Exam 3 content: Quality Control (Ch. 23) Flashcards
what is quality control, who is it rendered to, and what are the activities used for?
Specific type of controlling
Activities used to:
Evaluate
Monitor
Regulate
Services rendered to consumers
what are the components of an effective quality control program?
Top Level Administrators Support.
Organizational Fiscal & Human Services Commitment.
Quality goals reflect excellence vs minimums.
Ongoing Process
what are the L&M roles in quality control?
Communicate findings & role model high standards of care to subordinates.
Ensures that patients receive acceptable levels of quality care.
Participates in nursing-sensitive patient outcomes research.
Encourages benchmarks for quality improvement best-performing organizations
Creates a work culture that addresses near misses, medical errors and adverse events.
Use critical event analysis (CEA) or root cause analysis (RCA), when standards are not met.
Discuss quality control findings & regulations.
Establish research base practices.
what is the definition of quality health care?
Institute of Medicine (IOM):
Degree of rendered health services increase the likelihood of desired health outcomes consistent with professional knowledge.
Implications of Definition
Outcomes is one indicator of quality
Quality care must be consistent with current professional knowledge
Defining quality care is difficult
what is Quality control as a process? how is it measured?
Process of measuring quality care.
3 basic steps
- Identify the standard, or criterion
Benchmarking-process of measuring practices against best-performing organiz. - Collect information to determine if standard is met
- If criterion is not met, corrective action
what are the steps in auditing quality control?
Establish control criteria
Identify information relevant to criteria
Determine strategies to collect the information
Collect and analyze information
Compare the information with established criteria
Make a decision about quality
Provide information or take corrective actions regarding findings
Reevaluation
what is the definition for development of standards?
Predetermined level of excellence
what are the distinguishing development of standards?
Predetermined
Established by an authority Communicated and accepted by those affected Measurement tool No one set of standards Standards of practice
what is the development of standards: ANA?
Develops professional standards of care
ANA publishes standards for varied specialty areas
~ Scope & Standards of Practice & Professional Performance
~ Nursing Administrative Scope & Standards of Practice & Professional Performance
~ Many other specialties
~ All of these standards set high expectations for nursing, organizations, & units nationwide
what are the development of standards: Organization?
Outline practice guidelines within institution
They minimize or maximize quality of service performance
Allows measurement of unit & individual performance level
what are Clinical Practice Guidelines (CPG)?
it’s other contemporary standards
Clinical Practice Guidelines(CPG)
- Agency for Healthcare Research & Quality (AHRQ)
~ AHQR & AMA & American Association of health Plans
` Launched the National Guideline Clearing House (NGC)
Some guidelines based on expert vs research
Strength of evidence is missing
Some are not useful, lack flexibility
what is an audit? what are the different types?
Audits as a quality control tool
Audit:
Systematic, official review of a record, process, structure, environment or account to evaluate performance.
Controlling process to determine quality of service
3 types:
Retrospective
Concurrent
Prospective
what is outcome audit?
it is a quality control audit (there are three types)
- Outcome Audit
- End result of care
- Change in pt. health status
- Most valid, complex
Nursing Sensitive:
Fall rates, nosocomial infection rates, pressure ulcers, physical restraint use, & patient satisfaction rates
what is process audit?
it is a quality control audit (there are three types)
- Process Audit:
- Measure how nursing care is delivered
- Denotes relationship of process to quality care
- Critical pathways & standardized clinical guidelines
Measure if practice standards are implemented:
- Vital signs checked according to policy - Medication reconciliation
what is structure audit?
it is a quality control audit (there are three types)
- Structure Audit:
- Relationship between quality of care & appropriate structure
- Resource inputs where care is delivered, environment
- Includes existing elements prior to & separate of the pt. contact
- Structural standards
` Call light & in reach, water at reach - Structural measures
` Staffing ratio, staffing mix, ER wait times,& availability of fire extinguishers in patient care areas
what are standardized nursing languages?
Provides consistent nsg. Terminology to document care
12 ANA approved
- Nursing Minimum Data Sets (NMDS)
` Uniform definitions & categories to meet needs of data users. Shared language. Compares nursing effectiveness, costs, outcomes across settings & nsg. interventions - Nursing Interventions Classifications (NIC)
` Research-based classification system
` Provides a common, standardized language
` Consist of independent & collaborative interventions of nurses in all specialties.
` Linked with NANDA, NMDS, & outcomes - International Council of Nurses (ICN)
` International Classification for Nursing Practice (ICNP).
` Global compositional terminology for nsg.
` Represents a complementary part of professional health for decision making & policy development
what does the QA model target?
targets current quality
what does the QI model target?
targets ongoing and cont. improv. quality
what is total quality management (TQM)?
a quality improvement model
- Continuous quality improvement (CQI)
- Production & service focuses on individual
- Quality can always be better
- Empowerment of employees
what is Toyoto Production System (TPS)?
a quality improvement model
- Eliminate waste, & focus on efficient production
- Have caregivers to solve problems when they occur, find root of problem to limit reoccurrences, & prevents larger problem
who should be involved in quality control?
Everyone
Provides employees feedback
Transforming Care at Bedside (TCAB):
~ Engages leaders, empowers frontline & engages family & patients in dec. making
~ End result-improvement in patient safety indicators
Patient Safety Officer
Multidisciplinary Team
Pt. satisfaction may not equate with health
what is quality measurement as an organizational mandate?
Organizational accountability has increased
Managers must be cognizant of changing governmental & licensing regulations
- External Impacts on quality control
- Government establish guidelines to monitor quality of services
- Justify need for services - Professional Standards Review Organizations
- Fed. Gov. mandated certification of admissions
- Continued review & evaluation of care
- Analysis of patient, hospital & practitioner
- New surveillance affected industry - Prospective Payment System
- Drg’s-Fixed payment to providers
- Decline quality care - Joint Commission:
- Accredits more than 20,000 HCO in USA
- Great impact on planning QC
- Mandate QA program in hospitals
- Reviewed care, & evaluations
- Sentinel event database & RCA plan
- Sentinel Event Policy
- Nation’s Most comprehensive data bases - Core Measures (JC)
- Hospital Quality Measures
- To better standardize, valid, evidence-based data set
- Performance measurement requirements - National Patient Safety Goals
- Promote improvements in patient safety
- Annually
what are the centers for medicare and medicaid services (CMS)?
Hospital Quarterly Initiative (HQI)
~ Targeted health outcomes data source
~ Data made available to consumers & media
Pay for Performance/Quality Based Purchasing (P4P) HP get payments for reporting quality info.
Hospital Consumer Assessment of HP & Systems (H-caps) Survey of patient’s hosp. experience
~ 1st National, Standardized Public Reported
~ Incentive to improve quality care
National Committee for Quality Assurance (NCQA)
~ Compare quality of managed care org.
~ M & M only contracts services with NCQA accreditation
Maryland Hospital Assoc. Quality Indicator Project (QI Project)
~ Performance measurement most frequently used by JC requirement
Report Cards
~ Most states require
what is an ongoing threat to quality care?
medical errors
