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N471 > Managing and Improving Quality > Flashcards

Managing and Improving Quality Flashcards

1
Q

Institute of Medicine (IOM)

A

An independent, non profit organization that works outside the government that provides unbiased and authoritative advice to decision makers and the public

est. 1970

over 2000 members from disciplines beyond just healthcare like management, law, engineering, business, etc

75 members chosen each year to serve on the committee

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2
Q

To Err is Human

A

1999 IOM report on how safe you are in the hospital

found that 44-98000 deaths each year occurring in the hospital is due to preventable medical errors

ID’ed the pitfalls of hospital safety

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3
Q

To Err is Human Report found that what thing is the number 1 cause of death in hospitals

A

Medication Administration Errors are #1

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4
Q

Lessons Learned from To Err is Human

A

It is not necessarily the people of the healthcare system that are causing the issues, but the system itself since employees do not necessarily have the tools to do their job safely or a safety net to prevent errors

Errors are contributed by flawed systems, lack of proper training, perverse incentives

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5
Q

“Crossing the Quality Chasm”

A

IOM report in 2001 after To Err is Human

States that “the healthcare system is in need of improvement”

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6
Q

What were the 6 goals of healthcare improvement stated in Crossing the Quality Chasm by the IOM

A

Safe

Effective

Patient-Centered

Timely

Efficient

Equitable

SEPTEE

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7
Q

IOM’s 5 Core Competencies Report

A

IOM report outlining 5 core competencies needed in healthcare to improve the system

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8
Q

What are the IOM’s 5 Core Competencies

A
  1. Provide patient centered care - ID, respect, and care about patient’s differences
  2. Work in interdisciplinary teams - cooperate, collaborate, communicate and integrate care in teams
  3. Employ EBP
  4. Apply QI
  5. Utilize informatics
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9
Q

What are some of the IOM’s recommendations for improving hospital safety

A

Create a culture of safety

Create a blame free work environment

Improve staff safety - needle sticks, infections, violence

TCTB - transforming care at the bedside

Employing IHI and JC annual safety goals

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10
Q

What are some of the ways of TCTB (Transforming Care at the Bedside)

A

Provide safe and reliable care

Vitality and teamwork

patient centered care

value added care processes

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11
Q

___-___% of patient, even today, suffer 1 or more serious adverse events

A

6-10%

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12
Q

What are some examples of serious adverse events

A

Adverse drug events

Surgical site infections

needle stick infections

wrong side/site surgery

device associated infection

ventilator associated pneumonia

catheter and central line infections

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13
Q

What are some things the healthcare system has done to improve quality in hospitals

A

QI has emerged

surveillance for hospital acquired infections

looking at the donning PPE issues which cause spreading of infection rates

computerized medication distribution and bar coding use

patient safety standards implemented by many organization have been made a top priority

national safety standards created policies and practices in 2005

CMS will not reimburse hospitals if a condition is acquired in hospital

diagnostic errors followed more closely

focus on communication and collaboration among systems and services increase

research needed and done to measure and validate quality standards

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14
Q

National Safety Standards and the Center for Medicare Services (CMS) - 2005

A

Standards were made where Medicate/Medicaid would no longer reimburse hospitals for certain hospital acquired conditions like pressure injuries, falls with injury, and infections an makes hospitals report conditions

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15
Q

How does the USA’s health expenditures compare to other countries

A

While the US has nearly 2x the spending the outcomes and qualities are not better than other countries still

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16
Q

Quality Improvement (QI)

A

a FORMAL approach to the analysis of performance and systematic efforts to improve it

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17
Q

What is the old model used before QI

A

Quality Assurance - QI

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18
Q

TQM/CQI Stands For

A

Total or Continuous Quality Improvement

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19
Q

PI Stands For

A

Performance Improvement

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20
Q

High Reliability Organizations

A

Hospitals Strive to be this

It is an organization focusing and functioning well with minimal patient/system errors in outcomes

Health services end up improving outcomes, but organizations can provide this while still having poor outcomes so this can be hard to define

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21
Q

What is the challenge of high reliability organizations

A

it is challenged by the definition of quality and reliability

organizations can provide being high reliability organizations and still have poor outcomes

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22
Q

Edwards Deming

A

Father of Quality Evolution

Philosophy

Involved in TQM

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23
Q

Total Quality Management (TQM)

A

1940s

Emphasize the commitment to excellence throughout the organization and created by Edwards Deming

