Professional issues 3 Flashcards
Which statements represent norms in a culture of safety? (select 2)
a. providers are rewarded for erring on the side of caution even if wrong
b. a steep hierarchy exists so that junior personnel are excluded
c. explicit communication is frequent and ambiguity is challenged
d. workflow efficiency overrides patient safety concerns
a. providers are rewarded for erring on the side of caution even if wrong
c. explicit communication is frequent and ambiguity is challenged
Cultures of blame target
individuals for mistakes
Cultures of safety deal with
how individuals, groups, and systems interact to conduct their work
The element of a culture of safety include
values, beliefs, and norms
The majority of errors in medicine are due to
human error
A _______________ is typically designed for analysis when performance falls below acceptable levels; at this point, provider and systems data are reviewed
quality assurance program
_________________________ programs identify opportunities for improvement
Continuous quality improvement
Continuous quality improvement programs recognize that
errors will occur and focus on the processes involved in both successes and failures
JACHO defines a sentinel event as any
unexpected occurrence involving death or serious physical or psychologic injury or risk thereof
All sentinel events should undergo
root cause analysis
There is ___________________ to disclose medical errors that cause no harm
no duty
Reasons cited for reluctance to disclose errors include
personal shame
fear of loss of prestige among peers
fear of litigation
Medical errors are generally categorized as either:
failure of an action to occur as planned or
having or acting on the wrong plan altogether
What are 5 accepted norms included in a culture of safety?
anyone can raise safety issues
calling for help is encouraged
the hierarchy is flat
explicit communication is frequent
staff is rewarded for erring on the side of caution
Which skill is central to and most essential for effective crisis resources management?
a. communication
b. decision making
c. situation awareness
d. task management
a. communication
Crisis resource management uses a simple model in which _____________ is the “glue” that holds all the other components together
effective communication
Key aspects of crisis resource management include
know the environment
anticipate and plan
call for help early
mobilize all available resources
communicate effectively
prevent and manage fixation errors
cross-check and double-check everything
use cognitive aids
reevaluate repeatedly
use good teamwork
allocate attention wisely
Crisis resource management includes
task management
teamwork
situational awareness
decision making
communication
What proportion of anesthesia mishaps are estimated to occur as a result of human error?
a. 30%
b. 50%
c. 70%
d. 90%
c. 70%
A typical adult needs _________ of sleep daily
7-9 hours
Sleep needs may vary by
light exposure
genetics
disease states
pain
Sleep requirements do not change with
age
Chronic sleep deprivation (5 hours or less of daily sleep) is associated with
obesity
hypertension
diabetes
heart attack
stroke
depression
immune suppression
Working while fatigued poses a serious risk to
patient safety
Fatigue can lead to
diminished reaction time and impaired decision-making
_____________ is an actual sleep episode that lasts seconds to minutes
MIcrosleep
Research has shown that 24-hours of wakefulness is equivalent to a blood alcohol content of
0.1
Extended work hours tend to cause
anxiety
hostility
depression
and are though to contribute to disruptive workplace behaviors
The most common reports of sleeping or sleep-related behavior occur during an anesthetic occur when working
16 or more continuous hours
during the night shift
How does CRNA fatigue put patients at risk?
diminished reaction time
impaired decision making
decreased situational awareness
impaired concentration or memory
periods of microsleep
The MOST effective method of maintaining vigilance during an anesthesia workday is to:
a. ingest caffeinated beverages every 3 hours
b. have a 60 minute workout right before bedtime
c. use a PNS on yourself when sleepy
d. get a consistent 8 hours of sleep each night
d. get a consistent 8 hours of sleep each night
Recommended methods for preventing or mitigating fatigue include
napping
caffeine intake
exercise
recovery time between shifts
consistent sleep-wake pattern
medications
Exercising within ________- of sleep can disrupt sleep
3 hours
FDA approved prescription drugs such as ___________ can aid wakefulness
modafinil
What problems can arise when caffeine is used as a way of fighting fatigue?
excessive caffeine intake can reduce vigilance and prohibit sleep if taken too close to bedtime (within 4-7 hours)
What is the annual OSHA limit for workplace exposure to ionizing radiation in a 38 year old provider?
5 rem
Repeated exposure to ____________ can cause skin or eye irritation, allergic reactions, neurologic signs, or organ toxicity
methyl methacrylate
Anesthesia providers and other OR staff may develop allergic reactions to
volatile agents
muscle relaxants
latex
With the dramatic increase in out-of-OR anesthesia, there has been a parallel increase in radiation exposure from
CT suites, interventional radiology, and cardiac catheterization
Lower frequency electromagnetic fields from MRIs can cause transient symptoms of
nausea, dizziness, vertigo, or light flashes
One of the most significant acute stressors for an anesthesia provider is
being involved in a case with a bad outcome
The OSHA limit for occupational exposure to ionizing radiation is
5 rem annually with a lifetime limit of (N-18) x 5 rem, N= age in years
Auditory alarms must be ________ above background noise to be heard
20 dB
Recommended interventions when critical events occur include
relief from patient care responsibilities
peer support
professional support services
