Patient and Family Involvement
Quality and Safety
Communication
Infection Control
Accreditation Expert
100

Clinical: How would you communicate with someone you has a language barrier?

Use translation services, speak with family member

100

All Staff: Who is responsible for safety at UHN?

EVERYONE!

100

Clinical: What communication tools do you use to transfer a patient during care transitions?

IPASS
EPIC
Nursing Shift Reports at Bedside
Safety Huddles
After Visit Summary

100

All Staff: Who is responsible for infection prevention and control at UHN?

EVERYONE

100

All staff: Is Accreditation happening soon?

Yes - the survey team will be at Toronto General and Toronto Western the week of April 20-24, 2026

200

All Staff: How do you demonstrate that you are honouring the UHN Patient Declaration of Values?

Introduce yourself
Protect patient privacy
Smile, say hello and be friendly
Hear patient concerns and work to address them
Don't use medical jargon
Ask open ended questions or Teach-Back
Try to be at the same eye level as the patient



200

All Staff: Can you name any education you have received about patient or staff safety?

Code Response training (e-learning modules)
Work Place Violence e-learning module
Incident reporting training (IRIS system)
Hand hygiene training

200

All Staff: Can you name an Error Prevention Tool that UHN uses?

Question & Confirm
ARCC (ask a question, make a request, voice a concern, use chain of command)
STAR (Stop, Think, Act Review)
3-way repeat back
Clarifying Questions
SBAR
Phonetic and Numeric Clarification
5:1 FeedbackC
Cross Check

200

All Staff: How do you help decrease the spread of infection at UHN?

Wash your hands
Stay home when you are sick
Get the flu shot

200

All Staff: Why does UHN participate in Accreditation?

To ensure that we are providing high quality and safe care to patients. To learn what we are doing well and what we need to improve.

300

Clincal: Who can be called on to help when there is a disagreement between team members or between team members and patients?

The ethicist

Social Worker

300

All Staff: What are some ways you contribute to safety at UHN?

Wear ID badge
Get your flu shot
Wear your staff duress button if required
Complete training and education on new processes/procedures
Wash your hands

300

Clinical Areas: Can you name two pieces of information you ask a patient to verify their identification?

Name
Date of birth

300

Clinical and EVS: What are the 4 moments of hand hygiene?

Moment 1: Before contact with the patient or patient environment
Moment 2: Before aseptic procedures (i.v. insertion, wound care)
Moment 3: After contact with body fluid or section (i.e. blood, stool, urine)
Moment 4: Afer contact with the patient or the patient's environment

300

All Staff: Who can be approached by a surveyor during Accreditation?

Anyone

400

All Staff: Who can a patient or family member speak with if they have a concern, complaint or compliment?

Manager

Patient Relations

400

All Staff: What should you do if you see something unsafe?

If it is something simple fix it (i.e. clean up a spill)
Report it through the appropriate Help Desk
If you are able, complete an incident report report, if not, report it to your manager

400

All Staff: How does your team communicate information?

Email
Meetings
Safety Huddles

400

Clinical: What is Antimicrobial Stewardship?

Set of interventions aimed at promotign tracking and reporting the appropriate use of antimicrobials to help improve the rise of antimicrobial resistance

400

All Staff: Is the Accreditation survey a test?

NO! It is a chance to show off the amazing work we do every day. 

500

All Staff: How do you know that patients/clients are a priority at UHN

Are primary value is that the needs of the patient come first

We have a Declaration of Patient Values

500

Clinical: Do you know any of the system quality priorities at UHN?

Escalation of Care
Transfer of Accountability and Information
Recognition of Deterioration

500

Clinical: True or False: Clinical teams use EPIC to communicate with one another.

TRUE!

500

Clinical and EVS: Can you name an item of Personal Protective Equipment (PPE) that a clinical member of staff wears to help decrease the spread of infection?

Mask
Gloves
Gown
Face Shield

500

All Staff: Do you need to know answers off by heart if you are approached by a surveyor?

No!
You may not know the answer but you should be able to tell the surveyor where  you could find information
For example - the Intranet, various SharePoint sites, speaking with your supervisor or manager.

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