Exam 2 Flashcards
quality def
measuring performance against standards
quality focus
improved pt outcomes
shift focus from assurance and provider to
improvement and patient
six sigma def
quantitative data driven
ALMOST error-free environment
improves outcomes by measuring errors
(developed by Motorola)
six sigma themes
customer focus
data driven
process emphasis
proactive management
boundary less collaboration
aim for perfection
Team STEPS def
EB framework
purpose- optimize team performance
Team STEPS- leadership
coord. activities
ensure access to resources
Team STEPS- situation monitoring
used to gain understanding or maintain awareness
Team STEPS- mutual support
anticipate o/ needs
Team STEPS- communications
standardization (ex. SBAR)
Team STEP- 4 a’s
assess Status of pt
assess lvl of Team member
assess Environment
assess Progress towards goal
LEAN
most value w/ least resources
eliminate wasteful processess
dev by Toyota
LEAN principles
listen to customer
map processes (value stream map)
identify waste
create pull system (refresh resources after use)
use standard work
quality management def
philosophy
defines helathcare culture
emphasis on customer satisfaction, innovation and employee involvement
quality management 3 P’s
paitent not provider
prevention not inspection
process not person (quality should remain same regardless of staff change)
quality management principles (IGCFD)
involvement (democratic structure)
goal (improve systems w/o blame)
customers (define quality- internal (employees) and external( pts, insurance))
focus (on outcomes)
decisions (based on data)
PDSA
plan
do
study
act (adapt, adopt or abandon)
QM benefits (3)
greater efficiency= inc quality
dec malpractice lawsuits= dec costs
inc customer satisfaction
*pt centered care not direct benefit
focus of QI v QM
QM-customer satisfaction
includes everyone
QI- focus on identification and prevention of problems
ex. inc ICU transfers
quality improvement def
prevention of problems
ongoing process
monitors care through valid and reliable measures
QI steps (6)
identify needs
assemble multidis. team
collect data
establish measurable outcomes/quality indicators
select and implement plan
collect/eval plan
QI collect data ex
number of occurrences on e/ unit
type of meds
QI select/implement plan ex
policy and procedures
QSEN
quality and safety education in nursing
QSEN safety compentencies (PTEQSI)
patient centered care
teamwork/collab
EB practice
quality improvement
safety
informatics
standards def
written value statement
(3)
structure standards
organizational resources
physical environment
ex. omnicell for e/ unit
process standards
beh of nurse
concerned w/ actual delivery of care
ex. VS q4h
outcome standards
reflect desired outcome of care
physical health and function of client
ex. breath sounds are clear
sources that est. standards
JCAHO
american nurses association (ACA)
governmental and regulatory agencies (CDC), state boards of nursing, nurse practice acts
organizational internal policies and procedures
EB practice research
national quality foundation
methods of standard assessment (8)
peer review
chart audits
observation
checklists
fishbone, flow chart
histograms
questionnaires (pt satisfaction survey)
benchmarking
standard assessment- chart audit
most common technique of quality assurance
standard assessment- chart audit types
retrospective
concurrent
prospective
standard assessment- chart audit
retrospective
after DC
does documentation reflect quality care
standard assessment- chart audit
concurrent
real-time
ex. critical pathway
door to balloon time for MI
standard assessment- chart audit
prospective
BEFORE care begins
anticipated problems
ex. neuro assessment q1h, fall precautions
standard assessment- benchmarking
measuring practices/products against the BEST performing organizations
risk management def
interdiscip. process designed to protect financial aspects of organization and maintain high quality medical care
risk management characteristics
goal is prevention
takes corrective action against potential risks
an extension of quality management
TeamSTEP characteristics
leadership
situation monitoring
mutual support
communication
nurse v risk manager
the same
nurses are required to identify and report unusual occurrences and pot. risks
adverse event reduction
strategy to reduce mortality and morbidity
adverse event reduction parts (ASNR)
adverse event
sentinel event
near miss
root cause analysis
adverse event reduction- sentinel event
serious, unexpected occurrence= death or serious harm
ex. suicide, infant abduction, wrong surgery site
*JCAHO requires organizations to respond to these events in a formal way
adverse event reduction- near miss
can result in NO harm
highlights problem that must be fixed
adverse event reduction- root cause analysis
retrospective review of incident
id sequence of events
leads to dev of specific risk-reduction strategies
policy and procedure def
provide order, stability and guide decision making
policies def
formalized guideline
inc consistency in decisions and actions
directs action
ex. all nurses should provide quality care
policy requirements
written, cover all employees
readily avaliable
can be implied/unwritten
area ex. for policy development
confusion about responsibilities
protection of pt/family rights
personnel management and welfare (DNR)(vacation leave)
lack of guidance can cause negligence (ex. med errors)
areas where all staff should adhere to same pattern of decision making (ex. low blood sugar)
procedure def
step by step directions
how to carry out specific activity
procedure requirements
statement of purpose
identify who is to perform the activity
policy and procedure similarities- purpose
means for accomplishing goals and objectives
written rules that are extensions of mission statement
policy and procedure differences
policy-gen. guideline
procedure- more specific
give directions for actions
crossing the quality chasm (SEPTEE)
safe
effective
pt centered
timely
efficient
equitable
DMAIC method
define (From the customer perspective)
measure (w/ system)
analyze
improve (id reasons for variability)
control
Essay question 1:
what are the 5 rights of delegation
-name and define
essay question 2:
name and define and provide an example of the 4 levels of change
change agent def
person skilled in theory and implem of PLANNED change
planned v unplanned change
planned- deliberate action
unplanned (accidental)- adaptive response directed towards re-estb balance
change- lvl 1
alt in knowledge
ex. pt satisfaction survey
change- lvl 2
alt in feelings/attitudes
ex. survey results alert manager that floor moral is low
change- lvl 3
alt in behavior
ex. manager changes leadership style
change- lvl 4
alt. of multiple forces affecting an entire social system
ex. resurvey after leadership style change