CPPS Practice Exam With Complete Solutions

CPPS Practice Exam With Complete Solutions Culture eats - ✔Process for lunch Describe culture - ✔Collective mindset norms Drift - ✔Normalization of deviance What are the five elements of an ideal safety culture - ✔Reporting, inform, Just, flexible, learning James reasons book - ✔Managing the Risk of organizational accidents, 1997 Culture is it driven locally or at the organizational level - ✔Sexton at all believe that culture is more variable among units within the same hospital then among hospitals What are principles and science of patient safety - ✔1. Standardization and checklists, 2. human factors, 3. teamwork training How do you raise awareness about patient safety - ✔Through engagement in education such as engaging the team and patient safety initiatives on error reporting near misses and disclosure an apology How do you respond to patient safety survey results - ✔Identify and disseminate best practices from high-performing units Concerns for responding to patient safety survey data - ✔Response rate reliability of data What are surrogates of patient safety culture assessment - ✔Number one, voluntary reporting of near misses, number two must be accompanied by just culture regarding how reports are dealt with in number three patient safety is a strategic priority 3 Principles and science of patient safety - ✔One standardization, checklist, to human factors, three teamwork training Patient and family involvement and patient safety initiatives may include - ✔Patient advisory Council's, community forums What are the principles of standardization - ✔Era reduction within departments, across the organization, throughout the industry, and examples include color-coded wristbands

What are the principles of patient safety - ✔1 standardization, 2 checklists, 3 learning from errors, 4 human factors, 5 teamwork training, 5 error reporting and near misses, 7 disclosures What are the principles of checkless - ✔List of actions that should be performed optimize patient outcomes. They are based on sound theoretical basis and a history of success and patient safety. For example surgical safety checklist, handoff communication.

Patient safety principal learning from errors describe - ✔Here's our opportunities to want to dig deep for a root cause, and look for common causes and determine what we do when we find them Scribd the principles of human factors - ✔The interrelationship between humans the tools and equipment in the workplace and the environment in which they work. This is different than human error What are the 6 principles of teamwork training, Or a high-performing team - ✔Team structure, leadership, communication, situation monitoring, mutual support, coordination and collaboration What is the principal: error reporting and near misses - ✔Staff education, must provide clear expectation of what and how to report and be reviewed routinely and provide the Y such as giving examples storytelling lessons learned Describe the principle of patient safety disclosure - ✔Identify what needs to be disclosed, understand barriers model disclosure and apology, patient expectations, outline the process steps for the conversation 3 Disclosure barriers - ✔Lack of culture of safety, psychological barriers, legal barriers What are the process steps for a conversation on patient disclosure - ✔1. designate personnel roles, 2. Conversation outlines, 3. Accommodations for special communication needs, 4. Support services available to the patient family and healthcare team, 5. steps for follow-up conversation, 6. Documentation of the conversation What are elements that should be included in the conversation Outline for disclosure ✔What happened, convenience of regret, steps already taken to prevent reoccurrence, change in patient's care plan for outlook, who will contact the family next, support services to patient and family members Describe affective versus ineffective disclosures - ✔Effective disclosures provide the family with all information needed for appropriate care decisions and cannot be measured solely on the basis of whether malpractice litigation was avoided, and

ineffective disclosure does not serve the patient because important information is not communicated Lack of healthcare literacy leads to - ✔Readmissions, inability to navigate the healthcare spectrum, increase health costs, limited preventative medicine, self-reported poor health What are four balance measures for managing change - ✔Patient safety implications, proactive identification, countermeasures, post change monitoring What is psychological safety - ✔Psychological safety is a believe that one will not be punished or humiliated for speaking up with ideas, questions, concerns, or mistakes Psychological safety requires - ✔Softening of authority gradients Psychological safety is critical to - ✔A learning environment that enables individuals to willingly contribute to collective work on a team Traditional punitive healthcare cultures impede the creation of psychological safety by ✔Blaming people for hours Human error quote - ✔"The single greatest impediment to error prevention in the medical industry is that we punish people for making mistakes." Dr. Lucian Leape Professor Harvard school of public health testimony before Congress on healthcare quality improvement Institute of medicine book on building a safe healthcare system - ✔"To Err is human" , With a principal first, do no harm What are three elements about human error described in to air is human - ✔1. Human error cannot be one eradicated because it is a part of human condition, 2. The consequences of errors can be mitigated, 3. we can reduce the risk that can lead to harm Describe accountability of errors the two categories - ✔At risk behavior and reckless behavior Describe at risk behavior and how to manage - ✔Manage at risk behaviors requires feedback, coaching Describe how to manage reckless behavior - ✔Reckless behavior requires administrative consequence

