Risk Management Exam

List 2 of the 'Red Flag' areas and describe what Risk Managers should watch out for in each.

-Treatment Conditions: poor treatment results, repetition of the problem, lack of follow-up care, and equipment malfunction. -Conduct of staff: acting outside the scope of training, lack of qualified supervision, performance of a procedure for the first time without supervision, outspoken or rude behavior, personality conflict, and poor physician-staff relationship.

Which of the following is the evaluation tool that examines the steps in a system that failed and led to the adverse outcomes?

Failure Mode, Effect and Criticality Analysis

Discuss the importance of patient education.

Patient education is important for the recovery process. If the patient does not understand what is fully expected of them, the prognosis for recovery will be impaired. Also, with patient non-compliance, if harm results to the patient, litigation risk factors arise.

List the major categories covered in risk assessment.

Patient safety, infection control, hazardous material and waste, fire prevention, medical equipment and utilities management, disaster preparedness, and information management.

If adopted, __________ can set a standard of care to which the practitioner will be held.

Practice Guidelines

The analytic technique utilized after an adverse event occurs to prevent its recurrence is called:

Root Cause Analysis

Which of the following is the evaluation tool that is used to find and fix the fundamental system deficiencies that led to a sentinel or adverse event?

Root cause analysis

Discuss the various ways that risks of malpractice litigation because of infections that cause death or disability can be reduced.

a. There are several ways that risks of malpractice litigation because of infections can be reduced. These practices include early identification of infection, prompt diagnosis, appropriate treatment, consultations with infectious disease specialists, contact with the infection control program of the institution, continuous monitoring of the patient's progress, and concern for staff caring for the patient.

Infection hazards are naturally concentrated in the community setting.

a.FALSE

Discuss the difference between Respondeat Superior and Ostensible Agency.

a. Respondeat Superior states that the employer is liable for the actions of their employees, whereas ostensible agency is implemented in cases of independent contractors, in which the physician themselves would be held liable for wrong doing.

The cost of the loss in dollars is called:

a. Severity

A standard is a statement concerning proper procedures taken in a given situation.

a. TRUE

Almost every organization of healthcare professionals has a code of ethics which details the values, duties and responsibilities of their profession.

a. TRUE

Best Interest is the ethical standard which applies to individual who never had decision-making capacity.

a. TRUE

Ethics committees are usually interdisciplinary.

a. TRUE

Occurrence policies cover all injuries that occurred during the policy period, regardless of when they were reported.

a. TRUE

The concept of justice means that people should be treated in an equitable or fair fashion.

a. TRUE

The financial survival of a healthcare organization requires achieving the optimal balance between retaining risk and transferring risk.

a. TRUE

The goal of infection control is to prevent the transmission of infections to patients, visitors and healthcare personnel.

a. TRUE

The simple act of covering the nose and mouth with a tissue when coughing or sneezing is an effective infection control measure.

a. TRUE

Two physicians jointly participating in the diagnosis and treatment of a patient are liable for each other's negligent actions.

a. TRUE

Respondeat superior means

a. The employer is responsible for the wrongful acts of its employees

Describe the fire prevention steps represented by the acronym RACE.

a.Rescue: remove the patient from immediate danger. b.Alarm: shout "fire!" or "code red!, activate nearest fire alarm pull station, call 911 or hospital number and report the location of the fire. c.Confine: close all of the doors near the area. d.Extinguish/Evacuate: extinguish the fire if small, and evacuate the patients if instructed to do so by fire officials or hospital leadership.

Occurrence Reporting method yields the highest percentage of reportable incidents.

FALSE

Patient satisfaction is a measure of what actually happened during an encounter with the physician.

FALSE

Risk Management and Quality Assurance are 2 concepts that are mutually exclusive.

FALSE

The claim of Retaliation is very difficult to prove.

FALSE

Total Quality Management 85/15 rule states that 85% of the time the problem is an employee and 15% of the time it is a systems failure.

FALSE

While you should use specially marked bags for infectious wastes and/or linens, it is not necessary to separate them from the other waste and/or linen bags.

FALSE

List some examples of social media sites.

Facebook, Twitter, Instagram, Tumblr, Snap Chat

EMTALA is a state mandate that requires healthcare providers to take care of certain emergency patients until they are stabilized.

a. FALSE

Define and discuss the phrase "Due Process."

"Due Process" requires that there be a clear rule against the misconduct, a reasonable rule, a thorough and objective investigation in which the employee has the opportunity to offer his or her side of the story, notice of the charges and penalty sought, and an opportunity to respond or appeal in some fashion. In order to achieve these zones of relative safety, employers usually apply ascending penalties where feasible.

Define and discuss the phrase "Hostile Environment Sexual Harassment."

"Hostile Environment Sexual Harassment" occurs when conduct has the purpose or effect of unreasonably interfering with a person's work environment based on actions or word with a sexual connotation.

