Patient Safety and Ethics Flashcards

A competent adult female patient, admitted to a Saudi government hospital, refuses a blood transfusion on religious grounds. Her wali (male guardian) insists the transfusion proceed, arguing he holds legal authority over her medical decisions. Which action is most ethically and legally appropriate under Saudi healthcare regulations?

Answer: Respect the competent patient's refusal, document it thoroughly, and escalate to the treating physician and hospital ethics committee

Under the Saudi Patient Rights and Responsibilities Charter and SCFHS ethical guidelines, a mentally competent adult patient retains the right to refuse treatment regardless of guardian preferences. The wali system grants decision-making authority only for patients who lack capacity. The nurse's role is to document the informed refusal, ensure the patient has received full information, and escalate to the physician and ethics committee — not to override a competent patient's autonomous decision.

A scrub nurse in a Saudi accredited hospital suspects a surgical sponge was left in a patient who has already been closed and transferred to the PACU. The count was documented as correct, but the nurse's clinical intuition raises concern. According to CBAHI standards and the National Patient Safety Center (NPSC) framework, what is the priority action?

Answer: Immediately inform the surgeon and charge nurse, trigger an unplanned return-to-theatre protocol, and initiate an incident report as a potential sentinel event

Unintended retention of a foreign surgical object is classified as a Never Event and sentinel event under CBAHI standards and the NPSC framework. Saudi patient safety policy mandates immediate escalation — not waiting for symptom onset or radiological confirmation — because timely intervention reduces patient harm. A correct count does not exclude retention; clinical concern must trigger immediate action. An incident report must be filed and a Root Cause Analysis (RCA) initiated.

During medication reconciliation on a cardiology ward in Saudi Arabia, a nurse identifies that a patient is receiving both warfarin and a newly prescribed herbal supplement containing Ginkgo biloba, obtained during Hajj. The prescribing physician dismisses the concern, stating herbal supplements are 'not real medications.' Under Saudi MOH medication safety standards and the nurse's professional accountability per the SCFHS Code of Conduct, what is the most appropriate next step?

Answer: Formally escalate through the chain of command (charge nurse → department head → clinical pharmacist), document the interaction risk, and complete a near-miss incident report

Ginkgo biloba has a clinically significant interaction with warfarin, increasing bleeding risk — this is a known drug-herb interaction flagged in Saudi MOH medication safety guidelines. The nurse has a professional and legal duty under the SCFHS Code of Conduct to advocate for patient safety beyond a single verbal report. Formal escalation through the chain of command, involving the clinical pharmacist and documenting as a near-miss, fulfills this obligation. Unilaterally discontinuing the supplement exceeds nursing scope; leaving the decision solely to the patient ignores the safety mandate.

A nurse working the night shift in a Saudi tertiary hospital observes a colleague accessing the electronic health record of a high-profile patient multiple times without opening a clinical note or performing any documented care activity. The colleague is not assigned to this patient. Under the Saudi Health Information Law and the SCFHS Code of Professional Conduct, what is the nurse's primary obligation?

Answer: Report the suspected unauthorized access immediately to the nursing supervisor and the hospital's information security/privacy officer

Unauthorized access to patient health records constitutes a breach of confidentiality under the Saudi Health Information Law and violates the SCFHS professional code. There is no mandatory warning period or repeat-offense threshold before reporting. The nurse has an immediate professional and legal duty to report to the nursing supervisor and the hospital's information security/privacy officer. Delaying or conditioning the report undermines both the patient's rights and the institution's duty to investigate promptly.

A patient with a documented, ethics-committee-approved Do-Not-Resuscitate (DNR) order, in accordance with Saudi MOH end-of-life policy, suffers a cardiac arrest in a hospital room. The patient's adult son, acting as wali, is present and demands immediate full resuscitation, threatening legal action. What is the nurse's correct response?

Answer: Honor the valid DNR order, provide comfort-focused care, notify the physician, and compassionately explain the DNR status and its legal validity to the family

A DNR order that has been reviewed and approved by the hospital ethics committee in accordance with Saudi MOH policy is a legally and ethically binding clinical directive. The wali's authority does not override a valid advance directive for a patient who, while alive, expressed a competent wish. Initiating resuscitation under family pressure contradicts the patient's documented wishes and violates the ethical principle of autonomy. The nurse's duty is to uphold the DNR, provide comfort care, and engage the physician to communicate with the family — involving the ethics committee if the dispute escalates.

A newly licensed Saudi nurse on a busy medical ward is asked by a senior nurse to co-sign a medication administration record for an injection the senior claims to have given while the junior nurse was on break. The junior nurse did not witness the administration. Under the SCFHS professional accountability framework and Saudi patient safety standards, what must the junior nurse do?

Answer: Refuse to co-sign, explain that co-signature attests to witnessed administration, and advise the senior nurse to document the administration accurately themselves

A co-signature on a medication administration record is a legal attestation that the signing nurse directly witnessed or participated in the administration. Signing for an event not personally witnessed constitutes falsification of a legal clinical document — a serious breach under the SCFHS Code of Conduct that can result in license suspension. The junior nurse must refuse, clearly explain the reason without aggression, and encourage the administering nurse to document accurately. Co-signing with a conditional note does not mitigate the legal exposure; it still misrepresents the record.