TCRN Review - Professional Issues (Trauma Quality Management, Staff Safety, Disaster Management, Critical Incident Stress Management, Regulations and
... [Show More] Standards, Education and Outreach, Trauma Registry and Ethical Issues
List the characteristics of Trauma Center Designation - CORRECT ANSWER Outlined and developed at the state and local level
Varies from state to state
Requirements outlined through legislative or regulatory authority
List the characteristics of Trauma Center Verification - CORRECT ANSWER Overseen by the American College of Surgeons
Verifies commitment, readiness, resources, policies, patient care and performance improvement are in place.
What is the definition of level 5 Trauma Care? - CORRECT ANSWER Provides evaluation, stabilization and diagnostic capabilities and prepares patients for transfer to higher levels of care.
What are the level 5 Trauma Care criteria? - CORRECT ANSWER Basic ED facilities to implement ATLS protocols
Trauma nurses and physicians available upon patient arrival
After-hours activation protocols if facility not open 24-hours a day
May provide surgery and critical-care services if available
Has developed transfer agreements for patients requiring more comprehensive care a a level 1 through 3.
What is the definition of level 4 Trauma Care? - CORRECT ANSWER Provides evaluation, stabilization and diagnostic capabilities for injured patients before transferring to a higher level of care.
What are the level 4 Trauma Criteria? - CORRECT ANSWER Basic ED implement ATLS protocols and 24 hour laboratory coverage. Trauma nurses and doctors available on patient arrival.
May provide surgery and critical care services when available.
Transfer agreements with Level 1 or II.
Comprehensive quality assessment program.
Involved in prevention efforts and must have an active outreach program for its referring communities.
What is the definition of level 3 trauma care? - CORRECT ANSWER Ability to provide prompt assessment, resuscitation, surgery, intensive care and stabilization of injured patients and emergency operations.
What are the level 3 trauma criteria? - CORRECT ANSWER 24 hr immediate coverage by emergency medicine physicians, prompt availability of general surgeons and anesthesiologists.
Comprehensive quality assessment program.
Transfer agreements for patients needing level 1 or 2.
Provides back-up for rural or community hospitals.
Offers continuing education or nursing and allied health personnel or the trauma team.
Involved with prevention efforts and must have an active outreach program for its' referring communities.
What is the definition of level 2 trauma care? - CORRECT ANSWER Able to initiate definitive care for all injured patients.
What are the level 2 trauma criteria? - CORRECT ANSWER 24 hr immediate coverage by general surgeons as well as coverage by specialties.
Certain needs (cardiac surgery, hemodialysis, microvascular surgery) may be referred to level 1
Provides trauma prevention and continuing education programs to staff.
Incorporates a comprehensive quality assessment program.
What is the definition of level 1 trauma care? - CORRECT ANSWER Comprehensive regional resource central to the trauma system. Capable of providing total care for every aspect of injury from prevention through rehabilitation.
What are level 1 trauma criteria? - CORRECT ANSWER 24 hr in-house coverage by surgeons; prompt availability of specialties
Referral resource for nearby communities, provides leadership in prevention and public education to surrounding communities.
Provides continuing education to trauma team members.
Incorporates a comprehensive quality assessment program.
Operates an organized teaching and research effort to help direct new innovations in trauma care.
According to COBRA / EMTALA, what must accompany the patient upon transfer? - CORRECT ANSWER Signed certification of risks/benefits
Appropriate medical records, reports and consultation records (or copies)
According to _____, appropriate transportation with adequate life support equipment trained personnel on board (based on patient's condition) is required for transfer. - CORRECT ANSWER COBRA/EMTALA
What is the term for a process which seeks to improve the quality of care provided? - CORRECT ANSWER Process improvement
What are the three steps to process improvement? - CORRECT ANSWER 1. Identification of outcomes
2. Determining a plan to meet those outcomes
3. Measuring progress toward the outcomes
What is TRISS? - CORRECT ANSWER Trauma Injury Severity Score
How are patients selected for performance improvement? - CORRECT ANSWER Varies from institution to institution
What does the TRISS do? - CORRECT ANSWER Trauma injury severity score calculates the probability of survival for patients based on criteria.
What criteria are used in assigning a TRISS score? - CORRECT ANSWER Revised Trauma Score (RTS), includes respiratory rate
GCS
Systolic BP
Patient age
Mechanism of Injury (blunt vs. penetrating)
Abbreviated Injury Score (AIS)
Discuss the Abbreviated Injury Score (AIS) - CORRECT ANSWER The AIS assigns each injury a score of 1-6.
Once a score is assigned, it is squared.
Only the THREE most severely injured body areas are scored using the highest score in each body region.
Scores vary from 0 to 75. The higher the score, the lower the likelihood for survival.
