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Leadership > Lecture Exam 1 > Flashcards

Lecture Exam 1 Flashcards

1
Q

cause and effect diagram/fishbone

A
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2
Q

Institute for Safe Medication Pratices (ISMP)

A
  • non-profit
  • multidisciplinary board and staff
  • federally-certified PSO
  • international
  • mission
    • to advance patient safety worldwide by empowering the healthare community, including consumers, to prevent medication errors
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3
Q

nursing workforce challenges

A
  • at turn of century
    • decreased satisfaction
    • high turnover
    • structural supports emerge
      • externships
      • flexible scheduling
      • clinical advancement programs
      • educational reimbursement
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4
Q

what alarms are appropriate for your patient?

A
  • alarm review as part of handoff
    • why on the monitor, when can they come of?
    • see complete patient picture and strategize a plan to manage alarms (customization?)
  • what parameter violation can be tolerated?
    • ex: PVCs in HF
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5
Q

types of errors when calculating med doses involving wrong weight

A
  • confusing lbs vs kg
  • documented weight too high
  • documented weight too low
  • no weight available or used
  • incorrect estimated weight
  • confusing ideal vs actual weight
  • calculation error
  • confusing height/temperature vs weight
  • other/unknown
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6
Q

suggestions to improve cultural competency in agencies

A
  • beyond satisfaction surveys
    • opportunities for clients to provide feedback on services
  • mandate booster sessions
  • reivew quality and compliance regulations throughout year
  • advocate for national and/or state funding to deliver booster trainings focused on patient-centered care
  • structured discussions and resources to strengthen provider’s competence to work with YMSM
  • promote cultural humility to decrease stereotype threat when working with clients
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7
Q

adverse event reporting

A
  • unexpected occurrence/variation in system process with unintended results that could put the institution at legal risk
  • injury or potential injury to patient, family, or staff
  • damage to property
  • ex: falls, med errors, equipment failures, burns, blood borne pathogen epxosure, criminal activity
  • institutional policy and state laws dictate policy for mandatory and voluntary reporting
  • reporting “near misses” is essential to allow for system review and correction to prevent future adverse events
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8
Q

21st century alarm challenges

A
  • diffusion of complex technology
  • increased # of clinicians
  • increased complexity of environment
  • technology not just in ICU/ ORs
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9
Q

patient-provider communication is diminished when:

A
  • missed opportunities for patient-centered engagement and counseling
  • quality control policies not followed
  • stereotypes and assumptions lead dialogue
  • providers assign risk based on risk group categories vs client’s history
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10
Q

guideline for physiologic monitoring

A
  • if 80% of patients require that parameter, it should probably be on
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11
Q

immediate and delayed gratification as part of emotional regulation

A
  • we have tools to enable us to regulate emotional resposnes
  • we can experience an emotion
    • make an informed, thoughtful decision about best course of action
    • rather than immediately acting
  • put off quick gratification for more meanginful satisfaction and joy later on
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12
Q

HIV/STIs in Michigan

A
  • +75% in SE MI
    • +60% in Detroit are MSM
    • +25% in MI are YMSM 13-29
  • 6 of the 9 counties in SE MI account for majority of new:
    • chlamydia
    • gonorrhea
    • primary and secondary syphilis
  • adolescent and young adult men carry nearly 80% burden of syphilis
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13
Q

rank order of error reduction strategies

A
  1. forcing functions and constraints
  2. automation and computerization
  3. standardization and protocols
  4. checklists and double check systems
  5. rules and policies
  6. education / information
  7. “be more careful”
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14
Q

leadership develompent r/t nurse residency programs

A
  • shift handoff
  • delegation
  • prioritization / time management
  • clinical advancement
  • professional development
  • quality improvement
  • EBP project
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15
Q

5 primary emotions

A

nearly all emotions incorporate at least one of these:

