lack of training, education of human resources
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7
Q

describe the human factors that contribute to unsafe care

A
  • communication/teamwork failure
  • errors at transition times
  • stress, fatigue
  • poor working conditions
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8
Q

describe process factors that contribute to unsafe care

A
  • misdiagnosis
  • poor test f/u
  • counterfeit/substandard drugs
  • no teamwork training
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9
Q

list the types of medical errors

A

-slips
-lapses
-mistakes
(-violations)

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10
Q

define slip

A

action not carried out as intended/planned

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11
Q

define lapses

A

missed actions/omissions

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12
Q

define mistakes

A

wrong intended action (faulty plan, incorrect intention)

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13
Q

define violation

A

deliberate action, known to be against the rules (failing to follow proper procedures)
NOT AN ERROR

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14
Q

list the outcomes of errors

A

1) adverse event
2) near-misses
3) sentinel event
( 4) violation)

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15
Q

define adverse event

A

harm/injury resulting directly from management of disease by provider, rather than underlying disease

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16
Q

define near-misses

A

errors that occur, but do not result in injury or harm to Pts b/c caught in time or by luck

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17
Q

define sentinel event

A

adverse event with death or detrimental harm occurs

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18
Q

list the diagnostic errors

A
  • 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
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19
Q

list the common cognitive errors

A
  • 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
20
Q

define safety culture

A
  • environment where everyone can bring up errors freely
  • facilitates error identification
  • data collected for internal and external monitoring
21
Q

differentiate the two types of medical errors in Reason’s ‘swiss cheese’ metaphor

A

Active factors: mistakes, procedural violations –> immediate impact

Latent factors: faulty equipment, lack of training –> accident waiting to occur

22
Q

describe Human Factors (Ergonomic) Design

A
  • Forcing functions: prevent undesirable actions
  • Standardization: improves reliability; guidelines/checklists
  • Simplification: reduce wasteful activities
23
Q

what are the methods of analysis of medical errors

A

1) Root Cause Analysis: retrospective, how did it happen (not whose fault)
2) Failure Mode and Effects Analysis: forward looking approach

24
Q

describe a PDSA

A

Plan-Do-Study-Act Cycle: continuous, on-going, rapid evaluation of safety procedures with incremental changes always occurring

25
Q

define detectable pre-clinical phase (DPCP)

A

time interval between possible detection by screening and later detection after Sxs

26
Q

what is the organization makes the ‘gold standard’ recommendations on screening tests

A

USPSTF (US preventive services task force)

27
Q

list the grades from the USPSTF

A 
A- strongly recommend
B- recommends
C- no recommendation (either way)
D- recommends against
I- insufficient evidence
28
Q

what screenings are performed in infants (usually shortly after birth)

A
  • PKU

- congenital hypothyroidism

29
Q

define vaccine, vaccination, immunization

A
  • Vaccine- biologically derived substance that elicits protective immune response (when administered to susceptible host)
  • Vaccination- administration of vaccine
  • Immunization- development of immunity after vaccination
30
Q

define herd immunity

A

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

31
Q

what are the 4 conditions needed for herd immunity

A
  • disease restricted to humans
  • transmission must be relatively direct (human to human)
  • random-mixing in population
  • infections induce solid immunity
32
Q

active immunity

A

-protection via one’s own immunity
-long-lasting
(immunity via natural infection)

33
Q

passive immunity

A
  • transfer of immunity products from another person / animal to susceptible host
  • temporary protection that wanes over time
34
Q

live attenuated vaccines

A
  • 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
35
Q

define narcotics (give exs)

A
  • chemical agent to relieve acute and chronic pain by binding opioid receptors
  • ex: opiates/opioids
36
Q

anabolic steroids are considered _____ type of drugs

A

psychotropic

37
Q

list licit and illicit drugs

A

Licit (legal): EtOH, cannabis, Rx opioids, tobacco

Illicit (illegal): heroin, cocains, cannabis, amphetamines, Rx opioids/benzos

38
Q

injection drug users are at risk for (1) and (2)

A

1- HIV (10%)

2- Hep C (majority)

39
Q

drug dependence/disease is highest in this group

A

Men, 20-29 y/o

40
Q

list the effects alcohol has on organ systems

A
  • 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
41
Q

what are the 3 categories of risk factors for drug use and addiction

A

-Individual: genetics, sex
-Family: parental supervision / involvement, FHx
-Environmental: peer pressure, access, SES
(NOTE- the same categories with opposite components are protective factors)

42
Q

list the three prevention theories

A
  • Transtheoretical Model (stages of change theory)- continuous measures taken to change behavior
  • Health Belief Model- based on Pt’s personal beliefs
  • Community Organization Theory
43
Q

CRAFFT screening tool

A 
(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
44
Q

list the 3 principals of substance abuse Tx programs

A

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

45
Q

define the 3 Tx approaches for substance use disorder

A
  • Detoxification: acute, 5-21 days
  • Rehab: short-term, 28 days
  • Residential: long-term, 6-24 mos
46
Q

what are the 3 causes for concern in the US health care system

A
  • Outcomes: americans not healthiest among developed nations
  • Access: americans more likely to have unmet health needs
  • Inequalities: significant disparities in access/care
47
Q

list the 4 parts of Medicare

A

A- contributory hospital insurance
B- supplementary medical insurance
C- incentives for managed care
D- optional drug coverage

TERM 3- Premidterm (20 decks)

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