Exam 4 Flashcards
the ___ defines quality as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge
Institute of Medicine (IOM)
In 2000 it was estimated that 98,000 people die each year due to ___ and ___ errors in hospitals which lead the IOM to publish its first report in 2000
adverse events
medical
The IOMs first report in 2000 was called what
To Err is Human: Building a Safer Health System
Despite the recent efforts to increase the quality of care did the number or deaths due to adverse events and medical errors increase or decrease
Increase
IOMs 2000 report recommended ___ changes to reduce the number of errors and improve quality care
system
This four tiered approach was recommended by what report
- establish leadership, research, tools and protocols to enhance the safety knowledge base
- develop a public mandatory national reporting system and encourage participation in voluntary reporting systems
- use oversight organization, health-care purchasers and professional organizations to increase performance standards and expectations for safety improvements
- implement safety systems at the point of care in delivery health-care organizations
IOM 2000 report
Based on the info from the IOM’s ___ report the public became more ___ of how frequently medical errors occur and consumer demand for higher quality care has increased dramatically
2000
aware
The second part of the report in 2011 called ___ focused on developing a new health-care system that improves the ____
Crossing the Quality Chasm
quality of care
The 2001 report identified ___ aims for improvement
6
this is one of the six aims of IOMs 2001 report
___: avoiding injuries to clients from the care that is intended to help them
safe
this is one of the six aims of IOMs 2001 report
___: providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit
effective
this is one of the six aims of IOMs 2001 report
___: providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions
patient-centered
this is one of the six aims of IOMs 2001 report
___: reducing waits and sometimes harmful delays for both those who receive and those who give care
timely
this is one of the six aims of IOMs 2001 report
___: avoiding waste, including waste of equipment, supplies, ideas, and energy
efficient
this is one of the six aims of IOMs 2001 report
____: providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic locations, and socioeconomic status
equitable
___ ___ in health care attempts to guarantee that when an actions is performed by a health care professional it is performed correctly the first time and each time thereafter
quality assurance
QA requires that actions and activities are ___ measured and compared to a ___ of care established by a professional organization and that processes of monitoring be in place to provide continuous feedback to prevent errors
continuously
standard
continuous quality improvement is based on the belief that the organization with higher ___ ____ will capture a greater share of the market than competitors with ___ quality services
quality services
lower
the goal of continuous quality improvement is not only to meet expectations of the client but also exceed those expectations; this plan uses a ____ approach in a systematic manner to design, measure, assess, and improve the performance of the organization
multidisciplinary
standards for ___ are used to classify acceptable levels of performance; they may be written for outcomes, processes, or structures
benchmarking
What does HCAHPS stand for
Hospital Consumer Assessment of Healthcare Providers Systems
the HCAHPS provides a standardized ___ instrument and data collection method to obtain client satisfaction date on 8 key topics
survey
What are the 8 topics for the HCAHPS
- communication with HCP
- communication with nurses
- responsiveness of hospital staff
- pain management
- communication about medications
- discharge info
- cleanliness of environment
- quietness of hospital environment
the HCAHPS survey reveals a ___ perception of the quality of care they received
patient’s
what are the four approved method of administration of the HCAHPS survey
- mail only
- telephone only
- mixed
- interactive voice response
the HCAHPS survey is sent to clients ___ hours to __ weeks after discharge based on a list of diagnoses which determine legibility to receive the survey
48
6
the ___ Group’s mission is to promote giant leaps forward in the safety, quality, and affordability of health care by supporting informed health care decisions by those who use and pay for health care and promoting high value health care through incentives and rewards
Leapfrog
these four concepts underline the ___ mission
- health care in the US. is at unacceptably low levels of basic safety, quality, and overall customer value
- major leaps forward in the quality of health care can be achieved if those who purchase health care recognize and reward superior safety and quality
- the purchasing power of America’s largest employers can be used to encourage other purchasers to join and put additional pressure on HCPs to improve quality
- guided by specific innovations that present “great leaps” forward in the improvement of safety and quality of care, leapfrog can increase media involvement and consumer support for the group
leapfrog
what does AHRQ stand for
the Agency for Healthcare Research and Quality
The AHRQ uses ___ ___ or QIs as measures of health care quality from easily accessible inpatient hospital administrative date
quality indicators
___ ___ are standardized, evidence based measures of health-care quality that can be used to measure and track the quality of clinical performance and outcome
Quality indicators
continuous quality improvement is ___ oriented so that emphasis is placed on anticipating and preventing problems rather than reacting to them after the fact
proactively
case management protocols also known as clinical ____, monitor cost effective high quality care
pathways
case management protocols grew out of a need to assess, ___ and monitor cost effective, high quality client care in a systematic manner
implement
clinical pathways are an outgrowth of nursing ___ ___ but have the advantages of streamlining the charting process, encouraging documentation across multidisciplinary teams and systematically monitoring variances from prescribed plans of care
care plans
this is a component of quality management programs and focuses on identifying, analyzing, and evaluating risks and then reducing that risk to decrease harm to clients
risk management
when an adverse event does occur attempts are made to minimize losses; high risk areas include ____ ____, complications from ___ and treatments, ____ and refusal of treatment or refusal to sign treatment consents and client/family dissatisfaction
medication errors
tests
falls
The Joint Commission sets national patient safety ____that address particular risks for client. Hospitals improve quality and safety by making these goals a priority in client care they include
- improve accuracy of client identification
- improve effectiveness of communication among caregivers
- improve safety of using medications
- reduce risk of health-care associated infections
- identify client safety risks inherent in its patient population
goals
these are an unexpected occurrence involving death or serious physical or physiological injury or the risk thereof
sentinel events
Serious injury includes loss of ___ or ___ , these are not the same as errors.
