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Certified Professional in Patient Safety 2022 QUESTIONS AND ANSWERS| GRADED A
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Certified Professional in Patient Safety iatrogenesis Correct Answer: Greek for originating from a physician preventable adverse events Correct Answer: those that occurred due to error or failure to apply an accepted strategy for prevention Ameliorable adverse event Correct Answer: even...

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  • July 14, 2022
  • 19
  • 2021/2022
  • Exam (elaborations)
  • Questions & answers

Subjects

  • iatrogenesis
  • certified professional in patient safety
  • preventable adverse events
  • adverse events due to negligence
  • medical office survey on pt safety culture
  • most common root cause of sentinel events

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  • Certified Professional in Patient Safety
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Certified Professional in Patient Safety
iatrogenesis Correct Answer: Greek for originating from a physician

preventable adverse events Correct Answer: those that occurred due to error or failure to apply an
accepted strategy for prevention

Ameliorable adverse event Correct Answer: events that, while not preventable, could have been less
harmful if care had been different

adverse events due to negligence Correct Answer: those that occurred due to care that falls below the
standards expected of clinicians in the community

near miss Correct Answer: an unsafe situation that is indistinguishable from a preventable adverse
event except for the outcome - exposed but does not experience harm either through luck or early
detection

error Correct Answer: broader term referring to any act of commission or omission that exposes
patients to a potentially hazardous situation

adverse event Correct Answer: An injury caused by medical management (rather than the underlying
disease) and that prolonged the hospitalization, produced at disability at the time of discharge, or both

commision Correct Answer: doing something wrong

omission Correct Answer: failing to do the right thing

CPOE Correct Answer: Computerized Provider Order Entry
2009 HITECH Act and meaningful use program

computer alerts three main findings Correct Answer: 1. modestly effective at best
2. alert fatigue is common
3. fatigue increases with exposure and heavier use of CPOE systems

minimize alert fatigue Correct Answer: 1. increase alert specificity to reduce inconsequential alerts
2. tier alerts according to severity
3. make only high level/severe alerts interruptive
4. use human factors principles

three concepts that influence safety in ambulatory care Correct Answer: 1. role of pt and caregiver
behaviors
2. role of provider-pt interactions
3. role of community and health system

,Medical Office Survey on Pt Safety Culture Correct Answer: designed to assess safety culture in amb
care and data is available from AHRQ

Pt Engagement Correct Answer: 1. ed pt about their illness and medications with pt demonstrating
understanding "teach back"
2. empowering to act as a safety double check

checklist Correct Answer: Algorithmic listing of actions to be performed for a given clinical procedure
designed to ensure that no matter how often performed by a given clinician, no step will be forgotten
reduce risk of slips
consensus of required behaviors

slips Correct Answer: failure of schematic (autopilot) behaviors
lapses in concentration, distractions, or fatigue

mistake Correct Answer: failures in attentional behavior
lack of experience or insufficient training

Situational Awareness Correct Answer: the ability to access and track relevant to the task,
comprehend the data,
forecast what may happened based on the data, and
formulate an appropriate plan in response

situational awareness cannot be achieved without Correct Answer: clear and high-quality
communication between all providers

most common root cause of sentinel events Correct Answer: communication

elements the affect communication Correct Answer: 1. rigid hierarchies
2. overtly disruptive and unprofessional behavior
3. nonverbal cues
4. interpersonal relations
5. group dynamics

communication tools Correct Answer: read-back protocols
SBAR
teamwork training

process for prescribing and adm meds Correct Answer: 1. order
2. Transcribing
3. dispensing
4. administration
90% errors occur at ordering (48%) or transcribing thus CPOE prevent

CDSS Correct Answer: Clinical Decision Support System
assist healthcare providers in the actual diagnosis and treatment of patients, analyze data from clinical
information systems
avoids commission and omission errors

, unintended consequences of CPOE Correct Answer: 1. more or new work for clinicians
2. unfavorable workflow
3. never-ending system demands
4. persistence of paper orders
5. changes in communication patterns and practices
6. neg towards new technology
7. new types of errors
8. change in power structure, org culture , or professional roles

High Reliability Organizations (HROs) Correct Answer: persistent mindfulness with in an organization
cultivate resilience by relentlessly prioritizing safety over other performance pressures
consistently minimize adverse events despite carrying out intrinsically complex and hazardous work
safety is emergent vs. static
commitment to safety at all levels

HRO key features Correct Answer: 1. know high-risk nature of activities and determine to have
consistent safe operations
2. blame-free
3. collaboration across ranks and disciplines
4. commitment of resources to address safety concerns

Patient Safety Culture Surveys and Safety Attitudes Questionnaire Correct Answer: ask providers to rate
the safety culture in their units and org as a whole
poor perceived safety culture= increased error rates

just culture Correct Answer: id and addressing systems issues that lead individual to engage in unsafe
behaviors while maintain accountability
human error (slip)
at risk behavior (short cuts)
reckless behavior (ignoring required safety steps)

Debriefing Correct Answer: dialogue to learn from defects and improve performance through goal
discussion, reflection to incorporate improvement or discover opportunities in future performance
simulation
real-life emergency responses
teamSTEPPS

Components of debriefing Correct Answer: 1. setting the stage
2. description or reactions
3. analysis
4. application

plus delta debriefing Correct Answer: 1. What went well?
2. What did not go well?
3. what can we do differently or what needs to change to improve care?

debriefing framework Correct Answer: team evaluates if:

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