W1 Acute Clinical Concepts Flashcards
1
Q
What are the NSQHS Standards?
A
Standards developed to ensure safe, high-quality care in healthcare settings.
2
Q
List three types of acute care services.
A
- Critical care
- Surgical services
- Hospital in the Home
3
Q
What is the purpose of acute care?
A
Provision of care intended for surgery, diagnostic or therapeutic procedures, including management of childbirth.
4
Q
Who are considered frontline staff in a hospital?
A
- Receptionists
- Orderlies
- Volunteers
5
Q
What does the patient journey encompass?
A
All stages of interaction with the healthcare system from initial recognition of need to discharge.
6
Q
Define a clinical pathway.
A
A standardized document guiding the healthcare team in delivering evidence-based, streamlined care for specific health presentations.
7
Q
What are key aspects of clinical pathways?
A
- Evidence-Based Standardised Care
- Timelines
- Patient-Centred Care
- Interprofessional Collaboration
- Outcome Auditing
- Optimised Care
- Accountability
8
Q
What is the aim of the Clinical Governance Standard?
A
To ensure systems, leadership, and a culture of safety are in place to maintain and enhance quality and reliability of care.
9
Q
True or False: The Partnering with Consumers Standard aims to create a one-sided relationship between healthcare providers and consumers.
A
False
10
Q
What is the aim of the Preventing and Controlling Infections Standard?
A
To reduce the risk of preventable infections among patients, consumers, and healthcare workers.
11
Q
List two key guidelines of the Medication Safety Standard.
A
- Medication reconciliation and review
- Management of adverse drug reactions
12
Q
What does the Comprehensive Care Standard aim to achieve?
A
To deliver a coordinated, holistic model of care tailored to each patient’s individual needs.
13
Q
What is the aim of the Communicating for Safety Standard?
A
To promote timely, purpose-driven, and effective communication across the healthcare team.
14
Q
How many standards are developed by the Australian Commission on Safety and Quality in Health Care?
A
Eight
15
Q
What is clinical handover?
A
The transfer of information, professional accountability, and responsibility for aspects of a patient’s care between clinicians.
16
Q
What are key moments for clinical handover?
A
- Shift change
- Clinical updates
- Transfer between departments/facilities
- Admission and referral
- Discharge
- Response to patient clinical deterioration
17
Q
Fill in the blank: The ISBAR communication tool stands for Identification, Situation, Background, Assessment, and _______.
A
Recommendations/Referrals
18
Q
What is the first step in typical shift workflow?
A
Receiving Handover & Patient Allocation
19
Q
What is the purpose of bedside safety checks?
A
To ensure patient safety before proceeding with care.
20
Q
What is the aim of the Blood Management Standard?
A
To optimise the use of blood and blood products while conserving the patient’s own blood supply.
21
Q
True or False: Failure to recognise and respond to deterioration accounted for 29% of preventable deaths in healthcare in 2022–2023.
A
True
22
Q
What should be included in the patient assessment?
A
Focused assessment noting areas of concern that need follow-up.
23
Q
What is the role of diagrams in understanding the patient journey?
A
They help visualize pathways from admission to discharge.
24
Q
What does ISBAR stand for?
A
ISBAR stands for Identification, Situation, Background, Assessment, Recommendations
ISBAR is a communication tool used in healthcare for effective handovers.
25
What is the purpose of bedside safety checks?
To ensure that all necessary equipment is available, functioning, and properly stocked at the bedside in case of emergencies.
26
Which elements are included in the primary assessment?
* AIRWAY
* BREATHING and VENTILATION
* CIRCULATION WITH HAEMORRHAGE CONTROL
* DISABILITY (Neurological Status)
* EXPOSURE
27
What is the goal of the AIRWAY assessment?
To ensure the patient's airway is patent.
28
What does the AVPU scale assess?
The level of consciousness of a patient
## Footnote
AVPU stands for Alert, Verbal response, Pain response, Unresponsive.
29
Fill in the blank: The primary assessment consists of five sequential elements: AIRWAY, BREATHING, CIRCULATION, DISABILITY, and _______.
