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omission ✔Correct Answer-failing to do the right thing; not doing something you should have
done.
commission ✔Correct Answer-doing something wrong; doing something that should not have
been done
3 types of Quality Issues ✔Correct Answer-1) Underuse of care - pt not receiving beneficial
services
2)Overuse of care - pt receiving txmnt without benefit
3) Misuse - pt receive appropriate but poorly provided service putting them at risk of
complications
FMEA ✔Correct Answer-Failure Mode and Effects Analysis
FMEA Steps ✔Correct Answer-1) define topic and process to be studied
2) convene ID team with content and process experts
3) develop flow diagram of process and sub-process
4) list all possible failure modes of each sub-processes (adverse outcomes, risk rating for each
effect with severity, frequency, and detection - risk assessment)
5) determine action for each failure mode to eliminate, control, or accept
6) ID corresponding outcome measure to test the redesigned process
TJC RCA Factors ✔Correct Answer-1) Anesthesia Care
2) Care Planning
3) Communication
4) Continuum of Care
5) Human Factors
6) Information management
7) Leadership
8) Medication use
9) Nutrition Care
10) Physical Environment
11) Rehabilitation
12) Special Interventions
13) Surveillance, Prevention and Control of Infection
14) Operative Care
15) Pt Education
16) Pt Rights
17) Performance Improvement