answers 2026\2027 A+ Grade
iatrogenesis
- correct answer Greek for originating from a physician
preventable adverse events
- correct answer those that occurred due to error or failure to apply an accepted strategy for prevention
Ameliorable adverse event
- correct answer events that, while not preventable, could have been less harmful if care had been
different
adverse events due to negligence
- correct answer those that occurred due to care that falls below the standards expected of clinicians in
the community
near miss
- correct answer an unsafe situation that is indistinguishable from a preventable adverse event except
for the outcome - exposed but does not experience harm either through luck or early detection
error
- correct answer broader term referring to any act of commission or omission that exposes patients to a
potentially hazardous situation
adverse event
- correct answer An injury caused by medical management (rather than the underlying disease) and that
prolonged the hospitalization, produced at disability at the time of discharge, or both
commision
- correct answer doing something wrong
,omission
- correct answer failing to do the right thing
CPOE
- correct answer Computerized Provider Order Entry
2009 HITECH Act and meaningful use program
computer alerts three main findings
- correct answer 1. modestly effective at best
2. alert fatigue is common
3. fatigue increases with exposure and heavier use of CPOE systems
minimize alert fatigue
- correct answer 1. increase alert specificity to reduce inconsequential alerts
2. tier alerts according to severity
3. make only high level/severe alerts interruptive
4. use human factors principles
three concepts that influence safety in ambulatory care
- correct answer 1. role of pt and caregiver behaviors
2. role of provider-pt interactions
3. role of community and health system
Medical Office Survey on Pt Safety Culture
- correct answer designed to assess safety culture in amb care and data is available from AHRQ
Pt Engagement
- correct answer 1. ed pt about their illness and medications with pt demonstrating understanding
"teach back"
2. empowering to act as a safety double check
,checklist
- correct answer Algorithmic listing of actions to be performed for a given clinical procedure designed to
ensure that no matter how often performed by a given clinician, no step will be forgotten
reduce risk of slips
consensus of required behaviors
slips
- correct answer failure of schematic (autopilot) behaviors
lapses in concentration, distractions, or fatigue
mistake
- correct answer failures in attentional behavior
lack of experience or insufficient training
Situational Awareness
- correct answer the ability to access and track relevant to the task,
comprehend the data,
forecast what may happened based on the data, and
formulate an appropriate plan in response
situational awareness cannot be achieved without
- correct answer clear and high-quality communication between all providers
most common root cause of sentinel events
- correct answer communication
elements the affect communication
- correct answer 1. rigid hierarchies
2. overtly disruptive and unprofessional behavior
3. nonverbal cues
4. interpersonal relations
5. group dynamics
, communication tools
- correct answer read-back protocols
SBAR
teamwork training
process for prescribing and adm meds
- correct answer 1. order
2. Transcribing
3. dispensing
4. administration
90% errors occur at ordering (48%) or transcribing thus CPOE prevent
CDSS
- correct answer Clinical Decision Support System
assist healthcare providers in the actual diagnosis and treatment of patients, analyze data from clinical
information systems
avoids commission and omission errors
unintended consequences of CPOE
- correct answer 1. more or new work for clinicians
2. unfavorable workflow
3. never-ending system demands
4. persistence of paper orders
5. changes in communication patterns and practices
6. neg towards new technology
7. new types of errors
8. change in power structure, org culture , or professional roles
High Reliability Organizations (HROs)
- correct answer persistent mindfulness with in an organization