Patient Safety and Quality of Care
Core concepts
Patient safety rests on recognizing that harm is usually the product of systems, not individuals. Candidates should know the chain of infection-adjacent safety practices, but here the focus is on error prevention and quality improvement: the Swiss-cheese model of defense layers, just-culture reporting, root cause analysis (RCA) versus failure mode and effects analysis (FMEA - prospective, before an event), and the Plan-Do-Study-Act (PDSA) improvement cycle.
Know the universal safety protocols: correct patient identification using two identifiers (never the room number), handoff tools such as SBAR, fall-risk assessment and precautions, pressure-injury staging and prevention (repositioning, support surfaces), and safe medication practices including the "rights" of administration and independent double-checks for high-alert drugs. Understand never events and sentinel events and the requirement for immediate reporting and disclosure.
Traps in questions
- Confusing RCA (retrospective, after harm) with FMEA (prospective, before harm).
- Choosing "counsel the individual" when the question asks for the systems fix.
- Forgetting that two identifiers are required even when the patient is well known.
- Selecting restraints as a first-line fall or behavior strategy; least restrictive measures come first and require orders, monitoring, and time limits.
Worked example / rule of thumb
A patient falls overnight. The weakest answer blames the night nurse; the strongest answer asks what system allowed it - was the bed alarm on, was the call light in reach, was staffing adequate? Rule of thumb: for safety questions, fix the system, not just the person.