Safety Quiz 1

Question 1

what is the Joint Comission (TJC)

Answer 1

one of the bigger Hospital accrediting agencies

see if complying with CMS conditions

HFAP and DNV (other hospital accrediting agencies)

Question 2

what are the 3 standards from the joint commission that we discussed

Answer 2

• culture of safety
• use of systems for blame free reporting of a system or process failure
• uses data and info to guide decisions

Question 3

what is the HITECH act

Answer 3

hospitals got money to use electronic health records (now get penalized if not using it)

Question 4

what is POCA

Answer 4

phonetic and orthographic computer analysis

way to check how similar drug names are - aka how possible for mix ups

Question 5

Poison and prevention packaging act?

Answer 5

Packaging that is significantly difficult for children under 5 years of age to open
for substances include controlled and prescription drugs

Question 6

drug quality and security act of 2013?

Answer 6

• Registration of compounding facilities

- Introduces “track-and-trace” with identifiers down to the package level

Question 7

TJC has national pt safety goals

Answer 7

started in 2002:
ex: label medications before a procedure
caution with blood thinnrs
perform med rec

Question 8

what is NQF

Answer 8

national quality form
they will:
measure culture
approves standards/organization wide awareness
increase public access
they say “health orgs: must systematically identify and mitigate patient safety risks and hazards”

just SO MANY safe practices they come out with

Question 9

what is a CPOE

Answer 9

computerized prescriber order entry (per NQF - this is required)

Question 10

what is MDRO

Answer 10

multidrug resistant organism eradication program (NFQ says this is a must)

Question 11

_____ comes out with the targeted best practices

Answer 11

ISMP!

they also have the do not use - abbreviations list!/and sound a like drug list

Question 12

USP 800 is about?

Answer 12

hazardous drugs

Question 13

USP 1066 is about?

Answer 13

physical environment (lighting, distractions, noise)
and med safety zones!! (outlining things, layout of materials, ease of access)

Question 14

ASHP came out with stuff that was like hey, get a med safety leader…
Big qualities:
proactively develop ______
and provide ______

Answer 14

develop error mitigation strategies

provide med safety education to others

Question 15

3 modes of human factors:
\_\_\_\_\_\_ performance
\_\_\_\_\_\_ performance
&
\_\_\_\_\_\_ performance

Answer 15

skill based (auto pilot)

rule based (if then response mode)

knowledge based (figuring it out mode)

Question 16

skill based performance types of errors:

____ and _____

Answer 16

slip and lapse

fix by stopping and thinking about it

Question 17

rule based performance types of errors:

3 things?

Answer 17

used the wrong rule, misapplied rule, chose to not follow the rule

Question 18

Elements of a safe culture?

Answer 18

recruitment/training with safety in mind
open communication about harmful events/impacts
establish “just culture”
organizational commitment to error detection/reporting
common understanding that med use is high risk

Question 19

what organizations measures culture safety?/what surveys did degnan highlight

Answer 19

AHRQ/agency for healthcare research and quality

SAQ - safety attitudes questionnaire

Question 20

definition of human factors engineering?

Answer 20

discovers and applies information about human capabilities, limitations, and other characteristics to design better technologies, tools, and systems

Question 21

pt safety definition
and
med safety definition?

Answer 21

pt: prevention of errors and adverse effects to patients associated with health care

med safety: freedom from accidental injury due to medical care or medical errors
during the medication-use process

Question 22

Medication error definition?

Answer 22

any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of a healthcare provider, pt, or consumer

Omission or comission

(omiss: lack of action; comiss: did this instead of that)

Question 23

Near miss definition?

Answer 23

any event that could have had adverse consequences [for the patient] but did not”

aka close call; potential ADE

Question 24

ADE definition?

Answer 24

drug related injury; results from administration of a drug

example: confusion about how pt should take med

Question 25

ADR definition?

Answer 25

response to a drug that is noxious and unintended and occurs at doses normally used in [people] for the prophylaxis, diagnosis, or
therapy of disease, or for modification of physiological function.

an ADR is always an ADE!!!

Question 26

Sentinel Event definition?

Answer 26

unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof — needs immediate investigation and response

Question 27

training is not appropriate if …

Answer 27

System design not considered first
 Errors occurring across many people (3+
Already trained and problem persists
 ‘Stop using	in the wrong way’
 ‘Be more vigilant’