EXPOSURE
30
What is the purpose of the secondary patient assessment?
To focus on the patient’s primary complaint and other potential health issues.
31
What does the PQRST method assess in a focused pain assessment?
* Provocation or Palliation
* Quality
* Region or Radiation
* Severity
* Timing
32
What are vital signs?
* Respiratory rate
* Oxygen saturation
* Heart rate
* Blood pressure
* Temperature
* Level of consciousness
33
What is the purpose of the 'Between the Flags' system?
To halt clinical deterioration through early recognition and action.
34
What are the two levels of escalation in a two-level escalation system?
* Clinical Review
* Rapid Response: MET Call
35
True or False: The APINCHS classification includes high-risk medicines.
True
36
What does the 'A' in APINCHS stand for?
Antimicrobials
37
Name two examples of medications classified under Potassium and Other Electrolytes.
* Potassium
* Magnesium
38
What can errors in insulin administration lead to?
Hypoglycemia or hyperglycemia.
39
What types of medications fall under Narcotics and Other Sedatives?
* Opioids
* Benzodiazepines
* Anaesthetics
40
What is a key characteristic of Chemotherapeutic Agents?
They can be toxic to healthy cells if not properly managed.
41
What is the importance of patient assessment?
To collect information, analyze data, and guide care.
42
Which standard for Registered Nurses focuses on conducting assessments?
Standard 4: Comprehensively conducts assessments.
43
What is the goal of the exposure assessment in the primary survey?
To examine the patient thoroughly for injuries, rashes, and temperature changes.
44
What is one method for monitoring clinical deterioration?
Track and Trigger Systems.
45
Fill in the blank: A focused assessment is used when addressing a specific issue, such as _______.
pain
46
What is the role of the Medical Emergency Team (MET)?
To quickly intervene and prevent further deterioration.
47
What are some examples of opioids that are commonly misused?
* hydromorphone
* oxycodone
* morphine
* fentanyl
* alfentanil
* remifentanil
* analgesic patches
## Footnote
Opioids are potent analgesics that carry a high risk of misuse and addiction.
48
List two examples of benzodiazepines.
* diazepam
* midazolam
## Footnote
Benzodiazepines are often prescribed for anxiety and sleep disorders.
49
What are some examples of short-term anaesthetics?
* thiopentone
* propofol
## Footnote
Short-term anaesthetics are used for procedures requiring brief sedation.
50
What are chemotherapeutic agents?
Medications used in cancer treatment that can be toxic to healthy cells if not properly managed.
## Footnote
Chemotherapeutic agents require careful monitoring to minimize side effects.
51
List three examples of chemotherapeutic agents.
* vincristine
* methotrexate
* etoposide
* azathioprine
* Oral chemotherapy agents
## Footnote
These agents target rapidly dividing cancer cells but can also affect normal cells.
52
What is the primary function of heparin and other anticoagulants?
Agents that prevent blood clotting, where dosing errors can lead to bleeding complications.
## Footnote
Anticoagulants are critical for patients at risk of thromboembolic events.
53
List two examples of low molecular weight heparins.
* dalteparin
* enoxaparin
## Footnote
Low molecular weight heparins are often used for thromboprophylaxis.
54
What are vitamin K antagonists?
Medications that inhibit vitamin K, affecting blood coagulation.
## Footnote
Warfarin is a common example of a vitamin K antagonist.
55
What are direct oral anticoagulants (DOACs)?
Agents that directly inhibit specific factors in the coagulation cascade.
## Footnote
Examples include dabigatran, rivaroxaban, and apixaban.
56
What are systems in the context of medication safety?
Implementation of medication safety systems to reduce errors.
## Footnote
Safety systems are vital for preventing medication errors in healthcare settings.
57
List three examples of medication safety systems.
* Independent double-checks
* Safe administration of liquid medications using oral dispensing syringes
* Standardised order sets and medication charts
## Footnote
These systems help ensure accurate medication administration.
