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質問 # 81
Which of the following can be considered evidence in a malpractice claim?
* photographs of injuries
* thank you note from the patient to the physician
* patient journal of the hospital stay
* gift from the patient to a volunteer
正解：C
解説：
According to Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, evidence in a malpractice claim includes any relevant material that may help establish facts related to duty, breach, causation, or damages. Photographs of injuries are routinely admissible as demonstrative or documentary evidence to illustrate the nature and extent of harm. A thank you note from a patient to a physician may be introduced to reflect the patient's contemporaneous perception of care, credibility, or satisfaction at a particular time, depending on context. A patient's personal journal documenting experiences during hospitalization may also be considered evidence, particularly if it describes symptoms, interactions, or emotional distress relevant to damages.
A gift from a patient to a volunteer, however, is generally not probative of negligence or injury unless directly tied to issues of undue influence or misconduct. In typical malpractice litigation, such a gift does not establish standard of care, breach, or damages and would not ordinarily be considered relevant evidence.
Claims and litigation objectives emphasize careful documentation, preservation of relevant materials, and coordination with counsel regarding evidentiary matters. Therefore, photographs, written communications, and patient journals may be considered evidence in a malpractice claim.
質問 # 82
In a failure mode and effects analysis, the risk priority number is calculated by
正解：C
解説：
According to Health Care Risk Management standards endorsed by ASHRM and the American Hospital Association Certification Center, Failure Mode and Effects Analysis FMEA is a proactive patient safety tool used to identify and prioritize potential process failures before harm occurs. Within FMEA methodology, each potential failure mode is evaluated using three separate scoring components: severity, occurrence, and detection.
Severity measures the potential impact of the failure if it occurs. Occurrence assesses the likelihood that the failure will happen. Detection evaluates the probability that the failure will be identified before causing harm.
Each component is typically assigned a numerical value based on predefined criteria.
The Risk Priority Number RPN is calculated by multiplying the three scores: severity multiplied by occurrence multiplied by detection. This multiplication approach produces a composite score that reflects both the seriousness of potential harm and the likelihood that the event will occur and escape detection. Higher RPN values indicate higher-priority risks requiring mitigation.
Clinical and patient safety objectives emphasize systematic risk prioritization to allocate resources effectively and reduce preventable adverse events. Therefore, the RPN is calculated by multiplying severity, occurrence, and detection scores.
質問 # 83
A doctor fails to administer an indicated test, and the patient deteriorates and must be admitted. This is an example of:
正解：C
解説：
Failing to order or perform an indicated test can represent a diagnostic process failure-an omission that delays recognition of deterioration, leading to harm and escalation of care. Risk management objectives treat diagnostic safety as a systems issue: access to decision support, timely follow-up of abnormal results, clear responsibility for test ordering and review, effective handoffs, and adequate staffing/workload conditions to avoid missed steps. Such errors are often linked to underuse in the IOM quality framework (failure to provide beneficial service) and can drive claims due to preventable worsening. Preventive strategies include standardized pathways, trigger tools for abnormal labs, closed-loop test result management, and teamwork practices that encourage escalation when clinical concern persists despite uncertainty.
質問 # 84
A hospital's Ethics Committee is seeking advice on a case involving the elective sterilization of an adolescent patient who is developmentally disabled. One of the parents is refusing consent. The risk manager should evaluate which of the following?
* who has consent authority
* competency level of the patient
* diagnosis of the patient
* state statutes and laws
正解：B
解説：
Under Health Care Risk Management principles outlined by ASHRM and the American Hospital Association Certification Center, cases involving sterilization of minors, particularly those who are developmentally disabled, raise significant legal and regulatory concerns. The risk manager's primary responsibility is to ensure compliance with applicable consent laws and protect patient rights while minimizing organizational liability.
First, determining who has legal consent authority is essential. When parents disagree, state law typically governs whether both parents must consent, whether one parent's consent is sufficient, or whether court involvement is required. Second, evaluating the competency level of the patient is critical because decision- making capacity influences whether the patient can participate in consent or assent processes. Capacity assessments may require clinical and legal evaluation.
Third, state statutes and laws are highly relevant, as many jurisdictions impose strict legal requirements or court approval for sterilization of minors or individuals with developmental disabilities. These laws are designed to protect vulnerable populations.
The patient's diagnosis alone is not the determining legal factor; rather, decision-making capacity and statutory requirements are central. Therefore, the risk manager must evaluate consent authority, competency, and applicable state laws to ensure regulatory compliance and ethical integrity.
質問 # 85
A hospital's blood transfusions are99.7% error-free. Which function best estimates how many transfusions are likely before an error occurs?
正解：D
解説：
If each transfusion has an independent probability of error, the number of transfusions until thefirsterror is modeled by thegeometric distribution, which describes "trials until first failure." The expected number of transfusions before an error is approximately, so. Risk management objectives use this type of reliability thinking to convert percentages into operational intuition: "Even a 0.3% error rate becomes a predictable event in high-volume processes." That insight supports prioritizing controls (barcoding, two-person verification, bedside ID checks, standardized labeling, transfusion time-outs) because rare-event rates still produce real harm over time. Interpreting reliability this way also helps boards and leaders understand that
"99.x%" can be unsafe in critical processes and that system redesign is often necessary to reach high reliability.
質問 # 86
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