Post WWII it was adopted by the Japanese industrial industry and then adopted by the US to improve quality of health care

It looks at how to make organizations thrive in quality management

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24
Q

What are some of the tenet/ideas involved in TQM

A

Quality does not happen by accident

thee individual is the focal element on which production and service depend and the quest for quality IS AN ONGOING PROCESS

Doing the right things, the right way, the first time

Problem PREVENTION planning

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25
Q

How does Quality Assurance differ from Quality Improvement

A

QA is an older term - 1970s

It is a retrospective process that targets currently existing quality and often involves determining who is at fault through policing and is often punitive

Does not see the bigger picture and points fingers

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26
Q

How does Quality Improvement differ from Quality Assurance

A

new term - 1980s

involves prospective and retrospective views - target ongoing and continually improving quality

the goal is IMPROVEMENT

attempts to avoid blame and create a system to prevent errors while looking at the larger picture

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27
Q

Quality Improvement = Opportunities to…

A

look at things differently

think outside the box or do not be defined by “the box”

develop new options and solutions

eliminate things that make you crazy

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28
Q

What are some of the Root Causes of Errors

A

Patient ID

Care planning Process

Continuum of care - following up

Staffing levels - not safe

Orientation and training of staff - not sufficient

Competency assessment/credentialing

Supervision / Management / Leaders

Communication

Availability of information

Adequacy of technology support

Equipment maintenance

Physical Environment

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29
Q

Joint Commission

A

Governing body that regulates the healthcare industry with goals and safety measures

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30
Q

National Patient Safety Goals of the Joint Commission in 2018

A

improve accuracy of patient ID

Improve effectiveness of communication between caregivers

Improve safety of using medications

Reduce harm associated with clinical alarm systems

Reduce the risk of health care associated infections

Reduce the risk of patient harm resulting from falls

Prevent health care associated pressure ulcers

ID safety risks for patient population

prevent mistakes in surgery

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31
Q

Why do healthcare providers need to meet the National Patient Safety Goals of the Joint Commission

A

They need to meet goals for reimbursement

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32
Q

Who should be involved in quality improvement

A

Everybody working in healthcare should be playing a role

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33
Q

What are the 2 ways to identify what is best to use for quality improvement

A
  1. Benchmarking

2. Best Practices

34
Q

Benchmarking

A

Measure products, practices, and services against best performing organizations

Allows organizations to compare performance within the organization and with others

Data then drives improvement

35
Q

Best Practices

A

A program or protocol relating to improvements to quality of life, quality of care, staff development, or cost effectiveness practices

Institutions submit outcomes related to quality improvement initiatives; and may be designated a “best practice”

36
Q

What are the 3 measures of quality

A

Structure

Process

Outcome

37
Q

Structure of Quality

A

Assumes a relationship exists between quality care and appropriate structure

The physical environment in which healthcare is delivered

ex: Staffing ratios, staffing mix, emergency department wait times, availability of fire extinguishers in patient care areas

38
Q

Process of Quality

A

Used to measure the process of care or how the care was carried out

Assumes that a relationship between the process used by the nurse and the quality of care delivered

ex: Policies, procedures, protocols, critical pathways, standards of care tools used to measure deviations from best practice standards

39
Q

Outcome of Quality

A

What results occur for the patients, what things to help ongoing, morbidity, and mortality, infections, etc

End result of care or patients health status changed as a result of an intervention

ex: Non nursing sensitive outcomes - mortality, morbidity, LOS
ex: Nursing sensitive outcomes - falls, nosocomial infections, pressure injuries, restraint use, patient satisfaction scores

40
Q

NDNQI - National Database of Nursing Quality Indicators

A

Reporting body founding by the ANA in 2001 that hospital systems need to report standards too

It is used by over 2000 hospitals in the country

The gold standard for nursing quality data

Tracks up to 19 nursing sensitive quality measures based on structure, outcome, and process

Hospitals can use this to compare their nursing quality against national, regional, and state norms for hospitals of the same type and down to the unit level

41
Q

What is the gold standard for nursing quality data

A

National Database of Nursing Quality Indicators (NDNQI)

42
Q

What are some of the NDNQI Indicators

A

Nursing hours per patient day - by RN, LPN, UAP

Nursing turnover

Nosocomial infections

patient falls (with and without injury)

Pressure Injury Rate (HAP, CAP, Unit Acquired)

