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Which of the following takes place FIRST in a root cause analysis (RCA)?
Which of the following are examples of loss prevention techniques?
In a failure mode and effects analysis (FMEA), the severity score is an estimate of the severity of the
In the Just Culture model, which of the following types of behavior should result in the coaching of an employee?
According to The Joint Commission, an environment that enhances patient safety encourages
A root cause analysis (RCA) is a process to determine what happened,
A nursing assistant finds a patient on the floor. The patient explains he was to go to the bathroom when he slipped and fell. The incident is reported to the patient’s physician and head nurse. Who is responsible for completing the incident report?
The purpose of conducting a failure mode and effect analysis (FMEA) is to
Which of the following is most likely to eliminate wrong-site surgery?
The emergency exception to the informed consent rule allows physicians to assume an unconscious patient, about whom there is no information, would have given his consent to a procedure in an emergency situation when
An organization’s development of a no punitive approach to reporting of adverse events may result in an increase in the
Education and training of staff members regarding incident reporting should include which of the following instructions?
the most effective human factors design strategy to reduce risk is to
When considering solutions to minimize medication errors, which of the following is the most effective strategy?
Which of the following are examples of disruptive behavior by a clinician?
Removing concentrated electrolyte solutions (e.g., potassium) from patient care units will most likely result in
Which of the following is true about failure mode and effects analysis (FMEA)?
The following information is available:
What conclusions can be drawn from these data?
A risk manager is reviewing the results of a root cause analysis (RCA) performed following a heparin administration error on an adult inpatient unit. One of the contributing factors was staff confusion about which one of several heparin administration protocols was to be followed. In addition, “floating” nurses were providing patient care at the time of the error. Which of the following measures is most likely to prevent recurrence of this error?
A patient dies as a result of a transfusion error. Investigation reveals nurses have developed a “workaround” that involves cutting off patients’ barcoded wristlets and carrying them to centrally located barcode scanners, rather than bringing the barcoder to the patient bedside for scanning. Which of the following action plans will be most successful?
The following events occurred over the past month:
The risk manager established a work group to review these data and determine where the process failures occur. Based on the data, the group should FIRST focus on
Which of the following reasons for under-reporting of incidents should be of greatest concern to a risk manager?
A patient undergoes a laparotomy and does not do well postoperatively. The patient is taken back to surgery and a retained towel is extracted. The physician refuses to inform the patient and instructs staff to advise the patient a previously undiagnosed condition is the cause. The risk manager should FIRST
A premature neonate in the NICU is receiving intravenous vancomycin for a severe infection. During the routine blood test to monitor the amount of medication in the blood at peak potency, levels were determined to be toxic. Due to the risk of the baby developing hearing loss as a result of the toxicity, a disclosure to the family is warranted. The initial disclosure discussion should include which of the following statements?
The daughter of an elderly patient has been noted to take pictures of the staff while they are providing care to her father. She became verbally abusive to the staff when informed of the facility’s ban on picture taking during the provision of care. Which of the following is the risk manager’s best course of action at this time?
A 60-year-old woman fell at home and fractured her hip. She was brought to the hospital by EMS and was alert and oriented on admission. Following surgery, the patient was drowsy, but responsive to stimulation. On the morning following surgery, she was found to be nonresponsive. Thirty-six hours later, she remains in a coma with a poor prognosis. At a minimum, who should be involved in a root cause analysis (RCA) of this event?
When debriefing after an adverse event that caused harm to a patient, which of the following are critical elements?
A wrong-site surgery was discovered in the recovery room. The staff immediately reported the event and identified a deviation in not completing a “time out” prior to the surgery. In review of the event, the organization’s risk manager can confirm that Just Culture principles are being followed as evidenced by which of the following behaviors?
