Chapter 02: Clinical Safety: The Core of Leading, Managing, and Following

What did the IOM Health Professions Education report highlight as a concern for patient safety? A result of disciplinary silos.

A result of disciplinary silos.

After consulting with practice environments about quality and safety concerns in health care, a dean in a health care program implements what to improve quality and safety in health care? An interdisciplinary program for nurses, pharmacists, and medical practitioners that emphasizes collaborative learning teams.

An interdisciplinary program for nurses, pharmacists, and medical practitioners that emphasizes collaborative learning teams.

What would managers and staff review annually in order to ensure compliance with The Joint Commission (TJC) to improve patient safety? Appropriateness of charting terms and abbreviations

Appropriateness of charting terms and abbreviations.

In an effort to control costs and maximize revenues, the Rehabilitation Unit at Cross Hospital reduced the number of its managers and increased the number of units for which each manager was responsible. Within a year, the number of adverse events on the units had doubled. How do the increase in adverse events relate to decreased managers? Fewer clinical leaders facilitate best practice.

Fewer clinical leaders facilitate best practice

The NQF provides a model for advancement of healthcare quality that could be used in healthcare organizations. What does the use of this model by the Centers for Medicare and Medicaid Services specificity link with adverse patient events for healthcare facilities? Funding.

Funding.

As a manager in a new nursing home, where might you consult for guidance and evidence to support the development of safe patient practices? Hospitals

Hospitals.

As a nurse manager on the West Surgery Unit, you are interested in increasing patient safety and reducing morbidity and mortality on your unit. What recommendations would be consistent with the IOM The Future of Nursing report? Increase in the percentage of baccalaureate-prepared nurses to 80%

Increase in the percentage of baccalaureate-prepared nurses to 80%

Mary, an 85-year-old patient with cognitive impairment and gross instability, wanders continuously. Lately, she has fallen twice, and the family demands that she be restrained. As the unit manager, you have initiated a least restraint practice. What is an appropriate action in this situation? Initiating a multidisciplinary and family meeting to focus on Mary's needs

Initiating a multidisciplinary and family meeting to focus on Mary's needs.

As the manager on an acute care medical unit, you note that the incidence of medication errors has increased since the implementation of staffing changes. What is an important stratagem to reduce errors? Involve RN staff in determining reasons for errors and practice solutions to increase the safety of medication administration.

Involve RN staff in determining reasons for errors and practice solutions to increase the safety of medication administration.

A nurse manager is implementing strategies to support the steps in the AHRQ document "Five Steps to Safer Health Care." What does the manager include in the implementation? Patients are actively encouraged to make decisions related to care.

Patients are actively encouraged to make decisions related to care.

Sarah is a second-year nursing student. The clinical instructor overhears Sarah telling a patient that she "always" checks patients' bracelets before giving medication and she is not sure how the nurses on the unit "get away with" not making more errors than they do. The clinical instructor pulls Sarah aside and explores with her how her communication might affect the patient and what it reflects about her beliefs related to the team. What competency does this action outline? QSEN

QSEN.

What facilitate the development of decision-making skills related to safe patient care for a nurse manager? Regular reflection on decisions

Regular reflection on decisions.

Pleasant Valley Hospital has amended its safety practices and policies. What has the hospital elected to emphasize accordance with changes by The Joint Commission (TJC)? Safety goals specific to Pleasant Valley.

Safety goals specific to Pleasant Valley.

A client requires an appendectomy. The surgeon explains the procedure and asks the client to sign the consent. The patient speaks very little English and looks worried. What is the appropriate action by the nurse? Suggest that an interpreter explain the procedure to the client

Suggest that an interpreter explain the procedure to the client

The nurse is educating older adult patients on staying safe in the healthcare system. What information does the nurse include in the teaching? The need to understand and record all medications being taken. .

The need to understand and record all medications being taken.

What would be the primary emphasis in designing and implementing a quality, safe healthcare environment? The patient.

The patient.

On the West Surgery unit, you want to institute a new system for checking armbands that evidence suggests may increase safety in medication administration. The system involves technology. What strategy may assist with rapid adoption of the technology and system? Use early adopters among the staff as leaders and role models in implementation.

Use early adopters among the staff as leaders and role models in implementation.

During review of back injuries, it is determined that a large number of injuries are occurring in spite of mechanical lifts being used. Furthermore, it is determined that some lifts are outdated. In addressing this concern, the unit manager: meets individually with nurses who are observed to be using the lifts incorrectly to review the correct procedure.

meets individually with nurses who are observed to be using the lifts incorrectly to review the correct procedure.

To achieve Nurse-Sensitive Care Standards developed by the NQF, you advocate for which of the following in your health facility? Evidence-based practice to reduce the prevalence of pressure sores

Evidence-based practice to reduce the prevalence of pressure sores

How would a nurse manager and the staff prepare for redesignation as a Magnet® Hospital? Ensure that there are empirical data to support review of patient outcomes, actions taken, and results of actions.

Ensure that there are empirical data to support review of patient outcomes, actions taken, and results of actions.

How would the nurse executive begin to increase safety in patient care areas of the Valley Hospital? Ensuring that the senior nursing officer attends the board meetings.

Ensuring that the senior nursing officer attends the board meetings. The IOM report (2004) highlighted the importance of the attendance of the senior nurse executive at board meetings to be a key spokesperson on safety and quality issues.

What patients would be considered "at risk" consumers during a healthcare visit? (Select all that apply.) a. Clyde requires an anticoagulant. He tells the nurse about his medications. He does not include an herbal supplement. c. Sarah is a new parent who finds that nurses on the children's unit are very helpful. She is eager to accept all suggestions, including those that she does not yet understand. d. Claude is booked for bowel surgery. His doctor explains about the colostomy. Later, Claude tells his wife that he really doesn't know what the doctor meant by colostomy.

Clyde requires an anticoagulant. He tells the nurse about his medications. He does not include an herbal supplement. Sarah is a new parent who finds that nurses on the children's unit are very helpful. She is eager to accept all suggestions, including those that she does not yet understand. Claude is booked for bowel surgery. His doctor explains about the colostomy. Later, Claude tells his wife that he really doesn't know what the doctor meant by colostomy.

What does the SBAR approach to patient safety encourage? Consistency in assessment and practices

Consistency in assessment and practices.

You notice that Sally, a student on your unit, is giving information to an anxious young teen who seems very uncertain about preparation for an upper GI series. After Sally leaves the room, you ask her how she thought her conversation with the patient. What is the appropriate response for you to give Sally? Encourage her to ask the patient if he has questions or concerns about the procedure.

Encourage her to ask the patient if he has questions or concerns about the procedure.

The Rehabilitation Unit at Pleasant Valley Hospital has a high number of falls. What interventions might assist to reduce the number of falls on the unit? Encouraging involvement of nurses in education related to falls and safety

Encouraging involvement of nurses in education related to falls and safety The IOM (2010) emphasizes the need for nurses to engage in lifelong learning and to use evidence and best practices to inform practice and ensure safety.