  • joy
  • sadness
  • fear
  • anger
  • disgust
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16
Q

major types of misconduct resultingin disciplinary action against nurses

A
  • intentional violation of trust and committing of criminal acts on job
  • criminal conviction off job
  • serious med error
  • falsifying information or other documentation problems
  • narcotic control issues (drug diversion)
  • impaired nurses
  • incompetence
  • practice outside scope of practice
  • abandonment
  • inappropriate therapeutic relationships and boundary violations
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17
Q

drug diversion progarms

A
  • punitive action discourages nurses and colleagues from coming foward
    • endangers patient safety
  • some states have programs to channel impaired nurses out of traditional diversionary process and into treatment
  • support, confidentiality, on-the-job mointoring, low drug availability assignments
  • contracts between impaired nurse, employer, state board
    • not for all violations - not for sexual misconduct
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18
Q

professional role development r/t nurse residency programs

A
  • learning styles
  • stress management
  • conflict resolution
  • patient education
  • ethical decision-making
  • end of life care
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19
Q

setting alarms

A
  • understand defaults
  • know patient
    • history on monitor
  • nonactionable alarms as visual only?
  • default “leads off” alarms to be high priority?
  • who can adjust alarms and who is expected to adjust
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20
Q

statistics on nuisance alarm

A
  • 86-99% are nonactionable
  • reliability
  • nurses respond slower to patients with highest number of alarms (medsurg)
  • incremental icnrease in response time as number of alarms increases (Peds ICU)
  • alarm response
    • 16-35% of nursing time
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21
Q

disadvantages of EHR

A
  • a lot of time filling out blocks, can’t write about interaction with patient
  • power failure
  • loads slowly
  • auto mode - don’t think critically
  • learning new EHR
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22
Q

multistate licensure compacts

A
  • primary license in one state, no need for licenses in other compact states
  • what is not discussed:
    • compact cuts down on fees - helps smaller states
    • communication btwn practice facilities and state boards is cumbersum, slow, incomplete
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23
Q

why do nurses document?

A
  • communication
    • describe patient treatment and progress
  • reimbursement
  • legal evidence of continuity of care and ongoing evaluation of treatment outcomes
  • establish standards of care
  • database for trending patient outcomes
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24
Q

leverage/power of error-reduction strategies

A
  • high (blunt) - ex: car won’t start w/o fastened seat belt
    • fail-safes and constraints
    • forcing functions
    • automation and computerization
  • medium - ex: reminder to use seat belt
    • standardization
    • redundancies
    • reminders and checklists
  • low (sharp) - ex: illegal to not wear seat belt
    • rules and policies
    • education and information
    • suggestions to be “more careful”
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25
Q

registration

A
  • process by which state or other jurisdiction maintains list of people who have informed governing body that they perform professional services for public, in a particular field
  • least restricive, common for nursing in Europe
  • seen in other professions
    • respiratory therapy, ultrasound techs
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26
Q

why do nurses dilute medications?

A
  • discomfort with the med
  • vesicants
    • fear of extravasation
  • small volume to measure
  • “slow IV push” administration
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27
Q

methods of dilution among nurses

A
  • volume of diluent/method variable
    • personal formulas
    • 1 mL/min to slowly administer
    • different for peripheral vs central
  • no specific concentration desired
  • some had policies or guidelines for dilution
  • some unsure if there were policies
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28
Q

define self-acceptance

A
  • important/essential component of mindfulness
  • to truly know what is happening for me emotinally and mentally:
    • must avoid harsh, extreme ways of describing my state
    • refrain from blaming myself or others
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29
Q

multisite efficacy of an HIV testing intervention

A

examine how quality assurance metrics change over time and model dynamic changes between geospatial characteristics and YMSM HIV risk reduction behaviors over time

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30
Q

challenges in alarm notification

A
  • direct notification vs. middleware notification
  • challenges: medsurg
    • widely dispersed patients, out of view
    • ratio is higher
    • may not be able to visualize monitor
  • middleware
    • gets message, decides action plan
      • sends appropriate information
      • does receiver respond?
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31
Q

regulatory influence on alarm safety

A
  • FDA 2005-2008: 566 deaths; 2500 ventilator related reports
  • TJC 2009-2012: 98 events; 80 deaths
  • PSAP: 35 deaths, 31 from human error
  • Sentinel Event Alert 2013: alarm fatigue #1 cuase of adverse events
  • NPSG 2014: phased in over 2 years
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32
Q

sympathetic nervous system in the context of emotional intelligence

A
  • increase in activity when startled
  • limits cognitive activity to three options that benefit survival and little else (fight, flight freeze)
  • activates almost instantaneously
  • greatly inhibits ability to make thoughtful decisions
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33
Q

what does an alarm indicate?

