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Quantum Units Education®

LEP Guide for Improving Patient Safety

Executive Summary

1. At least 20 percent of the U.S. population is at risk for adverse events because of barriers associated with their language ability.

A. True

B. False

2. Which of the following is a quality and cost driven reason for support of work in patient safety for LEP patients?

A. Longer length of hospital stays for LEP patients.

B. Greater risk of line infections, surgical infections, falls, and pressure ulcers for LEP patients.

C. Greater risk of surgical delays and readmission for LEP patients.

D. All of the above.

3. Which of the following is a liability exposure when providing care to LEP populations?

A. Patient comprehension of medical condition, treatment plan, discharge instructions, complications, and followup.

B. Improper preparation for tests and procedures.

C. Poor or inadequate informed consent.

D. All of the above.

4. Research has identified five key recommendations to both improve detection of medical errors across diverse populations and prevent high-risk scenarios from becoming safety events.  In order to prevent errors for LEP patients, hospitals need to have all of these pieces in place.

A. True

B. False

5. An immediate strategy that can be implemented to prevent medical errors among LEP patients is which of the following?

A. Improving access to interpreters

B. Changing check-in procedures

C. Increasing the number of rounds

D. All of the above

6. All of the following are considered high-risk clinical situations that need immediate attention to prevent adverse events among LEP patients, except for:

A. Medication reconciliation

B. Patient discharge

C. Patient check-in

D. Informed consent

7. The key recommendations to address high-risk scenarios are all of the following, except:

A. Require presence of qualified interpreters.

B. Have physicians double check medications.

C. Provide translated materials in preferred language.

D. Use “teach-back” to confirm patient understanding.

8. Research has shown that TeamSTEPPS is effective in multiple settings at improving care outcomes, team communication, and team attitudes.  Unlike other team-based trainings, TeamSTEPPS is evidence based, field tested, comprehensive, and customizable.  It is publicly available at no cost.

A. True

B. False

9. The TeamSTEPPS LEP Module trains doctors, nurses, technicians, front desk staff, and interpreters together to improve team dynamics and prevent miscommunications when working with LEP patients.

A. True

B. False

10. Joint Commission standards require hospitals to do which of the following?

A. Document all relevant data to help staff coordinate communication assistance.

B. Create processes to identify patients with unique needs.

C. Provide the necessary equipment throughout the care continuum.

D. All of the above are required by Joint Commission standards.

11. Many LEP patients appear to communicate reasonably well in English.

A. True

B. False

12. Patients may not feel comfortable revealing that they have trouble communicating in English.  Thus, it is important to offer professional interpretation services, even when patients seem to speak enough English to “get by.”

A. True

B. False

13. The Department of Justice and the Department of Health and Human Services have stated that failure to provide appropriate interpreter services can be considered discrimination based on national origin.

A. True

B. False

14. All of the following are risks associated with using non-qualified interpreters, including family members, friends, or untrained staff, except for:

A. “Ad hoc” interpreters must be financially compensated for their services which cost hospitals substantial amounts of money.

B. “Ad hoc” interpreters are not trained or skilled in the interpretation process, such as the need to interpret everything the clinician and patient say, to interpret manageable chunks of information, and to avoid paraphrasing long explanations.

C. Family members are not neutral parties to the medical encounter; they may withhold information from the clinical care team or from the patient, or may add their own perspectives.

D. “Ad hoc” interpreters have been shown to commit more communication errors of clinical significance than trained interpreters.

15. All of the following are true with regard to interpreter roles, except:

A. The role of the interpreter is to strictly interpret word for word the conversation between patients and clinicians or other health care staff.

B. Interpreters should be welcomed and treated as core members of the care team for LEP patients.

C. Interpreters should be empowered to speak up if they recognize that a patient’s safety is at risk, particularly due to miscommunication or cultural misunderstandings.

D. Interpreters can be integrated into team meetings, especially for complicated LEP patients, and can participate in huddles, briefings, debriefings, handoffs, and discharges.

Chapter 1: Background on Patient Safety and LEP Populations

16. Identifying something as an adverse event indicates that an undesirable clinical outcome resulted from some aspect of diagnosis or therapy due to error, negligence, and/or poor quality care.

A. True

B. False

17. The root causes of patient safety events for LEP patients are related to communication and lack of use of qualified medical interpreters.

A. True

B. False

18. Greater attention should be placed on ensuring effective communication, including appropriate medication reconciliation, at discharge since as part of the Patient Protection and Affordable Care Act, the Centers for Medicare & Medicaid Services will limit reimbursement to hospitals that have excessive readmissions.

A. True

B. False

19. All of the following are open to liability, except for:

A. Informed consent

B. Wait time

C. Appointment slips

D. Discharge instructions

20. All of the following have been identified as causes of errors, or potential errors, for LEP and culturally diverse patients, except for:

A. Use of family members, friends, or non-qualified staff as interpreters.

B. Provider use of basic language skills to “get by.”

C. Telephonic interpreting.

D. Cultural beliefs and traditions that affect care delivery.

21. Provider use of basic language skills to “get by” is the most commonly reported cause of errors by frontline staff and leaders.

A. True

B. False

22. Nodding or smiling by the patient indicates that they understand the information exchanged and the provider is free to continue.

A. True

B. False

Chapter 2: Five Key Recommendations To Improve Patient Safety for LEP Patients

23. Race, ethnicity, and language preference data are often collected and linked to the patient safety reporting system upon admission to the care facility.

A. True

B. False

24. Patient safety systems should include data fields to track the role of language and culture in patient safety events reported by staff.  To support this practice, it is recommended that the standard formats for patient safety events be augmented by adding all of the following fields, except:

A. A field for patient preferred language and English proficiency.

B. A field for length of time residing in the United States.

C. A field for whether a hospital interpreter was present at the time of the adverse event or was used at any time during the visit.

D. A field to document the use of family or other non-qualified personnel for interpretation during the hospitalization or at the time of the adverse event.

25. Which of the following is the most important key condition for the predicted effectiveness of patient safety reporting systems?

A. User-friendly tools that facilitate reporting.

B. Staff who are educated about the issue of safety and the reporting process.

C. Organizational culture that makes staff members feel comfortable making reports when events arise.

D. All of the above are equally important.

26. Interpreters and frontline staff worry that they will be perceived as spies or snitches if they report errors, making them reluctant to do so.

A. True

B. False

27. Which of the following is important to developing institutional strategies to empower frontline staff and interpreters to report medical errors, while also providing them with the training and systems to do so effectively and efficiently?

A. Use medical error reporting as a learning tool for greater hospital staff understanding.

B. Expand the array of punitive measures to include lesser penalties for more minor errors.

C. Create or restructure reporting systems that are easy to use and efficient so that even interpreters who are not hospital staff members can complete an incident report quickly.

D. All of the above.

28. Interpreters are often not treated as team members or with respect.  Several incidents of doctors, nurses, and other staff displaying ignorance, condescension, impatience, and rudeness toward interpreters and LEP patients have been reported.

A. True

B. False

29. Which color of bracelet has been used to indicate LEP patients, along with their language, due to the chosen color not being offensive to any of the major language groups represented?

A. Red

B. Orange

C. Green

D. Blue

Chapter 3: Improving Team Communication To Foster Safety for LEP Patients: TeamSTEPPS LEP Module

30. The care team should call a qualified medical interpreter to the encounter for LEP patients by which of the following methods?

A. Telephone

B. Video

C. Web-based

D. Any of the above

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