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Module 7 (Critical Care) > Care Coordination/Risk Mgmt/Sentinel Events > Flashcards

Care Coordination/Risk Mgmt/Sentinel Events Flashcards

1
Q

Care coordination is the

A

deliberate organization of patient care activities between two or more participants involved in a patient’s care to facilitate the appropriate delivery of health care services.

need to be deliberate to work on every pt

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2
Q

Case Managers _________ pt care

A

coordinate

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3
Q

Case Mgr goals

A

to avoid fragmentation of care

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4
Q

The case manager must have

A

advanced training and knowledge of the surrounding area and be a resource for all patients

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5
Q

The case manager is responsible for what?

A

Does coding and billing for insurance
Arranges for home medical equipment
Schedule dialysis
Works with insurance for payment
Assists with financial aid
Arranges for home oxygen
Arranges for home health
Schedules physical therapy
Arranges for hospice/palliative care
Arranges transfers to other facilities
Arranges for transportation
jack of all trades

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6
Q

The case manager needs to do what when the pt says they are not going to do a certain care?

A

find the why and following up

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7
Q

Quality Improvement is the process of

A

improving care and reducing deficiencies
- everyone is involved and will buy into it
- need a set standard

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8
Q

Standards of care should reflect

A

optimal goals and be evidence-based.

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9
Q

Medical Errors are due mainly to

A

Poor processes and not error prone people
Adverse effects of meds (wrong method)

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10
Q

JCAHO requires evidence of _________ for accreditation status.

A

QI

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11
Q

Continuous Quality Improvement

A
  • proactive approach
  • anticipating and preventing problems (not reacting)
  • requires close and constant scrutiny
    promote teamwork and evidence based practice
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12
Q

Care should be:

A

Safe - protect pt
Effective - evidence based
Patient-Centered
Equitable - care is the same regardless of status or money
Efficient - avoid waste
Timely - wait times and delays

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13
Q

HCAHPS

A

Hospital Consumer Assessment of Healthcare Providers & Systems

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14
Q

HCAHPS are completed through

A
  • Patient satisfaction surveys! How did we do?
  • Compares similar institutions
  • Gives us an overall picture of how we are doing
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15
Q

HCAHPS problems

A

pain mgmt (now what is the acceptable number)

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16
Q

What are the 8 measured items of HCAHPS?

A

communication (bedside and face to face)
- doctors
- nurses
- about medications (7 Rights and short and sweet disclaimers)
responsiveness of hospital staff
pain mgmt
discharge information - follow-up and admission
cleanliness of environment
quietness of hospital environment - talking zones and allow for rest

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17
Q

How are standards developed?

A
  1. predetermined lvl of excellence serves as a guide for practice
  2. Objective, measureable, and achievable
    - outcome standards = results of the care given
    - process standards =??????
    - structure standards = ????????
  3. Established benchmark
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18
Q

QI Process

A
  1. Determined standards
  2. QI issues identified
  3. Team developed to review the issues
  4. Current structure/process analyzed
  5. Data collected, analyzed, and compared to benchmark
  6. If not met - possible influencing factors are determined
  7. Potential solutions and corrective actions are analyzed with 1 chosen
  8. Education or corrective action is implemented
  9. Issue reevaluated at a pre-established time
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19
Q

How can you improve quality

A
  • Serve on the policies & procedures committee
  • Use reliable sources for information
  • Be familiar with your facility’s P&P’s
  • Provide care consistent with P&P’s
  • Document thoroughly and correctly
  • Participate in review committee’s
  • Assist with education/training necessary (certifications)
  • Follow clinical practice guidelines
  • Act as a role model
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20
Q

Clinical Practice Guidelines

A

Provide diagnosis-based step-by-step interventions for providers to follow to promote high quality care and control resource utilization
Also called standardized clinical guidelines
Should reflect evidence-based practice

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21
Q

Audits are

A

routinely conducted to evaluate quality and if standards are met

22
Q

Outcome audits

A

Determine results of direct nursing care provided
- no VAP due to oral care every 4 hours

23
Q

Process audits

A

Review how care was provided
- CAUTI, Fall

24
Q

Structure audits

A

Evaluate factors outside of patient-staff interaction

25
Q

Issues in Healthcare most commonly discovered in audits

A

Patient discharge delays - now green car in EPIC and have 2 hours for discharge or the unit gets flagged
Care variation - don’t follow standards
Avoidable medical errors - enough sleep, double check, 7 Rights, questions if not right
Communication - providers to labs and providers and nurses = breakdowns between providers (2 hour windows and 1 hour window for criticals)

26
Q

Nursing High Quality Institutions

A

The Leapfrog Group
ANCC Magnet

27
Q

ANCC Magnet Model

A
  • better outcomes and more money
  • education and evidence-based practice and research
  • certifications
28
Q

Quality Gap

A

difference in performance between top performing agencies and the national average

29
Q

What is risk mgmt?

A
  • component of QI mgmt
  • Focuses on identifying, analyzing and evaluating risks
  • Patient records and incident reports used to track and analyze events (root cause analysis)
30
Q

What happens when an incident occurs in the hospital

A

what happened and why
- always call risk mgmt and nurse mgr
- backup

31
Q

Risk Mgmt overall goal

A

to reduce risk to decrease harm to patients

32
Q

Root Cause Analysis

A

Tracks events leading to error, identifies faulty systems and processes and develops a plan to prevent further errors.
- “root” of why

33
Q

STAR Review

A

stop think
act review

34
Q

Root Cause Analysis is set by

A

JCAHO sets mandatory National patient Safety Goals to address selected risks.
always ask why to get to the actual causes

35
Q

Root Cause Analysis overall goal

A

to promote quality evidence-based measures to maximize health benefits.