58
What is one strategy for risk reduction associated with high-risk medicines?
Develop a list of high-risk medicines used within the organization.
## Footnote
Identifying high-risk medicines is the first step in managing their use safely.
59
Fill in the blank: Healthcare organizations should implement a range of risk-reduction strategies, such as _______.
Forcing functions and fail-safes
## Footnote
Forcing functions are designed to prevent errors by making it impossible to perform a task incorrectly.
60
What is the purpose of audits and incident analyses in medication management?
To assess how high-risk medicines are managed within the organization.
## Footnote
These assessments help identify areas for improvement in medication safety.
61
Why is engagement with governance groups important in medication management?
It is essential in the process of managing high-risk medicines and ensuring safety.
## Footnote
Governance groups, like Drug and Therapeutics Committees, provide oversight and guidance.
62
What is acute care?
Care focused on short-term treatment for urgent health needs like surgery, diagnostics, childbirth, or trauma.
63
What are examples of acute care services? (Choose all that apply) A. Rehabilitation B. Emergency Department C. Critical Care D. Palliative Care
B. Emergency Department C. Critical Care
64
True or False: Acute care includes hospital-in-the-home services.
True
65
What is the main purpose of clinical pathways in acute care?
To provide evidence-based, standardized guidance for specific health presentations.
66
Fill in the blank: Clinical pathways aim to reduce ______ and enhance ______.
Care variations; healthcare efficiency
67
Name 3 types of non-acute (sub-acute) care.
Rehabilitation, palliative care, geriatric care.
68
Who are frontline staff in hospitals?
Receptionists, orderlies, volunteers.
69
What does NSQHS stand for?
National Safety and Quality Health Service.
70
Which NSQHS standard focuses on medication reconciliation and adverse drug reaction management?
Medication Safety Standard.
71
Scenario: A patient has a history of falls, cognitive impairment, and poor nutrition. Which NSQHS standard would guide their care planning?
Comprehensive Care Standard.
72
What is the goal of the Clinical Governance Standard?
To ensure systems, leadership, and culture support safe, high-quality care.
73
Multiple Choice: Which of the following is NOT a component of the Clinical Governance Standard?
A. Consumer co-design
B. Patient safety systems
C. Effective leadership
D. Quality governance
A. Consumer co-design (this belongs to Partnering with Consumers)
74
True or False: Consumers should be involved in planning, design, and evaluation of healthcare services.
True
75
Which NSQHS standard addresses hand hygiene and aseptic technique?
Preventing and Controlling Infections Standard.
76
What percentage of hospital-acquired complications in Australia were infections in 2022-2023?
37%
77
What process ensures medications are prescribed, dispensed, and administered safely?
Medication reconciliation.
78
Medication errors accounted for what percentage of preventable deaths in Victoria in 2022-2023?
9%
79
Comprehensive Care includes screening for risks like ______, ______, and ______.
Falls, pressure injuries, delirium.
80
What percentage of preventable deaths were linked to healthcare-associated falls in 2022-2023?
8%
81
What is the primary purpose of ISBAR communication?
To structure clear, effective handover communication.
82
Fill in the blank: ISBAR stands for ______, ______, ______, ______, and ______.
Introduction, Situation, Background, Assessment, Recommendation.
83
Which standard focuses on ensuring changes in a patient’s condition are communicated quickly?
Communicating for Safety Standard.
84
Communication-related issues accounted for what percentage of preventable deaths in 2022-2023?
5%
85
Which NSQHS standard covers safe use of blood products?
Blood Management Standard.
86
Which NSQHS standard covers early recognition and response to deterioration?
Recognising and Responding to Acute Deterioration Standard.
87
Fill in the blank: Acute deterioration can involve changes in a patient’s ______, ______, or ______.
Physical condition, mental state, vital signs.
88
Application: You notice your patient is suddenly confused and breathing rapidly. What action should you take, based on the Recognising and Responding to Acute Deterioration Standard?
Escalate care immediately using ISBAR and initiate appropriate clinical assessment.
