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Leadership Exam 2 > Quality and Safety > Flashcards

Quality and Safety Flashcards

1
Q

the importance of quality and safety

A

The core of leading and managing in nursing
Drives staffing and budgeting decisions, personnel policies, information technology, continuing education, and the workplace
environment
Shapes the culture of the Healthcare system
Goal is a comprehensive, systematic approach that prevents errors or identifies and corrects errors so that adverse events are decreased

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2
Q

leader role in quality and safety

A

Acknowledge safety challenges and allocate
resources
Identify and reduce risks
Enhance work environments to support higher-quality care, less patient risk, and
more satisfied nurses
Place emphasis on how culture impacts care by promoting diversity, equity, inclusion, and belonging

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3
Q

Major reports influencing safety: Quantified the role of safety-related errors resulting in patient morbidity and mortality

A

The Err is Human (2000)

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4
Q

leader implications of The Err is Human (2000)

A

Moved safety issues from the incident report level to an integrated patient safety report for the organization.
– Acknowledged system errors as more common cause of error than individual.
– Stimulated hospital boards to include reports on quality.

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5
Q

Major reports influencing safety: Identified the six major aims (safe, effective, patient-centered, timely, efficient, and
equitable) for providing quality healthcare.

A

Crossing the Quality Chasm (2001)

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6
Q

leader implications of Crossing the Quality Chasm (2001)

A

Moved care from discipline-centric to patient-centered.
- Reinforced the disparities that occur within
healthcare.
- Addressed which led to a more holistic environment built on evidence.
- Provided substantive support for information technology use.
- Served as impetus for “pay for quality.”

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7
Q

major reports influencing safety: Identified need to provide patient-centered care, work
in interprofessional teams, employ evidence-based practice, apply quality improvement, and utilize informatics

A

Health Profession Education: A Bridge to Quality (2003)

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8
Q

leader implication Health Professions Education: A Bridge to Quality (2003)

A

Attempted to shrink the chasm between education and practice so that interprofessional teams would work more effectively together.
– Exposed the issue of “silo” education and called for collaborative practice.
– Increased expectation for participation in lifelong learning.

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9
Q

major reports influencing safety: Identified many past practices that had a negative
influence on nurses and, thus, on patients

A

Keeping Patients Safe: Transforming the Work Environment of Nurses (2004)

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10
Q

leader implications of Keeping Patients Safe: Transforming the Work Environment of Nurses (2004)

A

Focused on direct care nurses and supported their involvement in decision-making related to their practice.
–Supported the concept of shared governance.
–Provided a framework for considering how nurses could determine staffing requirements.
– Supported public reporting of issues related to unsafe work environments.
– Moved the Chief Nursing Officer (CNO) into the boardroom as a key spokesperson on safety and quality issues

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11
Q

major reports influencing safety: Identified 8
recommendations based on evidence
that the profession must attend

A

Future of Nursing: Leading Change, Advancing Health (2010)

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12
Q

leader implications of Future of Nursing: Leading Change, Advancing Health (2010)

A

Created state coalitions focused on improving
nursing.
Created nursing/community/business partnerships to accomplish the work.
Moved the issue of nurses as leaders to a more visible level.

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13
Q

major reports influencing safety: Expanded vision of original Future of Nursing publication

A

Future of Nursing: 2020-2030: Charting a Path to Achieve Health Equity (2021)

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14
Q

leader implication of Future of Nursing: 2020-2030: Charting a Path to Achieve Health Equity (2021)

A

Increased emphasis on health promotion and health equity.
– Continued focus on 2010 recommendations to enhance professionalism.

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15
Q

recommendations from future of nursing (2010)

A
  1. Remove scope-of-practice barriers.
  2. Expand opportunities for nurse to lead and diffuse collaborative improvement efforts.
  3. Implement nurse residency programs.
  4. Increase the proportion of nurses with a baccalaureate degree to 80% by 2020.
  5. Double the number of nurses with a doctorate by 2020.
  6. Ensure that nurses engage in lifelong learning.
  7. Prepare and enable nurses to lead change to advance health.
  8. Build an infrastructure for the collection and analysis of interprofessional healthcare
    workforce data.
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16
Q

key priorities from future of nursing (2021)

A
  1. Work over the next decade to reduce health disparities and promote equity.
  2. Address rising costs through more equitable care delivery.
  3. Use technology to maximize reaching vulnerable populations.
  4. Prioritize patient- and family-focused care.
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17
Q

Federal agency devoted to improving quality, safety, efficiency, and effectiveness.

