CPHRM NEW

The ultimate goal of enterprise risk management is to:

Which of the following should be FIRST in a series of presentations to the Board, medical  staff, and employees regarding a risk management program?

Ultimately, the accountability for the risk management program belongs to the:

The best content and format for a risk manager’s report to the board is:

A growing healthcare organization has a risk manager who did not have any staff and reported to the director of nursing, who reported to the chief operation officer. The risk manager presented information to the employees, and the information was filtered upward through senior management. The risk manager knew changes needed to be made due to the growth of the organization. One additional staff member was added, and a personal computer was purchased for the department. Although this scenario represents some changes designed to address the issues related to growth, the major flaw in the organization was:

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 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 federal law that serves to limit the liability of hospital trustees is the :

Which of the following are primary elements of 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.

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.

For a risk management program to be Effective, it needs which of the following?
1. Organizational Commitment.
2. Visibility and access.
3. Physician acceptance or understanding.
4. Complete authority.

To have a successful quality improvement process, a risk management program must have which of the following?
1. An autocratic management style.
2. Interactive multidisciplinary teams.
3. A mindset that most problems are caused by processes.
4. Full support of senior management.

A strong healthcare risk management program should be:

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 is the best measure of risk management activity effectiveness?

In the risk management process, the fourth step is:

Which of the following is NOT part of risk identification and analysis?

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’s review of claims from the past five years is an example of risk :

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?

Which of the following reasons for under-reporting of incidents should be of greatest  concern to a risk manager?

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
1. Recognition and acknowledgement of risks to patient safety.
2. Initiation of actions to reduce risks to patient safety.
3. Involvement of legal counsel to promote individual accountability
4. Focus on processes and systems.

An organization’s development of a no punitive approach to reporting of adverse events may result in an increase in the

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?

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?
1. Acknowledging that even professionals will take short cuts
2. Supporting blameless reporting of events
3. Admitting that a mistake has been made
4. Protecting confidentiality of event details to reduce liability

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?

Nurse Johnson was administering medications to the two patients in room 236 using the
bar-coding system. According to the facility’s written procedure, the nurse was to administer each patient’s medication separately. She was to scan the medication, then scan the patient’s bar code, check for any error alerts, and then administer the medication if no alerts appeared. Ike nurses complained that going out to the medication cart between patients was time-consuming. To save time, Nurse Johnson habitually scanned the medication and the patient’s bar codes while the medication was being administered. On this day, after giving patient A his medication, he immediately became severely short of breath, signaling an allergic reaction, and respiratory support was required. Following an investigation it was determined that Nurse Johnson had given patient A the medication for patient B and an error alert would have activated in the
bar-coding system. Nurse Johnson’s behavior is an example of:

Safety culture surveys are intended to assess the organizational and unit-level attitudes regarding patient safety. Survey results can reveal differences in perception of safety between types of staff (such as MD and RN) and between departments or teams. They can be used to identify priorities for improvement and to help create a performance improvement action plan.

Which of the following is most likely to occur if a health system punishes an individual for an  unintended error that was the result of a system design issue?

A specific, fair, non-arbitrary method for determining system versus individual accountability in cases of medical error is known as which of the following?

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?

Education and training of staff members regarding incident reporting should include which of  the following instructions?

1. Document relevant facts and circumstances (e.g., patient ID, time, locations, identity of witness) while memories a refresh.
2. Where an error did not reach the patient (i.e., a near miss) and no serious harm was apparent, reporting is optional.
3. Where a single individual committed an error, it is necessary to investigate all pertinent facts and circumstances.
4. Where an error causing patient harm was the result of clerical error, an incident report should be completed

Which of the following is an advantage of occurrence screening compared to incident reporting?

Generally, an “incident” is defend as:

It is important to protect the discoverability of incident reports. Which of the following have significant impact on whether the reports are discoverable?
1. Joint commission/TJC standards.
2. State statutes.
3. Federal statutes.
4. Case law.

To maintain confidentiality of an incident report:
1. Send the incident report directly to risk management.
2. Never make the incident report part of the medical record.
3. Never mention the facts of the incident in the medical record.
4. Maintain the original in the risk management office and a copy in the originating department.

