Safety "minimizes risk of harm to patients and providers through both system effectiveness and individual performance. Show "the degree to which care, treatment, or services for individuals and populations increases the likelihood of desired health or behavioral health outcomes. Quality considerations include:
doing the right thing... Patient Quality Concepts (4) Access-available and affordable Majority of health care errors:
Number of people that die a year from medical errors Cause of preventable deaths in medical field Institue of Medicine; Suggests ways of improving or safety & quality of care Accreditation Organizations Joint Commission Health Care Compare websites Hospitals publically report their performance on specific patient quality measures. Don't participate=2% reduction in patient care reimbursement. 45 --include reports on patient satisfaction, mortality rates, readmission rates, and quality measurements data for common health problems and diseases. -->remarkable improvement Unexpected occurrences involving risk of or actual death or serious physical or psychological injury. -Wrong Patient, site, procedure=734 -Delay in treatment=604 -operative/postop complication=570 control of technology most important factor in reducing health care costs. Never events are health care situations that arise that are serious, often preventable, and not expected to occur in a hospital, such as a patient with stage IV ulcer. -patient suicide -infant discharged to wrong person -falls variation in use of medical care that cannot be explained on basis of illness, medical evidence, or patient preferences -underused of effect treatment -increased mortality following surgery -misuse of preference sensitive treatment -overuse of copious supplies Under health care reform legislation, health care organizations face risks: 1. decreased reimbursement resulting in low margins obligation to report health practice errors and provide health care transparency to patients. Patient self determination act federal law requiring health care instituatins that receive federal funding to: -give clients facility's policies -ask if they have advanced directive -give them health care rights American Nurses Association Developed a guide for carrying out nursing responsibilities in a manner consistent with quality n nursing care and ethical obligations of the profession. ANCC's Magnet Recognition Program developed by the American Nurses Credentialing Center to recognize healthcare organization that provide the very best in nursing care and uphold the tradition of professional nursing practice; professional certification is essential to meet multiple standards within this program Quality and Safety Education for Nurses- developed for future nurses who will have knowledge, skills, and attitudes necessary to continuously improve quality and safety of health care systems QSEN six elements of suggestion to improve practice:
knowledge-facts, info, skills acquired by a person through experience or education. Skills--proficiency acquired through training or experience. Attitude-the way a person views something Knowledge: integrate understanding of multiple dimensions of pcc. How culture influences. Skills: Elicit and communicate patient values, preferences, and expressed needs as part of clinical interview. Assessment: Value setting through patient eyes. Respect Teamwork/Collaboration (KSA) K-describe scope and practice roles S- follow communication practices that minimize risk A-value one's own ability to contribute to effective team functioning. HR >140 RR over 28/less than 8 sBP>180 or <90 ox sat <90 change in mental status the collection, interpretation, and integration
of valid research evidence, combined with clinical expertise, and an understanding of patient and family values and preferences to inform clinical decision making Knowledge- demonstrate knowledge of basic scientific, methods and processes and discriminate between valid and invalid reasons. use of data to monitor outcomes of patient care processes and use of QI methods to design and test changes to continuously improve quality and safety of health car systems. what is an example of KSA for quality improvement K- knowing the impact of nursing care on the client K- examine basic safety principles, as well as unsafe principles. S-demonstrate effective use of strategies to reduce risk of harm to others. A-values the contribution of standardization/reliability of safety. K- explain why info and tech skills are essential to good practice. S-apply technology and info management tools to support safe processes of care. A- value tech supporting decisions, error prevention, and care coordination. Major Example of Never Event Stage IV hospital-acquired pressure ulcer Very common cause of errors within health care settings? communication problems between caregivers Nurse notices that in her care of the patient a variety of unintentional deviations from her usual care resulted in an adverse patient outcome. She ask manager which indicates which QSEN competency? a patient reads that hospitals are not getting reimbursed by CMS for certain never events and asks a nurse to explain. Which of the following is an example of a never event? Stage IV hospital acquired pressure ulcer a group of emergency room nurses are asked to develop an action plan to improve the time before patients who presented with chest pain received EKG. Which of the following would not be a helpful working on a QI effort like this? identify whose fault it is that results are not very good. What is a common cause of errors within health care settings? Communication problems between caregivers The nurse is caring for a newly admitted patient. She introduces herself and asks the patient what his values, needs, and preferences