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Patient Safety – (Online Only)

Learning Objectives

  1. Define the goal of critical incident monitoring.
  2. Define a “near miss.”
  3. Compare incident reporting systems with chart reviews and risk management in relation to preventable events.
  4. Describe the purpose of a root cause analysis according to the JCAHO mandate of 1997.
  5. Describe the template in the form of a tree or ”Ishikawa.”
  6. List the limitations of root cause analysis.
  7. Describe the functions of CDSSs.
  8. State the incident rates of ADEs per 100 admissions.
  9. Define a non- preventable ADE (adverse drug event).
  10. Define corollary.
  11. State the drug classification most commonly associated with preventable ADEs.
  12. State which group of hospitalized patients benefit most from clinical pharmacists in reducing ADEs.
  13. Describe a computerized ADE monitor.
  14. List the economic consequences of injuries due to drugs.
  15. List several “high risk” medications.
  16. State the primary intention of a heparin nomogram.
  17. List 2 reasons unit-dose dispensing of medications was developed.
  18. Describe the shift of unit-dosing from the nursing ward to the pharmacy.
  19. Describe the McLaughlin dispensing system.
  20. State a common complaint by nurses about a Pyxis Medstation.
  21. Define hand disinfection.
  22. State what percent of hospitalized patients contract a nosocomial infection.
  23. List one of the main reasons for poor handwashing compliance.
  24. State the length of time in seconds that is recommended for adequate hand hygiene.
  25. State the estimated cost per episode of each nosocomial infection.
  26. List several statistics regarding cost and acquisition rate for hospitalized patients.
  27. Describe the psychological effect of contact precaution on the isolated patient.
  28. State the estimated cost associated with c. difficile in the hospitalized patient.
  29. State the most common nosocomial infections.
  30. State the percent of urinary tract infection that make up nosocomial infections.
  31. Describe the use of silver in urethral catheters.
  32. List the two antibiotics used for antimicrobial impregnated catheters.
  33. Define catheter colonization.
  34. List the three common organisms causing catheter-related infections.
  35. List the maximum sterile barrier precautions.
  36. State the most common skin prep agent used prior to insertion of a central venous catheter.
  37. Define ventilator-associated pneumonia.
  38. Define continuous oscillation and how it is tolerated by conscious patients.
  39. State the goal of selective digestive tract decontamination.
  40. List several potential pitfalls of localizing care to high-volume settings.
  41. Describe the two general categories of complications from minimal access procedures.
  42. State the percent of injuries predicted to occur during a surgeon’s first 30 cases.
  43. Define a surgical site infection.
  44. Define antimicrobial prophylaxis and its purpose.
  45. List the consequences of intraoperative hypothermia.
  46. List complications of central venous catheterization after placement.
  47. State the greatest benefit of ultrasound guidance.
  48. State the number of sponge, sharp, and instrument counts recommended and describe each.
  49. State the surgery where most retained sponges are found.
  50. Describe the “checkout list” as stated in 1987 by the FDA.
  51. State why a generalized checklist would be difficult or impossible.
  52. List examples of invasive monitors.
  53. Define capnography.
  54. State the most common medical complication of surgery.
  55. List the benefits of beta-blockade for elderly patients.
  56. List the strongest predictor of future falls.
  57. List the problems of wearing an external hip protector.
  58. List two tools that are widely used to identify at-risk patients.
  59. State the measures required with the Omnibus Budget Reconciliation Act of 1987.
  60. State the cost of treating a pressure ulcer.
  61. Define delirium.
  62. List general strategies to prevent delirium.
  63. List the members of a consultation team provided by published studies and common features.
  64. List the functions of a multidisciplinary team in a GEM unit.
  65. Describe a GEM unit.
  66. Define “clinically silent.”
  67. State the “gold standard” for diagnosis of DVT.
  68. List the reasons DVT prophylaxis is underused.
  69. List the major risk factors for radiocontrast-induced nephropathy.
  70. State the percent of hospitalized patients who are malnourished.
  71. State a complication associated with TPN.
  72. List the three risks of stress ulceration and GI bleeding.
  73. Describe teleradiology.
  74. Describe the high-risk patient.
  75. State the most effective delivery method for inpatient settings.
  76. State the function of acute pain services post-operatively.
  77. List the most common side effects of patient-controlled analgesia with opioids.
  78. Describe a closed ICU model.
  79. State what part of a nurse’s job is the largest.
  80. Describe how increasing the percentage of RNs in the skill mix has decreased risk-adjusted mortality.
  81. Define the term High Reliability Organization.
  82. Describe the safety climate.
  83. Define ergonomics.
  84. Describe the experiment of recognizing six alarms at one time.
  85. Define sign-out.
  86. State the two most common reasons reported by physicians for not notifying patients of abnormal results.
  87. State the oldest and most common machine-readable ID system.
  88. List several common factors in wrong-site surgery.
  89. List the three primary components of effective crew management.
  90. Describe the MedTeams behavior-based teamwork system.
  91. List four advantages of simulation.
  92. State two potential risks to simulation-based training.
  93. Define “sleep debt.”
  94. Describe how shift rotation impacts worker fatigue.
  95. Define “sleep inertia.”
  96. Describe intrahospital and interhospital transports.
  97. State the mortality rate during interhospital and intrahospital transport.
  98. Define informed consent.
  99. State the grade level at which hospital forms are written, according to Hopper et al.
  100. Define advance directive, living will, and durable power of attorney for health care.
  101. State why advance directives often do not change end-of-life interventions.
  102. Describe the five-page “Patient Fact Sheet.”
  103. Define “practice guidelines.”
  104. Define Critical Pathways.
  105. Define a “clinical decision support system.”
  106. List three techniques used to modify behavior of physicians.
  107. List the purpose of survey results used by JCAHO.

