Management and Communication Flashcards
Which of the following terms refers to patient harm that is the
result of treatment by the healthcare system rather than from
the health condition of the patient?
a. Adverse event
b. Dire consequence
c. Unanticipated event
d. Sentinel event
A Adverse event
Rationale: An adverse event is an unintended consequence of healthcare
or services that results in a negative patient outcome (e.g., infection or
physical or psychological injury). Incidents such as patient falls or improper
administration of medications are also considered adverse events even if
there is no permanent effect on the patient.
The antibiogram is usually prepared by:
a. Infection Prevention and Control Department
b. Laboratory
c. Pharmacy
d. Information Technology Department
B Laboratory
Rationale: Many hospital laboratories routinely perform antimicrobial
susceptibility testing on bacterial pathogens. Cumulative susceptibility
testing results are often organized into a summary table, or antibiogram,
which may be used by clinicians, pharmacists, infection control personnel,
and microbiologists as a reference guide to community or hospital-specific
resistance patterns. Antibiograms lend information that can be used to raise
awareness of resistance problems, support the use of optimal empiric therapy,
and identify opportunities to reduce inappropriate antibiotic usage and to
ascertain success of such efforts. Antibiograms are generally prepared by the
laboratory according to the Clinical Laboratory Standards Institute guidelines.
The Safe Medical Device Act (SMDA) falls under which
U.S. federal program?
a. Centers for Disease Control and Prevention (CDC)
b. Food and Drug Administration (FDA)
c. National Institutes of Health (NIH)
d. Agency for Healthcare Research and Quality’s (AHRQ)
B Food and Drug Administration (FDA)
Rationale: The FDA falls within the executive branch of the U.S. government
under the Department of Health and Human Services. The FDA develops,
implements, monitors, and enforces standards for the safety, effectiveness,
and labeling of all drugs and biologics, including food, blood and blood
products, medical and radiological devices, antimicrobial products, and
chemical germicides used in conjunction with medical devices
The Joint Commission standards for infection prevention and
control include all of the following, except:
a. Collaboration of representatives from relevant components
and functions within the organization in the implementation
of the program
b. Effective management of the infection prevention and
control program
c. Minimizing the risk for development of an healthcareassociated
infection (HAI) through an organization-wide
infection prevention program
d. Specific staffing requirement of one infection preventionist
(IP) for every 100 beds in the facility
D Specific staffing requirement of one infection preventionist (IP)
for every 100 beds in the facility
Rationale: The Joint Commission lists five standards for infection prevention
and control, which include minimizing the risk for development of an HAI
through an organization-wide infection prevention program, identification of
risk for the acquisition and transmission of infectious agents on an ongoing
basis, effective management of the infection prevention and control program,
collaboration of representatives from relevant components and functions
within the organization in the implementation of the program, and allocation
of adequate resources to the infection prevention and control programs.
However, there is no specific staffing requirement.
Each year in the United States, what percentage of hospitalized NOTES patients develop HAIs? a. Less than 2 percent b. 4 percent c. 10 percent d. 20 percent
B 4 percent
Rationale: In March 2014, the CDC released new data on healthcare-associated
infection rates in the United States hospitals. According to the Multistate
Point-Prevalence Survey of Health Care-Associated Infections, 1 in 25 patients
(722,000 infections) in the U.S. acquire HAIs each year, and approximately
75,000 patients who have an HAI will die during hospitalization. The report
notes that pneumonia is now the most common HAI in the United States,
accounting for 22 percent of infections. The second most common infections
are surgical site (22 percent), followed by gastrointestinal (17 percent), urinary
tract (13 percent), and bloodstream infections (10 percent). The report also
notes that the top organisms leading to HAIs are Clostridium difficile (12
percent), Staphylococcus (11 percent), Klebsiella (10 percent), Escherichia coli
(9 percent), Enterococcus (9 percent), and Pseudomonas (7 percent).
