SURVEY SUCCESS
An accrediting organization that evaluates a health care organization’s performance in areas that affect quality and safety.
Who is The Joint Commission?
Used to determine the course of action and focus for Infection Prevention
What is the MEDDAC-Fort Knox Infection Prevention Risk Assessment, Plan, and Goals?
Never eat, drink, smoke, apply cosmetics/lip balm or handle contact lenses if reasonable likelihood of exposure to bloodborne pathogens or hazardous materials
What is OSHA Bloodborne Pathogen Standards?
These are two unique patient identifiers used for EVERY patient
What is NAME and DATE OF BIRTH?
Committee that meets to discuss and review projects
What is the Performance Improvement Committee?
One syringe, One needle, One patient, One time...scrub the hub... multi-dose vials used for only one patient...single dose vials accessed only one time
What is are safe injection practices?
This Term describes the services provided at each site, the patient population served, location, and hours of operations.
What is Scope of Services
Basic steps we use to protect our patients and ourselves from infection. Includes things like hand hygiene, using appropriate PPE, cleaning equipment between patients, etc.
What is Standard Precautions?
These red containers should be secured and not filled more than 3/4 full.
What are Sharps Containers?
Because We Care!
What is MEDDAC-Fort Knox Motto?
This is a list of Joint Commission identified safety requirements which highlight problematic areas in health care and describe evidence and expert based solutions. A new list is published at least annually.
What are National Patient Safety Goals (NPSG)?
What is one method MEDDAC-Fort Knox uses when documenting performance improvement?
What is Plan Do Study Act (PDSA), A3, DMAIC, Quadrupple Aim, Quick Win?
Resource where information on High Alert medications can be found
The sum of what an organization is and does in the pursuit of safety
What is Safety Culture?
Gloves, gowns, masks, face shields are all examples of this.
What is PPE?
Should be cleaned every 6 months or after every isolation patient
What are privacy curtains?
This type of safety exercise prepares and keeps employees, patients, and visitors safe in the event of loss of power, potential disease outbreaks, or other unexpected events.
What are emergency or disaster drills?
This is the contracted service utilized for communication with patients who speak a primary language other than English.
What is the Language Line?
New requirement under the Performance Improvement Chapter
What is annual Performance Improvement Plan?
Any unpleasant reaction to a medication
Adverse Reaction
How MEDDAC-Fort Knox reports patient safety events
What is the JPSR system?
This is the most important task to prevent spreading of infections
What is Hand Washing/ Hand Hygiene?
Must remove or put in a work order to replace if unable to effectively clean
What is ripped or torn furniture?
What is needed on the bottom shelf of any clean/non-sterile storage location to prevent splashing of dirty water when floor is cleaned?
What is solid/imperious bottom shelving?
U,u
IU
Q.D., QD, q.d., qd
Q.O.D., QOD, q.o.d, qod
Trailing zero (X.0 mg)
Lack of leading zero (.X mg)
MS
MSO4
MgSO4
What are unapproved abbreviations?
Required to collect data on in regards to medications
What is adverse drug reactions and medication errors?
A technique that uses uppercase lettering to help differentiate look-alike drug names
Tall man lettering (TML)
This group of documents are located on the intranet, and helps guide and instruct personnel regarding patient care, treatment and services.
What is our Regulations and Policies?
Level of cleaning utilized when equipment or environment touches intact skin
What is Low Level Disinfection?
This type of storage material/container that is not allowed in storage or patient care area.
What is outside shipping boxes?
True or False? If you want your medical results, you may freely access your own chart in AHLTA?
What is FALSE?
MEDDAC defined criteria to screen, assess, and reassess pain
What is MEDDAC Regulation 40-27 Pain Management?
The organization monitors the use of _____ to determine if they are being prescribed safely and appropriately
What are opioids?
National Patient Safety Goal which requires you to immediately discard any medication or solution when found this way
What is NPSG #3 safe medication labeling?
Appropriate response when you don't know an answer for a Joint Commission surveyor
What is "I will find that answer for you"?
MRSA and VRE are considered this type of isolation precaution.
What is Contact Isolation?
Who is responsible for maintaining a safe and functional environment.
Who is EVERYONE?
These methods are employed to ensure patient privacy is protected in compliance with HIPAA regulations. (Name 2 of 5)
What are computer screen covers, turning over papers, removing CAC when stepping away from computer, not discussing PHI in public spaces and outside of patient care situations, proper channels for accessing PHI?
Process in which a health care provider educates a patient about the risks, benefits and alternatives to a given procedure, intervention or treatment plan
What is Informed Consent?
This is a comprehensive, systematic analysis to identify why the event happened and what can be done differently.
What is a RCA (root cause analysis)?
A _____ reviews the appropriateness of all medication orders or prescriptions for medications to be dispensed in the organization.
What is a Pharmacist?
Occurs every morning prior to 08:15
What is unit based huddles?
The required time a surface needs to remain wet to kill germs.
What is Wet/Dwell Contact Time?
How you know what level or cleaning your equipment requires?
What is Spaulding Classification or What are manufacturer's instructions for use?
Lays out our current practices during the pandemic
What is our OSHA COVID-19 Plan?
Conducted immediately prior to a procedure
What is Universal Protocol - Time Out?
Session where MEDDAC-Fort Knox leaders get together to set performance improvement priorities for the coming year
What is the Executive Planning Session?
_____ is the process to review current medications including over-the-counter and herbals.
What is Medication Reconciliation?