Pediatric pain assessment and reassessment

RN certification

RN surveys (job satisfaction and work environment)

Restraints

Staff mix

43
Q

Other than NDNQI what are some other measures looked at for quality data

A

P4P

Hospital and physician report cards

Hospital consumer assessment of healthcare providers and systems survey (HCAHPS)

44
Q

Pay for Performance (P4P)

A

incentive program from CMS for preventing complications and hospitalizations

Groups of providers are given incentives to get the patients out and kept out of hospitals through high quality care - make money keeping them out

45
Q

HCAHPs

A

27 item survey that measures patients perceptions of their hospital experience including how well nurses and docs communicate with patients, how responsive hospital staff are, pain management, medication information, discharge information, cleanliness of room, quietness

46
Q

Commonly Studied QI Topics

A

patient falls

adverse drug rxns

surgical site infections

nosocomial infections

VAP

hospital acquired pressure injuries

central line infections

47
Q

What are the 3 common quality models

A
  1. PDSA (PDCA) - Plan Do Study Act
  2. Six Sigma
  3. FADE
48
Q

PDSA (PDCA) Model of Quality

A

Plan Do Study Act

Plan - Set goals, predict, plan data collection

Do - Test the plan, document problems, reassess and revise

Study - Complete data analysis, review lessons, decide actions

Act - Implement, evaluate, decide next cycle

REPEAT

49
Q

Six Sigma Model of Quality

A

Define, Measure, Analyze, Improve, Control - DMAIC

Define - the problem (outcome) to work on and the customer and definition of value

Measure - determine which processes and inputs have the greatest impact on variation in the outcome and develop a data collection plan and gather data

Analyze - analyze data gathered with stat methods to determine the part of the process causing the most (unwanted) variation in the outcome

Improve - decide on a solution or a solution set and develop implementation and monitoring plans for the solution

Control - sustain gains achieved during the previous phase and transition solutions (new process) to person responsible

50
Q

FADEE Model of Quality

A

Focus, Analyze, Develop, Execute, Evaluate

Focus - define and verify the process to be improved

Analyze - collect and analyze data to establish baselines, identify root causes and point toward possible solutions

Develop - based on the data, develop action plans for improvement including implementation, communication, and measuring/monitoring

Execute - implement the action plans, on a pilot basis as indicated, and …

Evaluate - install an ongoing system measuring/monitoring (process control) to ensure success

51
Q

QI Process uses results of QI to do what things

A

recommend practice changes

implement revised practice

revise policies and procedures

provide education

and go back through the cycle again (continuous quality improvement = CQI)

52
Q

IOM Future of Nursing Report from 2010 States What things to improve quality

A

Nurses should practice to the full extent of education

Nurses should achieve higher education

Nurses should be full partners with physicians

Nurses should be involved more with health quality decisions

Nurses should play a fundamental role in health care transformation

53
Q

IOM Future of nursing Report for 2020-2030 States what things should be done to improve quality

A

Address diversity, improve health equity

Understand social determinants of health

Public and community health references should be known

Respond to health emergencies, pandemics, and disaster response better

Improve quality in nursing education

Simulation based learning in nursing

Addresses substance abuse disorders among nursing

54
Q

Evidence Based Practice (EBP)

A

The conscientious use of current best practice in making decisions about patient care

A problem solving approach to clinical practice integrating various things

More than just research

55
Q

EBP is a problem solving approach to clinical practice that integrates what things?

A

a systematic search for and critical appraisal of the most relevant answer to a clinical question

Clinical expertise

patient preferences and values

assessment of the patients history and physical exam

availability of healthcare resources

56
Q

How does QI differ from EBP

A

NO theoretical underpinnings

Evaluates a work process to improve practice

Data collected and reported internally!!!

57
Q

How does EBP differ from QI

A

Uses theory

Seeks to generate new knowledge or test interventions

Results add to the body of knowledge!!!