are for this hospital stay. The nurse is participating in which QSEN competencies? The nurse notices that in her care of the patient a variety of unintentional deviations from her usual care resulted in an adverse patient outcome. She asks for assistance from her manage in analyzing the incidents that occur ed in the care of the patient. This is an example of which QSEN competency? the nurse is using bar code administration technology to facilitate the administration of medications to her patients. This is an example of how bar code medication administration technology facilitates which QSEN component. Using a zero befor decimal is... a patient asks a nurse what it means to have a hospital accredited by THE Joint Commission. Which one of the following is not a joint commission quality compliance requirement. you are the nurse caring for a patient who was recently told he has heart failure. the patient will b relocating and would like to identify an acute care hospital in his new state that is adept in caring for heart failure patients. The patient asks you for you recommendation. Which is the best suggestion for objective answer? tell the patient that hospitals publicly report their quality data associated with caring for heart failure patients on a website and instruct him where he can retrieve this information. 1. Which of the following is not a key theme found in an HRO? Belief that nurses are key to changing a culture of an organization Which statement about an HRO is false? C. HROs understand that tasks are independent and often need to be isolated. A nurse is asked how the culture of an organization affects quality, safety, and performance improvement. Which response best demonstrates an understanding? A. “We have a committee on our unit that looks at patient outcomes, practice issues, and most recently, the number of falls on our unit. Our unit director lets us figure out the best way to fix the problem and suggest changes.” 5. An external driving force for change to a high-quality, safe, and reliable organization includes patient-centered care. An example of a patient-centered care force is: D. Number of respondents stating they were “very satisfied” with their care on their patient satisfaction survey 6. Which of the following points are essential to developing a culture of high reliability and safety? A. Empower interdisciplinary committees with the autonomy to make changes to patient care practices 7. Which of the following is a function of the quality and patient safety department? Submitting data to regulatory agencies 8. Establishing a fair and just culture requires that the organization commits to a nonpunitive reporting of errors. Which of the following best represents this philosophy? All medication errors are reported through a computer system. A quality department representative gets a report about the event without names. Which of the following hospital scenarios best demonstrates principles of an HRO
Process improvements are inter-professional and meetings are well attended. 1. A nurse receives a telephone order from a physician for specific x-ray tests. The nurse established the identity of the patient involved and the name of the ordering physician. Which of the following should the nurse do next? . Write the order on the order sheet and then perform a read-back to the physician to verify the order is accurate. 2. The nurse is informed that an RRT will be initiated at the hospital to better meet the needs of patients. Which of the following best describes the way in which the nurse should utilize the RRT? A. Provide support for medical–surgical nurses and decrease the number of patients experiencing an arrest that requires ICU admission. 3. The nurse is transferring a patient from the ICU to the step-down patient care unit. When the ICU nurse calls report to the receiving unit, what is the best way for the nurse to provide the handoff information? . Situation, background, assessment, recommendations (SBAR) 4. The nurse pages a physician due to the patient’s change in status. When the physician calls the unit, the physician yells at the nurse for interrupting dinner. Which of the following would be the nurse’s best approach? C. Refocus the communication on the patient and the reason for the call. 5. The nurse attends an inter-professional meeting to discuss the care of a patient who is a paraplegic after an automobile accident. Which of the following best describes the purpose of assembling an inter-professional team? To provide multiple perspectives to contribute to the patient’s care and wellbeing 6. Following a serious medication error that resulted in patient injury, a nurse is assigned to a team assembled to investigate the cause. The nurse knows which of the following represents the best method for doing so? 7. The nurse on the oncology unit cares for a patient who frequently comments that she would like better pain control through the night. The nurse tells the patient that a note will be placed on the
