CMT Patient Care and Safety 2 — Questions and Answers
Question 1: The Morse Fall Scale is used to assess a patient's:
- Pain level
- Risk of falling (Correct answer)
- Nutritional status
- Cognitive function
Correct answer: Risk of falling
The Morse Fall Scale is a validated tool that identifies patients at high risk for falls based on six criteria.
The Morse Fall Scale evaluates six risk factors: (1) history of falling (within 3 months), (2) secondary diagnosis (more than one medical condition), (3) ambulatory aid use (furniture, cane, walker, crutches), (4) IV therapy/heparin lock, (5) gait assessment (normal, weak, impaired), and (6) mental status (oriented vs. overestimates abilities). Scores range from 0-125: low risk (0-24), moderate risk (25-44), high risk (≥45). Fall prevention interventions based on risk level include bed alarms, non-skid footwear, call light within reach, toileting schedules, yellow fall risk wristbands, and one-on-one observation for highest risk patients.
Question 2: When repositioning a bedridden patient to prevent pressure injuries, how often should position changes occur?
- Every 4-6 hours
- Every 2 hours (Correct answer)
- Once per shift
- Only when the patient complains of discomfort
Correct answer: Every 2 hours
Bedridden patients should be repositioned at least every 2 hours to prevent pressure injuries from prolonged tissue compression.
Pressure injuries (formerly called pressure ulcers or bedsores) develop when sustained pressure compresses tissue between a bony prominence and a surface, causing ischemia and cell death. The 2-hour repositioning schedule is a standard of care based on evidence that tissue damage begins within 1-2 hours of sustained pressure. High-risk areas include the sacrum, heels, ischial tuberosities, trochanters, and occiput. Prevention strategies beyond repositioning include: pressure redistribution surfaces (specialty mattresses), moisture management, adequate nutrition (protein, calories, vitamin C, zinc), skin assessment at each repositioning, and minimizing friction and shear during movement.
Question 3: The acronym RACE in fire safety stands for:
- Run, Alert, Close, Escape
- Rescue, Alarm, Contain, Extinguish/Evacuate (Correct answer)
- Remove, Activate, Call, Exit
- Respond, Assess, Control, Eliminate
Correct answer: Rescue, Alarm, Contain, Extinguish/Evacuate
RACE stands for Rescue (remove patients from danger), Alarm (pull fire alarm), Contain (close doors to contain fire and smoke), Extinguish/Evacuate.
RACE is the universal fire response sequence in healthcare: Rescue—remove patients and personnel from immediate danger (closest to fire first); Alarm—activate the nearest fire alarm pull station and call the facility's emergency number; Contain—close all doors and windows to limit fire and smoke spread (fire doors are especially critical); Extinguish/Evacuate—attempt to extinguish small fires with the appropriate extinguisher (PASS technique: Pull pin, Aim at base, Squeeze handle, Sweep side to side) or evacuate if the fire is too large. Horizontal evacuation (to another fire compartment on the same floor) is preferred over vertical evacuation for patient safety.
Question 4: Which of the following patients is at highest risk for aspiration?
- An alert patient sitting upright eating lunch
- A patient with dysphagia lying flat (Correct answer)
- A patient with a broken arm eating soft foods
- An ambulatory patient drinking water
Correct answer: A patient with dysphagia lying flat
A patient with dysphagia (difficulty swallowing) who is lying flat is at highest risk for aspiration due to impaired swallowing reflexes and gravity.
Aspiration occurs when food, fluid, or secretions enter the airway below the vocal cords instead of the esophagus. Risk factors include dysphagia, decreased level of consciousness, stroke, neurological disorders, endotracheal/nasogastric tubes, flat positioning during feeding, and GERD. Prevention measures include: elevating the head of bed to 30-45 degrees during and for 30 minutes after eating, diet modification per speech therapy recommendations (thickened liquids, pureed foods), supervised meals, oral hygiene, and aspiration precautions signage. Aspiration pneumonia is a serious complication with significant morbidity and mortality in hospitalized patients.
Question 5: Standard patient identification requires verifying at least:
- One identifier (patient name)
- Two identifiers (name and date of birth) (Correct answer)
- Three identifiers (name, DOB, and room number)
- The patient's verbal confirmation only
Correct answer: Two identifiers (name and date of birth)
The Joint Commission requires at least two patient identifiers before any procedure, medication, or specimen collection. Room number is never an acceptable identifier.
The Joint Commission's National Patient Safety Goals require two patient identifiers before administering medications, blood products, specimens, or treatments. Acceptable identifiers include: patient name, date of birth, medical record number, Social Security number (limited use), or photo identification. Room number is explicitly prohibited because patients move between rooms. Verification methods include: checking the patient's identification wristband, asking the patient to state their name and DOB (never ask 'Are you John Smith?'), and scanning barcodes on wristbands. Two-person verification is required for high-risk procedures such as blood transfusions and surgical site verification.
Question 6: When using a mechanical lift to transfer a patient, the most important safety step is:
- Completing the transfer as quickly as possible
- Checking the lift's weight capacity and sling condition before use (Correct answer)
- Having only one person operate the lift
- Lifting the patient as high as possible for clearance
Correct answer: Checking the lift's weight capacity and sling condition before use
Before any mechanical lift use, the weight capacity must be verified against the patient's weight, and the sling must be inspected for tears or wear.
Safe mechanical lift operation requires: (1) Verify the lift's weight capacity exceeds the patient's weight, (2) Inspect the sling for tears, fraying, or damage before each use, (3) Ensure the correct sling size and type for the patient, (4) Require a minimum of two trained staff members for the transfer, (5) Explain the procedure to the patient, (6) Position the sling properly under the patient per manufacturer guidelines, (7) Raise the patient only high enough to clear the bed/chair, (8) Keep the lift's base wide and brakes locked when positioning, (9) Lower the patient slowly and remove the sling (unless it is a stay-in-place type). Mechanical lifts prevent musculoskeletal injuries—the leading cause of workplace injury for healthcare workers.
CMT Patient Care and Safety 2
The Morse Fall Scale is used to assess a patient's: