Leadership - Exam 2 Quality control and ptient safety

Question 1

Quality management~

Answer 1

teamwork, customer satisfaction, innovation, employee involvement

Includes:
- structure (unit, equipment, money, etc.)
- activities for establishing high quality care

Process
- nurse role EBP
- team process for best outcomes
- professional growth and job satisfaction#

Question 2

Total Quality Management (TQM)~

Answer 2

philosophy to improve quality, reduce cost, enhance service#

Question 3

Quality Improvement (QI)~

Answer 3

continuous

focus on patient#

Question 4

Performance improvement (PI)~

Answer 4

focus on staff
employees#

Question 5

Root cause analysis (RCA)~

Answer 5

analyze a problem

what and why it happened

take steps to prevent recurrence#

Question 6

Principles of QM and QI~

Answer 6

everyone must be committed (leaders and followers)

goal is to improve systems - not blame

active ways to improve quality

customers define quality (pt surveys)

focus on outcomes

data based decisions#

Question 7

Key organizations~

Answer 7

ANA

QSEN quality and safety education for nurses

IHI institute for healthcare improvement

AHRQ agency for healthcare research and quality

TJC joint commission#

Question 8

Safety Goals~

Answer 8

identify patients correctly

improve staff communication

use medicines safely

use alarms safely

prevent infection

identify patient safety risks

improve health care equity

prevent mistakes in surgery

these havent changed in a long time

from TJC#

Question 9

Steps in the QI process~

Answer 9

1. identify concern - needs of consumer
2. assemble interprofessional team for review
3. collect data to measure
4. establish measurable indicators
5. select and implement plan to meet outcomes
6. collect data to evaluate outcomes#

Question 10

Quality control tends to be~

Answer 10

reactive, fixing probs after the fact#

Question 11

Audit process~

Answer 11

measure what the nurse does during care

two types:
1. concurrent (chart still open - pt still here)
2. retrospective (chart closed - pt gone)#

Question 12

3 types of audits~

Answer 12

process audit: evaluate the process of care
- task-oriented
ex: how pain-scale used

structure audit: eval availability of supplies - environmental issues
- fire extinguishers
- ed wait times
- call lights w/in reach

outcome audit: measure outcome of care for specific interventions (morbidity, mortality, length of stay)#

Question 13

Risk management~

Answer 13

Minimize losses before and after care errors

includes financial, length of stay, public relations, employee dissatisfaction

high risks: falls, med errors, SI attempt, bad equipment

Led to from increase in liability suits in the 70’s#

Question 14

Near miss~

Answer 14

resulted in no injury#

Question 15

Sentinel event~

Answer 15

serious, unexpected

involves death or serious injury

suicide, abduction, surgery wrong

reported to TJC#

Question 16

Root cause analysis~

Answer 16

retrospective analysis to ID prob and prevent recurrence#

Question 17

Variance~

Answer 17

requires formal follow up

improvement areas, potential risk, sentinel event

means of communicating the risk:
- incidence report
- tool constructed to collect info, “unusual occurrence” - no opinions, no guilt
- no bias; objective; non-punitive#

Question 18

Variance forms~

Answer 18

Name/age/address/condition of pt

exact location

time and date

description

provider examination data

bedrail status

reason for hospitalization

names of witnesses

extent of OOB privileges

Who, what when where why?#

Question 19

Just culture~

Answer 19

deemphasizes blame for errors

addresses factors that led to misses, errors, events#

Question 20

Strategies to pregent medical errors~

Answer 20

better reporting (misses and errors)

usage of computerized provider order entry (every single time)

reform of medical liability system (legal strategies)

other point-of-care:
- bar coding usage
- smart IV pumps
- med reconciliation#

Question 21

Characteristics of effective health care delivery system~

Answer 21

• facilitate meeting goals of org
• cost effectiveness
• satisfy the patient
• provide role satisfaction to nurses
• allow implementation of nursing process - ADPIE
• provide adequate communication among providers#

Question 22

Select optimum mode of organizing pt care~

Answer 22

mode based on acuity (not economics alone)

knowledge and skill required is true driver of determining models of care

not every nurse wants challenge or autonomy#

Question 23

Total Patient Care model~

Answer 23

Oldest mode

nurse assumes complete responsibility

“case method” or “assignment” - patient as case

used in hospitals and home health

Disadvantage:
- each caregiver can change regimen
- nurse could be inadequate#

Question 24

Functional nursing model~

Answer 24

after WW2 due to shortage

uses unskilled workers to complete tasks

care assigned by task, not patient

Advantages: efficient
Disadvantage: fragmented care (everyone thinks a problem is someone else’s responsibility)#

Question 25

Team and modular nursing model~

Answer 25

personnel collaborate for caring patients under a nurse requires extensive communication and planning allows members to contribute own expertise Advantage: strong team Disadvantage: usually from improper implementation#

Question 26

Modular nursing~

Answer 26

similar to team nursing smaller team pair of nurses with ancillary staff for group of pts 1980's and 1990's#

Question 27

Primary nursing~

Answer 27

nurse assumes 24-hour responsibility from admission to dc during work, provides total direct care when off duty, associate nurses follow your care plan#

Question 28

Case management nursing~

Answer 28

collaborative process -assess -plan -implement -coordinate -monitor -evaluate coordinates care through the whole episode of illness MAPS (multidisciplinary action plans): - includes nursing care plan - all providers follow MAP - if patient deviates = variance#

Question 29

One best mode for organizing patient care~

Answer 29

There isn't one newer models blend older types#

Question 30

When changing mode of deliver of patient care - ask these Q's~

Answer 30

will this alter autonomy and decision making? will interactions and relationships change? will empys view work differently will this require wider or restricted range of skills? will this change feedback delivery - for self or other evaulation will communication patterns change#

Question 31

Interprofessional team~

Answer 31

complex process 2+ professionals complementary share common goals and shared decision making#

Question 32

Disease Management Protocols~

Answer 32

Step-wise process providing comprehensive, integrated approach to care example: cancer, diabetes, AIDS, etc. each have a similar process of care that can be followed/expected often employ special care coordinator focused on hospital care and prevention strategies#

Question 33

patient/family centered care~

Answer 33

focused on patient needs perspectives of pt and family honored providers communicate w/pts and families for empowerment#