front of the patient’s chart alerting the physician in case the nurse misses the physician during her rounds. Which of the following represents a better process to ensure the patient’s needs are met? 8. A patient’s family is angry about their family member’s deteriorating condition and tells the nurse that they are not satisfied with the patient’s care. Which of the following would be the most appropriate action by the nurse? Convey understanding and notify members of the health care team so that a family meeting with the team can be provided. . Which of the following processes would best assist the nurse to increase expertise, adjust practice, and improve self-regulation? Elicit constructive feedback from others 10. Skilled communications is essential to patient safety for which of the following reasons? . Miscommunication is responsible for many harmful events in the hospital. 1. The nurse will attend a seminar discussing patients with family/significant others at the center for all nursing and inter-professional care services. The nurse knows that which of the following will most likely be the primary topic? The nurse wants to use a patient-centered approach to perform patient care. Which of the following best describes the nurse’s approach? Providing care through the eyes of the patient 3. The nurse is preparing to review discharge instructions with a patient. The nurse instructs the patient regarding her medications and wound care for her foot. What indicates to the nurse the level of understanding the patient has regarding discharge instructions? D. The nurse observes the patient changing the dressing on her foot wound. 4. When rounding, the nurse discovers that a patient on isolation has soiled the bed. Upon inquiry, the patient indicated that he did not want to bother the nurse because she was busy. The nurse tells the patient to use the call bell anytime. How can the nurse most effectively communicate that she is available to the patient? Ensure that all the patient’s needs have been met before leaving the patient’s room, avoid appearing rushed, and let the patient know when the nurse will return. 5. The nurse is caring for a patient who has multiple chronic conditions and has been hospitalized twice in the last month. The patient has a complex medication regimen, limited family support, and admits to having missed his last two physician appointments because he did not have a ride. What is the benefit of a referral to a health home for this patient? Comprehensive care management enables access to and coordination of care. A nurse is reviewing discharge instructions with a patient. The patient asks the nurse about a cardiac medication he forgot to mention to the physician because the medication is not listed on the discharge instructions. Which action by the nurse is most appropriate when reconciling discharge medications? Contact the physician to notify him of the discrepancy and receive direction regarding the discharge instructions before discharging the patient. A patient newly diagnosed with breast cancer is asking in-depth questions about her diagnosis and sharing what she has found online that has worked for other patients. The nurse recognizes that this patient represents a growing number of informed health care consumers. Which intervention by the nurse demonstrates support for the patient’s involvement in her care? Advise the patient to begin building a PHR. A non-English-speaking patient arrives in the ED and is noted to be crying quietly. Which of the following is the most important for the nurse to consider in initially providing care for this patient? Expressions and interpretations of caring may be perceived differently across cultures. The nurse manager in the surgical step-down unit at a large metropolitan hospital would like to evaluate the perceived effectiveness of pain management for prior patients on the unit. The nurse knows that which of the following measures would best assist the nurse manager in understanding past patients’ experiences? Which of the following best describes the purpose of Boolean commands in electronic database searching? Define relationships between relevant search terms , Mr. Blake has walked two laps around the hall each hour while Mr. Otto has remained in bed. Based on this, you would like to change practice and incorporate an ambulation protocol into the care of these two patients. What would your first action be to achieve this? Perform a literature search to see if there is evidence to validate the efficacy of more frequent ambulation of patients to control pain. . You note that these patients have achieved more milestones quicker in physical therapy and often report less pain. You wish to see if any published literature exists to back up this observation. Which of the following statements is the most helpful to your search? In order to find the greatest amount of literature, it is necessary to consult at least one, and ideally more than one, specialized literature databases like PubMed or CINAHL. Lisa, a novice nurse-researcher, seeks to better understand the potential implications of a different wound dressing technique on postsurgical healing. Lisa’s research mentor is assisting her in developing a PICO question. Which question best demonstrates the PICO framework? For patients who have undergone a flap procedure following a single mastectomy, does dressing the flap with a moist bandage, rather than a dry bandage decrease healing time? They are wondering if a model that bases assignments on patient location might be more effective than models that base assignments on patient acuity. A member of the team suggests performing a literature search to see if any previous research has been done on the topic before designing the study. Why is this important? Searching the literature could help provide methods for study design, help avoid duplicating previous research, and help identify patient assignment models to study. You are a nurse on a general medical–surgical floor and are interested in improving the outcomes of your patients who have a tracheostomy. Your first step should be which of the following? Review your hospital’s current policy and practice for how best to care for tracheostomy patients. You are conducting a literature review and you plan to search for literature on your topic in both Medline and CINAHL. For best search results, it is important to remember which of the following? In most cases, the best search results will be returned if you search using the database’s system of controlled vocabulary subject