A
  • change in physiologic condition of patient
  • or mechanical default in system
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34
Q

amount of time spent on medication administration

A
  • nurses spend 26.9% of time on medication admin
  • 2/3 of med admin time r/t drug delivery to patient
  • 1/3 r/t drug preparation
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35
Q

timeline of alarm fatigue

A
  • 1964: patient dies on bird ventilator, pre ICU
  • 1974: first investigation into alarm related harm - hypothermia blanket
  • 1983: 6 devices with alarms in ICU
  • 2011: 40 devices with alarms in ICU
  • alarm safety is #1 health technology hazard by ECRI
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36
Q

patient outcomes r/t nurse residency programs

A
  • clinical emergencies
  • national patient safety goals
  • medication safety
  • safe patient handling
  • infection control
  • SIM center skills
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37
Q

continuing education requirements

A
  • 30 contact hrs every 2 years (per PA, as of 2008)
  • some states have particular requirements about content
  • conferences, grand rounds, CE in institution, journals, books, internet
    • teaching content
  • maintain records as accredited CE providers
  • maintain portfolio of education programs attended, clinical experiences, evidence of self-reflection, and application of expertise required in some jurisdiction and for some certifications
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38
Q

documenting by expection or WDL

A
  • comprehensive flowsheets with normal parameters delineated or assessment parameter
  • emphasize variations from normal
  • variation from previous assessment
  • references to clinical guidelines or nursing standards
  • decrease time nurses spend charting
  • subtle changes not always communicated to other care team members
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39
Q

strategize safety options for physiologic monitoring

A
  • leads off as high priority
  • delay in signal
  • adjust volume
  • monitor only when evidence-based indication
    • re-evaluate
  • electrode management - change q24h
  • adjust default settings for individual patients
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40
Q

complete record per Centers for Medicare and Medicaid

A
  • admission diagnosis and conditions
  • health history < 30 days prior, < 24 hrs after admission
  • consults, results, evals
  • informed consent
  • physician orders and progress notes
  • nursing notes
  • med records
  • lab reports
  • discharge diagnosis and summary, including follow up
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41
Q

history of legal regulation of nursing

A
  • national regulation began in NZ, 1901. Nurses who had completed education were “registered” or placed on list
  • “Permissive licensure” allowed nurses to opt for licensure began in US in NC 1903
  • mandatory licensing of nursing first legislated in New York, 1947
  • nurse licensure required in all 50 states to practice as RN
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42
Q

communication plan as QI tool

A
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43
Q

default settings on alarms

A

what are you going to treat if it alarms?

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44
Q

advantages of EHR

A
  • voice or touch activated
  • date/time automatic
  • abbreviations/terms standardizezd
  • terminals easily accessible
  • large amounts of data easily retrieved
  • graphic/video capability
  • streamlined billing
  • signatures automatically entered
  • computerized provider order entry
  • bar code med administration
  • information clear and legible
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45
Q

data collection related to alarm management

A
  • collaborate with clinical engineers to collect alarm data
  • define/categorize data
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46
Q

documenting falls in patient record

A
  • physical environment at time of fall
  • patient condition before and after fall
  • subsequent action taken and ongoing assessment
  • time of fall and who was notified
  • incident report will contain details of event
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47
Q

narrative documentation framework

A
  • running account of assessment, interventions, outcomes in chronological order
  • traditional
    • time consuming
    • repetitive
    • disorganized
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48
Q