What are some challenges with accountability for behavior - ✔Demanding perfection versus, "no harm,No foul. Associates cannot be expected to work without errors yet they must be held accountable for the decisions with the same consequences regardless of outcome Is it good example of a culture of accountability model - ✔Just culture Describe just culture - ✔Just culture refers to patient safety support system of shared accountability's Describe two levels of just culture - ✔Healthcare institution level in clinician and staff level In just culture of the healthcare institution level they are accountable for - ✔Safe system design in for an encouraging and supporting safe choices of clinicians with clear expectations Just culture at a clinician and staff level are accountable for - ✔The quality of their choices and understanding we're not perfect as humans but we strive to make the best choices possible What is the 2008 Book on just culture - ✔Marks, just culture training for healthcare managers 2008 Just culture quote - ✔"Don't simply punish people for their actions, but always hold them accountable for their decisions. " Define at risk behavior - ✔"Behavior choices that increases wrist where risk is not recognized or mistakenly believed to be justified." And a conscious choice to do something other than what is defined in policy, protocol, law or, excepted safety norms.

What are three elements of at risk behavior - ✔Normalize deviance, work around, drift Define reckless behavior - ✔Conscious behavior choice to disregard a substantial and unjustifiable risk, however there is no intention to cause harm Systemic migration of boundaries deviation is normal because - ✔There is a high individual benefit from taking shortcuts which leads to unsafe practice and also a potential high production performance which leads to greater potential for accident What is an example of a pier amid to promote pliability and professional accountability ✔Patient advocacy reporting system: pars process

What are the four levels of the powers process - ✔Informal cup of coffee intervention, awareness intervention, guided intervention by authority, disciplinary intervention Describe three key areas of focus in the Leadership domain - ✔One strategy, two operations, three engagement For Leadership safety should be a part of - ✔Mission vision values and goals If safety is to be seen as a strategic priority for all staff then - ✔Leadership must make it a key focus of their attention What is the leadership guide book called - ✔Leadership guide to patient safety, 2006,

by Botwinick What is the national patient safety foundation vision statement - ✔Creating a world where patients in those who care for them are free from harm What is the national patient safety foundation mission - ✔National patient safety foundation partners with patients and families and their healthcare community in key stakeholders to Advance patient safety and health care work for safety and disseminate strategies to prevent harm When it comes to safety is part of the mission vision values and goals out of 35 hospitals - ✔Seven explicitly included the word safe or safety Leadership should be involved in - ✔Assessing current quality and safety activities such as water teams currently doing, and looking for hidden pockets of excellence What are ways to set quality and safety priorities - ✔Look for trouble and trends, focus on big events that have happened, sorting the signals of those safety events, or on big hairy goal or BHAG Describe the inter-a process for setting quality and safety priorities - ✔One establish a hub for quality and safety signals/data, to identify themes through qualitative data review, three draft goals, for applied filters to help her ties, five that girls across institution, six articulate key tactics for each goal, seven approve goals and performance metrics, eight plan implementation and track progress How do you create a sense of urgency - ✔Show numbers but tell the stories, And calculate the cost of her such as human cost to patient family care team and financial cost and cost to our reputation What are The Institute for healthcare improvement's six activities for boards to focus on to promote patient safety - ✔One set aims, two get data and hear stories, three