Course Contents

PART I. Overview

  1. An Introduction to the Compendium
    • 1.1 General Overview
    • 1.2 How to Use this Compendium
    • 1.3 Acknowledgments
  2. Drawing on Safety Practices from Outside Healthcare
  3. Evidence-Based Review Methodology

PART II. Reporting and Responding to Patient Safety Problems

  1. Incident Reporting
  2. Root Cause Analysis

PART III. Patient Safety Practices & Targets

Section A. Adverse Drug Events (ADEs)

  1. Computerized Physician Order Entry (CPOE) with Clinical Decision Support Systems (CDSSs)
  2. The Clinical Pharmacist’s Role in Preventing Adverse Drug Events
  3. Computer Adverse Drug Event (ADE) Detection and Alerts
  4. Protocols for High-Risk Drugs: Reducing Adverse Drug Events Related to Anticoagulants
  5. Unit-Dose Drug Distribution Systems
  6. Automated Medication Dispensing Devices

Section B. Infection Control

  1. Practices to Improve Handwashing Compliance
  2. Impact of Barrier Precautions in Reducing the Transmission of Serious Nosocomial Infections
  3. Impact of Changes in Antibiotic Use Practices on Nosocomial Infections and Antimicrobial Resistance—Clostridium Difficile and Vancomycin-resistant Enterococcus (VRE)
  4. Prevention of Nosocomial Urinary Tract Infections
    • 15.1 Use of Silver Alloy Urinary Catheters
    • 15.2 Use of Suprapubic Catheters
  5. Prevention of Intravascular Catheter-Associated Infections
    • 16.1 Use of Maximum Barrier Precautions during Central Venous Catheter Insertion
    • 16.2 Use of Central Venous Catheters Coated with Antibacterial or Antiseptic Agents
    • 16.3 Use of Chlorhexidine Gluconate at the Central Venous Catheter Insertion Site
    • 16.4 Other Practices
  6. Prevention of Ventilator-Associated Pneumonia (VAP)
    • 17.1 Patient Positioning: Semi-recumbent Positioning and Continuous Oscillation
    • 17.2 Continuous Aspiration of Subglottic Secretions
    • 17.3 Selective Digestive Tract Decontamination
    • 17.4 Sucralfate and Prevention of VAP