Medicare is a state-run program so each state sets its standards for reimbursement.

a. FALSE

Physicians are all held to the same standard of the skill and knowledge regardless of their specialty.

a. FALSE

Negligent hiring is a legally recognized cause of action that requires a plaintiff to prove all of the following:

-the subject was an employee -the employee was incompetent or posed a forseeable risk -the employer knew or should have known about the incompetence or the risk of the employee -the employee caused a injury -the negligent hiring was the proximate cause of the injury, bringing the employee into contact with the damaged party

'Defend in Place' refers to the strategy to evaluate patients in the event of a fire.

FALSE

What is a sentinel event and why is it important to risk management?

A sentinel event is a single occurrence of sufficient concern to trigger a systematic response. It can be used to improve healthcare systems processes using a CQI approach.

Cultural Sensitivity is of no concern in the provision of healthcare services.

FALSE

Sexual Harassment can occur when an unwelcome sexual advance or request for sexual favors:

All of the above

Barriers to effective communication include all of the following except:

All of the above are barriers to effective communication

When considering why patients chose to sue providers, the theme of wanting to prevent similar incidents in the future is called:

Altruism

Slander is defamatory words in a written or printed statement.

a. FALSE

How do risk management and quality management work together/overlap?

An evaluation process helps determine how well risk management is doing within the organization, while the processes of total quality management and continuous quality improvement enable institutions to make the transition to higher levels of performance and high reliability. Risk management focuses on an institution's exposure to financial loss. In minimizing this exposure, risk managers contribute to quality patient care by ensuring that hazards and injuries are less likely to occur.

List the three categories of hazardous materials subject to regulation.

Biological, Chemical, and Radioactive

The risk of transmission of HIV to healthcare workers on the job is very high.

a. FALSE

Having an emergency power and water supply is part of which type of planning?

Disaster Planning

Discuss the importance of Informed Consent.

First, it is important to obtain informed consent to make sure the patient understands the information, risks, benefits, and projected outcomes. The patient has the right to make decisions about their healthcare, and understanding these factors is crucial in the decision-making process. Also, obtaining true informed consent is important to ensure that the consent form that is signed is valid. If the patient is coerced, or if there is a lack of information and competence, then true informed consent was not obtained.

There is a single model for every ethics committee.

a. FALSE

What is the BEST way to protect patient valuables?

Leave all valuables at home

Employers can achieve fewer accidents and lower workers compensation cost by:

Minimize safety hazards and investigate all accidents with a view toward future deterrence

The moral tenets for all clinicians include all of the following except:

Minimizing costs

Discuss the barriers to effective quality management.

One of the barriers to effective quality management is the separation of administrative functions that are usually performed by nonclinicians from the medical functions performed by professional staff. Physicians tend to focus their attention on patients and not on what they perceive to be administrative responsibilities. Also, the barriers to establishing error-prevention programs in healthcare organizations include perceptions on the part of both staff and management that there is no time to step back from a situation and analyze it or that no one "owns" any of the processes in place. Other barriers include a lack of recognition or rewards for taking problem-solving initiatives, attitudes of "this is the way it has always been done" or "nothing is ever done," and lack of vision or awareness of the desired end result.

'Employment at Will' states that the employer can terminate an employee for any or no reason.

TRUE

A barrier to quality initiatives in healthcare is the separation of administrative and medical functions.

TRUE

A sentinel event is a single occurrence of sufficient concern to trigger a systematic response.

TRUE

Exposure avoidance is the elimination of services that may cause losses.

TRUE

Healthcare employers are obligated to provide a safe workplace.

TRUE

In terms of safety, 'Red Rules' cannot be broken under any circumstance.

TRUE

People with HIV or AIDS are protected under the Americans with Disabilities Act.

TRUE

States differ in their requirements for reporting adverse events or incidents.

TRUE

Studies have concluded clinician communication provided in a timely manner with sincerity influences patients' responses to adverse events.

TRUE

To gain the most from benchmarking, it is advisable to go outside the organization to find the best within the industry.

TRUE

Name the oldest accreditation group.

The oldest accreditation group is the Joint Commission (Formerly JCAHO).

With some exceptions, the statutory period is deferred during the infancy of a minor patient and starts to run only on the patient's 20th birthday.

a. FALSE

Adequate insurance coverage is an example of risk __________.

a. Financing

The mutually beneficial social insurance system where the employer takes care of an injured employee's medical costs in exchange for the waiver of the right sue is:

Workers' Compensation

Quality Assurance and Risk Management:

a. Have a close relationship and overlap in several areas

Risk Management tools are

a. Incident, and occurrence reporting, along with occurrence screening

List 4 potential sources for infection outbreaks in a healthcare setting.

a. Noncompliance with prudent infection control practices such as hand hygiene, isolation techniques and procedures, and aseptic and sterile technique, environmental sanitation, contaminated equipment or supplies, and inadequate cleaning of equipment.

