Certified Professional in Patient Safety

iatrogenesis - Answer- Greek for originating from a physician preventable adverse events - Answer- those that occurred due to error or failure to apply an accepted strategy for prevention Ameliorable adverse event - Answer- events that, while not preventable, could have been less harmful if care had been different adverse events due to negligence - Answer- those that occurred due to care that falls below the standards expected of clinicians in the community near miss - 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 - Answer- broader term referring to any act of commission or omission that exposes patients to a potentially hazardous situation adverse event - 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 - Answer- doing something wrong omission - Answer- failing to do the right thing CPOE - Answer- Computerized Provider Order Entry 2009 HITECH Act and meaningful use program computer alerts three main findings - 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 - 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 - Answer- 1. role of pt and caregiver behaviors 2. role of provider-pt interactions 3. role of community and health system