A

Agency for Healthcare Research and Quality (AHRQ)

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18
Q

leader implications for Agency for Healthcare Research and Quality (AHRQ)

A

Provides outcomes research sections as resources for nurses.

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19
Q

Agency for Healthcare Research and Quality (AHRQ) - Builds a bridge between research and practice and issues reports on evidence-
based practices:

A

preoperative checklists
bundles to prevent central line– associated bloodstream infections
interventions to reduce falls
simulation exercises in patient safety efforts
hand hygiene
“do not use” abbreviations
barrier precautions to prevent healthcare-associated bloodstream infections
use of rapid response systems

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20
Q

Membership-based organization
related to quality measurement and
reporting.

A

National Quality Forum (NQF)

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21
Q

leader implications for National Quality Forum (NQF)

A

Provides source for Centers for Medicare & Medicaid Services’ never events
Sets standards and endorses measures that allow for quality comparison across metrics such as settings, states, and diagnoses
Serves as resource for Healthcare Facilities Accreditation Program
Serves as source of nurse- sensitive care standards.
Advises the Centers for Medicare & Medicaid
Services (CMS) about measures that can be used to determine payment- as a result, CMS will not pay for certain conditions that result from what might be termed poor practices or events that should not have occurred.

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22
Q

Not-for-profit organization that accredits
healthcare organizations internationally.

A

The Joint Commission

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23
Q

Leader implications for The Joint Commission

A

Focuses on outcomes that redirected accreditation processes and, thus, nurses’ roles within the process.

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24
Q

TJC changed its focus from process to outcomes, which placed more emphasis
on patient safety:

A

Issues annual patient safety goals that are setting specific
Issues sentinel event announcements.
Issues a list of “do-not-use” terms, symbols, and abbreviations
Changed to unannounced visits and,
thus, changed the way that organizations prepare for accreditation.
Approximately 4,200 U.S. hospitals and another 380 critical access hospitals maintain TJC accreditation

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25
Q

A federation of more than 130 national nurses’ associations

A

International Council of Nurses (ICN)

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26
Q

leadership implications for International Council of Nurses

A

Created the Global Nursing Leadership
Institute for strategic policy leadership
development. Authors an international
Code of Ethics for Nurses.
Emphasis includes providing culturally sensitive care to ensure quality and
safety on an international level.
Represents millions of nurses worldwide and designed to be the voice of
nursing internationally.

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27
Q

A designation signaling excellence in
nursing and obtainment of successful
outcomes within healthcare agencies.

A

Magnet Recognition Program

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28
Q

Leader implications of Magnet Recognition Program

A

Created unified approaches to seek this designation- Redirected focus to outcomes, including data and efforts related to patient safety.

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29
Q

organizations must demonstrate how they provide excellence across five elements:

A

transformational leadership
structural empowerment
exemplary professional practice
new knowledge, innovation, and
improvements
empirical quality results

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30
Q

Magnet Recognition Programs in the country

A

Since its inception in 1994, approximately 576 hospitals in the United States (about 9%) have
received Magnet recognition.
Hospitals in other countries also have received this designation.

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31
Q

Organization
Comprehensive resource, including references and video modules
Created knowledge, skills, and attitudes (KSA) for students and graduates related to quality and safety.

A

Quality and Safety Education for Nurses (QSEN)

32
Q

QSEN: Focus on continuous improvement of
the quality and safety of the workplaces
using 6 competencies:

A

Patient-Centered Care
Teamwork and collaboration
Evidence-based practice
Quality improvement
Safety
Informatics

33
Q

components of QSEN

A

Quality necessitates maintaining safety in
patient care, with a continual focus on clinical
excellence from the entire interprofessional
team.
Believes that patient safety is a key
component of quality improvement and
clinical governance while the prevention of
adverse events is paramount to improved
patient outcomes

34
Q

DNV-GL Healthcare

A

A relatively new accrediting organization in the United States that has extended accreditation to approximately 500 U.S.
hospitals
Directly address CMS requirements and the certification programs leverage the guidance and best practices of clinical specialty organizations across healthcare.

35
Q

Independent, not- for-profit organization focused on advancing and sustaining better
outcomes in health and healthcare.

