Man: Test 1 Decision making, quality improvement Flashcards
- 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
What are the steps of Quality Control
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
quality improvement
- 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
Standard
- systematic and official examination of a record, process, structure, environment or account to evaluate performance.
audit
o : performed after the patient receives the service Ex: survey, charting
Retrospective audits
o : performed while the patient is receiving the service Ex: manager rounds,charting
Concurrent audits
o : attempt to identify how future performance will be affected by current interventions Ex: clinical trials
Prospective audits
: 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
Outcome audits
: 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
Process audits
: 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
Structure Audits
-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
Total quality Management (TQM)
-target current existing quality, Often problem focused
Quality Assurance (QA
: target ongoing and continually improve quality, Proactive, Attempts to prevent problems
Quality improvement (QI
: refers to activities that are used to evaluate, monitor, or regulate services rendered to consumers
Quality Control (QC)
- 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):
JACHO: Joint commissions for accreditation of health care org.
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
JACHO: Joint commissions for accreditation of health care org.
sentinel events
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
JACHO: Joint commissions for accreditation of health care org.
. Implemented Core Measures
- 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
Medicare/Medicaid
•most well-known and widely used problem solving model
Identify problem->gather data->explore and evaluate alternatives->select solution->implement-> evaluate results
Traditional Problem Solving Model:
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
• Managerial Decision
•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
Intuitive Decision Making Model
-“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
critical elements in decision making
o Cause/Effect Diagram
-look at literature, don’t have to reinvent most time it is out there, current practice, suggesting for guidelines, what studies have been done
critical elements in decision making
o Evidence-Based Approach
- 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
critical elements in decision making
o Generate Alternatives
• Brainstorming
