TEST 2 - UNIT B - EF - QUALITY IMPROVEMENT Flashcards
The focus of quality improvement (QI) is
improving quality of care and client safety.
QI and quality assessment (QA) are different approaches to achieving
similar outcomes. The QI approach is proactive and process driven, whereas the QA approach is reactive and problem driven.
Basic steps in the QI process include
identifying, analyzing, developing, and testing/implementing.
Standardization is the part of the QI plan that makes a
process manageable, consistent, and easier to monitor.
Quality indicators include measures that monitor client safety and identify
potential risks of client interactions.
Nursing-sensitive quality indicators focus on
elements of client care that are affected by nursing care; they are classified as either structure, process, or outcome indicators.
The most common QI model is the
plan–do–study–act (PDSA) model.
QI tools used in the improvement process include
flow charts, histograms, and run charts.
Continuous quality improvement (CQI) is the
ongoing measurement, assessment, and improvement of quality initiatives to provide quality care and safety to clients.
Under CQI, a risk management (RM) plan is developed that includes
incident reporting, CEA, and sentinel, adverse, and never events.
Client satisfaction, cost-effective care, and performance evaluation are also part of a
RM plan.
There are both differences and overlaps among
QI, EBP, and research.
QI evaluates
effectiveness of nursing care and steps to improve care to achieve positive clinical outcomes.
EBP integrates
research with clinical knowledge and client values to improve practice.
Research is a
systematic approach to test theories and determine which practices would generate an improvement of quality of care.
· adverse event
o Any event that is not consistent with the desired or normal operation.
· audit
o Identifies errors or discrepancies of documentation of nursing care.
· continuous quality improvement (CQI)
o An ongoing measurement, assessment, and improvement of quality initiatives to provide quality care and safety to clients utilizing the QI tools and models.
· cost-effective
o The minimal expense of dollars, time, and other elements used to achieve results.
· cost-effectiveness analysis (CEA)
o Compares health care interventions to see which is most effective for the least amount of money without producing negative client outcomes.
· evidence-based practice (EBP)
o A problem solving approach to client care that uses the most accurate scientific evidence partnered with clinical expertise and client values.
· histogram
o A specific form of a bar chart that displays the distribution of continuous numerical value.
· Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
o A data collection survey utilized to measure client’s perception of their inpatient experience.
· Leapfrog Group
o A nonprofit organization that conducts free, annual surveys of hospitals and ambulatory care centers on a voluntary basis. Measurements included in the survey align with TJC, CMS, and the Centers for Disease Control and Prevention (CDC).
· never event
o An adverse event that should never occur.
· outcomes
o Includes measurable results that may be positive or negative.
· plan–do–study–act (PDSA) model
o A four-step process for quality improvement that includes plan, do, study, act.
· process
o Measures the mechanisms of the care provided.
· process flow chart
o A visual diagram used to clarify a complex process by providing a visual view of the steps in a sequential manner
· quality assurance (QA)
o Reactive, problem-driven measures to improve client outcomes and improve healthcare delivery.
· quality core measures
o Are standardized processes and best practices created to improve client care.
· quality improvement (QI)
o Proactive, process-driven, systematic actions to improve client outcomes and improve performance in healthcare delivery.
· randomized controlled trial (RCT)
o A research study in which study participants are randomly divided into 2 or more groups. After being assigned to groups, participants in one group receive the treatment being tested while clients in the other group receive a standard or control treatment.
· risk management (RM)
o The identification, evaluation and prioritization of risks to eliminate or mitigate their probability or severity or to leverage opportunities.
· root cause analysis (RCA)
o A systematic process that focuses on identifying the cause of an event and developing an action plan with strategies aimed at preventing future events.
· run chart
o A visual aid using lines to connect data points depicting how a process or information has changed over time.
· sentinel event
o Any event causing serious injury or death to a client in healthcare facility. Sentinel events can include, medication error, transfusing the wrong blood type, client suicide, or wrong-site surgery.
· standardization
o The process of creating and implementing consistent guidelines, methods, steps, processes, or practices that improve the quality of care and client safety.
· structure
o The condition or environment in which the care is provided.
The nurse should evaluate the results of the change to determine
effectiveness.
after idenitfying a problem what is the next step to take, Evidence-based practice indicates the next step the nurse should take is
to complete a literature review using credible sources of evidence.
Outcome audits are a
quality improvement tool used to measure the results of client care.
Routine equipment checks are not part of an
outcome audit.
Quality assurance is a system that focuses on a
problem-driven approach to improve client outcomes and promote a safe physical environment.
Routine maintenance checks are part of the
quality assurance process and are performed to ensure equipment is in proper working order.
The case manager coordinates client care throughout the course of an
illness. Routine equipment checks are not part of a case manager’s responsibility.
Quality improvement (QI) is a system that focuses on a
preventative approach to improve client outcomes and promote a safe physical environment.