established in monitor system level measures, four changing the environment/policies and culture, five learning starting with the board, and six establishing executive accountability Engaging the board what is a strategy - ✔That each board meeting they hear at least one story of an actual patient harmed or killed while receiving care in the system, as recommended in the book understanding patient safety, 2012 by wachter What are regulators role in patient safety - ✔Oversee aspects of operation and practices including access to our facilities people and records, feel the need for public oversight of healthcare entities and providers and without them it would be a messy free-for-all What are some examples of regulators - ✔CMS, state department of public health which enforce conditions of participation, the joint commission also which review compliance with conditions of participation What are some examples of developing the operational plan for patient safety ✔Transforming care at the bedside, leadership rounding, safety briefings, process redesign to improve reliability, senior executive adopt a work unit Describe transforming care at the bedside and when it was created - ✔Created in 2003

by Robert Wood Johnson foundation and the Institute for healthcare improvement What are the five themes of transforming care at the bedside - ✔One transformational leadership, to safe and reliable care, three vitality and teamwork, for patient centered care, five value added care processes What are some examples of transforming care at the bedside - ✔Rapid response teams, communication models, professional support systems Transforming care at the bedside, 2004 was written by - ✔Rutherford et al.

Why use leadership rounding - ✔The bridge is the Between executive leadership and frontline staff Patient safety advisory series on patient safety rounds - ✔Leadership series: executive patient safety walk around, 2008 What does safety briefings do - ✔One in bed safety into normal routine, to not depend on management, three refrigeration, for non-punitive, five structured, six look back, look ahead, follow up Describe reliability in healthcare three components - ✔Patients get intended test medications information and procedures, two at the appropriate time, three in accordance with their values

To support Hi reliability leaders support - ✔Standardization, to redundancy, three human factors engineering design Describe adopt a work unit for senior executives - ✔Pears a hospital executive to her work unit, educated improves awareness of safety issues, and power staff to take accountability, crates high trust partnerships, provides resources and tools When you advocate for resources what do you look to do - ✔Align it to your mission strategic plan and community needs assessment, and return on investment How do you embed accountability into investigations and system improvement - ✔By setting expectations for investigation a bears and near misses, to executive involvement in investigations and improvement activities, three ensure priority a patient safety activities in improvement What are the three areas an executive dashboard on patient safety should include ✔Clinical indicators, financial indicators, balance indicators What was the study that measured engagement - ✔The 2013 gallop poll called "state of the American workplace" and it measured 350,000 survey responses over a three-year.

But I focused on the financial sense of engagement better productivity and improve performance Were the results of the Gallup poll on engagement - ✔Only 18% of employees in America were actively disengaged and 30% were engaged Organizations with highly engaged employees have - ✔Patient safety incidents Journal of patient safety did a study finding what - ✔That there's a direct relationship between high levels of engagement and the strength of the safety culture and that if you were employee injuries were noticed when engagement increased What are four methods to improve engagement - ✔Leaders communicate mission and vision, to connecting purpose and work through storytelling, three empowering people using staff workflow recommendation, for listening What are methods to improve engagement for strategies outlined in the AHRQ guy to patient and family engagement hospital quality and safety - ✔Patients and families had advisors, to communication to improve quality, three nurse bedside shift report, for ideal discharge planning What is the 1984 book called in regards to the power of the story - ✔Donald Norman wrote that human empathy and storytelling has become more significant in this age of big data