36
Q

National Pt Safety Goals
- after QIs

A
  1. Identify pt correctly
  2. Improve staff communication (critical labs and dx procedures within 1-2 hours)
  3. Use medications safely (PINCH and star alert due to sentinel events)
  4. Use alarms safely
  5. Prevent infections
  6. Identify pt safety risks (SUICIDE)
  7. Prevent mistakes in surgery (time-outs and markings, consents physician for surgery)
37
Q

PINCH

A
38
Q

What are the 5 Steps to risk mgmt?

A

identify risk potential (nurses job)
analysing risk
evaluate the risk
treat the risk
monitor and review

39
Q

The CDC found that prolonged urinary catheter use is the leading risk factor in

A

catheter associated UTI’s.
-healthcare policy was adapted stating that physicians had to regularly evaluate the catheter and document a continued need for the catheter.
The result was a decrease in catheter dwell times and decrease in catheter associated UTI’s.

40
Q

The identifies these as high risk areas of risks

A

med errors
complications from tx and tests
falls - fall precautions (3 side rails)
refuse tx
refuse to sign consent
pt/family dissatisfaction

41
Q

ASentinel Eventis defined by The Joint Commission

A

as any unanticipated event in a healthcare setting resulting in death or serious physical or psychological injury to a patient or patients, not related to the natural course of the patient’s illness, or the risk thereof
- death
- permanent harm
- severe temporary harm with life sustaining interventions

42
Q

Most common sentinel events

A

falls
pt surgery mistake

43
Q

Examples of Sentinel Events

A
  • Infantabduction, or discharge to the wrong family
  • Unexpecteddeath of a full-term infant
  • Severeneonatal jaundice
  • Fall
  • Surgery on the wrong individual or wrong body part or object left in patient
  • Rapein an acute-care setting
  • Suicidein an acute-care setting, or within 72 hours of discharge
  • Hemolytictransfusion reaction due to blood group incompatibilities
  • Fire
  • Radiation therapy to the wrong body region or 25% above the planned dose
44
Q

At shift change, the off-going LVN reports to the oncoming RN that the newly hired CNA has not calculated the intake and output for several patients. Which of the following actions should the RN take?

A - complete an incident report
B-delegate this take to the LVN
C- ask the CNA if they need help
D- notify te nurse mgr

A

C- ask the CNA if they need help
– the nurse should find out what the CNA knows and whether further teaching is needed

45
Q

A nurse is participating in a quality improvement study of a procedure frequently performed on the unit. What information will provide data regarding the efficacy of the procedure?

A) Frequency with which the procedure is performed
B) Patient satisfaction with how the procedure was done
C) Incidence of complications related to the procedure
D) Accurate documentation of how procedure was done

A

Correct answer: C – Incidence of complications related to the procedure is an outcome measure directly related to the efficacy of the procedure

Efficacy = the ability to produce a desired or intended result.

D is wrong because documentation of HOW the procedure was done does not tell us if the procedure produced the desired results, which is what the question is asking.

46
Q

Efficacy =

A

the ability to produce a desired or intended result.

47
Q

The nurse is assigned four patients. Which patient should the nurse see first?

A) A patient admitted four hours ago with AMS
B) A patient 12 hours post-op angiogram
C) A patient who had 3 emesis episodes in 12 hours
D) A patient that had their pacer wires pulled yesterday

A

A
– this patient is at a high risk for falling and needs to have your eyes on them first.

48
Q

A nurse is preparing to transfer an older adult patient who is 72 hours post-op to a long-term care facility. Which of the following information should the nurse include in the transfer report? (Select all that apply)

A) Type of anesthesia used
B) Advance directives status
C) Vital signs on day of admission
D) Medical diagnosis
E) Need for specific equipment

A

B, D and E
– the receiving nurse and facility needs to know advance directive status to provide care and address needs

49
Q

A nurse is participating in an Interprofessional conference for a patient who has a recent C6 spinal cord injury. The patient worked as a construction worker prior to his injury. Which of the following members of the Interprofessional team should participate in planning care for this patient? (Select all that apply)

A) PT
B) ST
C) OT
D) Psychologist
E) Vocational couselor

A

A, C, D and E
– All of these resources will be helpful in this patient who has a loss in profession and someone who has had a C6 spinal injury – I want you to look at this injury and review what parts of the body this injury would affect.

50
Q

A nurse on a telemetry unit is caring for a patient who was admitted 2 hours ago for chest pain. The patient becomes angry and tells the nurse that there is nothing wrong with him and he is leaving now. Which of the following actions should the nurse take? (Select all that apply)
A) Notify the patient’s family of his intent to leave
B) After leaving, document that the patient left AMA
C) Explain to the patient the risks in leaving
D) Ask the patient to sign an AMA form before leaving
E) Prevent the patient from leaving until the doctor rounds

A

B, C and D
– these are all appropriate for a patient leaving AMA; A – this is a HIPAA violation, E – you should never try and prevent anyone from leaving, that is a huge violation of the patient’s rights and a risk to you and the patient

51
Q

The nurse receives an order to start a patient on 300 mg amiodarone by mouth daily. The patient is currently receiving a transfusion of amiodarone continuously via IV. What should the nurse do?
A) Administer the ordered oral dose of amiodarone
B) Start the oral amiodarone schedule the next day
B) Start the oral amiodarone schedule the next day
D) Stop the infusion 2 hours after the first oral dose

A

C
– if you are unsure what to do, always talk with and collaborate with the physician

Module 7 (Critical Care) (22 decks)

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