Risk Management, Quality Improvement, and Patient Safety Rights Flashcards
What is quality?
Doing the right thing at the right time in the right way to the right person AND having the best possible results
What are the 6 QI aims?
- safe
- effective
- efficient
- equitable
- timely
- patient-centered
What is Risk Management (RM)?
Processes to identify, evaluate, and control risk
Minimizes negative outcomes
What’s the difference between QI and RM?
- QI – making sure “good things” happen
- RM – reducing the likelihood that “bad things” will happen
The technical term for “bad things” is ______
adverse events
Darling v. Charleston Community Memorial Hospital
- Concept of charitable immunity is challenged
- opens hospitals to liability via negligence
What is an Enterprise Risk Management (ERM) approach?
Process that focuses on identifying and eliminating financial impact and volatility of a risk portfolio
Who governs RM?
state law
Steps in a RM program (4)
- Risk identification
- Risk evaluation
- Strategic risk response and implementation
- Review, evaluate,e and monitor whether objectives are being met
What is Risk identification?
- Systematic means of identifying potential risks.
- Requires understanding of facility’s business, legal, organizational, and clinical components
What is risk evaluation and assessment?
- Identifying which risks should be proactively addressed and which risks are lower in priority
What is strategic risk response and implementation?
- Applying risk control and risk financing techniques to determine how risk should be treated
Tools of Risk Management: A claims management program
requires knowledge of insurance polices
Tools of Risk Management: Incident Reporting
Helps to identify and respond to adverse events and occurrences inconsistent with standard of care
Incident documentation should be _____, concise, and present only the facts
objective
What is the Role of the Health Record in Risk Management?
Determine deviation from the standard of care
The JC’s def of sentinel events
A patient safety event not primarily related to the natural course of a patient’s illness or underlying condition that reaches the patient and results in death or severe hardship/disability.
Do incident reports go into the pt’s health record?
No, therefore, it is not subject to legal discovery
(NOTE: unless it results in pt death –> will show up in EHR).
JC requires _____ for sentinel events if commissioned by JC
root cause analysis (RCA)
Who develops definitions of sentinel events?
the organization
National patient safety goals
yearly goals to improve pt safety
JC Safety goals: requirements that support documentation (5)
- two pt identifiers
- final verification before invasive procedures
- read-back of verbal orders/results
- standardized abbreviations/acronyms
- improve the timeliness of reporting/test results
Healthcare Research and Quality Act of 1999
- created AHRQ to develop and promote error-reducing strategies
What does PSRO do? (1972)
Review the medical necessity of care
IOM report: To Err is Human year
1999
Office of the Nat’l Coordinator for Health IT(2004)
- coordinate nationwide efforts to advance the use of HIT and the electronic exchange of health info
Crossing the Quality Chasm establishes “Six Aims” year
2001
2005 Patient Safety and Quality Improvement Act (Patient Safety Rule)
AHRQ gets oversight responsibility for the creation and monitoring of PSOs
What does the office of civil rights do?
enforces the confidentiality provision of the Patient Safety Rule
ACA and National Quality Strategy
Quality initiatives to avoid costly mistakes, reward quality in a family-centered manner
National Quality Strategy: QIN-QIOs
Work with providers, stakeholders, and Medicare beneficiaries to improve patient safety, reduce harm, engage patients and families, and improve clinical care at the local and regional levels.
National Quality Strategy: BFCC-QIOs
Perform quality of care (medical case) and medical necessity reviews.
Examples of Reporting of Quality and Patient Safety Measures (3)
- medicare care compare
- HealthGrades
- Leapfrog
Patient Rights (6)
- care (and right to accept/refuse treatment)
- respect
- pt empowerment
- consideration of fam involvement
- ensure pt is edu abt their conditions
- informed abt health info use/disclosure
Sources of Pt rights (6)
- AHA Patient Care Partnership
- JC Standards
- Medicare Conditions of Participation
- Affordable Care Act (ACA)
- State laws
- Organizational patient rights policies
Rights of patients with mental illnesses
Involuntary civil commitment is permitted if the patient is a danger to self or others
Pt seclusion
Involuntary confinement of a patient alone in a room or area; patient is prevented from leaving
Pt restraint
Device or drug that restricts an individual’s movement; is not for diagnosis, treatment, or patient protection
