Quality Flashcards
The degree to which nursing services for healthcare consumers, groups, committees, and populations increase the likelihood of desirable outcomes and are consistent with evolving nursing knowledge.
Quality
Overarching philosophy that defines a healthcare culture emphasizing customer satisfaction, innovation, and employee involvement.
Quality Management
The ongoing process of innovation, improvements, prevention of error, and development of staff used by institutions that adopt the QM philosophy.
Quality Improvement
6 Criteria for Quality Care: Safe
Avoiding harm to patients from care intended to help them
6 Criteria for Quality Care: Effective
Providing services based on scientific knowledge to all who could benefit and avoiding providing to those who cannot (underuse v. misuse)
6 Criteria for Quality Care: Patient-Centered
Care is respectful of and responsive to individual patient preferences/needs/values and ensuring patient’s values guide clinical decisions.
6 Criteria for Quality Care: Timely
Reducing waits and harmful delays for both who receive and provide care
6 Criteria for Quality Care: Efficient
Avoiding waste of equipment, supplies, ideas, and energy
6 Criteria for Quality Care: Equitable
Providing care that does not vary in quality due to personal characteristics (race, gender, etc.)
What are the principles of QM/QI?
- Operates best in a flat, democratic organization with interdisciplinary involvement
- Shared commitment is essential for success; integration of goal of quality into vision, mission, philosophy
- Goal is to improve system/process, not place blame
- Focuses on patient-centered outcomes and relies on data-driven decisions
Independent group of items, people, or processes with a common purpose.
- Every step of work affects the following step
- Resources used in care delivery include personnel, facilities, materials, etc.
- (ex: staffing adequacy, effectiveness of charting, etc.)
Structure (QI Indicator)
Completion of specific tasks/treatments known to lead to better outcomes; achieving goals and relationships between separate systems & working together to meet them.
- (ex: timeliness/thoroughness of documentation, adherence to critical pathways or care plan)
Process (QI Indicator)
Direct measures of ultimate results of patient care, including patient experience of adverse events and patient’s health.
- Can be improved by examining process and relationships between
- Measures actual clinical progress
- Can be helpful in identifying opportunities for improvement
- (ex: patient falls, HAI rates, pt/nurse satisfaction)
Outcomes (QI Indicator)
A lifelong problem-solving approach that integrates the best evidence from well-designed research studies and evidence-based theories, clinical expertise, and evidence from assessment of the healthcare consumer’s history and condition, as well as the healthcare resources and patient’s preferences/values.
Evidence-Based Practice
Program that recognizes organizations for quality patient care, nursing excellence, and innovations in nursing practice.
- Nursing leaders align nursing goals with patient outcomes
- Lower burnout rates & higher satisfaction
- Higher levels of quality care by nurses supported by their organization resulting in improved patient outcomes
Magnet Program
Organizational strategy that supports nurses to have ownership, autonomy, and input in their professional practice.
Shared Governance
Initiatives that focus on key quality measures and provide comprehensive understanding and evaluation of the care an organization delivers and patient’s response to care.
- Care provided when a patient needs it in an affordable, safe, and effective manner
CMS Quality Initiatives
Review process that determines if an agency is meeting the defined standards of quality determined by the accrediting body.
- Standards vary but all share common goals of improving efficiency, equity, and delivery of high-quality care
Accreditation
National standards of care and treatment processes for common conditions used to reduce complications and improve patient outcomes.
- Compliances reports show how often the organization provides the recommended treatments
- HCO must report compliance to JCAHO, CMS, etc.
Core Measures
Core measures used by both CMS and JCAHO to improve care delivery by in healthcare organizations.
- (ex: vaccines, substance use, strokes, etc.)
National Hospital Inpatient Quality Measures
Guidelines specific to organizations accredited by JCAHO that focus on healthcare safety problems and ways to solve them.
- Updated annually to provide guidance for specific settings
- Documentation is PRIMARY EVIDENCE!
National Patient Safety Goals
What are the primary goals of NPSG?
- Identifying patients correctly
- Increased staff communication
- Safe medication use
- Prevent infection
- Prevent mistakes in surgery
An investigation of healthcare services performed by doctors, nurses, and other team members to ensure money is not wasted covering unnecessary/inefficient expenditures for proper treatment.