limb or function
True or false: not all sentinel events are due to errors and not all errors cause sentinel events
True
The ____ model was stated in the 1990s and has been used by medical schools and some of nursing to validate the skills and knowledge of their graduates
Competency Outcomes Performance Assessment (COPA)
This model is designed to promote competency for clinical practice at all levels
COPA model
Key components of the COPA model in several of its eight core competencies address ___ ____ and ___ reduction aligning well with the newer QSEN competencies
quality
safety
risk
what does QSEN stand for
Quality and Safety Education for Nurses
What are the 5 QSEN competencies
- client-centered care
- teamwork and collaboration
- evidence-based practice
- quality improvement
- safety
- informatics
____ is 1 of 12 department of health and human services agencies that supports research that improve the quality of healthcare and help people make more ___ health care decision
Agency for Healthcare Research and Quality (AHRQ)
informed
The research goal of AHRQ is to measure those improvements in terms of client outcomes, decrease ___, improved quality of life and cost effective quality care
mortality
The overall focus of AHRQ is in 3 areas
- safety/quality
- effectiveness
- efficiency
____: risk reduction by promoting quality care
safety/quality
____: translating research into practice to increase access and decrease costs
efficiency
____: improved health outcomes by using evidence to make informed health care decisions
effectiveness
____ _____ ____ (QIO) is a federal programs designed to review medical care, verify its necessity, and assist Medicare and Medicaid beneficiaries with complaints of quality of care
Quality Improvement Organization
Mission of the QIO is to improve the ___, ___, ____ and ___ of services delivered to Medicare beneficiaries
effectiveness
efficiency
economy
quality
the CMS changed the Medicare payment programs so that they would no longer pay for reasonable ___ medical errors that occur in the hospital, these events are referred to as ___ ___
preventable
never events
The Robert Woods Johnson Foundation and Institute for Healthcare Improvement joined forces to create a framework called ___ ___ at the bedside to institute change on medical surgical nursing units
transforming care
The goal of transforming care was to improve care and staff satisfaction by addressing 4 main categories
- safe and reliable care
- vitality and teamwork
- patient-centered care
- value-added care processes
this occurs when the nurse can recognize the client or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patients preferences, values, and needs
client-centered care
___ and ___ is the ability to function effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality client care
teamwork and collaboration
this is the use of information and technology to communicate, manage knowledge, mitigate errors and support decision making
informatics
lifelong learning: studies show evidence of decreased client mortality with a higher proportion of ____ prepared nurses providing care in an acute care setting
baccalaureate
research links improved quality of care to increased ___ ___ levels
nursing education
nursing cultures need to make ___ and ___ priority rather than focusing on what went wrong after an adverse events happens and trying to blame someone for the error
quality and safety
other characteristics of blame-free or just culture organizations include ____ working environments, commitment to safety and quality, ___ and using errors as learning opportunities
positive
transparency
the just culture holds staff ___ for at-risk or reckless behaviors and doesn’t tolerate them however it is prepared to handle human error occurrences.