A hospital’s adverse event program revealed the following data:
Based on the most appropriate way to measure adverse events, the trend for the rate of wrong-site surgeries is
A patient is transported from the telemetry unit to the radiology department. The primary advantage of this patient having an electronic health record (EHR) instead of a paper medical record is that the HER
Based on historical root cause analysis data compiled by The Joint Commission, most sentinel events could be prevented if
Effective handoffs from one care provider to another care provider are best accomplished when
Which of the following are a risk manager’s best strategies to drive organizational leaders and other staff to commit to a medication safety program?
Through media coverage, a risk manager hears of a recent patient safety event at a neighboring hospital. A medication was administered to three infants on two occasions resulting in one infant death and two infants requiring additional healthcare services. This medication is widely used in the risk manager’s organization. Which of the following is the risk manager’s best course of action?
Which of the following statements regarding monetary damages for a breach of contract is true?
A hospital’s insurance policy provides for replacement cost of its building. Replacement cost is the
The attorney for a patient presents a claim related to an injury received by the patient while in the facility. After investigation, the risk manager believes the claim has some merit and the plaintiff appears open to consideration of settlement. For a variety of reasons, the risk manager believes this claim should be settled prior to trial, if possible. Which of the following alternative dispute resolution methods is the best to bring this to closure?
When reserving for professional liability claims, the risk manager should set
During the contract review process, the risk manager is responsible for
A risk manager’s review of claims from the past five years is an example of risk
A risk manager for a hospital with a self-insured/self-administered professional liability insurance program settles a litigated claim for $25,000 on behalf of the hospital and its employed physician. Under the Health Care Quality Improvement Act (HCQIA), the risk manager
An organization has an existing claims-made policy covering professional liability losses. The policy provides primary coverage with no deductible and expires in two months. Recently, the organization’s broker secured a quote for identical coverage with a different carrier at a lower premium. The risk manager is concerned about incurring uninsured losses if the change in carriers is not carefully managed. Which of the following strategies is most cost effective in avoiding uninsured losses?
The following policy information is available:
What is the total cost of closed claims for policy year 2012?
The Patient Self-Determination Act (PSDA) requires facilities to
The Occupational Safety and Health Administration’s (OSHA’s) Hazard Communication standard requires employers to inform employees of
The Americans with Disabilities Act (ADA) prohibits an employer from asking about the existence, nature, or severity of a disability until
Which of the following grants hospitals limited immunity for physician staff credentialing meetings if the hospital meets certain procedural standards?
A patient’s right for advance directives is based on the ethical principle of
Which of the following are recommended actions for a risk manager who has heard a rumor that an inpatient with healthcare-associated infection has died?
1. Evaluate if it is a sentinel event.
2. Prepare a press release.
3. Inform the infection control department of this incident.
4. Determine if a precautionary notice should be submitted to the malpractice insurer.
Important considerations in evaluating the legality of an informed consent include
1. legibility of the patient’s signature.
2. patient’s ability to understand.
3. physician’s ability to explain the procedure.
4. medical terminology used in the consent process.
An organization has had a sentinel event in which a procedure intended for patient X was performedon patient Y. Which of the following is the most likely root cause of this event?
A risk manager is working with the performance improvement director to formulate a strategy for compliance with The Joint Commission’s National Patient Safety Goals requiring accredited organizations to implement measures to ensure clinical alarms are always enabled and audible. One of the proposed measures is to modify alarms on ventilators so that the volume control cannot be turned lower than a predetermined level. This measure is an example of which of the following human factors design principles?
Risk management strategies must be in place to evaluate and reduce liability exposures related to the use and maintenance of biomedical technology and equipment in health care. The risk manager’s role is to ensure
1. there is a process in place for adverse events and near misses.
2. the expense of the biomedical equipment and technology is factored into the annual budget.
3. there is compliance with the Safe Medical Devices Act (SMDA) requirements when applicable.
4. inventory control and tracking of biomedical-related equipment are being completed.
Which of the following provide guidance or regulation on an aspect of telemedicine?