Canada Health Act - components

A
  • public administration: providers accountable to province
  • comprehensiveness: all necessary services insured
  • universality: everyone entitled to same level of care
  • portability: do not lose coverage when moving
    • period of coverage when leaving Canada
  • accessibility: reasonable access to care facilities
    • all providers get reasonable compensation for services provided
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49
Q

data analysis related to alarm management

A
  • default settings
  • customization
  • detectability
  • monitoring failure
  • clinician communication devices
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50
Q

program outcomes r/t nurse residency programs

A
  • increases in
    • confidence and competence
    • organization and prioritization
    • communication and leadership
    • retention at 1 year
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51
Q

environmental assessment related to alarm management

A
  • culture
  • workflow of unit
  • infrastructure
  • practices
  • technology
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52
Q

Kotter’s 8 Step Model to Successful Change

A

change management

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53
Q

elements specific to nursing documentation

A
  • all work done by nurse, including education and psychosocial
  • demonstrate nursing knowledge of standards of care pertinent to that patient
  • reflect critical thinking and clinical judgement
  • all elements of nursing process
    • assessment, diagnosis, intervention, response to treatment, evaluatio of plan of care
  • communicate changes in patient condition to appropriate care team members
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54
Q

evaluation and observations related to alarm management

A
  • different environments
  • surveys, direct observation
  • assess staff perceptions of alarm management
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55
Q

scope of the problem: medication errors

A
  • National Quality Forum “Never Events” (29 types)
    • serious harm or death associated with med errors
    • preventable hypoglycemia
    • harm/death patient falls
  • J.Co Sentinel events
    • events so serious requiring a team to analyze what contributed to the problem (root-cause analysis) and take action
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56
Q

culture of patient safety and process improvement

A
  • patient safety is a science
  • cultures that lead to patient safety
    • engagement of staff
    • safety programs
    • transparency
  • system failure
    • incident report
    • outcomes
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57
Q

common causes of non-actionable alarms

A
  • alarms not customized
  • poor electrode adherence
  • wires disconnected
  • inadequate staffing
  • inadequate education
58
Q

Canadian healthcare overview

A
  • group of socialzied health care insurance plans that provide coverage to all citizens
  • government funded
  • differs by province/territory with guidelines set by federal government
  • all residents required to have health care
  • one of the highest life expectancies and lowest infant mortality rates of industrialized countries
59
Q

who regulates nursing?

A
  • every state has Nurse Practice Act that determines:
    • authority, power, composition of board of nursing
    • education program standards
    • standards/scope of nursing practice
    • types of titles/licenses
    • requirements for licensure
    • grounds for disciplinary action, other violations, and remedies
  • NPAs etablish boards of nursing in each state
  • to protect public from unregulated nursing care via licensing and disciplinary action
60
Q

targeted strategies for alarm management

A
  • change defaults
  • actionable alarms
  • electrode management
  • minimize nuisance alarms
  • workflow changes
61
Q

Vizient/AACN nurse residency program

A
  • collaboration btwn Vizient and AACN initiated after Chief Nursing Officer Council/Schools of Nursing Deans’ joint meeting on workforce issues April 1999
    • standarized curriculum
  • launced at HUP in 2002
  • based on Benner’s Novice to Expert and Dreyfus’ Model of Skill Acquisition
  • Focus on 3 domains
    • leadership development
    • patient outcomes
    • professional role
62
Q

culture vs. strategy in QI

A
  • tools
    • leadership management
    • process mappoing
    • customer value analysis
    • stakeholder analysis
    • data collection
    • small wins
63
Q

DAR documentation framework

A
  • focused - for patient events, changes in status, new problems
  • Data
  • Action
  • Response to interventions
64
Q

unnecessary/improper dilution r/t med safety

A
  • 83% dilute IV push meds
    • single dose vials/ampules
    • multi dose vials
    • prefilled syringes
    • pharmacy syringes
  • types of meds
    • opioids
    • antianxiety/psychotic
    • antiemetics
    • anticonvulants, cardiovacular, reversal agents, insulin, heparin
65
Q

parasympathetic nervous system in the context of emotional intelligence

A
  • take over when real/perceived danger is gone
  • calms us - restores mental and physical homeostasis
    • rest & digest; feed & breed
  • requires time (sevearl minutes) to complete restoration
66
Q

cost of turnover

A
  • $88,000/nurse
  • $300,000 for every 1% increase in turnover
  • Penn Medicine has 95.5% retention rate
67
Q

stakeholder analysis as QI tool

A
68
Q

components of sef-awareness

A
  • emotional self-awareness
  • accurate self-assessment
  • self-confidence
69
Q

policies and education related to alarm management

A
  • support National Patient Safety Goals (NPSG)
  • initial and ongoing staff education
  • engage managers
    • coaching
70
Q

brief history of unions

A
  • 1768 - fist recorded strike when NY journeymen tailors protested wage reduction
  • 1794 - began sustained trade union organization among American workers
  • 1852 - all across US and into Canada
  • 2009 - 12% Americans belong to unions
  • unions gave: weekend; 40 hr work weeks; restrictions on overtime w/o pay; holidays off or holiday pay; minimum wages; health care benefits; pensions; Worker’s Comp
71
Q

top five medication error event types associated with wrong patient weights

A
  • wrong dose/overdose
  • wrong dose/underdose
  • wrong rate (IV)
  • extra dose
  • other
72
Q

Swiss Cheese model of patient safety and process improvement

A
73
Q

who reads nursing documentation?

A
  • all members of care team
  • peer review committees
  • infection control and utilization review committees
  • nonhealthcare team members
    • licensing boards, attorneys, insurance companies
  • patients and reps
    • ideally with HCP present to interpret information
74
Q

Lewin’s Change Model

A

change management

75
Q

Tuckman’s model for group development (1965)

A
  • change and team function
  • examples:
    • leadership support
    • timing of project and countermeasures
    • action planning
    • monthly reports
    • communication plan
    • data collection plan
76
Q

how does state board of nursing provide protection?

A
  • assess competence of health care practitioner
  • entry-level:
    • NCLEX-RN
  • continued competence
    • mandatory continue education
    • how to ensure competence?
77
Q

PA Patient Safety Reporting System

A
  • established 2002
  • only state requiring reporting of all medical errors
  • ISMP contracted to review all “med errors”
  • 550,000 med errors since 2004
78
Q

define social skills

A
  • proficiency in managing relationships and building networks
  • an abiltity to find common ground and build rapport
  • hallmarks include:
    • effectiveness in leading change
    • persuasiveness
    • expertise in building and leading teams
79
Q

what is a union?

A
  • organized group of workers who collectively use their strength to have a voice in their workplace
  • through a union, workers have a right to impact:
    • wages
    • work hours
    • benefits
    • workplace health and safety
    • job training
    • other work-related issues
80
Q

monitoring and sustaining alarm management programs

A
  • quantitative data
  • clinician feedback
81
Q

flushes r/t medication safety

A
  • 54% nurses report drawing medication into manufacturer’s prefilled “flush” syringe
    • mislabeled
    • not for drug dilution, only flushing
82
Q

ways to improve medication safety

A
  • use of technology (pros and cons)
  • avoid distractions
  • independent double-checks
83
Q

SIPOC in process mapping

A
  • Supplier: people or organization that provides info, material, resources to be worked on in process
  • Input: info/materials provided by suppliers that are consumed or transformed by process
  • Process step: series of steps that transform and add value
  • Output: product or services used by customer
  • Customer: people, company, or other process that receives output from this process
  • X - Critical to Value: measurements? critical value?
84
Q

components of nurse practice acts

A
  • statements referring to health and safety of population
  • define professional nursing
  • define advance practice nursing
  • licensure requirements
    • criteria for operating school of nursing
  • requirements/procedures for practice
  • requirements for licensure renewal
  • designation of regulatory board
  • guidelines for delegation of nursing care
85
Q

client-centered counseling training

A
  • case studies
    • identify readiness and challenges
    • potential interventions to overcome client barriers to care
    • “best practices” to overcome barriers
  • training in motivational interviewing principles with HIV+ persons across continuum of care
    • case study and practice
  • discussing opportunities for cross-agency collaboration
86
Q

union values

A
  • early unions less about wages and more about conception of just society
  • ideals of American Revolution
    • social equality
    • honest labor
    • independent, virtuous citizenship
  • unions only included white men
87
Q

funding Canada’s healthcare

A
  • provincial and federal levels
  • income tax of citizens and corporations, sales tax
  • some provinces charge monthly health premium to offset costs
88
Q

Don Berwick

A
  • elected 1997 to IHI, President and CEO
  • CMS administrator, appointed July 2010
  • December 2014 speech to health care administrators
    • some is not a number and soon is not a time
  • influenced QI in healthcare and now the IHI open school, education forums, works to teach providers, caregivers, administrators how to do PI in healthcare systems
89
Q

what services are covered in Canada’s healthcare sysem?

A
  • preventative health care
  • dental surgeries
  • emergency care
  • maternity care
  • physical therapy
  • mental health care
  • hospital admissions
  • diagnostic testing and labs
  • non-cosmetic surgery
  • some elective surgeries (tubal ligation, breast reduction, vasectomies, bariatric surgeries)
  • IVF - one round per couple
90
Q

IHI Triple Aim

A

IHI learning initiative to better understand new models that can improve the individual patient experience and health of entire communities, at reasonable per capita cost

91
Q

nurse residency program accreditation

A
  • voluntary, nongovernmental peer review process that assures institution or program meets stated criteria of quality
    • self-study document and on-site evaluation
  • CCNE or American Nurses Credentialing Center
  • only 22 CCNE-accrediated programs in US
  • 260 Vizient/AACN NRPs
92
Q

how can nurses have a voice?

A
  • reasons to unionize:
    • staffing ratios, layoffs, frozen pensions, shift assignments, affordable healthcare, wages
  • Pennsylvania Association of Staff Nurses and Allied Professionals (PASNAP)
  • Service Employees International Union (SEIU)
  • National Nurses Union (NNU)
  • professional associations
  • In Philly
    • Crozer
    • Delaware County Memorial
    • Hahnemann
93
Q

risk r/t med safety

A
  • risk not inherently bad
  • healthcare can be “safe” but not “risk free”
  • which risk are worth taking?
94
Q

promising strategies to overcome challenges to alarm management

A
  • widen alarm parameters
  • institute alarm delays
  • customization of alarm limits
  • frequent changing of electrodes
  • disposable lead wires
95
Q

ensuring insulin pens are single patient only

A
  • standardize to one insulin pen type
  • tamper evident seal on each pen
  • labeled pen only (not cap)
  • education and monitoring
  • order-specific barcoded label
96
Q

define self-regulation

A
  • ability to control or redirect disruptive impulses and moods
  • propensity to suspend judgment and think before acting
  • hallmarks include:
    • trustworthiness and integrity
    • comfort with ambiguity
    • openness to change
    • patience
    • internal motivation (passion/inspiration for something beyond obvious/immediate material rewards)
97
Q

PA code includes specific provisions for the following:

A
  • venipuncture
  • IV fluids
  • resusictation and respiration
  • administration of drugs
  • monitoring, defibrillation, resuscitation
  • immunizations
  • anesthesia
98
Q

types of sentinel events, as defined by J.Co

A
  • elopement
  • abduction
  • infant discharged to wrong parents
99
Q

what is a near miss?

A
  • close call, or good catch
  • error that reaches the patient and doesn’t cause harm OR error that does not reach the patient
100
Q

evidence for nurse residency program

A
  • academic - clinical practice gap
  • J.Co recommendation in 2002
  • transition from student to professional role documented as challenging w/ min 12 mo to develop confidence and demonstrate role compentence
101
Q

documenting medication errors in medical record

A
  • document all meds, correct and incorrect
  • any changes in patient condition
  • do NOT document that an error has occured
    • incident report per institution policy
102
Q

to become successful in change…

A
  • you have to have a shared need
  • right leaders in addition to guiding coalition
  • culture
  • political implications
  • agenda, facilitation, communication
103
Q

phases of six sigma

A
104
Q

role of regulatory boards

A
  • adminster state nursing practice act
  • grant and renew licenses
  • take disciplinary action when provisions of act are violated
105
Q

incident reports

A
  • contain some info from med record
    • factual account of incident
    • patient assessment, treatment, response
    • names of providers notified
  • suggestions to avoid incidents
    • do not assign blame, state opinions, include suppositions
    • only information the author has witnessed
106
Q

private clinics in Canada

A
  • since 2003
  • accept private insurance or cash
  • not accountable to province
  • higher rates of post-op infetions and complications
  • increased burden on public health care system
107
Q

identifying the goal or outcome of alarm management

A
  • alarms
  • patient satisfaction
  • nurse satisfaction
108
Q

what can we control, r/t med safety?

A
  • cannot eliminate human error
  • must value safe med use
  • can manage behaviors
    • avoid at-risk behaviors
  • can mangage system design to promote safety
109
Q

what services are not covered in Canada’s healthcare system?

A
  • prescription meds
  • assistive devices
  • routine dental care and non-emergent surgery
  • vision care
  • private, semi-private hospital rooms
  • cosmetic surgery
  • ambulance transport
  • alternative medicine
  • chriopractice
  • private insurance available for purchase to cover extras
110
Q

navigating the search for nurse residency programs

A
  • skills/experience
  • organizational characteristics
  • interview process
  • resources
  • negotiation skills
111
Q

percentage of actionable alarms by unit type

A
  • adult ICU - <1-26%
  • adult medsurg - 20-36%
  • mized adult/peds PACU - 17%
  • peds ICU - 3-13%
  • peds medsurg - <1%
112
Q

how did unions evolve?

A
  • labor movement grew out of need to protect common interest of workers
  • organized labor unions fought for better wages, reasonable hours, safer working conditions
  • led efforts to stop child labor, give health benefits and provide aid to workers who were injured or retired
113
Q

alarms on mechanical vents

A
  • invasive vs noninvasive
  • confirm alarm settings at beginning of shift
    • collaborate btwn respiratory, providers, nurses
  • centrally monitored alarms?
114
Q

alarms on infusion pumps

A
  • understand reportable data about where / how alarms are created
  • superfluous?
    • for secondary infusions and near end of infusion
  • increased alarms
    • change in med prep
    • change in med consistency
  • do not teach patient to reset
115
Q

patient-provider communication is strengthened when:

A
  • patient-centered
  • empathic and sensitive
  • respectful and non-judgmental
  • structured to offer opportunities for YMSM to discuss sexuality
116
Q

interdisciplinary approach to alarm management

A
  • administrative sponsor
  • key staff members
  • patient safety officer
  • CNS
  • frontline staff
  • clinical engineers
  • IT staff
117
Q

mindfulness

A
  • state of active, open attention to present
  • when we are mindful
    • we observe our thoughts and feelings from a distance
    • without judging them good or bad
118
Q

action plan as QI tool

A
119
Q

what can nurses do to improve medication safety?

A
  • never believe errors won’t happen
    • manage around values; to err is human nature
    • being careful (5 rights) is not enough
    • acknowledge how easy it is to drift into risky behaviors
  • identify and change risky behaviors
    • model safe behavioral choices and coach peers
  • voluntarily report errors, close calls, hazards
  • participate in error ID and analysis on QI teams
  • advocate for and design safer systems/practices
  • participate in skill development and competency assignments
  • stay informed, conduct safety research
120
Q

define self-awareness

A
  • the ability to recognize and understand personal moods, emotions and drives, as well as their effect on others
  • hallmarks include
    • self confidence; realistic self assessment; self deprecating sense of humor
  • depends on ability to monitor own emotional state and correctly identify and name own emotions
121
Q

biggest challenge in assessing alarms

A
  • data
    • what are we collecting?
    • how do we get it?
    • disseminate info
  • analytics for sorting
  • forensive info if investigating adverse event
122
Q

certification

A
  • private regulation
  • state or federal government doesn’t have law or regulation covering subspecialty
  • in absence of government-mandated regulation:
    • trade association or independent certifying body develops standard
  • beyond minimal knowlege/competence in nursing specialty
    • not generally required by licensing bodies or employers
    • requirements vary
123
Q

components of relationship management

A
  • inspirational leadership
  • developing others / mentoring
  • influence / change catalyst
  • conflict management
  • building bonds
  • teamwork and collaboration
124
Q

physiological consequences of alarms for patients

A
  • increased HR
  • increased BP
  • dyspnea
  • increased gastric acid
  • increased anxiety
  • increased cardiac dysrhythmias
125
Q

what we know about technology related to medication safety

A
  • benefits
    • improved direct care processes
    • patient outcomes
  • challenges - inefficient technology systems
    • burden to nurses
    • bypass problems rather than solving them
      • leading to safety breeches
126
Q

