Deck 15: Informatics Tools to Promote Patient Safety and Quality Outcomes

Question 1

What are the current patient safety characteristics of your organizational culture? Identify at least three aspects of your culture that need to be changed with regard to patient safety, and suggest strategies for change.

Answer 1

No Answer

Question 2

Describe a current technology that you use in patient care that would benefit from human factors engineering concepts. What are some ways this technology should be improved?

Answer 2

No Answer

Question 3

Identify a workaround that you have used and analyze why you chose this risk-taking behavior over behavior that conforms to a safety culture.

Answer 3

No Answer

Question 4

The GAO (2016) interviewed patient safety experts and the related literature to identify three key gaps in patient safety practice implementation:
a lack of (1) information about the effect of contextual factors on implementation of patient safety practices, (2) sufficiently detailed information on the experience of hospitals that have previously used specific patient safety implementation strategies, and (3) valid and accurate measurement of how frequently certain adverse events occur. (p. 22)
Select one of these gaps and describe in detail how nursing informatics could help close this gap.

Question 5

Although nurses have an ethical duty to ensure patient safety, increasing demands on professionals in complex and fast-paced healthcare environments may lead to workarounds. What is a workaround?

A) A practice that deviates from accepted and expected practice protocols
B) A shortcut to save time
C) An inappropriate action or omission of appropriate actions
D) All of these are correct.

Question 6

A safety culture is a blame-free environment where individuals are able to report errors or near misses without fear of reprimand or punishment. Conversely, a just culture emphasizes individual accountability and:

A) encourages workarounds in the interest of saving time as long as no harm occurs.
B) encourages error reporting and seeks to understand workflow and process issues that lead to errors.
C) allows reckless behavior if it is justified.
D) All of these are correct.

Question 7

Multiple false alarms may lead to alarm fatigue and compromise patient safety by slow response or no response to physiologic alarms. Strategies to improve alarm response include:

A) increasing the sensitivity of the physiologic monitors and feeding alarms directly to beepers or phones carried by professionals.
B) feeding alarm data into a reporting database for further analysis.
C) discouraging healthcare professionals from rounding with physicians because they are often guilty of ignoring alarms.
D) All of these are correct.

Question 8

Integrating technology into the medication administration cycle helps to reduce errors by:

A) performing electronic checks against a database of safe medication administration parameters and providing alerts.
B) reducing the workload and increasing the efficiency of clinicians.
C) Employing human factors engineering principles to streamline workflow processes.
D) All of these are correct.

Question 9

Smart pumps are designed for safe administration of high-hazard drugs and to reduce adverse drug events during intravenous medication administration. What happens when a hard alarm is generated by a smart pump?

A) A licensed clinician or a pharmacist can override a hard alarm and administer the drug as programmed.
B) The pump must be reprogrammed so that the rate and dose for administration of the high-hazard intravenous drug falls within the facility's safe infusion parameters.
C) The nurse must call the physician for a verbal order to turn off the smart pump technology and administer the drug as ordered.
D) Members of the biomedical engineering department can reprogram the pump to avoid these nuisance alarms.

Question 10

Radio frequency identifier (RFID) technology may gradually replace bar-code technology in the medication administration cycle because RFID provides:

A) opportunities to check patient identification before administration of the medication.
B) easy integration into the electronic health record.
C) reduced potential that a counterfeit medication is inadvertently introduced into the supply.
D) All of these are correct.

Question 11

In addition to organizational commitment of resources to address safety concerns, what is a key feature of a safety culture as identified by the Agency for Healthcare Research and Quality?

A) Acknowledgment of the high-risk nature of an organization's activities and the determination to achieve consistently safe operations
B) A blame-free environment where individuals are able to report errors or near misses without fear of reprimand or punishment
C) Encouragement of collaboration across ranks and disciplines to seek solutions to patient safety problems
D) All of these are correct.

Question 12

Nurses have an ethical duty to ensure patient safety.

Question 13

In a "just culture," system or process issues that lead to unsafe behaviors and errors are addressed by changing practices or workflow processes, and a clear message is communicated that reckless behaviors will not be tolerated.

Question 14

When someone disregards established policies and procedures, it is thought of as reckless behavior.

Question 15

Organizations themselves can engage in root-cause analysis or failure modes and effects analysis to examine medical errors closely and to determine the system processes that need to be changed to prevent similar future errors.

Question 16

Many organizations are looking to informatics technology to help manage complex safety issues by using smart technologies that provide knowledge access to users, provide automated safety checks, and improve communication processes.

Question 17

The top patient safety issues are identified as early discharge and polypharmacy.

Question 18

Once the technology is integrated into the organization, biomedical engineers can become valuable partners in promoting patient safety through appropriate use of these technologies.

Question 19

The Patient Safety and Quality Improvement Act of 2005 mandated the creation of a national database of medical errors and funded several organizations to analyze these data with the goal of developing shared learning to prevent medical errors.

Question 20

Organizational leaders must drive the culture change by making a visible commitment to safety and by enabling staff to share safety information openly. Some of the strategies suggested by the Institute for Healthcare Improvement include appointing a safety champion for every unit, creating an adverse event response team, and reenacting or simulating adverse events to better understand the organizational or procedural processes that failed.

Question 21

According to the Agency for Healthcare Research and Quality, one way to balance the competing cultural values of blamelessness versus accountability is to establish a "just culture."

Question 22

Smart pump technologies are designed for safe administration of high-hazard drugs and to reduce adverse drug events during intravenous medication administration. Smart pumps have software that is programmed to reflect the facility's infusion parameters and a drug library that compares normal dosing rates with those programmed into the pump.

Question 23

Clinical decision making is guided by targeted information delivery ensuring that the five rights of clinical decision support are implemented: the right information provided to the right person in the right format through the right channel at the right time in workflow.