89
What is a clinical pathway often used for in acute care? A. Providing legal protection B. Guiding evidence-based care C. Documenting patient complaints D. Conducting staff appraisals
B. Guiding evidence-based care
90
What are the four main focuses of the NSQHS standards covered in Week 1?
Infections, Medication Safety, Comprehensive Care, Communication for Safety.
91
True or False: Clinical pathways replace the need for individualized care plans.
False (they guide care but must be tailored to patient needs).
92
What is the difference between acute and sub-acute care?
Acute = short-term, urgent treatment; Sub-acute = longer-term, recovery-focused care (rehab, palliative, etc.).
93
Who are the 'clinical experts' in the hospital team?
Nurses, doctors, allied health, specialists.
94
In the patient journey, what comes after admission and treatment?
Discharge or transition to ongoing care.
95
Application: A patient is admitted via the ED for emergency surgery. Which stages of the patient journey apply here?
Initial contact (ED), diagnostic (imaging/labs), admission (surgical ward), treatment (surgery), discharge planning.
96
What type of document is a clinical pathway?
A standardized, evidence-based guide for managing specific conditions.
97
Why is accountability a key part of using clinical pathways?
Completing the pathway confirms care elements were provided; deviations must be documented.
98
Fill in the blank: The NSQHS standards are developed by the ______.
Australian Commission on Safety and Quality in Health Care (ACSQHC).
99
How do clinical pathways support interprofessional collaboration?
They act as a shared guide, ensuring all team members contribute to consistent care.
100
Scenario: You are giving handover at shift change. What communication tool should you use?
ISBAR.
101
True or False: Every patient in acute care follows the exact same clinical pathway.
False (pathways are condition-specific and adapted to individuals).
102
Which standard emphasizes consumer involvement in healthcare design?
Partnering with Consumers Standard.
103
What should you do if a patient’s condition deteriorates unexpectedly?
Recognise the change, escalate using ISBAR, initiate urgent assessment.
104
Which standard covers infection prevention measures like workforce screening and environmental cleaning?
Preventing and Controlling Infections Standard.
105
Why is communication critical in acute care?
It ensures safe handover, rapid response to changes, and clear team coordination.
106
True or False: Clinical pathways are optional documents used only for high-risk patients.
False (they are widely used to standardize care).
107
What is clinical handover?
The transfer of information, professional accountability, and responsibility for aspects of a patient’s care between clinicians.
108
What is the main purpose of clinical handover?
To reduce errors and enhance patient safety using a systematic communication approach.
109
True or False: Clinical handover only happens at the end of a shift.
False — it also occurs during clinical updates, transfers, admissions, referrals, discharges, and deterioration events.
110
Which of the following is NOT a key moment for handover? A) Shift change B) Patient discharge C) Ward stocktake D) Response to clinical deterioration
C) Ward stocktake
111
Fill in the blank: According to the NSQHS standards, patient ________ must always be communicated during handover.
Identification
112
What does ISBAR stand for?
Identification, Situation, Background, Assessment, Recommendations/Referrals
113
You’re receiving handover for a patient who just had a seizure. What part of ISBAR would you use to describe the seizure itself?
Assessment
114
Multiple Choice: What is the first step in your shift workflow? A) Patient assessment B) Receiving handover & patient allocation C) Administering medications D) Checking IV fluids
B) Receiving handover & patient allocation
115
True or False: Medication rounds should occur before patient assessments.
False — assessments should happen first to ensure safe medication administration.
116
Fill in the blank: When planning your shift, you should schedule key care events like ________ rounds.
Medication
117
What’s one reason bedside safety checks are important?
To ensure equipment is available and functional in case of emergencies.
118
You’re checking oxygen supply at a patient’s bedside. What color should the oxygen flow meter be?
White
119
Which of the following is part of a bedside safety check? A) Ensuring the bed is comfortable B) Checking wall suction and portable suction units C) Asking the patient about their favorite TV show
B) Checking wall suction and portable suction units
120
Application: You notice the patient’s infusion pump is set to a much higher rate than prescribed. What should you do next?
