Prepare for the Certified Professional in Patient Safety (CPPS) exam with these practice questions and answers. This guide covers safety culture, error prevention, root cause analysis, and quality improvement.
Q: You are educating clinical managers in your healthcare facility on how to identify appropriate events for conducting a Root Cause Analysis. Which event provides the best opportunity for an RCA?
Answer: a. A post-op patient removes his own IV causing a skin tear from the tapeb. A patient with no known allergies experiences an anaphylactic reaction to an antibiotic requiring transfer to ICU.c. The biopsy samples from a colonoscopy are never received by pathology after the procedured. There have been 3 occurrences of depressed respirations in the same department in the last 4 months related to sedation
Q: The answer is C. The biopsy samples from a colonoscopy are never received by pathology after the procedure
Answer: a. Create a process map of how instruments are managed during surgery looking for latent flawsb. Revise the hospital policy to make it clear that surgeons must stay in the OR until instrument count issues are resolvedc. Counsel the surgeon about customary clinical standards for a surgeon using appropriate accountability systemd. Reeducate the OR nursing staff on keeping track of instruments on the sterile field
Q: The instrument count is incorrect at the conclusion of a surgical procedure. The hospital policy does not stipulate that the surgeon remain on the premises until an x-ray is obtained. The surgeon leaves the hospital to catch a flight. The x-ray reveals a retained instrument. Another surgeon is contacted to remove the retained instrument. What should leadership do next?
Answer: a. Ask staff if there are adequate scanners to meet their needsb. Counsel the nurse on the importance of following policyc. Request that the pharmacy run a report of BCMA compliance rates of the unitd. Ask the nurse what was occurring at the time, and why she chose to bypass the policy
Q: The answer is C. Counsel the surgeon about customary clinical standards for a surgeon using appropriate accountability system
Answer: a. Control charts of overall infection rate by quarter for the past two years for each hospital in the regionb. A table indicating the CLABSI infection rates of all hospitals in the region relative to the National Healthcare Safety Network benchmark for CLABSI infections for the past 2 yearsc. A written report summarizing the current CLABSI prevention protocols of each hospital in the regiond. A table showing the number of CLABSI infections in each hospital in the region by quarter for the past 2 years
Q: A nurse on a medical-surgical unit does not comply with barcode medication administration (BCMA) while caring for one of her patients. What should her supervisor do?
Answer: a. Ask information systems to either fix the old one or build a new oneb. Identify key stakeholders and perform a gap analysis of current state to ideal statec. Poll colleagues and purchase what they used. Purchase the lease expensive software and grow with it
Q: The answer is D. Ask the nurse what was occurring at the time, and why she chose to bypass the policy
Answer: a. Conduct a root cause analysisb. Conduct a failure modes and effects analysisc. Offer a “plan, do, study, act” sessiond. Offer to do a claims analysis for any related errors
Q: The Board of Hospital A wants to know how Hospital A’s safety performance in central line associated blood stream infection (CLABSI) compares to that of other hospitals in their region. Which data display would best inform them for that decision?
Answer: a. Assembling a multidisplinary team whose members will brainstorm potential failuresb. Conducting the 5 “whys” to figure out what could go wrongc. Listing potential root causes of adverse events in the current cath labd. Asking the medical director to participate in leadership rounds in the current cath lab to identify potential safety risks
Q: The answer is B. A table indicating the CLABSI infection rates of all hospitals in the region relative to the National Healthcare Safety Network benchmark for CLABSI infections for the past 2 years
Answer: a. The detectability increased and RPNs were lowerb. The detectability decreased and RPNs were lowerc. The frequency numbers decreased and RPNs were higherd. The frequency numbers increased and RPNs were lower
Q: Your organization utilizes a “home grown” electronic safety event reporting system that is no longer meeting the needs of the organization. Hospital administration is asking for your opinion for next steps. What next steps would you take to identify a replacement system?
Answer: a. exposes the fallibility of the involved clinician(s)b. Allows others to introduce work arounds to avoid the same situationc. Allows co-workers to learn the rationale for why an event occurred and incorporate new lessons learned into practiced. Sharing these events allows for exposure from litigation perspective and should not be encouraged
Q: The answer is B. Identify key stakeholders and perform a gap analysis of current state to ideal state
Answer: a. Hospital A routinely reviews and updates policies and procedures every 2 yearsb. Hospital B routinely studies close callsc. Hospital C routinely provides trainings on the use of newly introduced medical equipmentd. Hospital D routinely utilizes control charting to report safety performance
Q: Your organization is preparing to change to a new electronic health record. Many departments have been involved with the planning of this huge effort. What would you suggest as part of the preparation strategy?
Answer: a. human factors science represents the intersection of medicine and engineeringb. Human factors science consists of a set of principles that can be learned during trainingc. Human factors science addresses problems by modifying the design of the system to better aid peopled. Human factors science is about elimination human error
Q: The answer is b. Conduct a failure modes and effects analysis
Answer: a. Putting up posters around the organization that reinforce speaking up as a safety strategyb. Using culture of safety data to assist low performing departments with defining strategies for improvementc. Using tends in event reporting to identify staff who don’t speak upd. Re-educating management on the use of Just Culture principles
Q: A new cath lab is under construction in our hospital, and the medical director contacts you to express concerns related to the transport of patients from the cath lab to the ICU. You agree to assist in the design of an FMEA. Components of the FMEA will include:
Answer: a. Fining people who don’t participateb. Outlining specific targets for performancec. Defining required topics of performanced. Providing language for metrics defined in the improvement project
Q: The answer is A. Assembling a multidisplinary team whose members will brainstorm potential failures
Answer: a. Reprimand the discharging providerb. Ask nursing to be responsible for all medication reconciliationc. Gather a team of key stakeholders to flow map the medication reconciliation processd. Gather data on the accuracy and timeliness of medication reconciliation
Q: A new medication administrative safety process was implemented in a hospital. A team convened to perform a failure mode effects analysis and calculate a risk priority number (RPN). After a targeted medication safety program on the new process was delivered to nurses, the same team convened to perform another FMEA. The team would be happy to see:
Answer: a. highlight system-wide improvements that have been implemented in the past yearb. Present cases of harm with contributing root causes and actions takenc. display a graph of the numbers and types of safety events reported in the past yeard. Lead an open discussion of board members’ safety concerns and recommendations
Q: The answer is b. (I think) The detectability decreased and RPNs were lower
Answer: a. determine priorities based on pay for performance measurementsb. Focus primarily on accreditation standards and requirementsc. develop a mechanism to gather input from a variety of sourcesd. review the current literature to identify areas of concern
Q: Sharing lessons learned from RCA’s does what?
Answer: a. Procurement of new beds with built-in alarms to reduce falls with a