Question 24

Radio frequency identifier technologies have both supply chain and patient care applications to patient safety.

Question 25

A nurse is reading research on safety initiatives and reviews initiatives from which agency?

A) Agency for Healthcare Research and Quality
B) Food and Drug Administration
C) Medical Product Safety Network
D) The Joint Commission

Question 26

An error in medication administration occurs, resulting in an adverse patient outcome. The organization reviews system processes that need to be changed so that similar errors are avoided in the future. This process is known as a:

A) root-case analysis.
B) human error evaluation.
C) technology implementation evaluation.
D) pharmaceutical error analysis.

Question 27

A healthcare organization partners with a technology manufacturer to identify risks to patients. This approach to safety is known as a:

A) systems engineering approach.
B) human factors engineering approach.
C) health information technology approach.
D) safety culture approach.

Question 28

A nurse is educating a new nursing student on the culture of safety in the healthcare organization. The nurse emphasizes which of the following as essential to a culture of safety?

A) Leadership oversight and support
B) Simulation of adverse events
C) Use of a standardized nursing terminology
D) Implementation of an adverse event response team

Question 29

A nurse administrator is reviewing data from the Government Accountability Office (GAO) on patient safety and develops a database for medical errors and near misses in the healthcare facility. This database addresses which gap that was recognized by the GAO?

A) A lack of valid and accurate measurement of how frequently certain adverse events occur
B) A gap in the available information on the experience of hospitals that have previously used specific patient safety implementation strategies
C) A deficit in the information about the effect of contextual factors on implementation of patient safety practices
D) A lack of organization leadership and collaboration in support of patient safety

Question 30

A nurse is teaching a nursing student on the role of safety in health information technology. Which statement by the nurse is correct?

A) "Health information technology does not replace critical thinking, solid nursing practice, and careful patient monitoring."
B) "Health information technology reduces error because it serves as a backup to critical thinking and patient monitoring."
C) "Health information technology only improves patient safety and quality of care."
D) "Health information technology reduces the need for vigilance in patient safety."

Question 31

A patient is allergic to penicillin, and a trigger in the electronic health record will alarm after which of the following occurs?

A) A physician enters a medication order for penicillin.
B) A nurse reviews the documentation on the patient's allergies in the electronic health record.
C) A nurse enters data into the patient's medical history.
D) A pharmacist reviews the patient's demographic information.

Question 32

An electronic health record (EHR) undergoes an upgrade, and in order to ensure the end users' ability to use the system, which action should the informatics nurse take?

A) Provide end user training and support on the EHR upgrades.
B) Collect data on the end users' comfort with the upgrade.
C) Conduct a survey on the end users' satisfaction with the EHR.
D) Document usage of end users of the EHR with the upgrades.

Question 33

Smart pump technologies are designed to promote safe administration of high-hazard drugs.

Question 34

A benefit of computerized physician order entry is the ability of alerts that warn against the possibility of drug interaction, allergy, or overdose.

Question 35

A nurse is conducting research on methods to reduce alarm fatigue. Which of the following is one way technology can aid in this research?

A) Feed alarm data into a reporting database for further analysis
B) Collect qualitative data from surveys completed by nurses
C) Review online standards and guidelines from nursing informatics organizations
D) Analyze data on admissions and discharges in medical records

Question 36

A healthcare organization creates a blame-free environment in which staff member can report error and commit additional resources to address safety concerns. This organization is said to have a:

A) culture of safety.
B) culture of accountability.
C) safety promotion culture.
D) failure-tolerant culture.

Question 37

A staff nurse consistently exhibits disregard for established policies and procedures in an organization where there is just culture. Which statement by the nurse manager is correct about a just culture?

A) "Reckless behaviors like ignoring policies and procedures will not be tolerated."
B) "A just culture involves error reporting, not individual behaviors."
C) "Personal accountability is not part of just culture."
D) "Workflow, including procedures and policies, can be changed for individual nurses."

Question 38

A healthcare organization has committed to a culture of safety. Which of the following is a strategy to encourage adoption of a culture of safety?

A) Collaboration between leadership and staff on patient safety initiatives
B) Systemwide safety teams of administrators
C) Leadership safety directives
D) Individual accountability for development of safety plans

Question 39

A nurse manager is brainstorming ideas for the promotion of safety in patient care in the nursing unit. Which activity has been recommended by the Institute for Healthcare Improvement to promote safety?

A) Appoint a safety champion for the unit.
B) Change unit policies on error reporting.
C) Post the details on unit about previous patient safety errors.
D) Discourage collaboration among disciplines for patient safety.

Question 40

A nurse understands that medication errors occur commonly with the use of health information technology and uses which of the following to reduce this risk?

A) Bar-code medication administration
B) Standardized terminology in nursing technology
C) Interoperability
D) Data mining and dissemination

Question 41

A physician is entering a medication order for aspirin and an alert is generated, reminding the physician that the patient is allergic to salicylic acid, and lists alternative medications. This alert is known as which of the following?

A) Clinical decision support trigger
B) Pharmaceutical support alert
C) Health information trigger
D) Physician order entry alert

Question 42

A nurse is preparing to administer a medication and scans the patient's bar code and the medication bar code in the electronic medication administration system. This bar-code technology supports patient safety by ensuring which of the following?

A) The five rights of medication administration are upheld
B) The billing of the medication is assigned to the correct patient
C) The correct nursing documentation is completed
D) The pharmacy will receive receipt of the administration of the medication

Question 43

Nursing informatics skills and knowledge can assist in data collection to identify adverse events in hospitals.

Question 44

Automated medication dispensing devices promote patient safety through access security, safety, supply chain, and charge functions.