A

Institute for Healthcare Improvement (IHI)

36
Q

Leader implication for Institute for Healthcare Improvement (IHI)

A

Supports innovation, including rapid-cycle change projects designed to improve care rapidly.

37
Q

Dedicated to rapidly improving care through a variety of mechanisms, including rapid cycle change projects (built on The Theory of Diffusion)

A

Developed a framework built around improvements in safe and reliable care, vitality and teamwork, patient-centered care, and value-added care processes.
Adopts a Triple Aim framework to optimize health system performance. Eventually leading to the Quintuple Aim in 2022.

38
Q

Rogers Diffusion of Innovations
Key Idea

A

Diffusion is a process of communication about innovation to share information over time and among a group of people.
It provides a framework for successfully
implementing nonlinear change.
More complex change is less likely to be adopted.
Early adopters serve as role models

39
Q

Rogers Diffusion of Innovations
Application to Practice

A

Shared leadership supports diffusion and adaptation of innovation.
Engage key leaders in a change to infuse the energy from early adopters.
Using social media platforms in the hospital culture to engage employees communicates
changes quickly.
New changes are altered while they
are being adopted because new evidence or a
better idea emerges.

40
Q

what is quality management (QM)

A

Refers to an overarching philosophy that
defines a healthcare culture emphasizing
customer satisfaction, innovation, and
employee involvement.

41
Q

what is quality improvement (QI)

A

Refers to an ongoing process of innovative
improvements, prevention of error, and
development of staff used by institutions that
adopt the QM philosophy.

42
Q

benefits of quality management

A

Greater efficiency and proactive planning may overcome resource constraints
(limited reimbursement imposed by prospective payment plans and staff shortages)
QM is based on the philosophy that actions should be right the first time and that
improvement is always possible, which leads to reduced malpractice suits
When everyone has the ability to contribute, it makes employees feel valued and
empowered to make a difference, leading to enhanced job satisfaction

43
Q

planning for quality management: Centers for Medicare & Medicaid Services (CMS) has
developed several initiatives to measure and incentivize quality improvement which include

A

Hospital Value-Based Purchasing (VBP)
Hospital-Acquired Condition Reduction Program (HACRP)
Hospital Readmissions Reduction Program (RRP)

44
Q

Models of Quality Management

A

Lean Sigma and Six Sigma
Failure Mode and Effects Analysis
Root Cause Analysis

45
Q

Lean Sigma and Six Sigma

A

Use data-driven approaches targeting a nearly error-free environment and empower employees to improve processes and outcomes

46
Q

Six Sigma utilizes a 5-step methodology known as DMAIC to improve existing processes:

A

Define opportunities
Measure performance
Analyze opportunity
Improve performance
Control performance

47
Q

Principles of Quality Management and
Quality Improvement

A

Structure
Shared Commitment
Goal
Focus

48
Q

Structure of quality management and quality improvement

A

QM operates most effectively within a flat,
democratic organization structure
When decisions are made closest to where they have an effect, people are more satisfied, decisions are more practical, and quality is enhanced

49
Q

Shared commitment of quality management and quality improvement

A

An essential for organizational success.
Leaders, managers, and followers must be committed to QI (See Table 2.2 for Roles/Responsibilities)
Total organizational involvement is necessary for a culture transformation

50
Q

Goal of quality management and improvement

A

Improve systems and processes, not to assign blame
All levels must be educated on QI strategies
Communication is key

51
Q

focus of quality management and improvement

A

QI focuses on outcomes and relies on data-driven decisions
Outcomes must be specific and measurable
The use of statistical tools enables nurse managers to make objective decisions about QI activities

52
Q

who Defines quality by measuring factors important to them

A

customers

53
Q

internal customers

A

people or units within an organization who receive products or services (patients, staff, other departments).

54
Q

external customers

A

people or groups outside the organization who receive products or services (patients’ families, physicians, managed care
organizations, and the community at large).

