Man: Test 1 Decision making, quality improvement

Question 0

• Criterion or standard is determined
• Information is collected to determine if the standard has been met
• Educational or corrective action is taken if the criterion has not been met

Answer 0

What are the steps of Quality Control

Question 1

Step 1: Select a process to improve
Step 2: Describe the current process
Step 3: Consider causes for variance
Step 4: Review the literature
Step 5: Plan- how do we do things right now, what info have right now, what are causes make us fall short=complicated, not included in charting
Step 6: Do- identify what we are going to do, plan it, then implement
Step 7: Check- evaluation, or study, go back and see from previous info are we doing differently now, how did implementation go, anything done differently
Step 8: Act- consider what you should do from implantation

Answer 1

quality improvement

Question 2

• predetermined level of excellence that serves as a guide for practice. They are:
  o Predetermined, established by an authority, and communicated to and accepted by the people affected by them
  o Must Be: OBJECTIVE, MEASUREABLE, ACHEIVABLE

Answer 2

Standard

Question 3

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

Answer 3

audit

Question 4

o : performed after the patient receives the service Ex: survey, charting

Answer 4

Retrospective audits

Question 5

o : performed while the patient is receiving the service Ex: manager rounds,charting

Answer 5

Concurrent audits

Question 6

o : attempt to identify how future performance will be affected by current interventions Ex: clinical trials

Answer 6

Prospective audits

Question 7

: determine what results, if any, occurred as a result of specific nursing interventions for patients, nursing sensitive depends on accountability Ex: pt fall rates, nosocomial infection, pressure sores, restraint use

Answer 7

Outcome audits

Question 8

: measure how nursing care is provided, task oriented and focus on whether practice standards are being done, can be documented in pt care plans, procedure manuals or protocol statements Ex: medication reconciliation=process comparing old meds to newly ordered meds, vs at prescribed policy

Answer 8

Process audits

Question 9

: assume that a relationship exists between quality care and appropriate structure. Includes resource inputs such as the environment in which healthcare is delivered. Ex: staffing ratios, staffing mix, ER wait times, availability of fire extinguishers in pt. care areas, call light working, bed rails up

Answer 9

Structure Audits

Question 10

-Assumes that production and service focus on the individual and that quality can always be better
o Identifying and doing the right things, the right way, the first time and problem-prevention planning – not inspection and reactive problem solving - leads to quality outcome
o Based on the premise that the individual is the focal element on which production and service depend and that the quest for quality is ongoing
o ALWAYS room for improvement and is a never ending process
o Plan  Do  Check  Act
o empowerment of employees by providing positive feedback and reinforcing attitudes and behaviors that support quality and productivity, provide edu to all employees

Answer 10

Total quality Management (TQM)

Question 11

-target current existing quality, Often problem focused

Answer 11

Quality Assurance (QA

Question 12

: target ongoing and continually improve quality, Proactive, Attempts to prevent problems

Answer 12

Quality improvement (QI

Question 13

: refers to activities that are used to evaluate, monitor, or regulate services rendered to consumers

Answer 13

Quality Control (QC)

Question 14

• o Independent and non for profit
  A. First to mandate that all hospitals have a QA program
  Began to require quarterly evaluations of standards of nursing care as measured against written criteria
  B. Created Sentinel Event Policy:
  C. Implemented Core Measures (Hospital Quality Measures):

Answer 14

JACHO: Joint commissions for accreditation of health care org.

Question 15

unexpected occurrence involving death or a serious injury, immediate investigation and follow up to see improvement
Ex: wrong pt side or procedure, unintended retention of a foreign object, delay in tx, falls, change in pt condition nurse or doc doesn’t take action, post op comp, suicide, criminal event=assault, medical error, perinatal death or injury

Answer 15

JACHO: Joint commissions for accreditation of health care org.
sentinel events

Question 16

part of effort to better standardize its valid reliable and evidence based data sets, requires to collect data on specific areas MI=aspirin given, Pneumonia, Heart failure, and surgical complications
-specific to check and follow best practice meds given, labs drawn

Answer 16

JACHO: Joint commissions for accreditation of health care org.
. Implemented Core Measures

Question 17

• CMS sets standards for and measuring quality health care
• MQI targeted health outcomes as a data source
• Pay for Performance, Intent is to encourage consumers and their physicians to discuss and make better informed decisions on how to get the best hospital care, create incentives for hospitals to improve care, and support public accountability, reimbursed at higher rate when reduce hospital stays and readmissions