Human factor limitations that contribute to errors include:
1) Overdependence on multitasking skills
2) Permanent night shifts
3) Limited memory capacity
4) Stress, fatigue, and sensory overload
a. 1, 2, 3
b. 2, 3, 4
c. 1, 3, 4
d. 1, 2, 4
C 1, 3, 4
Rationale: Human factors refer to environmental, organizational and job
factors, and human and individual characteristics, which influence behavior at
work in a way that can affect health and safety. Human factor limitations that
contribute to errors include:
• Limited memory capacity: five to seven pieces of information are typical
for short-term memory
• Negative effects of stress and associated cognitive tunnel vision used
to compensate and focus in highly intense situations
• Negative influence of fatigue and sensory overload
• Overdependence on multitasking skills of staff in complex work
environments
The Institute for Healthcare Improvement uses the Model
for Improvement—a two-part model designed to accelerate
improvement for healthcare processes and outcomes. What
are the key component areas of this model?
1) Setting aims, establishing measures, selecting changes
2) Plan-do-study-act
3) Contemplation, action, termination
4) Perceived seriousness and cues to action
a. 1, 2
b. 2, 3
c. 3, 4
d. 1, 4
A 1, 2
Rationale: The first part of the Model for Improvement includes setting aims
(asking what are we trying to accomplish), establishing measures (how to
know that the change leads to an improvement), and selecting changes that
will make an improvement. The second part of the Model for Improvement
involves testing the selected changes in a plan-do-study-act cycle. Small-scale
testing is followed by refinement and more testing until the changes are ready
to be rolled out on a larger scale.
- Failure mode and effects analysis (FMEA) is used to examine
adverse events and identify what went wrong and what might
prevent it from happening again. Which statement best describes
the mode element of FMEA?
a. The way of operating or using a system or process,
or a way or manner in which a thing is done
b. The results or consequences of an action
c. The detailed examination of the elements or structure of
something—perhaps a process, substance, or situation
d. Lack of success, nonperformance, nonoccurrence, or
breaking down or ceasing to function
A T he way of operating or using a system or process, or a way NOTES
or manner in which a thing is done
Rationale: The FMEA tool is a proactive, preventive approach to identify
potential failures and opportunities for error. The mode is described as the
way of operating or using a system or process, or a way or manner in which
a thing is done. A mode is the way or manner in which something, such as a
failure, can happen. Combining the words “failure” and “mode,” a failure mode
is the manner by which something can fail. A failure mode generally describes
the way the failure occurs and its impact on a process. Any step in a process
can fail, and each failure may have many failure mode
A number of research studies have examined the relationship
between nurse staffing levels and the risk of HAIs in the hospital
setting. Which of the following statements has not been
supported by the literature?
a. Patients in an intensive care unit (ICU) with lower levels
of nurse staffing had an increased risk for ventilatorassociated
pneumonia
b. The use of nonpermanent staff significantly increases
a patient’s infection risk
c. A specific evidence-based nurse staffing level benchmark
has been determined that is associated with decreased
risk for HAI
d. There is a relationship between adequate numbers of
direct care providers (nurses) and the likelihood that
CDC guidelines will be followed
C A specific evidence-based nurse staffing level benchmark has
been determined that is associated with decreased risk for HAI
Rationale: Hospitals with low nurse staffing levels tend to have higher rates of
poor patient outcomes such as pneumonia, shock, cardiac arrest, and urinary
tract infections. Furthermore, a number of researchers have found the level
and/or the use of nonpermanent staff also significantly increases a patient’s
infection risk. Despite these data, determination of a specific evidence-based
nurse staffing level benchmark that is associated with decreased risk for HAI
has not been determined.
The Director of Infection Prevention and Control is leading a
process improvement project to decrease the rates of central
line–associated bloodstream infections (CLABSI) in one of
the hospital’s ICUs. The multidisciplinary team has discussed
multiple process improvement strategies to decrease these
bloodstream infections. In developing the final improvement
plan which of the choices below is most likely to help decrease
the rates of these infections?
a. Performing a gap analysis each month
b. Performing a failure mode effect analysis immediately
c. Incorporating the use of a CLABSI bundle and a checklist
to ensure that all aspects of the plan are followed
d. Perform a strengths, weaknesses, opportunities,
and threats (SWOT) analysis
C Incorporating the use of a CLABSI bundle and a checklist to
ensure that all aspects of the plan are followed
Rationale: Implementing a formalized process reduces errors caused by lack
of information and inconsistent procedures. Checklists and best practice
bundles can promote process improvement and increase patient safety. By
applying checklists to the prevention of infection within an organization
and using simple steps such as washing hands and cleaning the skin with
antiseptic, organizations can eliminate hazards and problems that affect
patients every day. Bundles can create standardized and simplified processes
and procedures, and the checklist provides an organized way to incorporate
best practices.