55
Q

publicly report data on performance for core quality indicators

A

accountability measures

56
Q

steps in the quality improvement process

A
  1. Identify needs most important to the consumer of healthcare services.
  2. Assemble an interprofessional team to review the identified consumer needs and services.
  3. Collect data to measure the current status of these services.
  4. Establish measurable outcomes and quality indicators.
  5. Select and implement a plan to meet the outcomes.
  6. Collect data to evaluate the implementation of the plan and the achievement of outcomes
57
Q

what is quality assurance

A

Ensure conformity to a standard
Focuses on clinical aspects of the provider’s care, often
in response to an identified problem
QA activities focus on process standards
Common methods uses is chart review/audit

58
Q

functions of risk management

A

Defining situations that place the system at some financial risk, such as medication errors
or patient falls
Determining the frequency of occurrence of those situations
Intervening and investigating identified events
Identifying potential risks or opportunities to improve care

59
Q

A systematic, proactive method for
evaluating a process to identify where and
how it might fail and to assess the relative
impact of different failures to identify the
parts of the process that are most in need
of change.

A

Failure Mode and Effects Analysis

60
Q

what is a never event

A

Errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients and that indicate a real problem in the safety and credibility of a healthcare facility.
Should NEVER happen
ex. surgery on wrong body part

61
Q

what is an always event

A

Should occur 100% of the time
ex. Hand hygiene and accurate patient identification

62
Q

sentinel event

A

A serious, unexpected occurrence involving death
or severe physical or psychological harm
ex. inpatient suicide, infant abduction, or wrong-site
surgery

63
Q

what is a near miss event

A

An unplanned event that did not result in injury, illness, or damage but had the potential to do so
highlights an imminent problem that must be corrected and can provide useful lessons in terms of risk
analysis and reduction

64
Q

what is a root cause analysis

A

Occurs after a sentinel event
Is performed by a team that includes those directly involved in the event and those in leadership positions
A retrospective review of an incident to identify the sequence of events with the goal of identifying the rootcauses
Leads to the development of specific risk reduction strategies; in certain situations, the plan must be reported to TJC

65
Q

external reporting of an event

A

to regulatory or accrediting agencies (TJC)

66
Q

internal reporting of an event

A

method of communicating risks or adverse
events is through electronic safety reporting systems or incident
reporting

Kept separate from the patient’s medical record
Serve as a means of communicating an incident that caused
or could have caused harm to patients, family members,
visitors, or employees
Used to improve quality of care and decrease future risk

67
Q

ways to decrease risk

A

Utilizing SBAR
Standardized hand-off communication
Utilizing Teach-back

68
Q

national patient safety goals

A
  • Improve the accuracy of patient identification.
  • Improve the effectiveness of communication among caregivers.
  • Improve the safety of using medications.
  • Reduce patient harm associated with clinical alarm systems.
  • Reduce the risk of healthcare–associated infections
  • The hospital identifies safety risks inherent in its patient population.
  • Prevent wrong site, wrong procedure, and wrong person surgery
69
Q

Describes a vast range of cultural
differences among individuals or groups

A

cultural diversity

70
Q

Describes the affective behaviors in individuals—the capacity to feel, convey, or react to ideas, habits, customs, or traditions unique to a group of people

A

cultural sensitivity

71
Q

Self-examination and in-depth exploration of
one’s own cultural background and subsequent
attitudes and behaviors. Involves the recognition
of one’s biases, prejudices, and assumptions
about individuals who are different.

A

cultural awareness

72
Q

Mastery of the ability to understand, appreciate, and interact with people from cultures and belief systems different from one’s own.

A

cultural competency

73
Q

Key Actions for Creating Diversity, Equity, and Inclusion

A
  • Identify and challenge unconscious biases.
  • Understand team differences.
  • Create a respectful practice environment.
  • Provide flexible scheduling to honor cultural practices.
  • Support ongoing professional development.
  • Create social support systems.
  • Create effective communication systems.
  • Empower staff through shared governance.
74
Q

Dealing Effectively with Cultural Diversity

A
  • Requires unwavering support by leaders and managers
  • Culturally sensitive work environment
  • Allow staff to verbalize their feelings
  • Capitalize on the knowledge that all staff bring something unique to the patient promotes better quality care outcomes
75
Q

tips for promoting quality and safety

A
  • Use the NAM (formally IOM) recommendations to frame your actions.
  • Keep current with the evidence and best practices.
  • Be prepared to intervene in unsafe situations.
  • Embrace that anything measured and recorded can be improved.
  • Concentrate QI energies on factors that are most important to patient
    quality and safety.
  • Collaborating to prevent problems is more effective than fixing problems
    after they occur.
  • Listen for differences and seek clarity.
  • Value diversity, equity, and inclusion.
  • Be proactive in creating a culturally competent workplace.

Leadership Exam 2 (7 decks)

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