CQI Flashcards
Measures to improve patient safety
<ul> <li>Use of two patient identifiers</li> <li>Proper hand hygiene technique</li> <li>Infection control precautions</li> <li>Effective communication techniques such as Situation, Background, Assessment, Recommendation (SBAR) or graded assertions</li> <li>Safe medication practices (e.g., avoid abbreviations, symbols, and certain dose designations)</li> <li>Principles of medication reconciliation</li> </ul>
What to tell the family in case of a medical error?
<ul> <li>Occurrence of the error (delay and medication dosing error)</li> <li>What effects it had on patient (delay in diagnosis, hypotension)</li> <li>The consequences of the effect (unclear at this point, could have negative cognitive effects, reduced cerebral/end organ circulation)</li> <li><em>Note</em>: it is typically helpful to mention what will be done to mitigate these errors from occurring again</li> </ul>
<p>Your community hospital has been flagged as having higher STEMI mortality than similar EDs in your area. You are interested in analyzing some metrics for STEMI care in your ED to identify and correct weaknesses/gaps in care.</p>
<p><strong>What time-based indicators might you assess? </strong></p>
<ul> <li>Time of patient presentation since onset of symptoms</li> <li>Time to first ECG</li> <li>Time to assessment by MD</li> <li>Time to ASA administration</li> <li>Time to thrombolytics</li> <li>Time to consultation by local IM/Cardiology</li> <li>Time for accepting physician to do so</li> <li>Time from acceptance to arrival of transport</li> <li>Time of transport arrival to time at destination</li> <li>Time to PCI (from initial arrival of patient and arrival of patient to PCI center)</li> </ul>
How to implement a CQI project ti investigate and improve quality in case of medical error?
<ul> <li><strong>Identify: </strong>Better system to prevent missed fractures</li> <li><strong>Plan:</strong> Initial XR interpretation documentation and Radiology follow up system</li> <li><strong>Execute:</strong> <ul> <li>Encourage the ERPs to document their preliminary XR reads on the imaging system <ul> <li><i>Quantify what % of each physician’s XRs have a prelim read documented</i></li> </ul> </li> <li>Speak with Radiology to ensure the ED is notified when their final read differs from the ERP’s initial read</li> <li>Ensure the ERP receiving that call follows up with the case same day</li> </ul> </li> <li><strong>Review:</strong> <ul> <li>Follow up after 6 months to ensure protocol is being followed</li> <li>Recheck ERP physician’s comment % is maintained</li> <li>Ongoing education and feedback on the process</li> </ul> </li> </ul>
Setting CQI project
<ul> <li><strong>Identify: </strong>Opportunities in the process workflow</li> <li><strong>Plan: </strong>How can the current process be improved?</li> <li><strong>Execute: </strong>Implement changes</li> <li><strong>Review: </strong>How changes working for the team?</li> </ul>
What is<b>Medication reconciliation</b>
“<span>is the process of creating the most accurate list possible of all</span><b>medications</b><span>a patient is taking — including drug name, dosage, frequency, and route — and comparing that list against the physician’s admission, transfer, and/or discharge orders, with the goal of providing correct</span><b>medications</b><span></span><span>to the patient at all transition points within the hospital.</span>”
Types of Bias
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“<span>Medication error.<br></br>What systems-based strategies could be implemented to prevent this adverse event from occurring in the future?</span>”
Two-person medication verification<br></br>Pre-printed order sheet<br></br>Pharmacy assistance in department<br></br>Checklist<br></br>Computer based dispensing<br></br>Dedicated procedure space with all equipment clearly labelled/dedicated location
<p>Outline the JAMA User’s guide to medical literature guide for validity</p>
<ul> <li>Was the assignment randomized? (each patient has an equal chance to be in either study arm)</li> <li>Were all enrolled patients accounted for at trial conclusion (complete follow-up, intention to treat analysis)</li> <li>Were patients, clinicians and study personnel blinded?</li> <li>Were the groups similar at the start of the trial?</li> <li>Aside from the experimental therapy, were the groups treated equally? (minimize co-interventions)</li> </ul>
