Nursing informatics certification, the NI-BC exam

To display monthly catheter-associated urinary tract infection rates over two years and distinguish special-cause from common-cause variation, the best tool is a:

1. frequency histogram
   A histogram shows how values are distributed at one point in the analysis and loses the month-by-month sequence needed to judge variation over time.
2. control chart
   A control chart plots data over time with a center line and statistically calculated control limits, so points beyond the limits or nonrandom patterns signal special-cause variation.
3. Pareto chart
   A Pareto chart ranks categories, such as infection causes, by frequency to find the vital few; it has no time axis.
4. run chart
   A run chart shows a trend over time around a median, but without control limits it cannot formally separate special-cause from common-cause variation; mixing up the two charts is a frequent error.

A misdirected fax exposes the unsecured PHI of 12 patients, and the risk assessment cannot show a low probability of compromise. Besides notifying the patients, the hospital must:

1. notify HHS and the media within 60 days.
   Media notice and HHS notice within 60 days apply when 500 or more residents of a state or jurisdiction are affected; using the large-breach rule for 12 patients is the common mix-up.
2. report nothing more because it is under 500.
   A small breach still has to go to HHS; being under 500 only changes the timing to an annual report, not the duty to report.
3. notify HHS within 24 hours of discovery.
   The Breach Notification Rule sets no 24-hour deadline; that figure is borrowed from other incident-reporting rules.
4. log it and report to HHS after year-end.
   Breaches affecting fewer than 500 people are logged and reported to HHS no later than 60 days after the end of the calendar year, in addition to notifying each affected individual.

Under the HIPAA Privacy Rule, which use of a patient's protected health information requires the patient's written authorization?

1. Sharing test results with a consulting cardiologist for treatment
   Sharing results with another provider caring for the patient is a treatment disclosure, permitted without authorization.
2. Disclosing it to the patient's employer for a hiring decision
   Giving PHI to an employer for employment decisions falls outside treatment, payment, and health care operations, so it needs the patient's written authorization.
3. Submitting a claim to the patient's health plan for payment
   Billing a health plan is a payment use, which the Privacy Rule permits without written authorization.
4. Reviewing charts during an internal quality improvement audit
   Internal quality review is a health care operations use; it is permitted without authorization, though the minimum necessary standard still applies.

Testing confirms that a medication order verified in the pharmacy system crosses the interface and appears correctly on the patient's eMAR. This is an example of:

1. unit testing
   Unit testing examines one component, such as a single field or rule, in isolation before it is connected to anything else.
2. user acceptance testing
   User acceptance testing is end users confirming the system fits their workflow before sign-off; it is not a check that an order crosses an interface correctly.
3. regression testing
   Regression testing reruns earlier tests after a change to confirm that functions that used to work still work; nothing in the stem describes a change being rechecked.
4. integration testing
   Integration testing checks that data pass correctly between separately built modules or systems, here the pharmacy application, the interface, and the eMAR.

A VTE prophylaxis alert tells prescribers that a patient lacks prophylaxis, but they must close it and search for the order separately. The most effective redesign is to:

1. add a one-click order within the alert
   Putting the recommended VTE order inside the alert makes the right action the easiest action and removes the separate search that causes prescribers to dismiss it.
2. make the alert a hard stop until ordered
   A hard stop blocks work even when prophylaxis is contraindicated or already addressed, which breeds workarounds; it adds force without fixing the missing order path.
3. add a link to the full VTE guideline
   A guideline link adds reading, not action; it supplies information the prescriber already has and leaves the extra order search in place.
4. show the alert again at every chart opening
   Repeating the same unactionable alert more often is a classic driver of alert fatigue and makes overrides more likely, not less.