Narrative medicine written in 2001 in JAMA by Dr. Rita Sharon - ✔Calls for a new approach to medicine called narrative medicine which translates from "tell me where it hurts" to tell me about your life What's the importance of near miss , two main reasons - ✔Provides an opportunity to examine failure points in the system, to proactive opportunity to improve before significant event occurs such as finding the holes in the Swiss cheese cost by processed effects and system failures address those defects to strengthen the defenses prevent harm closing those holes and Swiss cheese What are PSO's - ✔Patient safety organization's What is the purpose of PSO's - ✔To design improve patient safety to analysis of reported events and reduction or illumination of ricin has his associate with the delivery of patient care How are PSO's created - ✔Patient safety and quality improvement act of 2005 The value of patient safety organization's - ✔External experts, two aggregate safety data to provide insights, three develop more reliable information on how best to improve patient safety What are some additional approaches to Identifing risks - ✔One learning boards to patient safety leadership rounds three eliciting concern from patient families What is the role of learning boards - ✔Provide space for frontline workers including physicians to share defects, to promote visibility a specific threats, three show resolution of the facts, for promote threat awareness and reporting behaviors to enhance a culture of safety Who came up with patient safety leadership rounds - ✔Dr. Alan Frankel from IHi What are three elements of patient safety leadership rounds - ✔Increases the in basket of patient safety information, to change his culture of patient safety by increasing transparency, three engages in your leadership with frontline staff What are the four objectives of patient safety leadership rounds - ✔Provide an opportunity for Leadership to openly discuss operational failures, to encourage Franklin open discussions in a unit setting, three elicit information that can be collected in Integra gated manner, for ensure information collected facts actions or resource allocation Are the steps and implementing safety rounds - ✔Prepare hospital executives, prepare unit participants, facilitate the process

When patient safety rounds are implemented what are two factors that you need to consider - ✔Data gathering in follow-up and feedback, and the data gathering should include a database to facilitate trending in tracking improvements Rasmus is the software that - ✔Manages alerts on recalls and vendors alerts What is the responsibility of organizations when it comes to recalls and bender alerts ✔They must manage incoming information, to identify risks, three perform gap analysis, for action plan, for follow up and ensure safe resolution What are some examples of vulnerable patient populations - ✔Emergency departments behavioral health patients, patients with multiple co-mobilities, pediatric population's, elderly, publicly insured, low health literacy, non-English-speaking What's an example of a proactive risk assessment - ✔Failure modes and effects analysis What are the four phases of a root cause analysis - ✔One initiation phase, to screening phase where you were a view of that occurrences severity, three analysis phase where he schedule and conduct the real cars for bothering phase where are you examine compliance with a Denna find actions in need for potential changes to actions What determines a hit thorough/credible route cause analysis - ✔Thorough includes human and other factors, analysis of systems, addresses all areas addenda fight, identified rest points, potential improvement in credible includes very participants internally consistent , And addresses an exclamation of why things are not applicable or not a problem What are the three different methodologies for root cause analysis and describe each ✔Traditional, such is the joint commission drill down framework to healthcare performance improvement which focuses on improvements to illuminate human error and prevention and three will cost analysis or RCA squared which is the national patient safety foundation effort of prevention of future harm What are the goals of RCA squared - ✔Improve the effectiveness and utility of the RCA identifying significant flaws for remediation and to prevent future home through actions and to the second goal is to provide tools to assess events hazards in Rome abilities in the system RCA two squared recommendations - ✔Leadership involvement, 2 total process reviewed annually for effectiveness 3. Use a risk based prioritization system for events for start within 72 hours of recognizing need for review five compromise of 4 to 6 people six use tools such as flow charts cause-and-effect diagram and seven provide feedback to staff