The Director of Infection Prevention and Control has been asked NOTES
to develop a business plan to potentially expand the scope of
the organization’s infection prevention program. The objective in
developing a business plan for leadership is to:
a. Provide a detailed synopsis of the impact of new services
b. Demonstrate whether the expanded program will be worth
the investment
c. Summarize the infrastructure needs to support an
expanded program
d. Analyze program costs during the past 5 years
B Demonstrate whether the expanded program will be worth
the investment
Rationale: A business plan is a formal statement of a set of business goals,
the reasons they are believed attainable, and the plan for reaching those goals.
Business plans are decision-making tools and cost and revenue estimates are
central to any business plan for deciding the viability of the planned venture.
Which statement about organizational conflict is correct?
a. Conflict resolution should focus on people, not issues
b. Openness and transparency by management leads
to conflict
c. Conflict is a natural process within systems and fosters
a search for alternatives
d. Conflict is an immediate sign of dysfunctional work teams
C Conflict is a natural process within systems and fosters a search
for alternatives
Rationale: Organizational conflict is a state of discord caused by the actual or
perceived opposition of needs, values, and interests between people working
together. Organizational conflict stimulates a search for alternatives and can
represent an opportunity for productive change. Acknowledging the existence
of the conflict and investigating the source of it can lead to creative solutions
The lead IP has proposed using an electronic surveillance system.
Senior leadership at the healthcare organization now wants to
know what the expected return on this investment will be. What
is the IP’s next step?
a. Describe the project cost baseline developed from previous
department budgets
b. Provide a synopsis of the investment and direct and
indirect costs, including factors such as capital expenses,
depreciation, and inflation
c. Project the impact of the surveillance system on hospital
net revenue
d. Calculate the amount of time needed to pay back the
initial costs of the system
B Provide a synopsis of the investment and direct and indirect
costs, including factors such as capital expenses, depreciation,
and inflation
Rationale: Return on investment (ROI) is a financial ratio intended to measure
the benefit obtained from an investment. A high ROI means the investment
gains compare favorably to investment cost. As a performance measure, ROI is
used to evaluate the efficiency of an investment or to compare the efficiency
of a number of different investments.
An IP is updating the organization’s infection prevention plan,
which includes writing clearly stated goals and objectives. Which
of the following statements might she consider including?
a. Vaccinate employees and volunteers for influenza every year
b. Serve as leader for facility safety rounds as needed
c. Achieve a 20 percent improvement in hand hygiene practice
in the Emergency Department within 30 days
d. Collaborate with the laboratory to improve turnaround time
for culture results
C Achieve a 20 percent improvement in hand hygiene practice
in the Emergency Department within 30 days
Rationale: Goals are statements about general aims or purposes that are
broad and long-range intended outcomes and concepts. Specific measurable
objectives, however, describe the desired learning outcomes. Answer C is an
example of a specific, measurable objective and includes a time component
The Infection Prevention Manager observes increasing fatigue and
burnout among the infection prevention team. What should the
manager do first?
a. Contact Human Resources for assistance
b. Gather the team to identify issues and share concerns
c. Initiate a corrective action plan for the group
d. Recommend incentives to increase job satisfaction
B Gather the team to identify issues and share concerns
Rationale: Although some workplace stress is normal, excessive stress can
result in increased absenteeism and turnover rates, as well as decreased
productivity. Workplace stress can, however, be successfully reduced through
organizational and worker-focused interventions. The first step involves
identifying the problems and stressors in the organization. It is critical to
collaborate with the team to identify problems and discuss the opportunities
that exist for improvement and change.
