Chapter 02 Patient Safety and Risk Management

Chapter 02  Patient Safety and Risk Management

MULTIPLE CHOICE

1. Governmental and professional agencies and organizations, whether voluntary (governmental) or involuntary, have a significant influence on patient safety policies in the healthcare setting. Select the agency or organization statement that presents a true reflection of its focus or purpose.

1. The Joint Commission (TJC): Nonvoluntary bureau that tests healthcare

   institutions against evidence-based elements of performance

2. Surgical Care Improvement Project (SCIP): Trends surgical site infection statistics
3. American Society of Anesthesiologists (ASA): Professional organization of

   anesthesia providers and technologists

4. World Health Organization (WHO): United Nations based and supported authority

   on health throughout most of the world

ANS: D
WHO was created by and functions within the United Nations (UN) as the directing and coordinating authority for health throughout UN member nations.

REF: Page 21

2. Since its organization and establishment as a professional nursing association in the early 1950s, the Association of periOperative Registered Nurses (AORN) continues its endeavor to:

1. promote guidelines influencing patient safety.
2. create professional OR nursing care delivery models.
3. interpret healthcare statistics critical to perioperative nursing care.
4. ensure risk reduction strategies are the foundation of perioperative education.

ANS: A
The Association of Operating Room Nurses (now called the Association of periOperative Registered Nurses [AORN]) began organizing in the early 1950s. AORN’s conferences and publications were replete with patient safety information. Its first conference in 1954 included programs on methods’ improvement, explosion prevention, bacteria destruction, the surgeon-nurse relationship, and positioning.

REF: Page 18

3. The perioperative environment is a dangerous place for both patients and staff. The surgical patient is at risk for harm, regardless of age, surgical diagnosis, or planned procedure. Select the physical risks.

1. Chemical, thermal, and radiation burns
2. Anxiety and knowledge deficit
   Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 2-2

c. Lost or mislabeled specimen
d. Breaches of confidentiality, privacy, and dignity

ANS: A
A physical risk is some damaging or noxious element that comes into contact with the patient to cause harm, such as electrosurgical/laser beam, pooled prep solution, glutaraldehyde retained in an endoscope, or a retained foreign object.

REF: Pages 34, 37-38

4. Sara Martin, a healthy 32-year-old nursing student, is scheduled for excision of a left-sided subglottal cyst with frozen section and possible radical neck dissection. In addition to comfort and caring behaviors and reassurance from the perioperative nurse to mitigate Sara’s nervousness and fears, the admission process provides the opportunity to collect and verify information about the patient to ensure patient safety. Among the patient data that must be verified are:

1. allergies, history and physical report, level of anxiety.
2. lab and imaging results, blood transfusion orders.
3. signed consent, advance directives, and personal belongings.
4. All of the options must be verified.

ANS: D
Key features of the Universal Protocol for perioperative patient care are performing a preoperative verification process, marking the operative site, and conducting a “time out” immediately before starting the procedure. A properly performed “time out” includes information about the patient and the procedure.

REF: Page 19

5. Sara was positioned, prepped, and draped following general endotracheal anesthesia induction. The team assembled around Sara and the sterile field to perform the time-out as described in the WHO surgical checklist. Successful employment of the time-out can only be ensured when:

1. the time-out is initiated by the surgeon.
2. the entire team stops and focuses attention together.
3. perioperative services has a physician champion and surgeon buy-in.
4. someone simultaneously checks the patient ID band.

ANS: B
All members of the team must introduce themselves by name and role and participate in sharing critical elements of care. The team includes the surgeon, anesthesia provider, and nursing staff, plus any allied or ancillary care providers contributing to the procedure when the time-out is performed.

REF: Pages 21, 24

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 2-3

6. When unexpected events occur that have, or could have, compromised patient safety, a systematic investigatory process takes place. Significant information is gained through this meticulous exploration. The primary motive for carrying out a root cause analysis is to:

1. establish cause and trends based on who was involved.
2. determine precisely what happened and why.
3. find out what needs to take place to prevent a recurrence of the event.
4. uncover factors that contributed to the environment and the event.

ANS: C
Root cause analysis is a systematized process to identify variations in performance that cause, or could cause, a sentinel event. The analysis phase of root cause analysis progresses from “why” questions to “what can be done to prevent this” questions that flow and ultimately result in an action plan. Root cause analysis concentrates on systems and processes, not individuals.

REF: Page 19