An alarm activates as a nursing home resident wanders away from the nursing facility. A certified nursing assistant (CNA) care aide turns off the alarm and attempts to locate the resident.  The resident is located and returned to the nursing facility. The CNA aide should

The medical record historically has been a tool of risk management. In the event of an untoward outcome or unusual incident, documentation in the medical record should include all of the following EXCEPT:
1. A description of the occurrence
2. Comments about the notification of and related care provided by the patient’s physician
3. The fact that an incident report was completed
4. The fact that the risk manager was notified

Mrs. Cobb was admitted for surgery on her right leg. At the conclusion of the surgery, she awoke to learn that the wrong leg had been operated upon. An investigation revealed that the
pre-operative nurse had performed the site marking incorrectly and had placed the X-rays in the OR suite facing backward. The root cause analysis team identified that failure to have surgeons routinely participate in the site-marking process, with confirmation by the patient, was a participatory cause of the incident. This failure identified by the root cause analysis team is an example of:

Taxonomy is a necessary and important aspect of patient safety because:

the most effective human factors design strategy to reduce risk is to

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  measure  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?

High-reliability organizations:

A key characteristic of a high-reliability organization is a reluctance to simplify. This means that the organization utilizes detailed processes for each key function and strives to include as many steps as possible to decrease the possibility of errors.

High-reliability organizations share all of the following characteristics EXCEPT:

Many organizations are striving to become “highly reliable.” Which of the following characteristics is NOT considered indicative of a highly-reliable organization?

As part of an enterprise-wide evaluation of inpatient events, which of the following should be included as part of a comprehensive report?

A nursing home resident attempts to wander away from a facility and activates the alarm when he exits the building via the main entrance. A nurse, who is in her first week of training, turns off the alarm at the nurse’s station. She then goes outside to find the patient. The resident is found and is returned to the facility. The nurse in training then completes an incident report about the occurrence. She places a copy in the medical record and sends the original to the risk manager. She also makes an objective entry about the event in the nurses’ notes in the medical record.

With regard to the alarm, which of the following is the most accurate statement?

A nursing home resident attempts to wander away from a facility and activates the alarm when he exits the building via the main entrance. A nurse, who is in her first week of training, turns off the alarm at the nurse’s station. She then goes outside to find the patient. The resident is found and is returned to the facility. The nurse in training then completes an incident report about the occurrence. She places a copy in the medical record and sends the original to the risk manager. She also makes an objective entry about the event in the nurses’ notes in the medical record.

With regard to the incident report, which of the following is the most accurate statement?

Based on historical root cause analysis data compiled by The Joint Commission, most sentinel events could be prevented if

An organization has had a sentinel event in which a procedure intended for patient X was performed on patient Y. Which of the following is the most likely root cause of this event?

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 manager.

If The Joint Commission becomes aware of a sentinel event that meets the definition of a reviewable sentinelevent, the organization is required to submit to the Joint Commission its root cause analysis and action plan, or other wise provide for Joint Commission evaluation of its response to the sentinel event under an approved protocol, within calendar days of the known occurrence of  the event.

Which of the following statement about reporting a sentinel event is FALSE?

Which of the following should prompt a root cause analysis according to Joint Commission standards?
1. Surgery performed on the wrong body part
2. Infant abduction
3. Non-hemolytic transfusion reaction
4. Death from a community-acquired infection

Which of the following requires a root cause analysis be conducted according to the Joint Commission’s Sentinel Event Policy?

Which of the following takes place FIRST in a root cause analysis (RCA)?

A root cause analysis (RCA) is a process to determine what happened

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 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 non responsive. 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?

A risk manager should use a fishbone diagram to illustrate

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

A risk professional facilitating a root cause analysis following a medication error learns that the RN  did not use the dosing calculator in the electronic health record. As a next step, it is important for the  risk professional to

The root cause analysis process is complete when

The main goal of a root cause analysis is to investigate serious adverse events and

A risk professional conducted a root cause analysis on a medical error. The root cause analysis  revealed that the nurse acted with reckless behavior. Using the just culture model, which of the following is the best way to manage the nurse’s behavior?

In a failure mode and effects analysis (FMEA), the severity score is an estimate of the severity of the

The purpose of conducting a failure mode and effect analysis (FMEA) is to

Which of the following is true about failure mode and effects analysis (FMEA)?

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?

A Failure mode, effects and criticality analysis (FMECA)) is a process used to investigate  serious adverse events in an effort to identify the active and latent causes of the event.

An organization is purchasing a new cardiac monitoring system. Which of the following is important toconduct prior to implementation of the new monitors?

Following a sentinel event, prevention action items are identified. Which of the following should be  considered a strong action item in Action Hierarchy?

A risk professional decides not to undertake a particular activity because the risk associated with  the activity is unacceptably high. Which of the following techniques did the risk professional use?

Which of the following is an example of risk avoidance?

Which of the following is the risk control technique that a risk professional uses to eliminate the possibility for a loss to occur?