Answer 17

Medicare/Medicaid

Question 18

•most well-known and widely used problem solving model

Identify problem->gather data->explore and evaluate alternatives->select solution->implement-> evaluate results

Answer 18

Traditional Problem Solving Model:

Question 19

Making (rational decision making model)
o Determine the Decision and the desired outcomes
o Research and identify options
o Compare and contrast these options and their consequences
o Make a decision
o Implement an action plan
o Evaluate results

Answer 19

• Managerial Decision

Question 20

•Intuition should always be used as an adjunct to empirical or rational decision-making models
o Harness ones instincts and intuition to help make better decisions in all areas of their lives and solve problems
-However be careful to not misjudge and intuition should only be an adjunct to decision making founded on nurse’s scientific knowledge base

Answer 20

Intuitive Decision Making Model

Question 21

-“Fishbone Diagram”, takes main categories of things and group them to identifies cause/effect relationship, effect issue or problem, look at issue trying to figure out what is keeping us there, name things that contribute to effect, causes will group into like categories, action that can result in an improvement

Answer 21

critical elements in decision making

o Cause/Effect Diagram

Question 22

-look at literature, don’t have to reinvent most time it is out there, current practice, suggesting for guidelines, what studies have been done

Answer 22

critical elements in decision making

o Evidence-Based Approach

Question 23

• usually with group, has idea what problem is now need ideas about what I can do to improve areas, group start throwing out ideas not evaluating, quantity of ideas, later go back and evaluate ideas

Answer 23

critical elements in decision making
o Generate Alternatives
• Brainstorming

Question 24

• avoid, look at one thing and saying that all of those are the same Ex: one 80 yr old heard of hearing all 80 yr olds hard of hearing

Answer 24

critical elements in decision making
thinking logically
1. Overgeneralizing

Question 25

• way of doing it this way but not wrong, still get same effect, just because its new doesn’t mean it is right thing

Answer 25

critical elements in decision making
thinking logically
2. Affirming the consequences-

Question 26

• similar to over generalizing- “Something is similar in every way”, two different things, has these characters, b has a few characteristics must be the same Ex: bird and humans both have eyes, legs, eat saying all human and birds are the same/ based on limited amount of similarity

Answer 26

critical elements in decision making
thinking logically
3. Arguing from analogy

Question 27

allows one to visually examine the alternatives and compare each against the same criteria, Useful when changing the method of managing care on a unit or when selecting a candidate to hire from an interview pool

Answer 27

Decision Grids

Question 28

• Decisions are often tied to the outcome of other events

o Possible events  alternative actions  decision point

Answer 28

Decision Trees

Question 29

• Demonstrate how various alternatives create different consequences
o Lists the objectives for solving a problem down one side of the table, and rates how each alternative would meet the desired objective

Answer 29

Consequence Tables

Question 30

• specifically for group, have rate what they think is the best choice, do privately so not tempted to go with someone else’s decision

Answer 30

• Nominal Group Technique

Question 31

• Popular tool to determine the timing of decisions
o Essentially a flowchart predicting when events and activities must take place if a final event is to occur
o not a decision making tool, tool for planning after decision is med, flow charting, planning out how going to accomplish what you decided, designate time periods
o Especially helpful when a group of people is working on a project

Answer 31

PERT

Question 32

o Makes decisions in a rational manner
o Has complete knowledge of the problem or decision situation
o Has a complete list of possible alternatives
o Has a rational system of ordering preference of alternatives
o Selects the decision that will maximize utility function

Answer 32

Economic Decision Making

Question 33

o Makes decisions that are “good enough”
o Because complete knowledge is not possible, knowledge is always fragmented
o Because consequences of alternatives occur in the future, they are impossible to predict accurately
o Usually choose from among a few alternatives, not all possible ones
o The final choice is satisficing rather than maximizing

Answer 33

Administrative Decision Making

Question 34

1. Set aside time for planning and establishing priorities
2. Completing the highest priority task whenever possible and finishing one task before beginning another
3. Reprioritize what task will be accomplished based on new info received

Answer 34

There are 3 basic steps in time management:

Question 35

a. 3 categories of prioritization
1. Don’t do: reflect problems that will take care of themselves, are already outdated, or are better accomplished by someone else
2. Do later: reflect trivial problems or those that do not have immediate deadlines; thus they may be procrastinated
3. Do now: reflect a units day to day operational needs (daily staffing, dealing with equipment shortages, meeting schedules,

Answer 35

time management