Healthcare Systems and Population Health

Question 1

Model for Improvement

Answer 1

test changes through the plan-do-study-act cycle to evaluate change for effectiveness and any issues prior to being adopted by the entire organization

Question 2

Deming’s 14 points for QI to control for variabilities in processes to achieve improvement

Answer 2

1) Constancy of purpose toward improvement = long term planning
2) Adopt the new philosophy = including management
3) Cease dependence on inspection = if variation reduced, errors will be reduced; no need for inspection
4) Single supplier = multiple suppliers equals increased variation
5) Improve constantly and forever = continuous QI
6) Training on the job = lack of training equals variation
7) Institute Leadership = leadership focuses on vision and models; supervision is meeting specific deliverables
8) Drive out fear = fear prevents workers from acting in best interest of organization
9) Break down barriers between departments = departments interdependent
10) Eliminate slogans = processes are what make the most mistakes
11) Eliminate management by objectives = production targets equals shortcuts and poor quality goods
12) Remove barriers to pride of workmanship = increased worker satisfaction
13) Institute education and self-improvement
14) Transformation is everyone’s job

Question 3

Essential Tools for QI - Cause and Effect Diagram (Ishikawa / Fishbone)

Answer 3

Graphically displays relationships of many causes contributing to an outcome

Question 4

Essential Tools for QI - Driver Diagram

Answer 4

Visual display of what primary and secondary items contribute to achievement of an aim

Question 5

Essential Tools for QI - Failure Mode and Effects Analysis (FMEA)

Answer 5

Predicts where, how, and to what extent a system failure could occur so that improvements can be devised to prevent the failure

Question 6

Essential Tools for QI - Flowchart

Answer 6

Visual map of the steps in a process

Question 7

Essential Tools for QI - Histogram

Answer 7

Displays continuous data over time to reveal variation

Question 8

Essential Tools for QI - Pareto chart (80/20 rule)

Answer 8

Bar chart of contributing factors arranged from largest to smallest

Question 9

Essential Tools for QI - Plan-do-study-act cycle

Answer 9

Documents testing a change

Question 10

Essential Tools for QI - Project planning

Answer 10

Systematically plans the changes to be tested

Question 11

Essential Tools for QI - Run chart (control chart)

Answer 11

Graphs data over time (run chart) and with the addition of upper and lower control limits (control chart), helps distinguish causes of variation

Question 12

Essential Tools for QI - Scatter diagram

Answer 12

Helps identify cause-and-effect relationship between two variables

Question 13

Technology Support

Answer 13

Barcode dispensing, automated dispensing, and other robotic supports.

Allow improved mgmt of inventory = reduced costs

Question 14

Computerized Order Entry

Answer 14

Administration = right drug, right patient, right time.

Decision support systems for prescribers = right drug at right dose; also helps organization meet quality indicators.

QI programs and projects = ease of data collection.

Surveillance: abx, opioid, ADEs = reports can be generated by health records, can intervene in real time to increase patient safety

Question 15

Formulary

Answer 15

Standardized list of meds = variability reduction and improves efficiency

TJC requires hospital to develop and approve criteria for identifying formulary meds.

Criteria: indication, effectiveness, drug interactions, ADEs, potential for errors and sentinel events, other risks, and cost.

P&T committee responsible: generic drugs preferred, restricted/PA for use of specific drugs, policy/procedure to obtain non-form meds, therapeutic interchange, med use criteria.

Question 16

Medication Use Evaluation

Answer 16

Evaluation of med use processes and outcomes to improve safety, effectiveness, and costs.

Inter-professional QI program that is P&T responsibility.

Question 17

Surveillance - Abx Stewardship

Answer 17

Required by TJC - abx resistance and unnecessary use of abx.

IDSA - describes purpose = to be in compliance with evidence based guidelines. Also states who must be involved = ID Rph, physician, microbiologist, and infection control.

Required monitoring - redundant abx coverage, quarterly abx use, daily review of restricted agents, daily (de)escalation, IV:PO, PK monitoring, and renal dose adj.

Question 18

Surveillance - Adverse Drug Reaction (definition)

Answer 18

Any response to drug at doses normally used in humans.

Question 19

Surveillance - Adverse Drug Event (definition)

Answer 19

An injury resulting from a medical intervention related to a drug

Question 20

Surveillance - Medication Error (definition)

Answer 20

Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in control of the healthcare professional, patient, or consumer.

Question 21

Surveillance - Adverse Drug Reaction (Tools)

Answer 21

MedWatch (drugs) and VAERS (vaccines).

Naranjo algorithm and WHO Uppsala Monitoring Centre Scale = assess causality.

Question 22

Surveillance - Adverse Drug Event (Tools)

Answer 22

National Action Plan for ADE Prevention = identify significant ADEs and alight efforts to reduce ADEs

Question 23

Surveillance - Medication Error (Tools)

Answer 23

Most don’t lead to significant pt harm - those that do are also classified as ADRs or ADEs and reported there.

Question 24

ADRs, ADEs, and medication errors

Answer 24

They are all related and overlap

Question 25

ADR reporting

Answer 25

Postmarketing surveillance for FDA

Question 26

ADR vs ADE

Answer 26

All ADRs are ADEs.

BUT, ADE definition includes OD. Some also include omission or underdose as ADEs.

Question 27

Medication Errors

Answer 27

Deviation in dispensing and administering from prescribed order/script. As well as errors in prescribing and monitoring!

Question 28

Surveillance - Pain assessment and management

Answer 28

TJC requires surveillance activities.

Opioid stewardship ensures standards are being met.

PDMP must be consulted in compliance with state law.