Routine equipment checks are not part of a___ program.
QI
After completing a literature review, what is the next step to take? EBP indicates the next step the nurse should take is to
recommend changing the procedure to the policy and procedure committee.
NPSGs were established to
improve quality of care by addressing certain client safety concerns.
Client safety concerns include
infection prevention, reduced medication and surgical errors, improved client identification, and increased communication among staff members.
Improving staff retention is not a goal addressed in the
NPSGs.
Increasing client satisfaction is not a goal addressed in the
NPSGs.
Increasing client involvement in their plan of care is not a goal addressed in the
NPSGs.
The HCAHPS tool is provided to clients
48 hr to 6 weeks after discharge from a facility to measure client satisfaction of health care service.
The HCAHPS tool is issued to clients via a
phone call or through the postal mail.
The HCAHPS tool is issued to measure
client satisfaction about health care service.
HCAPS information is publicly reported and ensures the
accountability and transparency of the facilities that participate.
The “Study” step of the PDSA model includes
reviewing the data and summary of the results of the plan.
The “Plan” step of the PDSA model includes
the creation of a plan to implement the process change.
The “Do” step of the PDSA model includes
implementing the plan.
The “Act” step of the PDSA model includes
acting or adapting to the changes according to the testing.
Recognizing a problem is part of the _______ step in EBP. (Evidence Based practice)
*identifying
Evaluating whether the practice changes decreased the infection rate is part of the ____ step of EBP.
*reviewing
Researching credible sources of evidence for best practices is part of the ______ step in EBP.
searching
Incorporating the new practice into client care is part of the _______ step of EBP.
implementing
The four criteria used to identify core measures are
research, proximity, accuracy, and adverse effects.
Quality core measures are standards of care required for
health care facilities to ensure they are providing best practices of care.
Core measure data is collected by the health care facility and is submitted to
The Joint Commission.
Implementing the new guidelines to decrease client falls is part of the _____ step of the PDSA model.
Do
Developing guidelines to decrease falls is part of the_____ step of the PDSA model. In the planning step, the need for a change is identified, and plans are developed to initiate the change.
“Plan”
Reviewing whether the new guidelines are effective in reducing client falls is part of the____ step of the PDSA model.
“Study”
Accepting the new guidelines to reduce client falls is part of the______ step of the PDSA model.
“Act”
A study examining environmental factors that lead to obesity is an example of a
case-controlled study.
A study comparing a group of people who have diabetes mellitus with a group of people who do not have diabetes mellitus is an example of a
case-controlled study.
A study examining the cause of falls in a long-term care facility is an example of a
case-controlled study.
The nurse should include that a study randomly assigning people who smoke into either an experimental group or a control group to determine the effects of a new therapy to reduce smoking is an example of a
RCT.???? Confirm what this means
Benchmark is a part of
quality measurement that is based on a desired industry standard.
A benchmark is a
desired standard to guide quality improvement.
Structure is a *
quality measurement category that includes the environment in which care is provided, such as staffing, availability and function of equipment, and layout of a facility.
Outcome is a *
quality measurement category that includes the results of care that was provided.
Outcome evaluates the *
effectiveness of care delivered, such as wound healing or presence of infection.
Medication reconciliation is included in the process category of *
quality measurement.
The process category includes activities of
delivering care, such as administering medications, implementing fall precautions, and performing a medication reconciliation.
A client vomiting after receiving an oral medication is not a situation that requires an
incident report. The nurse should notify the charge nurse or the provider if this occurs.
A client refusing to take a medication is not a situation that requires an
incident report. The client has the right to refuse, and the nurse should notify the charge nurse or the provider if this occurs.
The nurse should administer time-critical medications within
30 min before or after the scheduled time.
Administering the wrong medication to a client requires an
incident report. The nurse should monitor the client for adverse effects and report the incident to the charge nurse or the provider.
Developing a plan to implement change is included in the _____ step of the QI process.
developing
Evaluating the results of the plan is part of the_______&_________step of the QI process. In this step, the nurse determines whether revisions to the plan are needed.
testing and implementation
In this step, of the QI process, the nurse determines whether revisions to the plan are needed.
testing and implementation
Recognizing a problem and a need for change is included in the______ step of the QI process.
identifying
Implementing the plan is included in the_____step of the QI process.
implementation
According to EBP, the first action the nurse should take is to
identify a clinical problem.
A sentinel event is a
serious, reportable event that results in death, permanent harm, or severe injury to a client.
Examples of sentinel events include
wrong site surgery, client suicide while in a health care facility, and infusion of an incompatible blood product.
A client fall is considered an
adverse event that requires an incident report.
An incident report is used to
evaluate the cause of an incident in an effort to prevent the incident from occurring again.
If a client who is confused wanders out of a unit, it is considered an
adverse event that requires an incident report.
A needlestick injury is considered an
adverse event that requires an incident report.
