Clin Lab - Patient Safety

Question 1

What is the estimated deaths/year are from medical accidents or medical errors?

Answer 1

250,000 - 400,000

Question 2

What is the 3rd leading cause of death for adults?

Answer 2

medical accidents or medical error

Question 3

What are the 1st two causes of death?

Answer 3

1st - MI
2nd - stroke

Question 4

What is included in the statistics of medical accidents/errors?

Answer 4

Hospital-based errors
–> doesn’t account for outpatient errors

Question 5

Types of errors

Answer 5

• Diagnostic
• Surgical
• Medications
• Systems issues
• Communication issues
  Preventable adverse outcomes - healthcare-associated infections (HAI), falls, pressure ulcers, venous thromboembolism, delirium

Question 6

What % of dx errors may affect total deaths?

Answer 6

10%

Question 7

What % of dx errors are preventable?

Answer 7

20%

Question 8

What is the leading type of malpractice case?

Answer 8

Diagnostic errors

Question 9

Types of diagnostic errors

Answer 9

• Failure to diagnose
• Misdiagnosis
• Delay in diagnosis

Question 10

What are the big 3 diagnostics that are missed?

Answer 10

• Cancer
• Vascular events - stroke, MI, dissection
• Infx

Question 11

What is more seen in outpt for diagnostic errors?

Answer 11

not sending someone for FU & condition worsens

Question 12

What is more seen in the ER for diagnostic errors?

Answer 12

stroke/MI

Question 13

What are the factors that incr the likelihood of diagnostic error?

Answer 13

• Communication
• Cognitive shortcuts (“heuristics”)
• Unlikely presentation
• External stressors
• Bias

Question 14

Examples of Communication factors that incr diagnostic error.

Answer 14

• Between providers
• Between patient & provider(s)

Question 15

Examples of Cognitive shortcuts “heuristics” that incr diagnostic errors.

Answer 15

Anchoring
Availability bias
Premature closure
Context error

Question 16

Describe anchoring

Answer 16

Hooked on a diagnosis & you have tunnel vision

Question 17

Describe availability bias

Answer 17

Whatever we’ve recently seen we tend to dx other pts w/ those same sx (influenced)

Question 18

Describe premature closure

Answer 18

Don’t make broad differential before considering all possibilities

Question 19

Describe context error

Answer 19

Demographics, hx, social situation

Question 20

Some studies have shown surgical errors may account for___ of all adverse events. How many pts?

Answer 20

• almost half
• 1 in 20 pts

Question 21

Types of surgical errors

Answer 21

• surgery (practice makes perfect)
• preventable infx
• injuries
• wrong procedure
• retained surgical objects
• patient awareness during surgery

Question 22

Examples of preventable infxs

Answer 22

• Surg site
• central line
• catheter assoc.

Question 23

Examples of surgical error injuries?

Answer 23

• Positional – nerve damage, compartment syndrome, pressure sore
• Burns – electrocautery
• Sharp object / puncture
• Equipment malfunction

Question 24

Describe wrong procedure errors during surg

Answer 24

wrong patient, wrong side, wrong nerve block, etc.

Question 25

Prevention of surgical errors:

Answer 25

- Informed consent - Checklists - Time-out - Infx prevention measures – abx, change of gloves/gowns, maintenance of temp/blood glucose levels, etc.. - Equipment check-outs - 2-person checks - Structured communication - Strict counts

Question 26

of prescription meds

Answer 26

10,000

Question 27

of OTC meds

Answer 27

300,000

Question 28

Most med errors are in the ___ and ___ of meds?

Answer 28

ordering & administration

Question 29

What things can cause medication errors & it's administration?

Answer 29

- Handwritten prescriptions - Sound alike drugs - Look-alike drugs / vials

Question 30

What can increase the possibility of systems issues?

Answer 30

- Medical devices - working environments - EMRs - system protocols

Question 36

How have Human factor engineering system issues been lessened?

Answer 36

- Usability - Standardization (color coding) - Forced functions – things happen in a particular way

Question 37

What are the 2 key areas of error dealing w/ transitions in care?

Answer 37

- patient related transitions (pt moves) - Provider-related transitions (pt stationary, providers change)

Question 38

Examples of Patient-related transitions (pt moves)

Answer 38

- ER to hospital floor - Room to imaging center - Surgery OR/PACU to hospital floor - Hospital to home or rehab - Primary care to specialist consultant

Question 39

Examples of provider-related transitions (pt stationary, providers change)

Answer 39

- Shift change – day/week - Specialist weekend coverage - Nursing meal breaks

Question 40

Types of Healthcare-assoc. conditions

Answer 40

- Infx - Pressure wounds - Venous thromboembolism - Injuries form preventable falls - Adverse effects from meds

Question 41

Examples of healthcare-assoc. infxs

Answer 41

- Catheter assoc. UTI (CAUTI) - Central line assoc. bloodstream (CLABSI) - Ventilator assoc. pneumonia (VAP) - Surgical site infxs - C. difficile - Multi-drug resistant organisms (MDRO) – MRSA, VRE

Question 42

Ways to prevent HC assoc. infx in surgery

Answer 42

- Surgical prep / wash - Prophylactic abx - Wound care

Question 43

Ways to prevent HC assoc. - catheter assoc. UTI.

Answer 43

- Reduction in use of catheters - Sterile technique - Nursing protocols for early removal

Question 44

Ways to prevent HC assoc. - central line assoc. bloodstream infx

Answer 44

- Aseptic technique / hand hygiene - US guided insertion - Avoid femoral artery - Daily antiseptic baths - Antiseptic or Abx impregnated dressings - Disinfect hub each time prior to accessing - Remove ASAP

Question 45

When can pressure wound occur?

Answer 45

- pre-hospitalization - during surg - during hospitalization

Question 46

Stages of Pressure ulcers.

Answer 46

Unstageable - eschar formed I - skin is unbroken but inflamed II - skin broken to epidermis or dermis III - extends to subcutaneous layer IV - extends to muscle or bone

Question 47

Prevention of pressure wounds

Answer 47

- Frequent repositioning - Cushioning - Daily skin checks - Adequate nutrition

Question 48

Illnesses/conditions assoc. w/ VTE in the hospital

Answer 48

- Infx - Stroke - Inflammatory dz - Malignancy - Surgery

Question 49

Prevention of thromboembolism

Answer 49

- Low risk – ambulate, compression pumps - Moderate / high risk – meds (Lovenox or heparin [kidneys])

Question 50

Causes of falls

Answer 50

- Patients forget - wet floors - wires/cords - meds - opioids/benzos/anesthesia - lack of glasses

Question 51

Prevention of falls

Answer 51

- Bed alarms - fall risk bracelet - sign on door - make things easily assessable - gripper socks - camera - make sure call button is working

Question 52

List quality improvement processes

Answer 52

- Mandatory reporting & public disclosure - Financial consequences - System-wide practices - Education - Monitoring