What is used to collect, store and retrieve data describing the etiologic factors, demographic characteristics, diagnoses, treatments, and clinical outcomes of individuals who meet specific case criteria. - CORRECT ANSWER Trauma Registry
What are the 3 types of performance improvement reviews? - CORRECT ANSWER Primary
Secondary
Tertiary
When do primary process improvement reviews occur? - CORRECT ANSWER Occurs in real time, while the patient is hospitalized
What are the advantages of the primary survey? - CORRECT ANSWER Allow immediate changes in plan of care to improve outcomes
What are the disadvantages of the primary survey? - CORRECT ANSWER Excludes outcome data and data not immediately available
Describe secondary performance improvement reviews. - CORRECT ANSWER Retrospective review after the patient is discharged (chart reviews, trauma registry)
What are the advantages to the secondary process improvement review? - CORRECT ANSWER allows comprehensive review of overall care, provides the opportunity to see trends in data, and compile statistics
What are the disadvantages to the secondary process improvement review? - CORRECT ANSWER Feedback to providers is delayed
Incidents must be reconstructed from memory
Patient care cannot be affected in real time
List some examples of tertiary performance improvement reviews - CORRECT ANSWER Morbidity/Mortality Reviews
Physician performance improvement conference
Trauma surgeon /medical examiner death review
Interdisciplinary performance review
What things should be considered during tertiary review? - CORRECT ANSWER Were accepted protocols and policies followed?
Were clinical management guidelines adhered to?
Was the case managed according to guidelines?
If the case involves a resident/student, was there adequate supervision?
Was the system response optimal?
Did the patient have pre-existing medical conditions that contributed to the occurrence?
Was the occurrence evident before hospitalization?
What are some system shortfalls to consider in review? - CORRECT ANSWER Prolonged prehosiptal time
Communications problems
Paging system failure
Delays in internal response
Blood bank delays
Equipment malfunctions
What 3 things will performance improvement reviews help determine? - CORRECT ANSWER 1. If traumatic death was preventable, potentially preventable, or non-preventable
2. What can be learned from the case to improve care in the future
3. Whether there were delayed injuries (found after admission) or missed injuries (found after discharge)
Based on the findings of performance improvement, what appropriate actions can be undertaken? - CORRECT ANSWER collection of data for a period of time to determine whether the variation represents a trend or an isolated occurrence
Change in, or better enforcement of, policy or procedure
Development of clinical management guidelines
Presentation of the issue as a topic of education
Physician/Provider counseling
Mandatory continuing education
Probation or suspension of staff members who have varied from the standard of care
What is loop closure? - CORRECT ANSWER Based on actions undertaken, address issues noted in performance improvement reviews. It is important to ensure those actions have had their intended effect. This is also referred to as loop closure.
What is the term for the conscious, explicit and judicious use of current best evidence in making decisions about the care of individual patients? - CORRECT ANSWER Evidence-Based Practice
What are 4 advantages to evidence-based practice? - CORRECT ANSWER Enhances patient outcomes
Allows measurement of outcomes
Reduces individual practitioner roles
Increases cost effectiveness of care and resource use
Define quantitative research - CORRECT ANSWER A deductive process that utilizes numeric findings for quantification
Define qualitative research - CORRECT ANSWER An inductive process where words, not numbers, are used to give meaning to data, involves interactions between the researcher and the subject.
List the 10 steps of research. - CORRECT ANSWER 1. Problem identification
2. Literature Review
3. Research question or hypothesis
4. Choosing appropriate study methodology
5. Sampling
6. Institutional Review Board approval
7. Data collection and measurement
8. Determining data validity and reliability
9. Data analysis
10. Results, conclusions and recommendations are drawn and published.
What is the purpose of the Institutional Review Board (IRB)? - CORRECT ANSWER The IRB functions to protect the rights and welfare of study subjects by ensuring informed consent is obtained from each subject and the subjects can make independent decisions about the risks and benefits.
What is the term for a question that identifies the phenomenon to be studied? - CORRECT ANSWER Research question
What is the term for an expansion of a research question which predicts the relationship between two or more variables? - CORRECT ANSWER Hypothesis
What is the term for the degree to which an instrument measures what it is intended to measure? - CORRECT ANSWER Validity
What is the term for what determines if the measurement tool yields stable and consistent results when repeated over time? - CORRECT ANSWER Reliability
List 10 factors that should be considered when reviewing research. - CORRECT ANSWER 1. Is the study design appropriate to the type of research done?