58
Q

Hierarchy of EBP Tools (Reviews and Studies)

A

Level I: Cochrane Systematic Reviews - Systematic review of RCTs

Level II: Systematic Reviews and Meta Analyses - RCT

Level IV: Evidence Summaries - case control and cohort studies

Level V: RCTs Case Cohorts, Control Studies - reviews of qualitative studies

Level VI: Clinical Research Critiques - single descriptive study

Level VII: Other reviews of the literature - opinions of authorities and or/reports of expert committees

Bottom: Case reports, case series, practice guidelines, etc

59
Q

Hallmarks of Effective Quality Control Programs

A

There must be support from a top level administration

There must be a commitment by the organization in terms of fiscal and human resources

Quality goals reflect search for excellence rather than minimums

Process is ongoing (continuous)

60
Q

High Reliability Organizations (HROs)

A

Organizations that perform well (minimal catastrophic error) despite high levels of complexity and the existence of multiple risk factors that encourage error

61
Q

High Care Quality

A

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

62
Q

Quality has properties/domains of

A

effectiveness

efficiency

equity

patient centeredness

safety

timeliness

63
Q

Benchmarking

A

the process of measuring products, practices, and services against best performing organizations

64
Q

Quality Gap

A

the difference in performance between top performing health care organizations and the national average

65
Q

Steps of Quality Control

A
  1. Establish control criteria or standards
  2. ID information relevant to the criteria
  3. Determine ways to collect information
  4. Collecting and analyzing information
  5. Re-evaluation
66
Q

Nursing Process Standard of Practice Process (Nursing Process)

A

Assessment

diagnosis

Outcomes ID

Planning

Implementation

Evaluation

67
Q

CPGs

A

Standardized clinical guidelines

provide diagnosis based, step by step intervention for providers to follow to promote high quality care while controlling resource utilization and costs

68
Q

Audit

A

Systematic and official examination of a record, process, structure, environment, or account to evaluate performance

69
Q

Retrospective Audits

A

audit done after service is received by the patient

70
Q

Concurrent Audit

A

performed audit while patient is receiving service

71
Q

Prospective Audit

A

audit attempting to ID how future performance will be affected by current interventions

72
Q

Outcome Audot

A

Audit to determine what results, if any, occurred as a result of a specific nursing intervention for patients

73
Q

Outcomes reflect …

A

the result of care or how the patients health status changed as a result of an intervention

74
Q

Process Audit

A

measure how nursing care is provided

audit assumes a connection between the process and the quality of care

They are used to measure the process of care or how the care was carried out and assume that a relationship exists between the process used by the nurse and the quality of care provided

75
Q

Structure Audit

A

assumes a relationship exists between quality care and appropriate structure

Includes resource inputs such as the environment in which health care is delivered. It also includes all those elements that exist prior to and separate from the interaction between the patient and the health care worker

76
Q

Standardized Nursing Language

A

provide a consistent terminology for nurses to describe and document their assessments, interventions, and outcomes of their actions

77
Q

TQM is a…

A

never ending process, everything and everyone in the organization are subject to continuous improvement efforts (workers not QI dept do the data collection)

78
Q

TQM Principles

A
  1. Create a constancy of purpose for the improvement of products and service.
  2. Adopt a philosophy of continual improvement.
  3. Focus on improving processes not on inspection of product.
  4. End the practice of awarding business on price alone; instead, minimize total cost by working with a single supplier.
  5. Improve constantly every process for planning, production, and service.
  6. Institute job training and retraining.
  7. Develop the leadership in the organization.
  8. Drive out fear by encouraging employees to participate actively in the process.
  9. Foster interdepartmental cooperation and break down barriers between departments.
  10. Eliminate slogans, exhortations, and targets for the workforce.
  11. Focus on quality and not just quantity; eliminate quota systems if they are in place.
  12. Promote teamwork rather than individual accomplishments. Eliminate the annual rating or merit system.
  13. Educate/train employees to maximize personal development.
  14. Charge all employees with carrying out the total quality management package.
79
Q

Patient satisfaction often…

A

has little to do with whether a patients health improved during a hospital stay

an important component of patient comfort, and therefore quality of care, quality is more encompassing and must always include an examination of whether the patient received the most appropriate treatment from the most appropriate provider in a timely manner.

80
Q

Prospective Payment System

A

providers are paid a fixed amount per patient admission regardless of the actual cost to provide the care - could reduce quality or abbreviate care

81
Q

Leapfrog Group

A

conglomerate of non health care fortune 500 company leaders who are committed to modernizing the current health care system and ID 4 EBP standards they believe will have the biggest impact on reducing medical errors

82
Q

What are the 4 major initiatives of the Leapfrog Group

A
  1. Computerized Physician Provider Order Entry (CPOE)
  2. Evidence based hospital referral
  3. intensive care unit physician staffing (IPS)
  4. National Quality Forum Endorse Safe Practice

N471 (12 decks)

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