IHI (LESSON 1)
A discipline concerned with the design of tools, machines, and systems that consider human capabilities, limitations, and characteristics.
What is Human Factors Engineering
1st Error Reducing Principles - reduces complexity
What is simplification
An incident that did not cause adverse consequences or harm the patient.
What is a near miss
Use the patient’s name and date of birth to make sure that each patient gets the correct medicine and treatment.
What are patients' identifiers
One of the most effective ways to prevent the spread of infection and illness.
What is Hand Hygiene
James Reason developed this framework and categorized three types of errors: Skill-based, Rule-based, and Knowledge-based.
What is SRK FRAMEWORK?
2nd Error Reducing Principles - Reduces variation.
What is Standardization
Unintentional harm caused by health care management rather than the patient's underlying condition.
What is adverse event
Get important test results to the right staff person on time.
What is improved staff communication
The evaluation of the“5 P's” of patient safety: Pain, Potty, Positioning, Possessions, and Personal needs.
What is Hourly Round
Every human being will make these types of errors. One way to prevent them and try to catch them early instead of late is through simulation activities.
What are cognitive errors
An effective safety device used in many industries — such as aviation and nuclear power
What are Checklists
A blame-free environment where individuals are able to report errors or near misses without fear of reprimand or punishment.
What is Culture of Safety
Make improvements to ensure that medical equipments are heard and responded to on time.
What is safety use of alarms
Right Patient, Right Medication, Right Dose, Right Time, Right Route, Right Reason, and Right Documentation
What are the 7 Rights of Medication Administration
Noise, heat, light, long work schedules, inadequate training, poorly designed rules or procedures, interruptions and distractions, and language barriers are factors related to the individual’s environment and can impact performance.
What are External Causes of Error
The state of being checked, restricted, or compelled to avoid or perform some action.
What is constraint
The World Health Organization (WHO), the Joint Commission, the American Nurses Association (ANA), the Institute of Healthcare Improvement (IHI), the National Patient Safety Foundation (NPSF), and many more.
Organizations that are involved in working to make health care safe.
Use the hand-cleaning guidelines from the Centers for Disease Control and Prevention or the World Health Organization.
What Infection Prevention
Bed in low position, call light and personal belongings within reach, declutter environment, locked wheels on hospital bed and wheelchair, nonslip, well-fitting footwear, patient/family education, purposeful hourly round.
What is Fall Prevention
Limited memory capacity, Fatigue, Stress, hunger, and illness, Language limitations, Hazardous attitudes: are factors related to the individual as opposed to his/her environment. They can cloud our judgment and thought processes.
What are Internal causes of error
Like constraints, this Error Reducing Principle makes it impossible to do a task incorrectly. They create a hard stop that you cannot pass unless you change your actions.
What are Forcing Functions
A structured communication framework that helps healthcare providers clearly, and consistently communicate pertinent information about patient care situations.
SBAR (Situation, Background, Assessment, Recommendation)
Mark the correct place on the patient’s body prior to...
What is preventing mistakes in surgery
Occurs when bacteria enter the urinary tract through a urinary catheter and cause infection.
What is catheter-associated urinary tract infection (CAUTI)