.png){kind=logo}
NUR 2206 Exam 4
- medical error
Answer failure of a planned action to be completed, or the use of wrong plan to achieve an aim
- situational monitoring
Answer process of continual scanning your environment
- STEP is used for
Answer monitoring situations in the delivery of health care
- STEP stands from
Answer status of patient, team members, environment, progress toward goal
- status of patient includes...
Answer Pt Hx, VS, Meds, PE, Plan of Care, Psych Issues
- Team Members includes monitering .............................. Fatigue, Workload, Task Performance,
Skill, Stress
- environment monitering includes ...
Answer Facility Info, Admin Info, Human Re- sources, Ability to Triage Acuity. Equipment
- progress monitering includes..
Answer What is the status of Team's pts, Do we have established goals for the Team?, What are the Teams tasks / priority actions, Evaluate - is plan still appropriate? 1 / 4
- cross monitoring
Answer error reduction strategy to provide safety net within the team
10. IM SAFE
Answer Illness, medication, stress, alcohol and drugs, fatigue, eating and elimination
- Institute for Safe Medication Practices (ISMP) goals
Answer advance patient safety worldwide by empowering healthcare community, including consumers, to prevent medication errors
- safety policy changes - institutional level
Answer bar code scanning and safety huddles
- The Joint Commission (TJC) policy changes
Answer no abbreviations
- human error
Answer predictable, occurs with a lapse in personal behavior, understand how mistakes are made to prevent & decrease the probability of error
- human and systems factors
Answer Refers to the study of human behavior, abilities, limitations, and other characteristics as they affect the design and smooth operation of equipment, systems, jobs, and work environment
(AHRQ)
- adverse event (AE) 2 / 4
any injury caused by medical care that does not rise to level of being sentinel
- adverse drug event (ADE)
Answer specific type of AE - any injury resulting form medical intervention related to a drug
- categories of errors
Answer adverse event, sentinel event, medication error
- sentinel event
Answer An adverse event in which death or serious harm to a patient occurs; usually refers to events that are not expected or anticipated
- medication error
Answer Any preventable event that may cause or lead to unintended
/ incorrect medication use (prescribing, dispensing and administering)
- how to identify cause of error
Answer Root cause analysis, and reporting of errors
- root cause analysis (RCA)
Answer A structured process for identifying the causal or contributing factors underlying adverse events or other critical incidents; Identify underlying problems that increase the likelihood of errors while avoiding focusing on mistakes by individuals
- reporting of errors 3 / 4
Blame-free, non-punitive reporting systems
- unsafe practices
Answer work arounds, dangerous abbreviations, relying on memory
- Work-arounds (AHRQ)
Answer A deviation from the expected pattern of work by by- passing safety features; Often the result of poorly designed processes or equipment
- Strategies to Eliminate Errors & Unsafe Practices
Answer Open communication (TeamStepps), reporting systems, rounding, peer-checking, checklists, 60-second situational awareness, pt ID, safety-enhancing technologies
- culture of safety key components
Answer leadership, communication, and the environment
- environmental safety covers..
Answer falls, fire, poisoning, suffocation, fire-arms, equipment-related accidents, procedure-related accidents
- safety for falls
Answer use alert bracelet, bed alarms, call bell in reach
- safety for fire
Answer RACE
Rescue, Alarm, Contain, Evacuate/extinguish
- / 4
.png)