1. The Joint Commission (TJC)
2. Food and Drug Administration (FDA)
3. National Practitioner Data Bank (NPDB)
4. Agency for Healthcare Research and Quality (AHRQ)
Which of the following obligations applies to an off-campus outpatient facility one mile away from a hospital?
A physician, concerned about the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, asks the risk manager whether she can talk to a patient about his condition in front of the patient’s friend. The risk manager should advise protected health information can only be disclosed if the
1. patient signs a written authorization.
2. patient does not object when given the opportunity.
3. person with the patient is a family member.
4. patient agrees to the disclosure.
The Emergency Medical Treatment and Active Labor Act (EMTALA) requires a Medicare/Medicaid hospital with emergency services to
1. conduct a medical screening for emergency medical conditions.
2. stabilize a patient to the extent of its capability prior to transfer to another facility.
3. provide medical treatment for all patients who come to the emergency department.
4. avoid billing patients without insurance.
The Safe Medical Devices Act (SMDA) applies to
Which of the following should be reported to the National Practitioner Data Bank (NPDB)?
The Emergency Medical Treatment and Active Labor Act (EMTALA) permits a registered nurse (RN) to perform a medical screening if the RN is designated by the medical staff as qualified and is working under an approved standardized procedure when
Upon removal, an epidural catheter is noted to be broken, with approximately 6 inches remaining in the patient. Risk management actions should include preserving the broken catheter and notifying the
1. Food and Drug Administration (FDA).
3. Occupational Safety and Health Administration (OSHA).
4. professional liability insurer.
When dealing with patients for whom English is not the primary language, clinical staff should be encouraged to
A 72-year-old male presents to an emergency department with a history of severe abdominal pain and deteriorating mental status. The consulting surgeon identifies that the patient needs surgery for a ruptured appendix and resulting sepsis. The patient has an advance directive and staff is unable to locate the patient’s only surviving son. Which of the following is the best principle to guide the surgeon’s decision regarding whether to proceed with surgery?
How should a risk manager respond to a subpoena for medical records, properly served on the facility, which seeks a patient’s history of mental health and substance abuse diagnosis and treatment?
The chair of the Institutional Review Board notifies a risk manager that a data file of research subjects was released to a third party. Subsequent review of the file revealed that the patients’ state of residence and fax number are included in the file. The risk manager’s best course of action is to
The following three events occurred in a hospital:
1. a patient received a unit of blood that was the incorrect ABO
type, resulting in a hemolytic transfusion reaction
2. an infant was discharged to the incorrect family
3. an assault on an on-duty staff member led to permanent harm
Based on The Joint Commission’s (TJC’s) sentinel event policy, the risk
Which of the following patients should be considered a primary candidate for organ donation?
For most general business decisions, which of the following types of insurance affords hospital board members the best protection from liability claims?
Which of the following may be defined as the ongoing activity of comparing one’s own process, product, or service with the similar process, product, or service that is known to be the best?
Which of the following represents operations consistent with a risk manager’s role?
1. developing and maintaining budgets
2. training department staff
3. collecting epidemiological information
4. developing annual goals for the department
Which of the following steps in the risk management process refers to all of the options available to a risk manager in handling a given risk?
The biggest competitor of a premier academic community hospital recently bought a da Vinci robot and is extensively advertising its advantages. To remain competitive, the community hospital considers purchasing a da Vinci robot as well, believing that this will help maintain market share. When considering the purchase of this technology, the risk manager should use an enterprise risk management approach and include which of the following types of risk domains?
Which of the following categories of events most qualifies as a proper subject for risk identification and risk assessment within an enterprise-wide risk management program?
A risk manager asks the Director of Engineering to assess the hospital’s environmental risks as relates to state and federal laws pertaining to the hospital’s regulated underground storage tanks. Which of the following should the director provide to the risk manager as part of the assessment?
Which of the following is an advantage of occurrence screening compared to incident reporting?
