Patient Safety
Test Your Knowledge
Survey Readiness
Potpourr
Etc
100
What is the process in identifying patients at risk for suicide?
We require a risk assessment for suicide for any patients treated for primary disorder of behavioral or emotional disorders
100
What is the contact time for routine cleaning (HB Quat, Sani wipe, etc)? C-diff (Oxivir) Cleaning?
□ For routine cleaning, contact time is two minutes. □ For C-diff (Oxivir) , contact time is 5 minutes
100
When do I need to use two patient identifiers?
□ Two patient identifiers are required when administering any care or treatment -taking lab samples -administering medications or blood products -Prior to procedure -Prior to delivering diet -Transporting patients
100
What is the process for reporting broken equipment?
□ Remove from immediate care area □ Utilize broken equipment tabs to report details of the issue (orange-PSN event)
100
How do you contact the Command Cetner and why would you use it?
The number is 5-3333 (i can find this information on the intranet site) I would call this number if I needed to mobilize a needed resource (e.g., help clearing the halls, facilitiy emergency)
200
Describe how you perform a time out prior to surgery and procedures (part of the Universal Protocol)?
Prior to any procedure or surgery we conduct a time out which includes: -Correct Patient Identity -Agreement on procedure to be done -Correct side and site procedure (This is described in our universal Protocol policy)
200
What are some common survey tips which can help lead to survey success? (e.g., first day prep, how to ?greet and talk to surveyors)
□ Implement Just-in-time Checklist □ Welcome surveyors to the unit, be friendly and positive □ Answer only the question asked □ You know this stuff- do what you do everyday!
200
What are the requirements for oxygen storage? ?
□ Always In appropriate storage device □ Clear delineation between Full (green) and Empty (red) □ 12 E cylinders or 1 H cylinder and 2 E cylinders
200
What are some key environmental requirements for patient care areas ALL THE TIME?
□ Fire extinguishers accessible □ Electric panels and oxygen valves unblocked □ Fire doors closed □ Gas cylinders secured □ Medical records confidential □ Hallways clear- equipment to one side of hall □ Medication secured □ Disinfectant wipe lids closed □ Checklists completed
200
What are my responsibilities regarding advance directives?
We need to ensure that the patient is asked whether they have an advance directive, to assist the patient if they want to know more about advance directives, and to honor advance directives. it is our responsibilitiy to know if the patient has an advance directive
300
How do you report errors or other safety concerns?
□ Patient Safety Net (PSN) □ CUSP Rounds □ Departmental Chain of Command □ I have the right to report any patient safety concern to TJC
300
What is the rule of thumb for all logs and checklists?
□ Keep only the current month’s checklists on the unit, others stored and supplied only if requested by surveyors
300
What are the requirements for laryngoscope storage?
□ Must be in a protective cover to prevent re-contamination □ Acceptable to open the peel pack to test the light but always return to peel pack or place in clear plastic bag
300
What is the best way to deal holes in walls, stains on ceiling tiles, cracked floor tile
Place a work order through facilities (link on our TJC website) Urgent and time sensitive requests must be reported to Facilities Engineering and Clinical Engineering via phone x5-8300.
300
How do you determine what type of restraint policy you follow (violent versus nonviolent?)
This is based on the patient's behavior- if the patient is agressive or violent in anyway then the violent restraint policy is required, regardles of geographical location
400
What are the requirements for medication reconciliation?
□ A Home Medication List is obtained, no later than 24 hours after admission □ Medications ordered are compared to patient home medication list; discrepancies are resolved □ On discharge, a new Medication list is sent home with the patient
400
Where can I find emergency preparedness resources?
□ Hopkins on Alert badge □ Staff Emergency Response Reference Matrix □ Policies and Procedures (ceck out our new link on TJC website)
400
What needs to happened when I receive a critical action value?
□ Write it down, read it back □ Notify the provider and document in a CAV note □ Do not PING the results It would be acceptable to ping “I have CAV results. Call me at x-0000” Remember- some policies still require you to notify the provider at certain times- e.g., heparin protocol for certain aPTT levels
400
What are the requiremens for a fluid warmer?
-Documentation of the temperature is required daily on a log -All IV fluids in the warmer must be labeled (with 14 day expiration) -Once removed from a warmer, the fluids must be utilized within 24 hours (they should never be returned to the warmer)
500
What are the requirements for labeling medications for procedures and operations?
□ All containers are labeled on and off the sterile field (includes syringes, medication cups, basins) unless they are immediately used □ Labeling includes drug name, strength, quantity, diluent and volume if not apparent from container, include expiration date if expires in less than 24 hours.
500
What do I need to know about use of multi-dose vials?
□ Multi-dose vials can not be stored in immediate care areas (procedure rooms, clinic room, OR, Treatment rooms). They would be treated as a single-dose vial in these areas, and discarded immediately after the case is over. □ If stored in a medication room, they must be dated with 28 day expiration once opened
500
What are some of the annual requirements that every employee is required to do?
□ Complete the yearly educational requirements (fire safety, Hazard Communication, Blood borne pathogens as applicable) □ TB testing for those employees with patient contact □ Fit testing, per unit risk assessment (if you wear a N95 mask, you need to be fit tested) □ Have a yearly performance evaluation? □ Competencies as required by job duties?
500
How do you ensure the right patient is receiving the right care and treatment?
We always use two patient identifiers to verify the patient’s identity (matching this in two places- for example the MAR and patient id band) -Inpatient: patient’s name and history number -Outpatient: name and birthday
500
What is therapeutic duplication and how can it be prevented?
Therapeutic duplication is when there are two or more drugs ordered for the same indication (e.g., nausea, pain) without clear indications for which to give first. Always clarify orders with the provider
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