What are the 5 major elements of an RCA - ✔One timeline to framework three causeand-effect diagram for process charts five action plan with measurable actions Describe the VA national center for patient safety's hierarchy of actions classifications ✔One weaker in action that depends on caregivers to remember training or written policy, to intermediate actions that are somewhat dependent on staff remembering to do the right thing but provide tools to help staff remember order facilitate process, three strong the action may not totally illuminate vulnerability but provide very strong controls in guard rails What did the VA national center for patient safety real cost analysis in 2015 define ✔Hierarchy of the actions that classified corrective actions in three categories weaker, intermediate, Strong What are some examples of RCA pitfalls - ✔Lack of leadership support, skipping the chronology, reliance on policy and procedure, failure to explore at risk behaviors, tell you to identify late and failures, tell you to explore human factors Ihi Improvement definition of the term bundles - ✔A structured way of improving the process of care and patient outcomes, a small straightforward set of evidence-based practices, generally 3 to 5, that when perform collectively and reliably, have been proven to improve patient outcomes What are some example of bundles - ✔Central line bundles such as hand hygiene sterile contact barriers, proper cleaning a patient skin, finding best pain, checking every day for infection, removing in changing the line only when needed Pitfalls of bundles - ✔They are not checklist despite Tim Tatian to call them checklist and they must all be done to be effective Describe checklist and purpose - ✔In memory tool for complex processes, effective and industries that have hardwired culture of safety such as aviation, compliance with and benefits of checkless are heavily affected by organizational culture What are some reasons for checklist failure three - ✔Lack of ownership, checklist is a logical Erin appropriate, perception that the process waste time and resources What are some benefits of health care IT or health IT - ✔Reduce medication errors, illuminate a legible writing, enable computerized order entry, a cheap ass practice using clinical decision support, preventative care recommendations, track, testing, referrals, centralize patient records, allow access across all settings What are some consequences of HIIT poor health IT - ✔More new work for clinicians, unfavorable workflows, constant demands for system changes, problems related to paper persistence, changes in communication patterns and practices, negative

emotions, generation of new kinds of errors, changes in institutional power structure, over dependency on technology Describe the sociotechnical model for analysis of HIIT - ✔One hardware and software, to clinical content, three human computer interface, for people, five workflow, six internal organizational policies, procedures, environment and culture, seven external rules, regulations, and pressures, eight system measurement in monitoring What are some air categories in HIIT - ✔One hardware and software, clinical content, human computer interface, people, workflow and communication When implementing health IT what should you do - ✔Perform a health IT risk analysis that understands how HIIT is a tool and does not improve workflow or does, need to redesign on safe workflows and adopt HIIT to new were safer ones and need for constant surveillance What are some examples of sources of patient safety information - ✔Internally they are safety event that a survey results, medication safety events, sentinel event trends, complaints and grievances, claims last rounds, financial losses, dashboards, safety huddle, standard operating procedure compliance, safety attitude questionnaire, SAQ Describe qualitative data - ✔Categorical measurement not expressed in numbers for the natural language such as a story, it can be categorized to increase ordering, such as very tall Describe quantitative data - ✔Anything that can be expressed in a number her quantified, can be analyzed the testicle he, associated with a measurement scale, such as 6'7" Inferential test - ✔Test of significance, which is the probability that a relationship exist between two variables, measured in P value At what level does a p-value Become significant statistically - ✔P less than .05 In statistics describe a run - ✔The run is one or more consecutive data points on the same side of the mean Describe the difference between a run chart and control chart - ✔Control charts are the same is run charts but have control limits Describe the horizontal line that runs through data - ✔That's the central tendency of the data What is the rule of thumb to make a determination of special cause variation - ✔Seven consecutive observations on one side of the mean or centerline

A trend is points that cross the centerline in an upward trend or downward trend that's an indication of - ✔Special cause variation Points below or above the mean is known as a - ✔Pattern Describe the purpose of reports - ✔To address information needs related to a particular objective or set of objectives for things like organizational strategic planning, monitoring operations, analytical purposes and reports require customization to the audience Describe the difference between a scorecard and dashboards - ✔Hey scorecard is a collection of key performance indicators are KPI's together with their associated performance targets and a dashboard is a container of related group of items and report sometimes including scorecards What are some good ways to present written results to decision-makers - ✔SBAR format such as situation background assessment recommendation Process measures are often described as - ✔Leading because they give you information about what is to come where the achievement of an outcome Outcome measures are often described as lagging because - ✔The outcome is not immediately now What is a conceptual model for measuring include - ✔Structure, process, Outcome, And is based on the national patient safety foundation online patient safety curriculum, 2012 What is John Kotter's eight steps of change - ✔One create a sense of urgency to build the guiding team three develop a change vision and strategy for understanding by and five empower others six short-term wins seven don't let up he relentless eight create a new culture Crew resource management team steps - ✔Isn't example of a team training or improvement methodology framework What is the number one contributing factor cited in sentinel events - ✔Communication The VA National center for patient safety is a Denna five communication in approximately what percent of the 7000 RCA's of adverse a pencil close calls - ✔75% Resident physicians from surgery, internal medicine, OB/GYN training programs of university teaching hospitals perceived communication failures as a what percent factor of adverse events and near misses - ✔91%