The risk manager can develop and maintain an effective working relationship with the pharmacy by
A risk manager should use a fishbone diagram to illustrate:
Which of the following should be FIRST in a series of presentations to the Board, medical staff, and employees regarding a risk management program?
When evaluating the effectiveness of the risk management program, it is important to
1. confirm data is normalized using commonly recognized benchmarks.
2. mandate adverse events are reported within 30 days of the occurrence date.
3. examine trends of reduction in claims volume and severity.
4. evaluate success of measures implemented to address identified risk.
A defibrillator failed during resuscitation and a patient died. It is unclear what role, if any, the defibrillator failure played in the patient’s death. The risk manager sequesters the defibrillator. Which of the following should the risk manager do NEXT?
Which of the following elements should be included in a policy on disclosure of unanticipated outcomes?
1. who is responsible for the disclosure
2. documentation of the disclosure
3. how to disclose deliberations from the peer review process
4. follow-up discussions with patient and family
In building an effective risk management program, which of the following areas should be considered?
1. preventing patient injury
2. minimizing financial losses
3. the ratio of risk managers to occupied beds
4. the scope and cost of insurance coverage
Which of the following is the best measure of risk management activity effectiveness?
Risk management policies should be
1. routinely shared with other hospitals.
2. reviewed by corporate counsel.
3. the basis for staff education.
4. updated annually.
Which of the following are most important for the risk manager to consider when establishing annual goals for the risk management department?
1. organizational strategic plan
2. loss/claim experience
3. demographic shift in the market area
4. regulatory environment and changes
When preparing the risk management department budget, which of the following costs are likely to be provided by the organization for inclusion without the risk manager’s ability to modify?
A member of the risk management team is married to a physician and is known to socialize with the nursing staff. As her supervisor, the risk manager is concerned about potential risk exposure. Which of the following is of greatest concern?
Receipt of a media inquiry immediately followed the initial notice of an adverse patient event. Obtaining the cooperation of the media while the investigation proceeds will be facilitated by
A medical records custodian receives a subpoena duces tecum to appear at a deposition with a medical record. Attached to the subpoena is a letter from the requesting plaintiff attorney advising that if a copy of the record is mailed, then appearance at the deposition is not required. A risk manager should advise the custodian to
An organization recently adopted Just Culture principles in their approach to handling employee errors. The organization’s risk manager is asked by a unit director how to handle an employee involved in an error where there was no harm to the patient, but a workaround was used which resulted in an error. Which of the following is the risk manager’s best response?
A risk manager leads a team performing a failure mode and effects analysis (FMEA) on patient falls. The team recommends implementation of bed alarms as a control measure. After several months, the team reconvenes and recalculates the risk priority number as a means of evaluating the effectiveness of the intervention. Which of the following changes in the severity, occurrence, and detection scores will the team most likely observe?
– severity – occurrence – detection
When left alone in an emergency department (ED) treatment room, a patient attempts suicide by using the instruments in a suture set to slash his wrist. The patient is immediately taken to surgery to repair the damage. To identify appropriate process changes, the risk manager should conduct
Which of the following describes the difference between a cross-claim and a counter-claim?
An alternative dispute mechanism that results in a decision by a neutral third party is
Which of the following best describes the implications of a reservation of rights letter from an insurance carrier?
The risk manager of a hospital has a $250,000 indemnity-only deductible for its professional liability insurance program, with limits of $5 million per claim, no aggregate. The hospital resolves a claim for $5 million in indemnity, and closes the file with $125,000 in defense costs. Which of the following amounts represents what the hospital will pay on this claim?
After changing professional liability policy carriers, a risk manager discovers several potential claims were never reported to the prior carrier. Which of the following information should the risk manager consider?
1. whether the policies are occurrence or claims-made
2. the type of claims involved
3. the definition of claim under the policies
4. the timing of the change in carriers
An emergency response plan for infant or child abduction should be developed with collaboration of an interdisciplinary team that includes nursing and