- Allows hospitals to objectively measure how their resources are being used to meed pt needs.
- Uses info from patient records, demographics
- Evaluate resource allocation, efficiency, quality
Utilization Review
The science and practice of integrating nursing knowledge with information and communication technologies to promote the health of people, families, and communities worldwide.
- Information/technology used to communicate, manage knowledge, mitigate error, and support decision-making.
Nursing Informatics
How do nurses use informatics?
By identifying, collecting, processing, and managing data and supporting/expanding nursing practice, research, education, knowledge, and administration.
What are the benefits of nursing informatics?
- Improved patient safety
- Reduced delays in care
- Reduced waste
- Promotion of patient-centered care
- Support quality improvement
The ANA developed a program to monitor and evaluate nurse staffing and the quality of nursing care in a specific unit.
- Safety & quality initiative to explore and identify linkages between nursing care and patient outcomes.
- Obtained data benchmarked
- Quarterly and annual reports of structure, process, and outcome indicated to evaluate nurse-sensitive measures at unit level
National Data-Base of Nursing Quality Indicators (NDNQI)
Widespread search to identify best performance against to which others measure, comparing best practice with your practice; organizations learn to identify desired standards of quality.
- Compare unit-based data to researched-based national data
Benchmarking
What is required for Magnet Status?
NDNQI and nurse-sensitive indicators.
Measures nursing quality, improves nurse satisfaction, strengthens work environment, assesses staffing levels, and improves reimbursement.
What are some nursing-sensitive indicators?
- Nursing hours per patient day
- Patient falls with and without injury
- Pressure ulcer prevalence
- RN satisfaction survey
- Skill mix
- HAIs
- Nurse vacancy rate
The systematic process uses measurable data to improve healthcare services and the overall health status of patients by using data to monitor the outcomes of care processes and using improvement methods to design & test changes to continuously improve quality/safety.
The Quality Improvement Process
QI Process: PLAN
Identify focus and what will be measured. Collect subjective and objective data. Determine timeline including framework for when data is collected/reviewed.
QI Process: DO
Working with the hc team to implement project and ensure data collection occurs.
QI Process: STUDY
Working withe the hc team to review/analyze collected data. Were outcomes met?
QI Process: ACT
Repeating the process.
Discuss outcomes, determine barriers/strengths/weaknesses, decide if additional changes are needed. Use outcome findings to continue process to ensure quality & safe care.
Nursing Data: EBP Research
Integrating individual clinical expertise built from practice, with best available clinical evidence from systemic research applied to practice.
From auditing medical records and patient surveys.
Nursing Data: Nursing Audits
Process of collecting and analyzing data to evaluate the effectiveness of nursing interventions.
Concurrently (while pt admitted) or retrospectively (time series data and trends over time). Patient satisfaction via questionnaires, focus group, etc.
Nursing Data: Regulatory Requirments
Accreditation bodies generate surveys that provide data for QI. NPSG.
Nursing Data: Sentinel Event Data
Unexpected occurrence involving death or serious physical/psychological injury to the patient.
Team must analyze event using root-cause analysis to generate data to prevent future occurrences, where improvement can be made and develop an action plan.
Nursing Data: Near Miss Data
Unexpected event that did not result in death or injury but had the potential to do so.
Root-cause analysis to identify why it occurred and prevent event from happening.
What is Just Culture?
Cultivates environment encouraging nurses to report their mistakes and near misses for an opportunity to learn about error. Insight leads to improved patient outcomes.
Quality Improvement vs. Nursing Research
Quality improvement evaluates structures, processes, and outcomes to determine if improvements are needed.
Nursing research identified new innovations in nursing practice.
The ties between safe/quality patient-centered care, EBP, research, and quality improvement.
- EBP is scholarly research
Scholarly Inquiry
Systematic inquiry designed to develop knowledge about issues of importance to nursing professions to advance the nursing profession through the discovery of new research & provide scholarly evidence regarding improved patient outcomes from evidence-based interventions.
Nursing Research
How is nursing research conducted?
Using PICOT
P-population/problem
I- intervention
C- comparison
O- outcome
T- time
What are the requirements of nursing research?
- Study approved by the institutional review board
- Participants are protected
- Benefits outweigh the risks
- Informed consents are obtained
- Vulnerable populations are protected.