Describe systems thinking - ✔In approach to analysis that focuses on the way the system constitutes parts into relate and influence one another within a whole Describe human factors - ✔Human factors analysis represents science at the intersection of psychology in engineering and it looks at all aspects of work system to support human performance and safety And human factors we tend to - ✔Overestimate our abilities and underestimate out limitations What are internal factors in human performance - ✔Fatigue stress anxiety depression What are external factors in human performance - ✔Noise distractions interruptions task design environmental conditions What are elements were key components of systems that determine safety - ✔People and tasks people are influenced by the health literacy of staff, practice norms, physical limitations and test include complexity of actions and sequencing What is the role of tools technology and techniques in determining patient safety - ✔It's impacted by the complexity of the Quitman, Erica Naman considerations of operation, sufficiency of training particularly when newly introduced What is the role of the environment as a key component in determining safety - ✔Noise, distractions and interruptions, clutter proximity of needed tools What is the role of the organization as a key component of systems that determine safety - ✔The culture of safety financial decisions operational decisions and policies and procedures What are some strategies in designing for human factors - ✔1.Simulation where people can recognize problems and understand the effects on their responses in a safe environment 2. Pilots were you test a design using PDSA, 3 Workflow analysis principles - ✔One workflow need sleep providers to do the right thing and protect the patient, two balls workflows our legacy processes sometimes referred to as this is the way we have always done it, three make no assumptions What should you do when you do in a workflow analysis of a process - ✔Include all members of the team, map out the current workflow, redesign with a blank page and don't make assumptions, get constant feedback

What are four of workflow analysis caveats - ✔Look for real and perceived barriers, 2 identify unintended consequences,3 always do a small test of change PdSA and four identify did we solve the problem that prompted the RCA Standardization must balance the need between these two thanks - ✔Standardization with the need for critical thinking Describe normalize deviance - ✔It is stripped, shortcuts, continuum of intent Why does normalize deviance occur - ✔Because of competency or other personal motivations and sometimes rule violations or an early signal of system design flaws or performance clause are ignored How to normalize deviance the addenda fight - ✔Error reporting in review, performance improvement efforts, complaints James reason defines human error as a - ✔Failure of a plan sequence of mental or physical activities to achieve their intended outcome Two main cognitive processes - ✔One automatic processing and 2 conscious processing Describe automatic processing - ✔Leads to slips and lapses, you have the right plan or intention but did the wrong thing and Hayward and interruptions fatigue time pressure emotion anxiety fear boredom Describe conscious processing - ✔Problem solving that can lead to mistakes due to errors and planning What are the three stages in drift or normalization of deviance - ✔First stage no intention of quite as human error, second stage unconscious intent equates as a draft and third stage conscious intent which equates his recklessness People will consider deviating based on the strength of behavioral incentives such as if ✔Consequences are weaker than the rules or preconditions, the consequences are uncertain, the consequences are delayed or not a parent What are the three elements of the hierarchy of controls starting with the least - ✔One mitigate to facilitate three illuminate with the third leading to standardization and simplification the base What are five examples of risk reduction strategies - ✔Forcing functions to automated alerts and decisions tree three checklist for rules and policy five education

What are characteristics of high reliable organizations - ✔One simplify and standardized to avoid reliance on memory three crate redundancies and double checks for learn from failure five learn from the expertise of frontline workers six use forcing functions and can strange judicially Describe the three step design strategy for human factors - ✔First step Simplify and standardize, two apply controls to prevent terror and three identify errors and interrupt process before causing harm