headings, instead of simply using key words. You are searching for evidence in an electronic database and you notice that it makes use of a system of controlled vocabulary. Because of this, it is usually best to do which of the following? When the database allows it, break your search question down into separate subject headings and search for each subject heading separately before combining search results. Members of a nursing unit are planning to search the literature, but their PICO question is very broad and involves many concepts. Searches of this type are best approached in which of the following ways? It is often best to initially search for only the core concepts of a question and then add the more specific criteria as needed after initial results are retrieved. You are working with a principal investigator on a study to improve how frequently used nursing supplies and equipment are ordered and stored through your organization. You have been asked to conduct a literature search to look for journal articles discussing best practices. What kind of database will best serve your needs? The nurse proposes research on comparing postoperative patients with three or more inpatient days and indwelling catheters versus patients with shorter stays and without indwelling catheters. The nurse knows that the next step in formulating the research is which of the following? The nurse manager is notified that a trauma patient is arriving at the ED with polytrauma sustained in a high-speed rollover accident. The nurse manager utilizes the Benner novice to expert continuum to assign an expert nurse to care for this patient. Which of the following nurses is most likely to be assigned? An RN with an associate’s degree in nursing and 8 years of clinical experience in the ED The oncology unit has a nurse-led support group for improving quality of life for cancer patients. The patient declines participation, stating that he is a private person and is not interested in participating in a group. Which of the following is the best response by the nurse? This program is based on research that found support groups help cancer patients cope with their disease. I think you should come to the next meeting anyway.” The nurse is gathering rigorous evidence to study improving outcomes for patients who are at high risk for falls. Which of the following should the nurse not use? The nurse is involved in a task force to design patient care plans using EBP. Which of the following statements is true regarding EBP? Patient values are a key component of EBP The nurse wants to implement EBP in the care of patients on the unit. Order the following actions for appropriate implementation of EBP. Narrow the focus of interest into a PICO question. The nurse on the telemetry unit has initiated a pilot project to provide early intervention for arrhythmias by using a dedicated RN for cardiac monitoring in an effort to decrease adverse patient incidents. A nurse from the surgical ICU is interested in adopting this program. What is the best response initially by the telemetry unit RN? The program outcomes have not been evaluated yet. We will share the results of the study with your unit when ready.” The ED nurse reads an article that states that patient morbidity and mortality are increased when patients are given plasma volume expanders in the initial treatment of hypovolemic shock. The nurse is concerned about patient outcomes in the ED as plasma volume expanders are prescribed. What is the best action by the nurse? . Narrow the issue to develop a researchable PICO question. The nurse performs health screening at the community center. The nurse notes that several of the patients do not use age-appropriate child restraint systems (CRS) to transport their children in an automobile. The nurse knows that the best way to approach this issue is which of the following? The nurse must take into account the individual cultural backgrounds, socioeconomic issues, and support structures at play to realize that CRS usage is not always a viable option. which of the following is a primary goal of QI Many initiatives shaped how QI is viewed today. Which of the following options did not historically influence the current status of quality health care delivery in health care organizations? They decide on one tool that is appropriate for their medical–surgical population of patients. To implement the tool, they teach the nurses how to use it and document the patient’s literacy level score in the chart. Is this considered research, QI, or EBP? It is EBP since the nurses evaluated the evidence and selected the most appropriate tool for their patient population. 5. Which of the following processes demonstrates the use of Deming’s PDSA method for QI? Collect baseline data, use small-scale trials for change, collect data and compare against desired outcomes, and adjust the plan Which of the following processes demonstrates the use of Deming’s PDSA method for QI? Collect baseline data, use small-scale trials for change, collect data and compare against desired outcomes, and adjust the plan Many organizations are combining Lean and Six Sigma concepts within their QI efforts. What option below best explains why this combination may be successful? Lean focuses on optimizing existing processes for cost reduction and efficiency while Six-Sigma focuses on minimizing variability to eliminate defects. . Which option below is true about a fishbone diagram? It is a QI tool to identify relationship between possible factors. . HFMEA is different from an RCA because of which of the following? HFMEA is a proactive process to assess and eliminate complex, hazardous processes before they result in adverse events. RCA is a retrospective analysis of an event that has already occurred.