Early Intervention Services (EIS) for HIV

A
  • Ryan White Funding - goal to link HIV+ persons with medical care and re-engaging those who dropped out of care
  • EIS:
    • provides facilitated referrals to ancillary services
    • assists in securing health insurance and HIV-care coverage
    • promotes health education and literacy on continuum of HIV care
  • on-going evalulation of impact of EIS providers to linkage to care rates in Detroit metro are promising
127
Q

managing risk r/t med safety

A

risk = severity x likelihood

safety =/~ freedom from unjustifiable risk

128
Q

influence of ISMP

A
  • investigating/analyzing medication/vaccine error reports
  • translating erros into action
    • nationwide hazard alerts and press releases
  • influencing safer practice and reducing patient harm
    • advocate for national standards and guidelines
    • impact product improvement
    • testify at Congressional hearings, etc.
    • disseminate guidelines, info, tools
    • educate
    • international medication safety network (IMSN)
  • promote culture of shared accountability
129
Q

define social awareness/empathy

A
  • ability to understand emotions of other people
  • skill in treating people according to emotional reactions
  • hallmarks include:
    • expertise in building and retaining talent
    • cross-cultural sensitivity
    • serbice to clients and customers
  • empathy does not necessarily implly compassion
    • social awareness can be used for compassionate vs manipulative behavior
  • empathy can lead to sympathy - concern or wish to ease negative emotions/experiences in others
130
Q

complete record per J.Co

A
  • discharge diagnosis and summary, including follow up
  • special language/communication needs
  • advanced directives
  • allergies
  • discharge meds
  • emergency care documents
  • treatment goals, reassessment, response to interventions
  • communication of treatment plan to patient
  • documentation of receiving/verifying verbal orders
131
Q

documenting treatment complications in medical record

A
  • document complication completely and objectively
  • document all treatment given in response to complication
132
Q

life cycle of alarm

A
  1. patient or device condition crosses threshold
  2. alarm sounds
  3. alarm indicates condition reqiring staff response
  4. alarm signal communicated through established channels
  5. sufficient info communicated so caregivers understand nature of alarm
  6. information should reach caregiver who can respond
  7. caregiver should know how to respond and respond appropriately
  8. alarm resolved
133
Q

staffing and education r/t alarms

A
  • when/where does education occur?
    • dysrhythmia course
    • monitor education
      • customization?
    • policies about customization
  • more than just cardiac monitors
  • staffing
    • relates to telemetry model
    • is telemtry value added for the patient?
    • what is the escalation process?
134
Q

disciplinary measures

A
  • denial of application for licensure/refusal to renew license
  • reprimand or censure of a license
  • placing license on probation
  • imposing fine
  • insisting on CE, practice restriction, informing board of changes in employment
  • publication of details of proceedings
135
Q

Six Aims of quality healthcare

A
  • Safe - avoid injuries
  • Effective - based on scientific knowledge
  • Patient-centered - individual
  • Timely - reduce waits and harmful delays
  • Efficient - avoid waste
  • Equitable - not varying in quality
136
Q

components of social awareness

A
  • empathy
  • organizational awareness
  • service orientation
137
Q

components of self-regulation

A
  • self-control
  • transparency
  • adaptability
  • achievement drive
  • passion/inspiration
  • initiative
138
Q

who is being monitored and why? r/t alarm fatigue

A
  • evidence
    • standards for who on cardiac monitor and how long
  • indication
    • what are you looking for?
      • ischemia? arrhythmia?
  • medical history
139
Q

percent of alarms that don’t require clinical intervention

A

85-99%

140
Q

nursing unions

A
  • National Nurses Union (NNU) - 1903
  • 2008 - 23% of RNs belong to union
  • 21% of hospitals have unionized nurses
141
Q

“care system” outliend in “Crossing the Quality Chasm”

A

Leadership (6 decks)

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