NMC CBT Patient Safety and Risk Assessment 2 — Questions and Answers
Question 1: What is the primary purpose of the NHS incident reporting system?
- To identify and discipline staff who make errors
- To collect data on patient safety incidents to identify trends and develop solutions (Correct answer)
- To determine financial liability for negligence claims
- To create records for the coroner
Correct answer: To collect data on patient safety incidents to identify trends and develop solutions
The system collects data to identify patterns and trends, enabling system-wide safety improvements in a learning culture.
The LFPSE (Learn from Patient Safety Events, replacing NRLS) collects data to: identify patterns nationally; analyse root causes; develop safety alerts and guidance; promote open reporting ('just culture'). Reporting is encouraged, not punished. All organisations must have local systems (commonly Datix). Near-misses should also be reported.
Question 2: Which validated tool is commonly used for falls risk assessment in UK hospitals?
- Waterlow score
- MUST screening tool
- STRATIFY (St Thomas's Risk Assessment Tool in Falling Elderly Inpatients) (Correct answer)
- VIP score
Correct answer: STRATIFY (St Thomas's Risk Assessment Tool in Falling Elderly Inpatients)
STRATIFY assesses transfer ability, mobility, visual impairment, toileting frequency, and previous falls history.
STRATIFY assesses five factors: (1) fall on presentation or since admission; (2) agitation; (3) visual impairment; (4) frequent toileting; (5) transfer/mobility score 3-4. Score 0-5; >=2 = high risk. Interventions: bed rail assessment, footwear, walking aids, medication review, environmental modifications, toileting schedules. NICE CG161 provides guidance.
Question 3: Which four harms does the NHS Safety Thermometer measure?
- Falls, medication errors, surgical complications, infections
- Pressure ulcers, falls, catheter-associated UTIs, and VTE (Correct answer)
- Cardiac arrests, drug errors, wrong site surgery, complaints
- Hospital-acquired pneumonia, pressure ulcers, falls, readmissions
Correct answer: Pressure ulcers, falls, catheter-associated UTIs, and VTE
The four key harms: pressure ulcers, falls, CAUTIs, and VTE. Harm-free care means none of these occurred.
The NHS Safety Thermometer (now largely superseded by PSIRF) measured monthly: (1) Pressure ulcers (new cat 2-4); (2) Falls (resulting in harm); (3) CAUTIs (UTIs in catheterised patients); (4) VTE (new DVT/PE). 'Harm-free care' = free from all four. These remain key quality indicators under PSIRF.
Question 4: How should a nurse manage a hazard identified in the clinical environment using risk assessment?
- Remove the hazard immediately without documentation
- Identify the hazard, assess who might be harmed, evaluate risk, implement controls, and record findings (Correct answer)
- Report to the HSE directly
- Close the ward until removed
Correct answer: Identify the hazard, assess who might be harmed, evaluate risk, implement controls, and record findings
Risk assessment follows the HSE five-step approach: identify, assess, evaluate and control, record, and review regularly.
HSE five steps: (1) Identify hazards; (2) Decide who might be harmed and how; (3) Evaluate risks using risk matrix (likelihood x severity), implement controls (hierarchy: eliminate, substitute, engineering, administrative, PPE); (4) Record findings and actions; (5) Review regularly. Required under Management of Health and Safety at Work Regulations 1999.
Question 5: What does the 'Swiss Cheese Model' (James Reason) illustrate about patient safety?
- Accidents are always caused by a single human error
- Accidents occur when multiple defence layers have aligned failures, allowing a hazard through all barriers (Correct answer)
- Only organisational failures cause patient harm
- Technology failures are the primary cause
Correct answer: Accidents occur when multiple defence layers have aligned failures, allowing a hazard through all barriers
Multiple defence layers (like Swiss cheese slices) each have weaknesses (holes). Accidents happen when holes momentarily align.
Reason's model: multiple barriers prevent errors reaching patients. Each layer has weaknesses from active failures (individual errors) and latent conditions (system design, culture, staffing). Accidents occur when holes align. Latent conditions are more important than active failures. This supports a systems approach: strengthen defences, address latent conditions, create error-resilient systems.
Question 6: A patient has a DNACPR form. Which statement is correct?
- DNACPR means no treatment should be given
- DNACPR applies only to CPR — all other appropriate treatment continues (Correct answer)
- DNACPR can only be decided by the patient
- DNACPR decisions never need review
Correct answer: DNACPR applies only to CPR — all other appropriate treatment continues
DNACPR relates specifically to CPR only. All other treatment should continue as appropriate.
DNACPR does NOT limit any other treatment (antibiotics, fluids, oxygen, pain management, nursing care). It should involve the patient/family (Tracey v Cambridge 2014). Made by a senior clinician when CPR would not succeed or when a capacitous patient refuses. Must be regularly reviewed. ReSPECT provides a broader emergency care framework.
NMC CBT Patient Safety and Risk Assessment 2
What is the primary purpose of the NHS incident reporting system?