Culture Of Safety/patient Safety

Question 1

What is culture of safety?

Answer 1

Focuses on the care that was delivered

Communication about errors/near misses and actual harm without discipline

How care will be changed to avoid reoccurrence

Question 2

How does the AORN advocate for both patient and worker safety?

Answer 2

Evidence based practice guidelines

Associations mission statement, position statements and took kits

Question 3

What does the AORN provide to help achieve workplace safety?

Answer 3

Provide a standardized foundation to help deliver safe patient care

Question 4

What are the US regulatory organizations at a state level?

Answer 4

Public health departments
Insurance commissioners
Licensing boards

Question 5

What are US accreditation agencies?

Answer 5

The joint commission
Accreditation association for ambulatory health care
Accreditation commission for health care
DNV GL

Question 6

What are US professional organizations?

Answer 6

AORN

Ambulatory surgery centre association

Question 7

What does WHO focus on?

Answer 7

Safety
Checklists
Communication tools

Question 8

What is the 3 step universal protocol for site marking and who came up with it?

Answer 8

The joint commission

1. Verification
2. Site marking
3. Time out

Question 9

Verifying patient?

Answer 9

2 identifiers

Name
DOB
Hospital number

Involve patients and/or family when possible

Question 10

What are some key components to site marking?

Answer 10

2 identifiers 
Identifying right site 
-include patient when able
Done by surgeon before procedure 
Must be visible after prep and draping

Question 11

The institute of medicine (IOM) published report:
To Err is human..
what did that report identify?

Answer 11

To prevent errors safer system must be identified

When error occurs system needs to be examined

Standardization of process can improve safety

Question 12

Human factors effects on patient safety?

Answer 12

Skill based
- has knowledge for action and attention was diverted

Knowledge based

• errors in perception, judgement or interpretation
• further training may fix

Situational factors
- lack of attention and situational factors play time in error

Question 13

What are some elements that promote culture of safety in Perioperative setting?

Answer 13

Correct cleaning/care of instruments 
Effective communication 
Fall prevention 
Fire safety 
Infection prevention 
Patient centred 
Patient handling/movement 
Safe sharps 
Appropriate staffing 
Teamwork

Question 14

Unrestricted zones?

Answer 14

Public hallways/waiting areas

No dress code

Question 15

Semi-restricted zone?

Answer 15

Surgical attire is required

• scrubs
• hair covering
• clean shoes

Secured by public access without approval

Ex. Hallway leading to OR, supply rooms

Question 16

Restricted zone?

Answer 16

OR’s

Dress code, PPE

• scrubs
• hair covering
• clean shoes
• surgical mask and eye wear

Question 17

What is HVAC?

Answer 17

Heating
Ventilation
Air conditioning

Question 18

What is the temp of an OR?

Answer 18

20-24 degrees C

Or

68-76 degrees F

Question 19

What is the humidity range in an OR?

Answer 19

20-60%

Question 20

How many air exchanges happen in an OR?

Answer 20

A minimum of 20 air exchanges per hour with a minimum of 4 outdoor exchanges per hour

Question 21

True or false.

OR’s are negative pressure rooms?

Answer 21

False

OR’s have positive pressure rooms that moves from restricted to unrestricted areas

Question 22

Transferring patient to OR safety?

Answer 22

Cover patients hair
Keep away from sterile equipment
Ensure bed locked

If patient able to transfer self safely let them otherwise ensure enough people/equipment use to safely move

Question 23

Max weight 2 hands can lift?

Answer 23

22.2lbs

Question 24

Most weight 1 hand can lift?

Answer 24

11.1 lbs

Question 25

What is the Briefing period?

Answer 25

Done before procedure Patient awake Involves all team members

Question 26

What are some things covered in briefing period?

Answer 26

``` Patient Verification Consent Procedure Site marked Allergies Medications - pre op abx Anesthetic equipment ready Monitors ready Patient imagining and bloodwork done Warming VTE prophylaxis ```

Question 27

Time out?

Answer 27

``` Pause right before start of procedure Patient asleep Final assessment - right patient - correct site - correct position - correct procedure ```

Question 28

How long do you give antibiotics prior to procedure?

Answer 28

30min prior to cutting

Question 29

4 stages of surgical checklist?

Answer 29

Pre procedure check in Briefing Time out Debriefing

Question 30

What is covered in debriefing?

Answer 30

``` Procedure Unexpected events Total blood loss Wound class Counts Specimens collected Anesthesia review - how much used ```

Question 31

3 most common types of distractions that affect patient safety?

Answer 31

Distractions Interruptions Noise

Question 32

Where are fires most common on patient?

Answer 32

Above xiohoid process Head, neck or upper chest

Question 33

Where can fires occur in OR?

Answer 33

On or in patient - surgical drapes, patients skin or body cavity

Question 34

Fire triangle?

Answer 34

Ignition source Ex. Lasers Oxidizer Ex. O2, nitrous oxide Fuel Ex. Alcohol prep, drapes

Question 35

What time of emergency carts are there?

Answer 35

Code cart Difficult airway Malignant hyperthermia LAST

Question 36

What is LAST?

Answer 36

Local anesthetic systemic toxicity Needs 20% lipid emulsion

Question 37

What is malignant hyperthermia?

Answer 37

Biochemical chain reaction triggered by anesthesia Treated with dantrolene sodium

Question 38

What are social determinants of health?

Answer 38

Economic and social conditions that influence individual and group differences in health status Health factors found in ones living and working conditions

Question 39

What are some social determinants of health?

Answer 39

Where they work Where they are born Where they grow up Where they they live ``` Affect.. Education Employment opportunities Living conditions Access to health care ```

Question 40

What are some S&S of malignant hyperthermia?

Answer 40

``` Severe muscle rigidity or spasms Rapid, shallow breathing Rapid heart rate Abnormal heart rhythm High body temperature. Excessive sweating Patchy, irregular skin color (mottled skin) ```

Question 41

What are S&S of LAST?

Answer 41

``` agitation/confusion dizziness/drowsiness auditory changes/tinnitus perioral numbness metallic taste dysarthria ``` Untreated: seizures, respiratory arrest and coma