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Regulatory Compliance & Standards Flashcards

7 cards from real CHSP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 7 Regulatory Compliance & Standards flashcards as text

  1. A hospital receives a citation for a 'repeat violation' from OSHA. Compared to an 'other-than-serious violation,' the penalty for a repeat violation can be up to how many times higher?

    Answer: 10 times

    OSHA can assess penalties for repeat violations up to 10 times the penalty for an 'other-than-serious' or 'serious' violation, reflecting the increased risk from ongoing non-compliance.

  2. The Sentinel Event Policy of The Joint Commission requires organizations to conduct a root cause analysis (RCA) and submit an action plan within how many days of a sentinel event?

    Answer: 60 days

    TJC's Sentinel Event Policy requires organizations to submit a thorough and credible RCA and action plan within 45 calendar days of the event or of becoming aware of it.

  3. Under the Americans with Disabilities Act (ADA), healthcare facilities are required to provide accessible routes to all areas of the facility because they are classified as:

    Answer: Public accommodations

    Hospitals and medical offices are classified as public accommodations under ADA Title III, which requires them to remove barriers to access for individuals with disabilities.

  4. Which standard specifically addresses ventilation requirements for airborne infection isolation (AII) rooms in healthcare facilities?

    Answer: ASHRAE Standard 170

    ASHRAE Standard 170 (Ventilation of Health Care Facilities) specifies ventilation requirements for AII rooms, including negative pressure and minimum air change rates.

  5. A healthcare facility's hazardous materials management program must address OSHA's requirement to maintain Safety Data Sheets (SDS) that are:

    Answer: Readily accessible to employees during each work shift

    OSHA's HazCom Standard requires that SDS be readily accessible to employees during their work shift, which may include electronic access as long as it is always available.

  6. Under NFPA 101, a healthcare occupancy is required to have a corridor width of at least how many inches to facilitate patient evacuation?

    Answer: 60 inches

    NFPA 101 requires corridors in healthcare occupancies to be at least 8 feet (96 inches) wide in areas used by patients, but the minimum for non-patient areas is 44 inches; however, for patient use areas, the 96-inch (8-foot) standard applies to facilitate bed/gurney evacuation.

  7. Which regulation requires healthcare facilities to develop and implement an Emergency Operations Plan (EOP) that addresses six critical areas including communication and resources?

    Answer: CMS Emergency Preparedness Rule (42 CFR Part 482.15)

    The CMS Emergency Preparedness Rule (42 CFR Part 482.15) requires hospitals to develop a comprehensive EOP addressing communication, resources and assets, safety and security, staff roles, utilities, and patient clinical needs.