Patient Safety & Quality Improvement USMLE Step 1 Practice Question
A 34-year-old woman at 32 weeks gestation presents to the obstetric unit with a chief complaint of headache and blurred vision for 6 hours. Vital signs are: BP 158/102 mmHg, HR 92/min, RR 18/min, temperature 37.2°C, SpO2 98% on room air. Urinalysis shows 3+ proteinuria. Serum creatinine is normal. Deep tendon reflexes are normal and clonus is absent. The patient denies epigastric or right upper quadrant pain. In response to a recent maternal mortality review identifying delayed recognition of preeclampsia as a root cause, the hospital's obstetric service implements a standardized early warning scoring system (MEWS) to be calculated by nurses every 2 hours. The protocol includes specific action thresholds that trigger mandatory escalation to the attending physician. Which of the following components is most critical to the success of this quality improvement initiative?
Answer choices
- AEstablishing automated electronic health record alerts that automatically calculate and display MEWS scores without requiring nurse interpretation
- BCreating a hospital policy with documented consequences for staff who fail to calculate MEWS at the prescribed intervals
- CProviding comprehensive staff training on MEWS calculation methodology, recognition of abnormal scores, and clear protocols for escalationCorrect answer
- DPurchasing advanced continuous vital sign monitoring equipment for all obstetric beds to reduce measurement error
- EIncreasing the frequency of MEWS documentation from every 2 hours to every 30 minutes to maximize sensitivity for deterioration
- FPublishing the protocol in the hospital newsletter and presenting it at departmental grand rounds without formal competency assessment
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