Lecture 11 Quality control

Question 1

Quality control

Answer 1

Activities that evaluate, monitor, or regulate services rendered to the consumer.

Question 2

If nursing is to strive for excellence, quality control criteria should be _

Answer 2

Pushed to optimal levels, rather than minimally acceptable levels.

Question 3

Health care quality

Answer 3

The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

Question 4

Steps in the process of quality control

Answer 4

1. The criterion or standard is determined.
2. Information is collected to determine if the standard has been met.
3. Educational or corrective action is taken if the criterion has not been met.

Question 5

Benchmarking

Answer 5

1. The process of measuring products, practices, and services against best-performing organizations.
2. Used for standard development and performance improvement.

Question 6

Standards

Answer 6

Predetermined levels of excellence that serve as guides for practice; established by an authority and communicated to and accepted by the people affected by them.

Question 7

ANA Standards of Practice

Answer 7

1. Assessment - collection of data.
2. Diagnosis - analyze assessment data to determine diagnoses or issues.
3. Outcomes identification - identify expected outcomes for an individualized plan.
4. Planning - develop a plan to attain the expected outcomes.
5. Implementation - implement the plan.
6. Evaluation - evaluate progress toward the attainment of outcomes.

Question 8

ANA Standards of Professional Performance (1 of 2)

Answer 8

1. Ethics - practices ethically and integrates ethical provisions.
2. Education - attains the knowledge and competency that reflects current nursing practice.
3. Evidence-based practice and research - integrates evidence and research findings into practice.
4. Quality of practice - enhances the quality and effectiveness of nursing practice.
5. Communication - communicates effectively in a variety of formats in all areas of practice.

Question 9

ANA Standards of Professional Performance (2 of 2)

Answer 9

1. Leadership - in the practice setting and in the profession.
2. Collaboration - with the patient, family, and others in the conduct of nursing practice.
3. Professional practice evaluation - evaluate own practice in relation to professional practice standards.
4. Resource utilization - factors related to safety, effectiveness, cost, and impact on practice.
5. Environmental health - practices in an environmentally safe and healthy manner.

Question 10

Audit

Answer 10

A systematic and official examination of a record, process, structure, environment, or account to evaluate performance.

Question 11

Outcome audits analyze _

Answer 11

What results occurred, if any, as a result of specific nursing interventions.

Question 12

Process audits measure _

Answer 12

How nursing care is provided; assumes a connection between quality of care and process (i.e., established policies, medication reconciliation).

Question 13

Structure audits focus on _

Answer 13

The relationship between quality of care and structure (i.e., staffing, wait times, etc.).

Question 14

Total quality management (TQM) or continuous quality improvement (CQI)

Answer 14

1. A philosophy that assumes that production and service focus on the individual and that quality can always be better.
2. Identifying and doing the right things, the right way, the first time, and problem-prevention planning (as opposed to inspection and reactive problem solving) lead to quality outcomes.

Question 15

Toyota Production System (TPS)

Answer 15

1. A production system built on the complete elimination of waste and focused on the pursuit of the most efficient production method possible.
2. Solving problems at the time they occur, and determining the root cause, can prevent larger problems.
3. Usually requires a change in organizational culture, values, and roles.

Question 16

Quality measurement as an organizational mandate

Answer 16

1. Accountability for the internal monitoring of quality and patient safety has increased exponentially over the last 30 years.
2. This has fostered a culture of quality within institutions, which is also highly data driven, due to the use of statistics.
3. Changing government and licensing regulations affect quality control and standard setting.

Question 17

Professional standards review organizations mandate _

Answer 17

Certification of the need for a patient’s admission and continuous review of care.

Question 18

Prospective payment system (PPS)

Answer 18

A hospital payment system with predetermined reimbursement for services given (regardless of the actual cost).

Question 19

Diagnosis-related groups (DRGs)

Answer 19

Predetermined payment schedules reflecting historical costs for the treatment of specific patient conditions.

Question 20

Although the PPS helped to contain rising health care costs, critics have argued that _

Answer 20

The system promotes abbreviated hospital stays and services leading to a reduced quality of care.

Question 21

The Joint Commission

Answer 21

1. Mandated that all hospitals have a quality assurance program in place by 1981 to include all clinical departments, disciplines, and practitioners.
2. Agenda for Change (1990s) - shifted the focus of the accreditation process from organizational structure to organizational performance or outcomes.

Question 22

The mission of The Joint Commission is to _

Answer 22

Continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.

Question 23

To augment the core measures and promote specific improvements in patient safety, The Joint Commission issues the _ annually.

Answer 23

National Patient Safety Goals (NPSGs).

Question 24

Sentinel event

Answer 24

1. An unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof.
2. The Joint Commission maintains a database of these and their underlying causes.

Question 25

Core measures (Joint Commission)

Answer 25

1. Valid, reliable, and evidence-based data sets initially (2002) addressing quality of care for acute myocardial infarction, pneumonia, heart failure, and the surgical care improvement project.
2. Later (2013) expanded to include perinatal services, stroke, venous thromboembolism, etc., and will likely be expanded further.

Question 26

The organization that confers voluntary accreditation to managed care organizations is _

Answer 26

The National Committee for Quality Assurance (NCQA).

Question 27

The Leapfrog Group

Answer 27

1. A growing conglomeration of non-health care Fortune 500 company leaders who are committed to modernizing the current health care system.
2. Has identified four evidence-based standards that they believe will provide the greatest impact on reducing medical errors: (1) Computerized physician-provider order entry; (2) evidence-based hospital referral; (3) ICU physician staffing (intensivists); and (4) the use of Leapfrog Safe Practices scores.

Question 28

Nursing Minimum Data Sets (NMDS)

Answer 28

1. A standardized nursing language in which a minimum set of items of information with uniform definitions and categories is collected to meet the needs of multiple data users.
2. Used to compare nursing care across clinical settings and nursing interventions.