How can a new nurse participate in QI activities? Conduct data collection and share information with others. A key element of benchmarking is to do which of the following? Measure and compare the results of key work processes with those of the best performers in evaluating organizational performance. In which of the following situations is internal benchmarking useful? When a health care organization determines a need to evaluate a process that currently has no standardized benchmarks Which of the following would not be considered a trigger for process improvement? Compliance with pneumococcal vaccinations upon discharge is 70%. The national average is 89%. A checklist of specific steps to follow when caring for a patient on a ventilator is instituted in the ICU. The goal is to eliminate ventilator-acquired pneumonia. The checklist is based on evidence-based guidelines. This is an example of what type of indicator? At what point in the systematic problem assessment do most QI plans fail? During education and dissemination of changes because of the lack of clarity on how the new care process will affect staff and expectations for performance
The NDNQI was created to provide access to measurements from different types of hospitals on specific quality indicators. Which of the following statements best describes the benefits of using nationally standardized benchmarks from the NDNQI? Comparing against national benchmarks allows a clinical unit to evaluate its performance on a quality indicator against a large database of other similar units. . The National Quality Forum is a repository of clinical indicators. The clinical indicators are tested and validated before being released to the public. As of 2011, how many quality health care indicators does the National Quality Forum endorse? Informatics nursing is an uncommon area for benchmarking quality indicators. What would be an appropriate source for a nurse informaticist to look for quality indicators and benchmarks? National Association for Nurse Informaticists Limitations to benchmarking can affect the entire QI process. Which of the following is an example of a limitation to benchmarking? Differences in understanding data collection techniques Nurses need to increase awareness of the implementation of technology and informatics in patient care. Which of the following best represents a collaborative effort to ensure best practices in nursing informatics? The nurse is monitoring the telehealth computer and notices that the patient’s pulse oximetry reading drops below 90%, which is the predetermined action criteria for this patient. Which of the following depicts the most appropriate next step the nurse should take? . Call the patient and assess how the patient is feeling and what is currently happening. You are reviewing a control chart that depicts the number of falls over a 24-month period. You note a special cause variation occurred at month 6. Which characteristic below is indicative of a special cause variation? The 6th month data point is above the mean at 3 SDs. One of the key concepts of QI is how a need for change does actually become an improvement. Which of the following is not an appropriate option for launching a QI project? Ongoing concerns identified in the medication usage review committee When considering data display options, which order of display, from least scientific to most scientific, exists when examining process variation? Run chart–Pareto chart–control chart Stratification of data refers to Segmenting the data from aggregate to more specific subsets When a QI team wants to document a process from beginning to end, which of the following tools is most helpful? Why is baseline data useful in QI activities? It is used to compare pre intervention to post-intervention outcomes. Of the options below, which is the most important requirement when creating an operational definition? Creating a numerator/denominator for measurement purposes The nurse is preparing a patient for discharge. Which of the following represents the nurse’s most effective application of the information technology at the bedside? Accessing current research materials in preparation to answer the patient’s questions upon discharge The nurse is caring for a patient and preparing to administer scheduled medications. Which of the following represents a benefit of using informatics technology with regard to medication administration? Automated medication systems provide decision-making aids that alert the nurse to potential problems. the nurse uses the EMR to review key components of the patient’s health. What most directly impacts the nurse’s ability to effectively utilize the EMR? Local policies, training, and institutional guidelines on the EMR The facility is using a newly implemented EMR for patient care. The nurses have expressed some frustrations with the high volume of system alerts that are generated throughout the day. Which of the following demonstrates the most appropriate response to excessive alerts by the nurse? Collaborate with the nurse informaticist in the institution to make necessary adjustments. One feature of some EMR is decision-making pop ups. For example, the nurse will be alerted to the patient’s medication allergies when administering medications. Which of the following best describes the potential work place benefit for the nurse? It is safer and provides a double check opportunity for the nurse to remember to ask the patient. the nurse wants to decrease the rate of medication errors for patients and advocates for use of a CPOE system. Which of the following best indicates the benefit of CPOE systems? Eliminates the need for the nurse to decipher illegible handwriting A patient presents to the ambulatory surgery clinic for scheduled rhinoplasty. During the admission interview, the patient notes a history of an allergic reaction to an antibiotic medication 3 years prior. The patient states that she does not know the name of the drug. Which of the following actions is best for the nurse to take? A nurse on the cardiac unit overhears the licensed practical nurse (LPN) explain to a coworker how to check the status of patients in the labor and delivery unit even though the computer system should not provide this access. Where does the responsibility for system security reside to guard against this type of access? With the designated security officer who will make sure the entire system is secure Which of the following describes the purpose of organizational charts?Its purpose is to illustrate the reporting relationships and chains of command within the organization.
What is the purpose of organization charts quizlet?What is the purpose of an organization chart? An organization chart is a visual representation of a firm's structure that illustrates job positions and functions.
Which of the following best describes a simple organizational structure?A simple structure is the basic structure of the organization that describes the basic designing, low level work, centralization decision-making power. This is generally organized in organizations having less capital and workforce.
Which one of the following best describes an organisation with a flat Organisational structure?The flat organization has few management levels, so the managers hold more authorities than the tall organization. It is sometimes known as the self-managed organization as all the employees in the organization is responsible for their roles and responsibilities.
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Which of the following best describes the purpose of an organizational chart quizlet?
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