Which of the following are examples of loss prevention techniques?
1. Incident investigation
2. New employee education
3. Policy and procedure review and revision
4. Relocation of a business to a safer area

Obtaining an insurance policy for coverage of medical malpractice claims is an example of risk

Which of the following are risk treatment strategies?

1.Risk anticipation.

2.Risk avoidance.

3.Risk retention.

4.Risk transfer.

A risk professional has identified a new enterprise-wide technological risk in the transition to a cloud application for internal team collaboration and data storage. On a monthly basis, the risk professional receives a report on login failures, changes to network administrative permissions, and unauthorized sharing of files. This is an example of risk

A hospital has contracted with a construction firm to build a new plant. The hospital risk professional specified in the contract that the construction firm is responsible for any damage to the plant while it is being

1. transferred the risk.
2. mitigated the risk.
3. controlled the risk.

D.shared the risk.

built. By doing so, the risk professional

Proactive risk mitigation activities include which of the following?

All of the following are effective error prevention strategies EXCEPT:

In July 2001, the Joint Commission created additional Patient Safety Standards that speak to risk management as a resource for policy-making, not just a data source for monitoring improvement. These standards require organizations to develop policies and procedures for which of the following?

1.Proper response to an adverse event
2. Prevention of accidental harm
3. Disclosure of adverse events to patients and families
4. Fiscal accountability

When debriefing after an adverse event that caused harm to a patient, which of the following are critical elements?
1. Individual team members should not feel personally responsible for the adverse event.
2. The focus is on individual team members’ strengths and weaknesses.
3. Teams learn practical applications to assist in dealing with difficult situations in the future.
4. Teams can develop new communication methods to use during subsequent events.

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 betoxic. 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?

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

A risk professional receives a call from a nurse manager seeking help with a patient’s family member. The nurse manager states she has tried everything to please this family. She indicated the family threatened a lawsuit.The nurses are now afraid to go in the room. Upon hearing this, the risk professional should

In disclosing a medical error to a patient, it is important the care provider

Which of the following is the most appropriate information to share with the family during an initial disclosure process?

A physician contacted the risk professional to report a wrong site surgery. The physician stated disclosure of the event to the patient has occurred. The risk professional should be aware that

Which of the following represents an appropriate disclosure of an adverse event?

Following an untoward event, the principal purpose of disclosure is to

A 12-year old female is administered an excessive amount of a drug and develops transient tachycardia that necessitate monitoring in the pediatric intensive care unit for eight hours. If the preliminary information indicates there is clear liability on the part of the organization, the most prudent course of action for the risk manager would be to

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).
2. Manufacturer.
3. Occupational Safety and Health Administration (OSHA).
4. Professional liability insurer.

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?

Medical devices may play an essential role in the management of a claim. If a medical device is involved,which of the following should not be done?

During an operation on an I8-year-old male in a Joint Commission accredited hospital, an  electrocautery device ignites the surgical drapes. Operating room staff quickly extinguishes the fire. However, the patient suffers second-degree burns to his right thigh. Based on all applicable state and federal laws and regulations, what is the risk manager’s best course of action?

Within the Safe Medical Device Act, the Food and Drug Administration (FDA) defined a reportable event as”information [from any source) that reasonably suggests that a device has or may  have caused or contributed to a death or serious injury.” Such events must be reported to the FDA  alone whenever:
1. They involve a serious patient injury
2. They involve a patient death
3. The identity of the manufacturer of the device is unknown
4. The distributor of the device is unknown

A patient expires in the Operating Room due to a suspected anesthesia machine failure. The risk professional should first

The Safe Medical Devices Act of 1990 requires

The Safe Medical Devices Act (SMDA) applies to

During the contract review process, the risk manager is responsible for Mi
1. Evaluating insurance coverage.
2. Using a systematic approach to evaluate liability issues.
3. Recognizing and referring certain contractual issues to legal counsel.
4. Reviewing the cost of the contract to ensure the services purchased are within budget.

Which of the following is necessary for a contract to exist?
1. The contract represents a “meeting of the minds”
2. There is a consideration of “this for that”
3. The purpose of the contract is a legal one
4. The contract is documented in writing

If a Facility is accredited by the Joint Commission, which of the following are important risk management reasons to review contracts?
1. To assure the Joint Commission standards are met regarding contracted services
2. To evaluate indemnification/hold harmless provisions
3. To apply appropriate state law CO the COM= provisions
4. To monitor financial performance for the organization

Legal essentials for a valid contract include:
1. A bargained for exchange of legal value between die contracting parties
2. The purpose or object of the contract is legal
3. The contract must be in writing
4. The contract contains risk assumption provisions

A surgeon has asked the hospital to allow for use of a new electronic device that assists with closing  incisions.When reviewing the vendor’s contract for use of the device, the healthcare risk professional  should ensure which of the following is covered in the terms?

