Medical Error Prevention: Patient Safety

Continuing Education Credits

• P.A.C.E.® Contact Hours: 2 hour(s)
• Florida Board of Clinical Laboratory Science CE Credit Hours -
  Medical Errors: 2 hour(s)

Objectives

• List and describe the six aims of the National Academy of Medicine (NAM) - formerly called the Institute of Medicine (IOM) - to improve health care quality.
• Describe the NAM (IOM) aims within the context of quality clinical laboratory services.
• Define "total testing process" and recognize problems (errors) that could occur in each phase of the total testing process.
• Identify outcomes of patient safety errors with respect to clinical laboratory services.
• Discuss patient safety goals.

Course Outline

• Six Aims of the National Academy of Medicine (NAM) to Improve the Quality of Healthcare
• State of Quality in Healthcare
• Six Domains of Quality in Healthcare as Defined by the National Academy of Medicine (NAM)
• Improving Effectiveness
• Patient-centered Care and Timeliness
• Preventing Medical Errors Through Patient Involvement
• Efficiency and Equity
• According to the National Academy of Medicine (NAM), quality health care systems in the United States should be:
• One way patients and their families can become active participants in their healthcare is by:
• The National Academy of Medicine (NAM) Aims Within the Context of Quality Clinical Laboratory Services
• Clinical Laboratory Services and Safety
• How might patient harm result from each of these problems related to clinical laboratory services? Consider your answer and then click on the defined ...
• Clinical Laboratory Services and Effectiveness
• Clinical Laboratory Services and Patient-centered Care
• Clinical Laboratory Services and Timeliness
• Clinical Laboratory Services and Efficiency
• Clinical Laboratory Services and Equity
• Which of the following best defines "effective clinical laboratory services?"
• How might a laboratory ensure equity in laboratory testing services?
• Recognizing Problems (Errors) that Could Occur in Each Phase of the Total Testing Process
• Medical Errors
• How might the following factors contribute to medical errors? Consider your answer and then click on the defined problem to reveal the potentially har...
• Total Testing Process
• Safe Preanalytical Component of Total Testing Process
• Safe Analytical Component of Total Testing Process
• Safe Post-analytical Component of Total Testing Process
• Patient-Centered Preanalytical Component of Total Testing Process
• Patient-Centered Analytical Component of Total Testing Process
• Patient-Centered Post-analytical Component of Total Testing Process
• Identify the phase of the total testing process in which each error occurs.
• Misinterpretation of an alphabetic flag in the result field - using a lowercase letter L (l) to indicate "low result", where the result could be inter...
• Outcomes of Patient Safety Errors with Respect to Clinical Laboratory Services
• Outcomes of Laboratory Services
• The Laboratory Quality Management System and Non-Conforming Events (NCEs)
• Reportable Errors
• Reporting of Errors
• NCEs of External Origin
• NCEs of Internal Origin
• Root Cause Analysis (RCA)
• Root Cause Analysis (RCA), continued
• Management of Non-Conforming Events (NCEs)
• RCA Example: Cause-and-Effect Diagram
• Failure Mode and Effect Analysis (FMEA)
• Five Whys
• A patient event occurs that results in a "near miss" (an event that was averted but may have resulted in death or serious injury). The error was caugh...
• Nonconforming events (NCEs) may be of external or internal origin. From the answer choices, choose the NCE of internal origin:
• Sources of Data to Identify Errors and Patient Outcomes
• Monitoring Laboratory Processes to Prevent Medical Errors
• Data Sources to Identify Errors
• All of these sources may be useful for identifying patient safety problems, except:
• Patient Safety Goals
• The Joint Commission National Patient Safety Goals 2023 for Clinical Laboratories
• National Patient Safety Goal: Identify Patients Correctly
• Which of the following is not an acceptable patient identifier to use prior to performing venipuncture procedures?
• National Patient Safety Goal: Improve Staff Communication
• National Patient Safety Goal: Prevent Infection Through Hand Hygiene
• What is generally considered the single most important procedure for preventing the spread of nosocomial (hospital-acquired) infection?
• References
• References

Additional Information