Safety in Nursing

Question 1

What is patient safety?*

Answer 1

The reduction and mitigation of unsafe acts within the healthcare system, as well as through the use of best practices shown to lead to optimal patient outcomes

Question 2

Describe what an incident is in healthcare*

Answer 2

Events, processes, practices, or outcomes that are noteworthy by virtue of the hazards they create or the harms they cause to patients - event or circumstance that could have resulted, or did result, in unnecessary harm to a patient

Question 3

Define harm in patient safety*

Answer 3

A product of unsafe acts or safety events and can impact any dimension of health

It occurs as a result of health care interaction, whether or not it is related to the reason the person entered the healthcare system

Question 4

What are the four types of incidents?

Answer 4

1. harmful incident
2. near miss
3. no-harm incident
4. critical incident

Question 5

What are the three conceptual models for patient safety?*

Answer 5

1. Swiss cheese model
2. Domino model
3. Iceberg model

Question 6

Describe the Swiss cheese model and how to prevent harm through this model*

Answer 6

• A harmful event passes through several layers to reach the patient
• Have to find the holes in each layer it passed through and find ways to prevent them
• Prevention at even one layer would stop the event

Question 7

Describe the domino model and how to prevent harm through this model*

Answer 7

• Event passes through multiple layers/dominoes, but as it passes through, it creates more momentum (more falling dominoes)
• Have to find ways to stop the momentum
• Only have to stop the domino at one layer from falling to stop the event

Question 8

Describe the iceberg model and how to prevent harm through this model*

Answer 8

• The incident is only the tip of the iceberg that we can see
• Have to look at all the submerged (invisible) aspects that led to the event
• Correction/prevention often occurs at the invisible level

Question 9

What are contributing factors? Do conceptual models aid or hinder in identifying them?*

Answer 9

They are the reasons, situations, factors, or latent conditions that played a role in the genesis of an adverse event

Models help identify contributing factors

Question 10

What is a system failure?*

Answer 10

Faulty organizational process, operation, or structure that places the patient and/or HCP in danger of harm

Question 11

What two dimensions shape organizational culture?*

Answer 11

1. The organizational framework
2. The behaviours demonstrated by the employees of the organization

Question 12

Describe how an organizational framework enhances a culture of safety*

Answer 12

• Funding for safety mechanisms (equipment, processes)
• Organizational leaders must make safety a priority
• Empower staff to engage in safety projects

Question 13

Describe how the behaviour employees enhances a culture of safety*

Answer 13

• Everyone must be on board
• Thinking about safety at all times
• Follow policy and procedure at all times
• Avoid shortcuts

Question 14

Describe reporting culture*

Answer 14

Reporting is the norm - must trust that reporting will not result in punishment

Question 15

Describe informed culture*

Answer 15

Gains knowledge from analyzing adverse event reports - is the outcome of a reporting culture

Question 16

What type of safety culture is the outcome of a reporting culture?*

Answer 16

Informed culture

Question 17

Describe flexible culture*

Answer 17

Open to changing processes based on new knowledge gained - requires teamwork and shared accountability, shared power, and open communication

Question 18

Describe learning culture*

Answer 18

Learns from experience, makes necessary adjustments to the system - requires the culture to be informed and flexible

Question 19

How does risk management enhance safety culture?*

Answer 19

It minimizes the occurrence of untoward events by planning for their occurrence and placing safeguards to offset the danger

Often takes the form of policies, procedures, and processes

Question 20

How does quality improvement enhance safety culture?*

Answer 20

Includes activities to enhance the patient’s (and/or staff’s) experience, outcomes, and safety

Question 21

What is an adverse event?*

Answer 21

Results in harm to the patient

Question 22

What is a critical incident?*

Answer 22

Results in significant impairment or loss of life

Question 23

What is a near miss?*

Answer 23

An event caught right before it reached the patient

Question 24

How can inter-professional communication hinder safety culture?*

Answer 24

Power/authority gradients within healthcare can serve as barriers to effective communication (i.e., Staff nurse ignores student nurse concerns about the patient)