QSEN

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NurseFaith
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262527
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QSEN
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2014-02-17 23:10:04
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  1. According to WHO, in developed countries worldwide, what is the approximate likelihood that a hospitalized patient will be the victim of some type of medical error?
    <10 %
  2. Since the publication of To Err is Human in 1999, the health care industry overall has seen which of the following improvements?
    Wider awareness that preventable errors are a problem
  3. Safety has been called a “dynamic non-event” because when humans are in a potentially hazardous environment:
    It takes significant work to ensure nothing bad happens
  4. James is a first-year surgery resident on his first pediatric rotation. His attending (consultant) asks him to start intravenous (IV) replacement fluids on a two-year-old boy who is having vomiting and diarrhea. Having trouble remembering the guidelines for calculating fluid replacement rates for very small children, James asks Maria, a nurse on the unit. Maria responds, “You’re the doctor. It’s your job to decide this.” James picks a rate that is much too high, putting the child into fluid overload. 
    To prevent this type of error from recurring in this unit, which of the following is MOST important?
    An improved culture of safety and teamwork
  5. James is a first-year surgery resident on his first pediatric rotation. His attending (consultant) asks him to start intravenous (IV) replacement fluids on a two-year-old boy who is having vomiting and diarrhea. Having trouble remembering the guidelines for calculating fluid replacement rates for very small children, James asks Maria, a nurse on the unit. Maria responds, “You’re the doctor. It’s your job to decide this.” James picks a rate that is much too high, putting the child into fluid overload. 
    Who is likely to be negatively affected by this medical error?
    • The patient and his family
    • James (the first-year surgery resident)
    • Maria (the nurse on the unit)
    • (all)
  6. According to James Reason, by definition an “unsafe act” always includes:
    A potential hazard
  7. Anita, a nurse practitioner, is seeing Mr. Drummond in clinic. Mr. Drummond is a 57-year-old man with diabetes and chronic kidney disease. Having kept up on the literature, Anita is aware that tightly controlling his diabetes can slow the progression of his renal disease. She discusses her plan to increase his dose of glargine (long-acting insulin) by 12 units per day with one of the family physicians in the clinic, who agrees. At the end of the day, as she is working on her documentation, she realizes she never told Mr. Drummond to increase his insulin dose.
    This is an example of what type of error?
    Lapse
  8. Roger, a pharmacist in a hospital, is working in the discharge pharmacy filling medications for patients who are going home. He sees a prescription for ciprofloxacin, an antibiotic, and he asks his pharmacy technician Mike to fill it quickly, as the patient is waiting and anxious to leave. Mike checks the shelves and sees they are out of ciprofloxacin, but they do have levofloxacin (an antibiotic in the same class that covers most, but not all, of the same types of infections). Mike knows he should usually check with the prescribing physician before making a substitution. However, in the interest of efficiency in this particular case, Mike deems it OK to go ahead. He substitutes the medications.
    This is an example of what type of error?
    Violation
  9. Which of the following is the most significant advantage of shifting to a systems view of safety within health care?
     -It is easier to identify and remove people who are unsafe
     -It allows us to change the conditions under which humans work
     -It prevents human mistakes
     -It allows us to view unsafe acts as violations
     -All of the above
    It allows us to change the conditions under which humans work
  10. At University Hospital, the rate of Clostridium Difficile colitis has doubled during the past year. After reviewing the data, the hospital’s senior leaders conclude that this is due to poor hand hygiene on the part of the staff, even though they have a clear hand washing policy in place and don’t believe most staff are intentionally disregarding the policy. They decide to start a hand washing campaign and post signs all over the hospital reminding providers to wash their hands.
    What type of error is this intervention best designed to address?
    Lapse
  11. Which of these is a behavior providers should adopt to improve patient safety?
    Follow written safety protocols, even if they slow you down
  12. After a team training system is implemented in an operating room (OR), a junior circulating nurse notices that a particular anesthesiologist goes missing from the OR at odd times, often seems sluggish, and occasionally slurs her words. Concerned that the physician might be impaired due to medication abuse, the nurse ponders what to do next.
    What would be the MOST appropriate way for the nurse to respond?
    Talk to the medical director now, in confidence
  13. Linda, a pharmacist at an outpatient pharmacy for a medium-sized medical group, receives a call from John, a nurse practitioner in the cardiology clinic. John tells Linda he needs to call in a new prescription for hydrochlorothiazide at 50 mg once a day for Ms. Krane. At the end of the conversation Linda says to John, “Okay, so you want Ms. Joanne Krane to have a new prescription for hydrochlorothiazide at 50 mg by mouth once a day. Thirty pills and six refills.”
    What has Linda just done?
    Provided a read back
  14. SBAR” stands for:
    Situation-Background-Assessment-Recommendation
  15. When it comes to self-care, which of the following statements is true?
    If you’re especially stressed because of a divorce, it may adversely affect your performance

