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DIRECTIONS: Choose the one best response to each question.

Which of the following can help reduce errors in the delivery of health care?

A. Checklists to ensure important steps are not forgotten

B. Clinician honor code

C. Liberal use of sedatives to help patients sleep while in the hospital

D. Recommendations for handwashing

E. Use of ordering systems that rely on handwritten physician notes

The answer is A. (Chap. 1) A series of reports from the Institute of Medicine (now the National Academy of Medicine) called for an ambitious agenda to reduce medical error rates and improve patient safety by designing and implementing fundamental changes in health care systems. It is the responsibility of hospitals and health care organizations to develop systems to reduce risk and ensure patient safety. Medication errors can be reduced through the use of ordering systems that rely on electronic processes or, when electronic options are not available, that eliminate misreading of handwriting. Whatever the clinical situation, it is the physician’s responsibility to use powerful therapeutic measures wisely, with due regard for their beneficial actions, potential dangers, and cost. Implementation of infection control systems, enforcement of handwashing protocols, and careful oversight of antibiotic use can minimize the complications of nosocomial infections. Central-line infection rates have been dramatically reduced at many centers by careful adherence of trained personnel to standardized protocols for introducing and maintaining central lines. Rates of surgical infection and wrong-site surgery can likewise be reduced by the use of standardized protocols and checklists. Falls by patients can be minimized by judicious use of sedatives and appropriate assistance with bed-to-chair and bed-to-bathroom transitions. Taken together, these and other measures are saving thousands of lives each year.

All of the following statements regarding practice guidelines set forth by governing agencies and professional organizations are true EXCEPT:

A. Clinical practice guidelines protect caregivers against inappropriate charges of malpractice, yet do not provide protection for patients from receiving substandard care.

B. Practice guidelines have largely reached a stage of nuance allowing them to address every unique illness and patient presented to the modern physician.

C. Practice guidelines provide a legal constraint to physicians, and deviation from guideline-based care invariably leaves physicians vulnerable to legal action.

D. Where different organizations disagree regarding practice guidelines, a third-party agency has been appointed to mitigate these disagreements such that now all major organizations’ guidelines are consistent.

E. All of the above statements are ...

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