Chapter 4: The Nurse's Role in Healthcare Quality and Patient Safety

A team of community health nurses has reaffirmed its commitment to providing quality health care for the clients who depend on them. The team is referring to the Institute of Medicine criteria for quality care. What aspects of the care that the team provides reflect these criteria? Select all that apply.

- Each client receives the care that he needs in a time-appropriate manner - Actions are taken to keep preventable risks to clients at an absolute minimum - The client's preferences are prioritized when choosing interventions - Benefits of care are distributed between clients in an equitable way.

On two occasions over the past several weeks, a staff member has been assaulted by a client or a member of a client's family. Administrators have recognized the need to enact a strategy for dealing with this safety threat. What strategies would be justified? Select all that apply.

- Increase the number of nurses and non-nursing staff who work on the unit. - Introduce an alarm system that can be easily accessed by all staff members - Ensure that there is adequate lighting in all locations on the unit - Increase the presence of security staff on the unit

A safety audit has revealed that nurses are carrying used needles out of clients' rooms because there is a shortage of appropriate receptacles on the unit. A nurse on the unit should recognize what implication of this this? Select all that apply.

- The situation constitutes a violation of OSHA regulations - A root cause analysis may help identify the underlying factors

What aspect of a nurse's practice would fall under the control of the Occupational Safety and Health Administration (OSHA)? Select all that apply.

- The specifications of the "sharps containers" where contaminated needles are disposed of - The handling and disposals of wastes that are categorized as bio hazards - The maximum acceptable weights that nurses should be lifting during client transfers

A safety audit is being conducted on a hospital unit and the factors that have contributed to medication errors on the unit are being explored. What are factors that are known to underlie medication errors? Select all that apply.

-Interruptions to nurses who are in the process of preparing medications - Nurses' having to provide care for large numbers of clients - Nurse fatigue and caring for clients who have heavy care needs - The incidence of emergencies and urgent situations on the unit

Root cause analysis would identity an active error in which adverse event?

A nurse drew up 20 units of insulin rather than 2 units by misreading the lines on the syringe. - Active errors are most often one-time events that are attributed to an individual's actions.

As members of the quality improvement committee of a large health care institution, a group of nurses are reviewing recent incident reports. Which staff member has most likely committed an intentionally reckless behavior?

A nurse who signed up for the adminisisstration of a client's anti-seizure medication after realizing that she forgot to give it. - Falsifying records to conceal errors and failing to assist a client not assigned to the nurse

A client has been admitted to the hospital for the treatment of endocarditis. The nurse should be most aware of the potential for safety violations when providing what aspect of the client's care?

Administering the client's oral analgesics and intravenous antibiotics

During a busy shift at a long-term care facility, three call lights are illuminated simultaneously. A nurse is walking toward the closest of the three rooms and notices a colleague preparing medications in the hallway. The nurse should:

Avoid talking to the colleague unless there is evidence of an urgent client need.

A nurse has been caring for a client with a diagnosis of heart failure for several weeks, and the client's prescribed dose of digoxin has been unchanged since admission. However, after scanning the bar code on the medication prior to this morning's dose, the nurse notes that the computer is promoting a higher dose than on previous days. What is the nurse's most appropriate response?

Confirm in the client's health record is a change in dose has been ordered and then administered the new dose.

A health care institution has introduced Tall Man Letters on the electronic medication administration records that are being used throughout each care site. The nurse should anticipate what benefit of this practice?

Fewer drug errors will occur involving drugs that have similar names.

New intravenous (IV) access ports are being introduced in a hospital that are described as being "mistake-proof". The nurse should understand that these new ports may:

Have a design that makes it difficult to attach incorrect tubing to the ports.

A health care institution's most recent strategic plan includes a commitment to creating a culture of safety. The organization can best meet his commitment by:

Having every employee focus on safety, not only direct care providers.

A nurse is pouring a client's scheduled medication at the medication cart outside the client's room when a colleague asks for assistance with transferring another client from the commode. What is the nurse's appropriate response?

Help the colleague after administrating and documenting the medication

The allergy status of a client who was diagnosed with suspected cellulitis was not documented and the client recieved a dose of an antibiotic that caused an allergic reaction. Root cause analysis (RCA) s consequently being performed. What goal should the team who is performing RCA prioritize?

Identifying processes that may have been made it possible for a client to receive a drug without having allergy status documented.

A client with diabetes mellitus received a double-dose of insulin, with two nurses inadvertently administering a scheduled dose. What aspect of this adverse incident may be categorized as a systemic, root cause?

Insulin administration is documented on two separate flow sheets in client's health records.

A nurse is caring for a client who is being treated for complications of diabetes. Which action by the nurse best reduces the client's risk of experiencing an adverse outcome while receiving care?

Monitoring the client's health status frequently and thoroughly

Local media reports have focused on the large amounts of waste that are produced by a local hospital, and there is public pressure to reduce waste. What principle should guide the hospital's waste-reduction efforts?

Much hospital waste is considered a biohazard, but much other waste can be conventionally recycled.

The administrators of a long-term care facility have been ordered to acquire mechanical client lifts because care staff have been performing manual client transfers that are too heavy. What organization would most likely make this ruling?

Occupational Safety and Health Administration (OSHA)

A review of safety practices on a hospital unit is being conducted because of the high incidence of workplace injuries over the past year. Which strategy is most likely to reduce the occurrence of injuries to nursing staff?

Providing more education to staff about injury prevention and safety practices

A nurse was covering for a colleague during the colleague's scheduled break and nearly administered an intravenous antibiotics to the wrong client, catching the error while programming the IV pump? What is the nurse's best response to this adverse incident?

Report the event using the appropriate documentation so processes can be examined to promote safety.

A client with dementia was assigned to a shared hospital room due to a shortage of private rooms. During the night, the client became acutely confused and attacked his roommate, seriously injuring him. When following up this adverse event, the institution must:

Report this sentinel event to the Joint Commission and to relevant state agencies.

A new manager has been hired at an outpatient clinic and has affirmed a commitment to to enhancing safety. The manager states that key strategy in this goal will be swift and severe consequences for staff members who commit errors when providing care. What is a known, negative consequences of this strategy?

Staff members may be tempted to cover up errors rather than reporting them.

A nurse who is recent graduate has been formally reprimanded after administering a medication to the wrong client. This reprimand would be considered to be consisted with a just culture if?

The reprimand has been deemed appropriate and relevant to the nurse's actions. - Just culture is an approach to error evaluation that examines the nature of the error in order to assist in determining the appropriate response to the individual who made the error.

A neonatal was born by vaginal delivery and initial assessment revealed no distress. However, the infant soon developed dyspnea and then apnea. The care team in the room attempted to manage the infant's distress independently and neglected to call an emergency code, which was later

Why did no one in the room choose to call a code? - Root cause analysis can often begin by asking "why" questions.