accountable
a blame-free nursing environment contributes to ___ by analyzing system errors to identify possible improvements
quality
this is an essential component of client care and management of nursing units in today’s health care system
delegation
delegations this allows health care managers to ____ the use of caregivers who are educated at multiple levels in a variety of programs
maximize
if delegation is performed properly it permits nurses to meet the ____ of high quality care for all clients and is a basic skill that ___ must meet
requirements
RNs
the goal of ___ is to meet the increased ___ for services as they intersect with the shrinking resources of the health care system
delegation
demands
delegation includes the understanding that the authorized person is acting in the place of the ___ and will be carrying out tasks that generally fall under the RNs scope of ____
RN
practice
the person taking on the ___ level task must be ___ to perform the task within the nurse’s state practice act
RN
authorized
when delegating to non-nurses the RN must always ___ those individuals to ensure that the care given meets the standards of care
supervise
legally the authority of power to delegate is restricted to professionals that are licensed and governed by NPA; not all ____ functions can be delegated to assistive personnel because of restrictions in the nurse practice act and institutional policies
RN
According to the ANA delegation is the transfer of ___ for the performance of an activity from one individual to another while retaining ___ for the outcome
responsibility
accountability
when a person accepts a ___ tasks they accept the ___ attached to it
delegated
responsibility
delegatees ___ ___ practice on the RNs license, they practice on their own license or within their own levels of education. when they agree to accept the delegated task, they are responsible for their own actions in performance of the task
DO NOT
Before delegating any task, RNs should give careful consideration to the condition of the client and the client’s health care needs; assessing clients is a designated responsibility of ____
RNs
without a thorough ___ it is likely that critical needs will remain unidentified by less trained personnel leading to potential errors in care
assessment
the tasks being delegated must be relative ___ and ___ and should not require the use of nursing ___ while being performed
uncomplicated
routine
judgement
primary consideration in delegating and assigning staff is the delegating nurse needs to know the ___ of staff and the education and ___ levels of the personnel to be delegated
availability
competency
the RN needs to know the institution’s official position description for the UAP as well as the UAPs _____
abilities
RNs who delegate are also responsible for ___ the UAP about the task to be done. IF the UAP is unfamiliar with the task the RN is required to ___ how the task or procedure is performed and the document the training
educating
demonstrate
when a nurse delegates tasks, the outcomes of tasks should be clear and ___
predictable
the tasks should not require ____, ____, ___; if any of these elements are required it needs to be reassigned to an RN
excessive supervision
complex decision-making
detailed assessment during its performance
mastering delegation skills can seem daunting, there are 5 common sense steps to attain this skill known as the 5 rights of delegation which are
- right task
- right person
- right direction/communication
- right supervision/feedback
- right circumstances
lateral violence can either be ___ or ___
covert or overt
This type lateral violence is more obvious and includes name calling threatening body language physical hazing bickering fault finding negative criticisms intimidation gossip shouting blaming put downs raised eyebrows rolling of the eyes verbally abusive sarcasm pounding on table throwing objects shoving a chair against wall
overt
This type of lateral violence is difficult to identify and includes unfair assignments marginalizing a person refusing to help someone ignoring someone making faces behind someone's back refusing to work with certain people whining sabotage exclusion fabrication
covert
this is any speech or action that disrupts the harmony of the teaching or learning environment
academic incivility
this can be defined as any behavior that could reasonably be considered humiliating, intimidating, threatening, or demeaning to an individual or group o individuals in the workplace
lateral violence
this is any behavior that could be reasonably be considered humiliating, intimidating, threatening, or demeaning to an individual or group of individuals
bullying
this is the process whereby a nurse direct another health-care team member to perform specific nursing tasks, procedures, and activities that are beyond the person’s traditional role and are not routinely performed by them
delegation
this is the allocation of tasks that each staff member is already authorized to perform during a given shift
assignment
this is the provision of guidance and oversight of personnel to whom a nursing tasks was either delegated or assigned
supervision
this requires the physical presence and ongoing direction of the supervising RN and they be available on site or through various means of written and verbal communication
direct supervision
this is the assignment of the team member’s ability to complete the delegated or assigned tasks of patient care which he or she received from the supervising RN
evaluation
this is the duty of a person as a reasonable and prudent member of a particular group by training or licensure to complete tasks and assignments that are within their power, control, and authority
responsibility
this is an obligation or willingness to be answerable for ones own actions and/or the actions of another, particularly where there is assignment or delegation of tasks
accountability
examples of \_\_\_ barriers to effective delegation include Lack of experience Lack of confidence in others Personal insecurity Demanding perfectionism Poor organizational skills Indecision Poor communication skills Lack of confidence in self Fear of not being liked by everyone Micromanaging management style
internal
examples of ____ barriers to effective include
Unclear policies about delegation
Policies that do not tolerate mistakes
Management-by-crisis model for facility
Unclear delineation of authority and responsibilities
Poor staffing
Lack of competence
Overdependence on the person delegating
Unwillingness to accept responsibility for ones own practice
Immersion in trivia and gossip
Work overload
external
when delegating to ___/___ consider this
Look for the lowest level of skill required for the task.
Look for the least complicated task
Look for the most stable patient
Look for the client with the chronic illness
NO MEDICATIONS
UAPs/CNAs
these 3 goals directed the development of the HCAHPS ___
- produce a method to provide comparison of client satisfaction data
- create hospital motivation to improve care quality
- increase hospital transparency in terms of quality of care
survey
A type of incivility that encompasses physical abuse, emotional abuse, verbal abuse, or any combination of the three.
bullying
recommended changes for advocacy strategies to reduce errors and improve the quality of health care by recommending a four-tiered approach
IOM 2000 Report: To Err is Human: Building a Safer Health System
IOM 2001: Crossing the Quality Chasm identified 6 aims for improvement including:
What is Safe, Effective, Patient-Centered, Timely, Efficient, and Equitable.
