quality assurance

Question 1

what is quality improvement (QI)

Answer 1

an approach to continuous study and improvement of the processes of providing health care services to meet the needs of patients and others

Question 2

quality improvement (QI) synonyms

Answer 2

continuous quality improvement (CQI)
continuous improvement (CI)
total quality management (TQM)

Question 3

what is quality assurance (QA)

Answer 3

deals with people. involves outcome analysis (was the diagnosis promptly prepared, distributed, and filed for subsequent evaluation)

Question 4

what is the joint commission on accreditation of healthcare organizations (JCAHO)

Answer 4

ten step monitoring and evaluation process. resolves identified patient care problems.

Question 5

QA monitors proper:

Answer 5

patient scheduling, reception, and preparation.

Question 6

JCAHO ten step QA program

Answer 6

1. assign responsibility
2. delineate scope of care
   3 identify aspects of care
   4 identify outcomes affecting the aspects of care
   5 establish limits of the scope of assessment
   6 collect and organize data
   7 evaluate care when outcomes are reached
   8 take action to improve care
   9 assess and document actions
   10 communicate information to organization-wide QA programs

Question 7

what is quality control (QC)

Answer 7

deals with instrumentation and equipment

Question 8

a program of QC is designed to ensure that:

Answer 8

expected outcomes are achieved through optimal equipment performance

Question 9

QC–preventative maintenance initiative (PMI)

Answer 9

periodic scheduled monitoring of equipment performance (usually annually). usually makes major repairs unnecessary

Question 10

a successful QC program has 3 steps

Answer 10

1 acceptance testing
2 routine performance monitoring (PMI)
3 maintenance

Question 11

what is continuous quality improvement (CQI)

Answer 11

a plan that integrates QA, QC, and assessment into a complex system wide improvement program.

Question 12

CQI–QC measures

Answer 12

radiation output, mechanical integrity of treatment and simulation units, brachytherapy sources and equipment

Question 13

CQI–QA measures

Answer 13

aspects of treatment planning, delivery and patient care

Question 14

CQI–assessment

Answer 14

peer review and audit mechanism. use cause and effect diagrams/ “fishbone” diagrams

Question 15

quality improvement team

Answer 15

composed of ALL the staff in the radonc department who interact with the patient and family. each individual makes contributions to the quality of care and level of patient satisfaction.

Question 16

QI activities–physicians

Answer 16

active participation in QA activities: chart review, morbidity and mortality, review and development of departmental policies, port film preview, patient and family ed, and completion and review of incident reports

Question 17

QI activities–physicists/dosimetrists/engineers

Answer 17

develop and carry out the QC program. weekly and final physics reviews of tx records

Question 18

QI activities–radiation therapists

Answer 18

active participation in QA and QC activities: warm up procedures, preforms QC tests, verify presence of completed and signed RX and consent forms, reviews RX and TX plan on each patient prior to 1st TX, deliver accurate treatment per RX, accurately record treatment delivered, take and review portal images ** , eval health status of the patient daily before tx, participate in patient & family ed, provide care and comfort to meet needs of patient

Question 19

QI activities–radiation nurses

Answer 19

perform nursing assessment on each new patient (determine physical and psychological status, evaluate educational needs & evaluate effectiveness of ed program) & monitor patient’s health status on routine or as needed basis throughout course of TX (order, evaluate, and record blood counts. evaluate and record weights).

Question 20

QI activities–departmental support staff

Answer 20

gathers pertinent information and prepares the treatment chart before the patients initial visit, contacts patient and/or family to set up appointments, gives instruction regarding information to be brought with the patient, greets and assists patient and family daily (sets tone for entire rt treatment encounter)

Question 21

QI committee

Answer 21

aka improvement committee. report to the medical director and are repsonsible for: the development and monitoring of the QI program activities, collecting and evaluating data, determining areas for improvement, implementing changes and evaluating the results of the actions taken.

Question 22

development of a QI plan

Answer 22

GOALS: 1 plan promotes ongoing collection of info on all aspects of care.
2 uses the info to verify and identify areas in need of improvement
3 implement action to modify quality of care
4 assess effectiveness of actions taken
5 report findings to department and hospital wide

Question 23

flowchart

Answer 23

pictorial representation of the steps necessary in a process. helps in identifying the steps in a process and who is responsible for those actions.

Question 24

flowchart standardized shapes

Answer 24

ovals to identify the beginning or the end of a process.
rectangles indicate an action to be taken.
diamonds represent a decision to be made.

Question 25

QI process

Answer 25

each department evaluates strengths and needs to formulate and implement QI standards. many processes already outlined by professional organizations (ACR, AAPM, ACMP, and NRC).

Question 26

continuous QI methods–lean

Answer 26

system wide set of methods and tools for improving a process (developed by automobile industry (1910), emphasizing speed and efficiency, very simple and easy to implement). 5 whys exercise (asking progressive questions about a perfieved difficulty forces team members to think critically about the actual sources of waste and inefficiency.

Question 27

continuous QI–once the QI committee determines the root cause they can then try to:

Answer 27

implement further training, ensure compliance with existing standards, or eliminate other barriers.

Question 28

goal of continuous QI

Answer 28

to identify the ROOT CAUSE of a problem so that it can be eliminated at the deepest level

Question 29

continuous QI methods–six stigma

Answer 29

improvement of a process through precision and accuracy, through elimination of defects.
1 use all data to find root cause
2 its not a people problem, look at “process” problem
3 its a continuous process; always look and readjust

Question 30

components of a continuous QI plan

Answer 30

1 ecaluation of quality and appropriateness of care
2 evaluation of patterns or trends
3 assessment of individual clinical events
4 action to be taken to resolve identified problems
5 identification of indicators to monitor acceptable thresholds
6 methods of data collection
7 annual review of QI plan for effectiveness

Question 31

routine QC–major component of any RAD ONC QUI plan focuses on QC of:

Answer 31

simulator, image processing equipment, immobilization device, accessory equipment, treatment planning systems, treatment units and their safety equipment