An organization has decided to complement its successful wound service line with the addition of two hyperbaric chambers. The decision was made to utilize these services through a well-known contracted service.The best way to assess the risk this new service may pose is to

For a contract to be legally valid, it must contain which of the following?

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?

Which of the following are examples of advance medical directives?

1. Living will
2. Durable power of attorney for health are
3. Physician’s do not resuscitate (DNR) order
4. Legal guardianship papers

In the process of determining whether a patient has adequate mental or cognitive capacity to make healthcare decisions, the physician must determine if the patient is:

1. Able to communicate either verbally or in writing
2. of age according to state law
3. Able to understand the nature of the situation
4. Able to understand the consequences of the decision

Which of the following is NOT a type of consent?

Mature or emancipated minors generally can consent to treatment of which of the following?

1. Sexuallytransmitted disease
2. Pregnancy
3. Alcoholabuse
4. Mentalhealth

Which of the following topics must be discussed during the informed consent process?

An unknown child is carried into a plastic surgeon’s office by a witness after a hit and run. The child has sustained notable trauma and is unconscious. The child has significant bleeding from a laceration, the office calls 911 and the risk professional because the surgeon wants to suture the wound. If the surgeon sutures the wound, is consent needed?

Under which of the following conditions can a relative consent to a minor’s health care treatment?

A power of attorney for healthcare comes into effect and is used when a patient

Which of the following describes written or verbal instructions when patients are unable to make decisions for themselves?

Which of the following is NOT a type of consent?

The emergency except on to the informed consent rule allows physicians to assume an unconscious patent, about whom there is no information, would have given his consent to a procedure in an emergency situation when

A patent’s right for advance directives is based on the ethical principle on

Important considerations in evaluating the legality of an informed consent include

1. Legibility of the patient’s 
2. Patient’s ability to 
3. Physician’s ability to explain the
4. Medical terminology used in the consent process.

A hospital-informed consent policy and procedure should provide clinical staff with which of the following?

Informed consent is based upon the principle of

Which of the following are four commonly accepted principles of biomedical ethics?

The Patient Self-Determination Act (PSDA) requires facilities to

The Patient Self-Determination Act (PSDA) obligates which of the  following  entities  to provide  their clients with information regarding advance directives?

1. Hospitals
2. Providers of outpatient services
3. Health maintenance organizations (HMOs)
4. Home healthcare services

The Patient Self-Determination  Act obligates  which of the following  entities to provide their clients with information regarding advance directives?

1. Hospitals
2. Physician’s offices
3. Health maintenance organizations (HMOs)
4. Home healthcare services

Which of the following federal laws requires healthcare agencies to provide patients with  information about advance directives?

The Patient Self-Determination Act (PSDA) requires facilities to do which of the following?

Which of the following statements is true about the staff member who refused to administer the  transfusion?

When the above patient refuses the transfusion, which of the following actions should be taken?

Ethics consultations and decision-making done systematically will help to ensure that ethical principles are met. This approach would include all of the following except:

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 
2. patient does not object when given the 
3. Person with the patient is a family 
4. Patient agrees to the 

The Health Insurance Portability and Accountability Act (HIPAA):

1. Prohibits the flow of individually identified health information for unauthorized purposes
2. Allows individuals to know who is accessing their information
3. Allows individuals the opportunity to obtain corrections to inaccurate or incorrect  information   
4. Provides for legal recourse against individuals who misuse or mishandle health information

According to HIPAA, which of the following disclosures are permitted without an individual’s authorization and without granting the individual an opportunity to agree or object to the disclosure?

1. A physician discloses an individual’s medical record to a colleague, who is a cardiac  surgeon, for review prior to consultation on that individual’s heart condition.
2. A hospital discloses individually identifiable health information to the company that  provides its billing 
3. A hospital discloses 2 patient’s name and general condition in its facility 
4. A nursing home discloses patient health information to an accreditation organization for the purpose of obtaining 

HIPAA requires a written agreement for covered entities and business associates in which of the following situations?

1. A skilled nursing facility transferring patients to a hospital pursuant to a transfer  agreement
2. A transcription service providing medical record transcription for a physician’s office
3. A hospital contracting for exterior maintenance services
4. A software maintenance company providing services to a hospital’s finance functions

For which of the following purposes can a healthcare facility use and disclose patient health information without the patient’s authorization based on the HIPAA Privacy Rule?

Which of the following documents explains a healthcare organization’s rules for releasing a patient’s medical information?