2. Do the study findings address current clinical problems?
3. Is the subject population for the study appropriate? Was there an appropriate number of subjects in the study?
4. Is the study applicable to current practice and the area it is to be applied?
5. Is the study population similar to those with whom the research will be applied?
6. Is the study's setting similar to or different from the intended practice setting?
7. Is there evidence that a critical review of literature was done before the research was undertaken?
8. Are the research instruments reliable and valid?
9. Do other studies support or oppose the study findings?
10. Was the study ethical, legal, and feasible?
What is the goal of mitigation? - CORRECT ANSWER To reduce loss of life and property by limiting or avoiding potential impact and incorporating lessons learned from previous events
What is the goal of disaster triage? - CORRECT ANSWER To do the most good for the greatest number of people
What are the 4 steps to disaster management? - CORRECT ANSWER Mitigation
Preparedness
Response
Recovery
Shorten the meaning of mitigation - CORRECT ANSWER "What do we need to get ready?"
What are the steps of mitigation? - CORRECT ANSWER Hazards Vulnerability Analysis
Take actions to reduce risks identified during Hazards Vulnerability Analysis
What is the act of determining the hazards that a hospital is at risk for, so actions can be taken to minimize those risks? - CORRECT ANSWER Hazards Vulnerability Analysis
Shorten the meaning of preparedness - CORRECT ANSWER Getting things ready
What are the 4 steps to preparedness? - CORRECT ANSWER 1. Develop mutual aid agreements and contracts
2. Determine/stockpile resources needed for five days of autonomous functioning.
3. Develop disaster plans, educate staff on those plans, and perform disaster drills to practice the plans
4. Establish a command and control structure (HICS) and an alternate communication plan
Shorten the meaning of response in relation to disaster management. - CORRECT ANSWER "During"
provide care after a disaster has occurred
What are the 4 levels of disaster triage? - CORRECT ANSWER Black (deceased)
Red (immediate)
Yellow (delayed)
Green (non-urgent)
Describe Black relating to disaster triage - CORRECT ANSWER Dead or likely to die from injuries despite treatment
Describe Red relating to disaster triage. - CORRECT ANSWER Likely salvageable with immediate intervention
Describe Yellow relating to disaster triage - CORRECT ANSWER Requires medical care but unlikely to die without immediate intervention
Describe Green relating to disaster triage - CORRECT ANSWER Walking wounded: likely to survive even if medical care is not rendered
List the 5 steps of Recovery in disaster management. - CORRECT ANSWER 1. Inventory and replenish supplies
2. Dispose of garbage and other waste
3. Restore the physical plant
4. Incorporate disaster records into regular medical records
5. Psychological care
What is CISM? - CORRECT ANSWER Critical Incident Stress Management
List the two types of CISM interventions - CORRECT ANSWER Defusing
Debriefing
What is a three-step informal process that occurs right after the event (preferably before the participant sleeps) - CORRECT ANSWER Defusing
What is an eight-step formal process that takes place 1-14 days after the event? - CORRECT ANSWER Debriefing
Discuss the CISM - CORRECT ANSWER Activated for any incident which potentially creates emotional distress for those involved
Is not a quality improvement activity or an event to air concerns
The purpose is to mitigate the impact of traumatic events and restore adaptive functioning of care givers
Led by trained counsellors
Only those present during the event are invited to attend
What is the term for the ability of an individual to determine his or her own course of action. Included in this principle are independence, self-reliance and competency. - CORRECT ANSWER Autonomy
What is the term for the duty of health care providers to be of a benefit to the patient, as well as to take positive steps to prevent and to remove harm from the patient? - CORRECT ANSWER Beneficence
What term requires that we not intentionally create needless harm or injury to the patient, either through acts of commission or omission? - CORRECT ANSWER Non-Maleficence
What is the term for providing all information needed to make an informed and balanced decision? - CORRECT ANSWER Honesty or Veracity
What is the term for the fair distribution of goods in society? - CORRECT ANSWER Justice
What is information that relates to past, present or future physical or mental health or condition of an individual; provision of health care to an individual, and past, present or future payment for the provision of health care to the individual? - CORRECT ANSWER Protected Health Information
What ensures patients will receive information about how their health data will be used and disclosed? - CORRECT ANSWER Health Information Portability and Accountability Act (HIPAA)
List the instances in which patient consent is not required for their information to be shared. - CORRECT ANSWER Information may be shared between one or more health care workers involved in the patient previously or in the future.
Information may be shared if the activities involve obtaining premiums, determining or fulfilling responsibilities for coverage and provision of benefits, and furnishing or obtaining reimbursement for health care delivered to an individual.
Health care operation activities
PHI may be released for health oversight, law enforcement, crime reporting, military and veteran's activities, national security and intelligence activities, organ and tissue donation, abuse and neglect reporting, judicial and administrative proceedings, public health surveillance, public health and safety, public benefits programs, fraud reporting, and certain research purposes.
What are the health care operation activities in which a patient consent is not required to share their information? - CORRECT ANSWER Quality assessment and improvement activities
Competency assurance activities
Medical reviews, audits or legal services
Insurance functions: underwriting, risk rating and re-insuring risk
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