ABFM Quality Assurance and Improvement 3 — Questions and Answers
Question 1: A patient safety report describes a nurse administering the wrong medication dose due to a look-alike drug labeling issue. A root cause analysis focuses on which level of the problem?
- Individual practitioner competency and disciplinary action
- Systemic and environmental factors that enabled the error (Correct answer)
- Patient characteristics that contributed to the adverse event
- Cost-benefit analysis of the medication involved
Correct answer: Systemic and environmental factors that enabled the error
Root cause analysis (RCA) focuses on identifying underlying systemic factors rather than blaming individual providers.
Question 2: The National Patient Safety Goals (NPSGs) published by The Joint Commission are updated annually and primarily address which area?
- Reimbursement thresholds for quality metrics
- High-priority patient safety issues identified across accredited organizations (Correct answer)
- Physician licensure and credentialing standards
- Electronic health record meaningful use criteria
Correct answer: High-priority patient safety issues identified across accredited organizations
The Joint Commission's NPSGs identify specific patient safety concerns and establish requirements to address them in accredited healthcare organizations.
Question 3: In the ABFM Maintenance of Certification (MOC) program, Performance Improvement activities require physicians to demonstrate improvement through which sequence?
- Benchmark, intervene, re-measure, report to state board
- Measure baseline, implement change, remeasure, document improvement (Correct answer)
- Complete CME modules, pass written exam, submit case logs
- Peer review, external audit, corrective action plan
Correct answer: Measure baseline, implement change, remeasure, document improvement
ABFM PI-CME activities require measuring current performance, implementing a change intervention, and remeasuring to document improvement.
Question 4: Which concept best describes a near-miss event in patient safety terminology?
- An adverse event that caused permanent patient harm
- An error that reached the patient but caused no detectable injury
- An unsafe condition that was caught and corrected before reaching the patient (Correct answer)
- A sentinel event requiring immediate root cause analysis
Correct answer: An unsafe condition that was caught and corrected before reaching the patient
A near-miss (close call) is an event that had the potential to cause harm but was intercepted before affecting the patient.
Question 5: A practice calculates that 80% of patient complaints stem from 3 of 15 identified problems. Which QI tool best illustrates this finding to prioritize interventions?
- Run chart
- Pareto chart (Correct answer)
- Control chart
- Scatter diagram
Correct answer: Pareto chart
A Pareto chart displays problems in descending frequency, visually demonstrating which few causes account for the majority of issues (the 80/20 rule).
Question 6: Which framework classifies patient safety events by their severity, from near-miss to catastrophic harm?
- The Donabedian model (structure-process-outcome)
- The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) index (Correct answer)
- The HEDIS measurement framework
- The IHI Breakthrough Series Collaborative model
Correct answer: The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) index
The NCC MERP index categorizes medication errors and near-misses from Category A (no error potential) through Category I (patient death).
Question 7: In a FMEA (Failure Mode and Effects Analysis) conducted before implementing a new insulin protocol, what is the primary goal?
- Analyzing why a previous adverse event occurred
- Prospectively identifying potential failure points before they cause harm (Correct answer)
- Measuring post-implementation outcomes against benchmarks
- Conducting peer review of individual prescribing patterns
Correct answer: Prospectively identifying potential failure points before they cause harm
FMEA is a prospective risk assessment tool that identifies potential failure modes and their effects before a process is implemented.
ABFM Quality Assurance and Improvement 3
A patient safety report describes a nurse administering the wrong medication dose due to a look-alike drug labeling issue.
A root cause analysis focuses on which level of the problem?