Pause the infusion if unsafe, check the prescription, and notify your buddy nurse and the nurse in charge.
121
What is the purpose of a patient assessment? (Name at least two)
Establish a baseline, identify early changes in condition, guide care planning.
122
What does the “B” stand for in the primary assessment (ABCD)?
Breathing (and Ventilation)
123
True or False: You should complete a full primary survey before treating any identified issues.
False — treat life-threatening issues immediately.
124
Fill in the blank: In the “Look, Listen, Feel” method for breathing assessment, you should listen for abnormal sounds like ________ or ________.
Wheeze, stridor
125
What are the five elements of the primary survey?
Airway, Breathing, Circulation, Disability, Exposure
126
Multiple Choice: A patient is confused and clammy with a capillary refill time of 5 seconds. Which part of the primary survey is most relevant? A) Airway B) Circulation C) Exposure D) Recommendations
B) Circulation
127
In ISBAR, what should you prepare before making a call? (Name 2 things)
Written questions and all relevant patient information (charts, test results, medications, etc.)
128
True or False: ISBAR is only used for nurse-to-doctor communication.
False — it’s used for all clinical handovers.
129
Application: You need to call a doctor to request a review for a patient with worsening chest pain. Write a brief ISBAR example for this call.
(Example Answer) I: Hi, this is [Your Name], nurse on Ward 3B. I’m calling about John Smith, DOB 15/06/1960, Hospital ID 123456. S: I’m calling because John has worsening chest pain. B: He was admitted yesterday with pneumonia and has a history of heart disease. His vital signs were stable, but his pain has increased despite PRN analgesia. A: Currently, his BP is 90/60, HR 115, SpO2 94% on room air, and he’s diaphoretic. R: I’m requesting you review him urgently and consider additional pain management and cardiac assessment.
130
Multiple Choice: What is the primary goal of the “A” step in the primary survey? A) Assess airway patency B) Assess pain levels C) Assess allergies D) Assess medication list
A) Assess airway patency
131
Why is the team huddle important at the start of your shift?
It gives a quick overview of the ward and any important updates about patient conditions.
132
True or False: You should always check IV infusions and pump settings during bedside safety checks.
t
133
Application: Your buddy nurse asks you to give a bedside handover to the next shift. What are 3 key things you should include?
Patient identification, current condition, recent interventions/care, plan for ongoing care.
134
What should you do if the suction equipment at the bedside isn’t working?
Replace it, notify the nurse in charge, and escalate if needed to ensure functioning equipment is available.
135
True or False: Every patient assessment should be holistic and culturally appropriate.
t
136
Fill in the blank: Standard 4 of the Registered Nurse Standards relates to conducting ________ assessments.
Comprehensive
137
What is one key difference between a full-picture handover and a shift-to-shift handover?
Full-picture is comprehensive (full history & progress), shift-to-shift focuses on current status and recent care.
138
You’re handing over to a community nurse after discharge. What’s one important focus for this type of handover?
Ongoing treatment and post-discharge care plan.
139
Why should you involve the patient in bedside handover where possible?
To promote patient-centered care and allow them to ask questions or clarify concerns.
140
True or False: The ISBAR format is flexible and can be adjusted for different clinical contexts.
t
141
What should you do if you notice a discrepancy between verbal handover and written notes?
Clarify immediately with the previous nurse and escalate if necessary.
142
Multiple Choice: What’s the best way to ensure safe medication administration after handover? A) Skip patient assessment if they look fine B) Rely only on handover notes C) Conduct your own focused assessment before administering medications D) Administer all meds at once to save time
C) Conduct your own focused assessment before administering medications
143
In the primary survey, what does “Exposure” mean?
Expose the patient to identify any hidden injuries while maintaining dignity and warmth.
144
What is the difference between a patient assessment and a bedside safety check?
Patient assessment focuses on the patient’s health, while bedside safety checks focus on equipment and environment safety.
145
True or False: Clinical handover is only necessary for admitted patients.
False — it applies across admissions, transfers, referrals, and discharges.