Section C. Surgery, Anesthesia, and Perioperative Medicine

  1. Localizing Care to High-Volume Centers
  2. Learning Curves for New Procedures—the Case of Laparoscopic Cholecystectomy
  3. Prevention of Surgical Site Infections
    • 20.1 Prophylactic Antibiotics
    • 20.2 Perioperative Normothermia
    • 20.3 Supplemental Perioperative Oxygen
    • 20.4 Perioperative Glucose Control
  4. Ultrasound Guidance of Central Vein Catheterization
  5. The Retained Surgical Sponge
  6. Pre-Anesthesia Checklists To Improve Patient Safety
  7. The Impact Of Intraoperative Monitoring On Patient Safety
  8. Beta-blockers and Reduction of Perioperative Cardiac Events

Section D. Safety Practices for Hospitalized or Institutionalized Elders

  1. Prevention of Falls in Hospitalized and Institutionalized Older People
    • 26.1 Identification Bracelets for High-Risk Patients
    • 26.2 Interventions that Decrease the Use of Physical Restraints
    • 26.3 Bed Alarms
    • 26.4 Special Hospital Flooring Materials to Reduce Injuries from Patient Falls
    • 26.5 Hip Protectors to Prevent Hip Fracture
  2. Prevention of Pressure Ulcers in Older Patients
  3. Prevention of Delirium in Older Hospitalized Patients
  4. Multidisciplinary Geriatric Consultation Services
  5. Geriatric Evaluation and Management Units for Hospitalized Patients

Section E. General Clinical Topics

  1. Prevention of Venous Thromboembolism
  2. Prevention of Contrast-Induced Nephropathy
  3. Nutritional Support
  4. Prevention of Clinically Significant Gastrointestinal Bleeding in Intensive Care Unit Patients
  5. Reducing Errors in the Interpretation of Plain Radiographs and Computed Tomography Scans
  6. Pneumococcal Vaccination Prior to Hospital Discharge
  7. Pain Management
    • 37.1 Use of Analgesics in the Acute Abdomen
    • 37.2 Acute Pain Services
    • 37.3 Prophylactic Antiemetics During Patient-controlled Analgesia Therapy
    • 37.4 Non-pharmacologic Interventions for Postoperative Plan

Section F. Organization, Structure, and Culture

  1. “Closed” Intensive Care Units and Other Models of Care for Critically Ill Patients
  2. Nurse Staffing, Models of Care Delivery, and Interventions
  3. Promoting a Culture of Safety

Section G. Systems Issues and Human Factors

  1. Human Factors and Medical Devices
    • 41.1 The Use of Human Factors in Reducing Device-related Medical Errors
    • 41.2 Refining the Performance of Medical Device Alarms
    • 41.3 Equipment Checklists in Anesthesia
  2. Information Transfer
    • 42.1 Information Transfer Between Inpatient and Outpatient Pharmacies
    • 42.2 Sign-Out Systems for Cross-Coverage
    • 42.3 Discharge Summaries and Follow-up
    • 42.4 Notifying Patients of Abnormal Results
  3. Prevention of Misidentifications
    • 43.1 Bar Coding
    • 43.2 Strategies to Avoid Wrong-Site Surgery
  4. Crew Resource Management and its Applications in Medicine
  5. Simulator-Based Training and Patient Safety
  6. Fatigue, Sleepiness, and Medical Errors
  7. Safety During Transportation of Critically Ill Patients
    • 47.1 Interhospital Transport
    • 47.2 Intrahospital Transport

Section H. Role of the Patient

  1. Procedures For Obtaining Informed Consent
  2. Advance Planning For End-of-Life Care
  3. Other Practices Related to Patient Participation

PART IV. Promoting And Implementing Safety Practices

  1. Practice Guidelines
  2. Critical Pathways
  3. Clinical Decision Support Systems
  4. Educational Techniques Used in Changing Provider Behavior
  5. Legislation, Accreditation, and Market-Driven and Other Approaches to Improving Patient Safety

PART V. Analyzing The Practices

  1. Methodology for Summarizing the Evidence for the Practices
  2. Practices Rated by Strength of Evidence
  3. Practices Rated by Research Priority
  4. Listing of All Practices, Categorical Ratings, and Comments