Quality Improvement Flashcards
What does the Institute of Medicine (IOM) say about what type of errors take place in hospitals?
98k die from medical errors in hospitals
Mainly medication errors than workplace injury
To Err is Human meaning
From the IOM - The problem isn’t bad people - it is good people working with bad systems.
Crossing the Quality Chasm
From IOM as well
Need to make a fundamental change in the hospital system to close the quality gap which led to the American health system redesign
Six aims of IOM
Safe
Effective
Patient centered
Timely
Efficient
Equitable
How did the focus of safety change in general?
Healthcare cared about safety but then it became a main focus
T/F
Healthcare has been using simulation for teaching for decades
False. We still don’t have enough simulations
Explain the Fifth and final step of the Management Process (3 steps)
- Evaluate services given to patient.
- Compare the care given to them to the standard
- And if workers don’t meet those standards, we take action to correct the gap.
Management controlling functions (3)
- Periodic evaluation
- Measurement of performance of individual and group
- Auditing goals
Hallmarks of effective quality control programs?
Support from top-level administration
Commitment of resources (human & fiscal)
Goals that exceed the standard
Continuous processing and improvement
What type of goals do quality improvement programs have?
Goals that exceed the standard
What type of resources do quality control programs have?
Fiscal and human resources
What type of support do quality programs have?
Support from top level administration
What type of progression do quality improvement programs have?
Continuous progress and improvement
First steps of the Quality Control Process
- Determine the criterion or standard
Second steps of the Quality Control Process
- Collect information to determine if the standard was met
Third steps of the Quality Control Process
- Education or corrective action taken so that we can meet the criteria
Steps in Auditing Quality control (8)
Establish control criteria
Identify the information relevant to he criteria
Determine ways to collect info
Collect and analyze info
Compare info
Make judgement about the quality
Provide information take corrective action if necessary
Re-evaluate
Define Standards
Predetermined baseline condition or level of excellence that constitutes a model to be followed and practice
- should be individual to each organization and profession for safety
Define Quality Gap
Difference in performance between top performing health care organization and the national average
- if its a big gap, you want take action to close it
Define Benchmarking
Process of measuring products, practices, or services against a best performing organization
- can be in any industry
Used to determine how your own organization differences from a top competitor & to use them a role model as a quality for the brand
What strategies can help us determine why a benchmark difference occurs?
Critical event analysis
Root cause analysis
- they analyze the why so we can learn from our mistakes and prevent future mistakes
Root cause analysis
Investigate the errors and factors that that took place by risk management department which lead up to the mistake
Frequent audits used in quality control (3)
Structure
Process
Outcome
Explain structure audit
Monitor setting structure in which patient care occurs
- inputs, environment , patient room
- staffing ratios and mix , wait time
Things that contribute to less quality
Explain process audit
Measuring the process of care or how the care was carrie out (how nursing care was provided)
- bp checks, fetal heart tones, etc
Explain outcome audit
Determine the results that occurred because of specific nursing interventions
What is the best indicator of quality outcomes from the audits?
Outcome audit
Why do we use standardized nursing language?
It helps nurses stay on the same page. Usually used with the software. And helps make gathering audits a lot easier.
T/F
We can separate the nursing interventions from other disciplines to see how nursing effects patient outcomes
True. This is good because it allows us to have accountability and to grow
Nursing sensitive structure audit
supply o fnursing staff
skill
educatoin of staff
Nursing sensitive process audit
assessment, intervention, and job satisfaction
nursing sensitive outcome audit
patient outcomes that improve if there is better nursing care and quality
T/F
Nurses should practice to the full extent of your license
False. This means minimal standards. Nurse should practice to full extent of their education.
What should the relationship be between nurses and doctors
Full partnership
What are Clinical Practice Guidelines
Diagnosis based step by step interventions for physicians and nurses to follow to provide good care
- based off the evidence
What model has the American health system chagned to
Went from quality assurance to quality improvement
Quality assurance vs quality improvement
Quality assurance - targets existing quality
Quality improvement - targets ongoing and continually making improvements
TPS - toyota production system
Complete elimination of waste ?
The joint commission includes
Oryx
Core measures
National Patient Safety Goals
Oryx of Joint commision
Took outcome measures of quality and make it apart of the accreditation processes
Core measures of joint commission
Core measures includes
Sentinel event
errors, misses
re-admissoin rates for same problems
rate of HAI
Core measures of 2019
pg. 635
Recordable and reportable data
- acute MI
- children asthma care
- ED visits
- hospital outpatient department
- inpatient psych
- immunizatoin
- prenatal care
- stroke
- venous thrombo embolism
- pneumonia
- heart failure
National patient safety goals
Augment and promote specific improvements in safety
Sentinel events (serious) that have to be reported to the Joint commission
serious med errors
significant drug reactions
wrong surgical sites
blood transfer reactions
infant abductions
Define sentinel event
Patient safety events that results in death, permanent harm, or severe temporary harm
What is CMS
Centers for medicare and medicaoid
Pay for performance by CMS
Hospital performance effects reimnbursement
HCAHPS
Hospital consumer assessment of healthcare providers and systems
What HCAHPS
National, public survey for patients
- first of kind
- measures their perception of hospital performance
T/F
Vast majority of med errors are on the individual
False. Usually a system issues. Hospitals should be more focused on the system
EBP referral
Send a patient to a better hospital
Better reporting of the error
Leapfrog initiative
Reform medical liability system - diligent in civil law suit
Point of care strategies
- bar coding
- smart iv pumps
- med reconciliation
National quality forum
Endorses safe practices
4 Leapfrog initiatives
Computerized physician order entry to cut down safety issues
EBP referral
ICU physician staffing
Leapfrog safe scores
Computerized physician order entry
to cut down safety issues and readibility
Computerized physician order entry to cut down safety issues
EBP referral
ICU physician staffing
Intesivist or specialized icu doctors help outcomes
QSEN
patient centered care
teamwork colloboration
EBP
Quality improvement
safety
informatics
What type of resources do quality control programs have?
Fiscal and human resources
