Patient Safety, Quality, and Professional Practice
Domain 8 tests patient safety, quality improvement, and professional practice: error prevention, infection control, escalation, delegation, advocacy, and ethical reporting. Questions often ask what to do first or how to respond to a near miss.
Core rules
- Use two patient identifiers and perform hand hygiene before and after contact.
- Report errors and near misses through the safety system; disclose to families per policy.
- Use a just-culture approach: focus on system fixes, not blame.
- Quality improvement uses PDSA cycles, measures, and small tests of change.
- Follow scope of practice and delegation rules; the nurse retains accountability for assessment and teaching.
- Advocate for the child and family, especially when a concern is not being addressed.
Worked example
A nurse notices a near-miss: a 10-fold insulin dose was prepared but caught before administration. First, stop and keep the patient safe. Notify the charge nurse and prescriber per policy, complete an incident report, and support staff. Review the process: separate storage, independent double-check, and clearer labeling. Share the lesson through the safety huddle. The report is not punishment; it is data for prevention.
Traps
Blaming an individual, failing to report a near miss, and skipping two identifiers. Also avoid delegating assessment or teaching to unlicensed staff, and do not promise confidentiality you cannot keep when a child is at risk.