objective 1.3 Flashcards
must shape health care culture
and provide specific skills for assessment,
measurement, and evaluation of patient care.
* The goal of an organization committed to quality care is
a comprehensive, systematic approach that prevents
errors or identifies and corrects errors so that adverse
quality management
- The concept of patient safety and the emergence of the
principles of high reliability organizations have
transformed the way health care leaders look at culture,
teamwork, and how best to support and organize care
to advance the safety agenda. - Hospital leaders, including nurses, must sharpen their
expertise in patient safety and high-reliability principles
to ensure structures and processes are aligned to result
in effective outcomes for patients and the health care
system.
high reliability organizations
what are the 5 key principles of high reliability organizations?
- Preoccupation with
failure - Reluctant to simplify
- Sensitivity to operations
- Commitment to resiliency
- Deference to expertise
- Can enhance quality and safety outcomes and reduce
risk for patients and staff - Improve nursing sensitive outcomes as measured by
reductions in central line infections, catheter-associated
urinary tract infections, falls, and pressure injuries - Have an organization-wide approach to managing risk
through a relentless focus on safety - Tools include: standardized checklists, encouraging near
miss reporting, daily safety huddles
high reliability organizations
what are the 6 domains of safety competencies?
contributing to a culture of patient safety
working in teams for pts safety
communicating effectively for pts safety
managing safety risks
optimizing human and env factors
recgonizing, responding to and disclosing AE
- Leads cultural transformation
- Sets priorities for house-wide
activities, staffing effectiveness,
and patient outcomes - Builds infrastructure, provides
resources, and removes barriers
for improvement - Defines procedures for immediate
response to errors involving care,
treatment, or services and
contains risk - Assesses management and staff
knowledge of the quality, risk,
and safety activities regularly,
and provides education as
needed - Implements and monitors
systems for internal and external
reporting of information - Defines and provides support
system for staff who have been
involved in a sentinel event
senior leader
- Is accountable for quality and safety
indicator performance within areas of
responsibility - Displays safety goals, performance
metrics, and targets to staff on a quality
board - Leads safety huddles at the quality board
- Escalates safety concerns and risks to
senior leader - Meets regularly with staff to monitor
progress and help with improvement work - Writes and submits to senior leaders a
periodic action plan that includes
performance metrics, successes, and
plans for improvement - Uses data to measure effectiveness or
improvement - Works with staff to develop and implement
action plans for improvement of measures
that do not meet target - Provides time for unit staff to participate in
safety and quality improvement activities - Directly observes staff and coaches as needed
- Consults patient safety specialist, quality
management team, or risk management team
as appropriate - Shares information and benchmarks with
other units and departments to improve
organization’s performance
nurse manager
- Follows policies, procedures, and
protocols to ensure quality and
safe patient care - Remains current in the literature
on quality and safety specific to
nursing; promotes evidence-
informed practice standards - Communicate with and educates
peers immediately if they are
observed not following quality and
safety standards - Reports quality and safety concerns
and risks to supervisor/manager - Invests in patient safety by
continually asking self, “What risks
do I observe on the unit? What
concerns should I bring up at the
safety huddle? What else do I need
to do to meet our safety goal
target?” - Participates actively in quality
improvement activities
nurse
- An interprofessional teams
undertakes the QI process - Members should represent a
cross-section of workers who
are involved in the issue - Nurses, allied health
professionals, physicians,
clerical, support staff
assemble the qi team
- Begins with the selection of a clinical activity or
issue for exploration and improvement - The aim of QI efforts should be concentrated on
changes to patient care or systems that will have
the greatest effect - The aim can be established in a number of ways
but always involves a standard of practice - The aim statement is specific, including how
much improvement is expected by when, and can
be reviewed by the team and patients to ensure
that it brings value to care
identify the aim
- The team needs to identify
what measures or
outcomes would be best
collected to explore the
current status of the
activity, service, process,
or procedure identified for
improvement - Nursing-sensitive outcomes
- Patient outcomes
- Process indicators
- Benchmarking
identify the measures
- Change ideas can often be generated from the QI team
who see opportunities for improvements in their work,
or from best practices from other organizations or
literature. - Student role?
- Several useful tools for change idea generation can
include process maps and fishbone diagrams
defining the changes
This is done through the
use of the Plan-Do-
Study-Act (PDSA) Cycle,
which can be used to
test both small scale
change ideas and
organizational wide
initiatives
testing change ideas
State the purpose of the PDSA (developing,
testing, or implementing a change idea).
* What is the change idea?
* What indicator(s) of success will you measure?
* How will data on these indicators be collected?
* Who or what are the subjects of the test?
* How many subjects will be included in the test and
over what time period?
* What do you hypothesize will happen?
plan
