Quality Improvement & Patient Safety Flashcards
7 cards from real RHS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Quality Improvement & Patient Safety flashcards as text
What does the term 'sentinel event' refer to in healthcare quality improvement?
Answer: An unexpected occurrence involving death or serious physical or psychological injury
A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof, requiring immediate investigation and response.
Which organization developed and annually updates the National Patient Safety Goals (NPSGs)?
Answer: The Joint Commission
The Joint Commission developed the National Patient Safety Goals and updates them annually to address specific areas of concern in patient safety across accredited facilities.
A root cause analysis (RCA) in healthcare is primarily used to:
Answer: Identify underlying system factors that contributed to an adverse event
RCA is a systematic process for identifying basic or contributing causal system factors behind an adverse event in order to prevent recurrence.
The Swiss Cheese Model of accident causation in patient safety was developed by:
Answer: James Reason
James Reason developed the Swiss Cheese Model, which illustrates how multiple layers of defense can simultaneously fail, allowing errors to reach and harm patients.
What does PDSA stand for in the quality improvement cycle used in healthcare?
Answer: Plan, Do, Study, Act
PDSA (Plan, Do, Study, Act) is a four-step iterative improvement cycle used to test changes on a small scale and learn from results before broader implementation.
Which error prevention technique requires the recipient of a verbal or telephone order to repeat it back to the prescriber?
Answer: Read-back verification
Read-back (or repeat-back) verification requires the order recipient to verbally repeat the order to the prescriber for confirmation, reducing transcription and misinterpretation errors.
What is the primary purpose of a 'near miss' reporting system in a healthcare organization?
Answer: To identify potential hazards and system failures before they cause patient harm
Near miss reporting allows organizations to identify vulnerabilities in systems and processes proactively, enabling corrective action before an actual patient harm event occurs.