    Lack of sleep can be similar to being drunk

    Spending quality time with friends can make you a safer health care provider
  16. Janet is a new physical therapist on the orthopedic surgery unit. Although learning a new position has been exhausting and somewhat stressful, she remains excited about the opportunity, and two weeks into her new job she has already volunteered to take on extra patients while a colleague is away. Today, she has 16 patients, one of whom is George Martinez. He is a 47-year-old man who had a left knee replacement two days ago. She goes to see Mr. Martinez in Room six. For privacy reasons, patients’ first names are not listed outside the doors on Janet’s unit, so she does not realize she is walking into the wrong patient’s room, and she does not check the patient’s name on his wristband as protocol indicates she should. She is now in the room of Rudy Martinez, a 56-year-old man who had an emergent left knee repair yesterday for a torn meniscus. Janet starts to bend his knee, causing him to yell in pain. Worried, Janet finds George Martinez’s nurse and tells her about the situation and background of the problem, as well as her assessment that something must be wrong
    Which of the four critical behavior(s) did Janet violate?
    • Follow safety protocols &
    • Take care of yourself
  17. Nearing the end of her 18-hour work shift, a resident sees a patient with extremely high blood glucose levels. She writes the patient a prescription for insulin; however, in her exhaustion, she closes her “U” (for “units”), and it looks more like an extra zero. As a result, the pharmacist dispenses an insulin dose that’s ten times stronger than the patient needs.
    Which of the following is an endogenous (internal) cause of the resident’s error?
    Fatigue
  18. Nearing the end of her 18-hour work shift, a resident sees a patient with extremely high blood glucose levels. She writes the patient a prescription for insulin; however, in her exhaustion, she closes her “U” (for “units”), and it looks more like an extra zero. As a result, the pharmacist dispenses an insulin dose that’s ten times stronger than the patient needs.
    To prevent this problem from happening again, which of the following would be the best course of acting
    Develop a system that prevents messy handwriting from causing miscommunication that leads to error.
  19. “Latent errors” are best defined as:
    Defects in the design and organization of processes and systems.
  20. Two women — one named Camilla Tyler, the other named Camilla Taylor — arrive at a particularly busy emergency department at about the same time. Ms. Tyler needs a sedative, and Ms. Taylor needs an antibiotic. The doctor orders the medications, but mixes up the patients when filling out the order sheets. The pharmacist dispenses the medications as ordered, and the nurse administers an antibiotic to Ms. Tyler and a sedative to Ms. Taylor.
    What is the active error in this scenario?
    The nurse administers an antibiotic to Ms. Tyler and a sedative to Ms. Taylor.
  21. Two women — one named Camilla Tyler, the other named Camilla Taylor — arrive at a particularly busy emergency department at about the same time. Ms. Tyler needs a sedative, and Ms. Taylor needs an antibiotic. The doctor orders the medications, but mixes up the patients when filling out the order sheets. The pharmacist dispenses the medications as ordered, and the nurse administers an antibiotic to Ms. Tyler and a sedative to Ms. Taylor.
    What is one of the latent errors in this scenario?
    The forms are completed by hand at the same time for different patients.
  22. Approximately what percent of medical harm is caused by incompetent or poorly intended care?
    <10%
  23. Which of the following statements is true?
    Blaming and punishing an individual for making an error can be appropriate if that individual intentionally caused harm.
  24. A colleague accesses and delivers a medication, believing it is the correct one. Unfortunately, it isn’t — it is another medication in a similar vial. Which of the following is the best way to address his error?
    Investigate whether others find the vials confusing and consider making a change to how they are packaged or accessed.
  25. When an error occurs, which of the following is a productive response?
    Interview all participants in the process to determine what happened.

    Determine if reasonable changes can be made to prevent the same type of error in the future.
  26. Which of the following situations seems to warrant punitive action?
    A colleague routinely refuses to perform a mandatory safety process.

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