Define Res Ipsa Loquitur and the 4 elements that a plaintiff must demonstrate.

a. Res Ipsa Loquitur means "the thing speaks for itself." The four elements a plaintiff must demonstrate are: The injury would not ordinarily occur in the absence of negligence, the injury was caused by the actions or instrumentality within the exclusive control of the defendant, the injury was not due to any action on the part of the plaintiff, and the evidence surrounding the circumstances relating to or concerning the injury was mostly within the control of the defendant.

Define and discuss false claims.

a. A false claim can be made by anyone who "knowingly" submits or causes the submission of a false or fraudulent claim to the United States. Anti-fraud activities of the federal government under the regulations of the False Claims Act range from audits of hospitals, nursing homes, medical care organizations, and practicing health professionals to targeted medical care claims.

_________ analytics relies on the basic fundamental premise that the less significant the risk, the less funding that needs to be allocated to that risk.

a. Actuarial

Define Advanced Directives and discuss the difference between Living Will and Durable Power of Attorney for Healthcare.

a. Advanced Directives can make substituted judgements much easier to achieve. This includes living wills, health care proxies, and durable powers of attorney for health care. Living wills often contain what the patient would not want, and there is some difficulty because they are often not specific to the situation at hand. Durable Power of Attorney for Health care allows for the designation of a surrogate decision maker, who is able to discuss the pros and cons of specific interventions.

Describe a patient grievance procedure.

a. All patients are required to be given the Patient's Bill of Rights within four hours of admission to the hospital, breastfeeding mothers are required to be given the Mother's Bill of Rights in some states. Informed consent is required for medical treatment and informed consent for surgical and invasive procedures to be given to the physician of record. In the event that a patient refuses treatment, a physician may treat the patient to save his or her life. Patients also have the right of privacy, the right to receive treatment information in their primary language, and the right to non-discrimination.

Define the term outbreak and discuss how a risk management might identify when such occurs in the facility.

a. An outbreak can be defined as an increase in the occurrence of infections with reference to the recorded baseline infection rate. An outbreak may be identified based on cases of infection that are clearly associated in time and place.

List the key areas of risk exposure.

a. Automobile liability, aviation/aircraft liability, business income and extra expense dependent on another, crime/fidelity, cyber-liability, Directors' and officers' (D&O) liability, emergency evacuation, employment practices, employee benefit liability, employee injury and illness/worker's compensation, fiduciary liability, general liability, licensing board disciplinary proceedings, media expense, medical equipment breakdown, medical waste pollution, patient confidentiality/privacy, peer review and medical staff credentialing, professional liability, and property

List the cognitive and affective skills needed by healthcare clinicians

a. Cognitive skills: nonroutine problem solving, critical thinking, systems thinking. b. Interpersonal skills: complex communication, social skills, teamwork, cultural sensitivity, dealing with diversity c. Intrapersonal skills: self-management, time management, self-development, self-regulation, adaptability, executive functioning

Describe the difference between Compensatory damage and Punitive damage.

a. Compensatory damage awards cover economic losses for past and future medical and supportive care, or past and future loss of earnings resulting from physical impairment. Punitive damage awards more than usual compensatory damages reflect gross negligence or deliberate wrongful intent.

Autonomy is the obligation to do good for patients (or at least no harm).

a. FALSE

Term denoting nonconsensual, unlawful or wrongful physical constraint or touching.

b. Battery

An insurance company owned solely for the benefit of an individual healthcare organization to insure its own risks is known as:

b. Captive Insurance Company

Polices that cover injuries reported during the policy period that occurred after the policy retroactive date are called:

b. Claims made policies

Multidrug-resistant organisms are microorganisms that are resistant to one or more classes of antibiotics and are:

b. Difficult to treat as few or no antibiotics are effective

The number of times an event occurs and can be gauged in relation to any relevant period of time or are is called:

b. Frequency

____________ is/are infections that occur in patients while they access healthcare institutions for care.

b. Healthcare-associated infections

Continuous collection of information to search for liability risks is an example of risk __________.

b. Identification

Incident or occurrence reports are a method of risk __________:

b. Identification

The Federal mandate that requires healthcare providers to offer a safe work environment for their staff is

b. OSHA

_________ means planning for losses by using available cash, establishing loss reserves or borrowing fund.

b. Risk Retention

_________ takes place when an outside party pays for losses that occur.

b. Risk Transfer

Substituted judgment is used when

b. Someone previously with capacity for decision-making has lost that capacity

A living will is:

c. A & B

Written guidelines to ensure that everyone follows the same specific procedure in a given clinical or administrative situation are called ____________ standards.

c. Explicit

The federal mandate that ensures the continuity of healthcare coverage for persons changing jobs is:

c. HIPAA

Which of the following categories are not potential hazards found in hospitals?

c. Hydrostatic

The process in which a patient is given all the information needed to allow them to make a decision on medical care is called

c. Informed consent

__________ is an important way to prevent the spread of infections.

d. All of the above

Which is NOT a type of standard? a. Explicit or Implicit b. National or local c. Validated or consensual d. Used or ingnored e. Periodically updated or static

d. All of the above are types of standards

The 4 requirements of Negligence do not include:

d. Health care worker must be an employee of the facility