Patient Safety
What the exam tests
This domain tests human factors, handover, medication safety, wrong-site surgery prevention, incident reporting and a just culture.
Core rules
- Use structured handover such as SBAR: situation, background, assessment and recommendation.
- Use closed-loop communication: the receiver repeats back the instruction.
- The surgical time-out confirms patient identity, site, side, procedure and consent before incision.
- Medication reconciliation at admission and discharge reduces prescribing error; high-risk drugs need double-checking.
- Report incidents and near misses through the local system. Reporting should be blame-free for system learning, while accountability remains for reckless conduct.
- Never events include wrong-site surgery and retained instruments; they require immediate disclosure and investigation.
Worked example
During a time-out, the nurse notices that the consent form and imaging refer to the left side while the surgeon has marked the right side. The team stops, checks the notes and imaging, corrects the marking and documents the near miss. The case proceeds only after the discrepancy is resolved.
Traps
Allowing hierarchy to suppress a junior team member; blaming an individual for a system error; not reporting a near miss because no harm occurred; and proceeding with surgery when consent and site marking disagree.