WEEK 3--Quality improvement / safety--(REARDON)

Question 1

Institute of Medicine’s (IOM)’s six guiding aims for Quality Improvement.

Answer 1

HINT: STEEEP

S-afety—-preventing injuries to patients

T-imely—reduce waits/delays for those who give and receive care

E-ffective–provide service based on EBP to those that would benefit, and refrain from providing services to those not likely to benefit

E-fficient–preventing the waste of equipment, supplies, ideas, and energy

E-quitable–providing care that does not vary based on personal characteristics (gender, ethnicity, geographic location and socioeconomic status)

P-atient Centered Care–care to include patients and their families. Patient values guide all clinical decisions

Question 2

CORNERSTONES OF QUALITY IMPROVEMENT

(3)

Answer 2

1. QUALITY (the customer perspective of quality)
2. SCIENTIFIC APPROACH (improvements to an organization must be based on sound, valid data
3. “ALL ONE TEAM” (embodies the principles of believing in people, treating everyone in the workplace with dignity, trust and respect with all working together)

Question 3

FIRST NATIONAL, STANDARDIZED, PUBLICLY REPORTED SURVEY OF PATIENTS’ PERSPECTIVES OF HOSPITAL CARE

Answer 3

Hospital Consumer Assessment of Healthcare

Providers & Systems (HCAHPS)

Question 4

HCAHPS

Answer 4

HOSPITAL CONSUMER ASSESSMENT of HEALTHCARE

PROVIDERS and SYSTEMS

(national, standardized, publicly reported survey of patients perspectives of the hospital)

Question 5

GOALS (4) OF Hospital Consumer Assessment

of Healthcare Providers & System (HCAHPS)

Answer 5

1. Produce data about pt perspectives of care that allow objective and meaningful comparisons of hospitals on topics that are important to consumers
2. CREATES INCENTIVES FOR HOSPITALS TO IMPROVE QUALITY OF CARE
3. Enhances accountability in health care
4. Impacts Medicare reimbursement via Value-Based Purchasing (reimbursement model)

Question 6

MAJOR AREAS (7) OF PATIENT EXPERIENCE / SATISFACTION

THAT ARE EVALUATED WITH HCAHPS

Answer 6

1. Communication with Nurses
2. Communication with Doctors
3. Communication about medication
4. Cleanliness/quietness of the hospital
5. responsiveness of hospital staff
6. Discharge information
7. Overall rating of hospital

Question 7

HOURLY ROUNDING was implemented

to——–

(4 P’s)

Answer 7

1. decrease the number of call lights
2. Decreased patient falls (est.cost / fall = $11,000/incident)
3. Improved pt satisfaction
4. Decreased skin breakdown (pressure ulcers)

Pain, Position, Possessions, Potty

Question 8

HALLMARKS OF EFFECTIVE QUALITY

CONTROL PROGRAMS

Answer 8

1. Support from top-level administrators
2. Commitment from the organization in terms of fiscal and human resources
3. Quality goals reflect the search for excellence rather than minimums
4. The process is ongoing and continuous

Question 9

Higher spending does NOT always result in higher

quality care. Sometimes it represents

(3)

Answer 9

1. Duplication of services
2. over-utilization of services
3. use of technology that exceeds a particular patients needs

Question 10

UNITED STATES SPENDS MORE MONEY ON

HEALTHCARE THAN ANY OTHER COUNTY

IN THE WORLD:

US ranks _________ out of 36 for infant mortality

US Ranks _____ and ____ for female/male mortality

US ranks ___ for life expectancy

Answer 10

33 (infant mortality)

42nd and 43rd (female/male mortality)

36th (life expectancy)

Question 11

Where does and organizations money get

budgeted to…?

(3)

Answer 11

1. Personnel ^{<em>(LARGEST EXPENDITURE)</em>}
   
   1. Workforce (all employed by the organization) b/c health care is labor-intensive
2. Operating Budget
   
   1. Expenses that change in response to the volume of service (ie, electricity, repairs, supplies, maintenance)
3. Capital
   
   1. purchase of buildings
   2. purchase of equipment that has a long life (>1 year)
   3. items with HIGH cost (> $5,000)

Question 12

HOW ARE HOSPITALS PAID?

(4)

Answer 12

1. Indemnity Plan (FEE FOR SERVICE) (FFS)
   
   1. Least restrictive-reimbursed fully on an unlimited basis
   2. reimbursement was based on costs incurred to provide the service, PLUS profit (fee-for-service), with no ceiling on the total amount that could be charged.
   3. encouraged over-treatment
   4. skyrocketing healthcare costs
2. Managed Care (POS) or (PPO)
   
   1. Point of Service (POS)- permitted out of network
   2. Preferred Provider Organization (PPO)
      
      1. GOALS-minimize payment for excessive healthcare services, use the least expensive option.
      2. Review and Oversight- MD/Nurse at insurance company reviews the necessity of service-approves or denies
3. Consumer-Driven Healthcare Plan (CDHP)
   
   1. Pre-tax dollars deposited by employer or employee into HSA or Health reimbursement account (HRA)
   2. High deductible plan=higher annual deductible and out-of-pocket than traditional plans
   3. tradeoff= lower monthly premium
4. TRICARE (military coverage)

Question 13

what is standard?

(5)

Answer 13

• a predetermined level of excellence that serves as a guide for practice
• known as: BEST KNOWN METHOD of BEST PRACTICE
• based on scientific evidence (NOT haphazard)
• uniform and systematic method
• perform procedures based on the standards, as compared to learning by watching
• employees trained on standards

Question 14

What is Benchmarking?

Answer 14

• a tool that compares the performance of an individual/organization to industry standards.
• allows the organization to determine how/why their performance differs from exemplar organizations
• Developed by the American Nurses Association (ANA)

Question 15

ANA HAS ESTABLISHED STANDARD CRITERIA (3) AND CRITERIA THAT THE STANDARDS MUST (3)….

Answer 15

CRITERIA FOR STANDARD

• Predetermined
• Established by authority
• Communicated to and accepted by the people affected by them

STANDARDS MUST BE….(CRITERIA)

• Objective
• Measurable
• Achievable

Question 16

DIFFERENCE BETWEEN Clinical Practice Guidelines (CPG’s) and Clinical Pathways/Protocols?

Answer 16

CPGs reflect broad statements of best practice with little operational detail, while protocols offer information that is adapted to local contexts and reflects the agreed-upon approach

Question 17

Methods of Standardization

(3)

Answer 17

1. Clinical Pathways ^{(Critical Pathways)}
   
   1. Optimal sequence/timing of interventions
      
      1. BENEFITS
         
         1. decrease in variation of care
         2. achieve expected outcomes
         3. decrease length of stay
         4. cost-effective
         5. pt / family satisfaction
2. Clinical Algorithms / Protcols
   
   1. allows for decisions based on pt status
3. Clinical Practice Guidelines ^(CPG)
   
   1. DX based, step-by-step interventions
   2. in what order interventions will lead to best possible outcome
   3. reflect research finding-best practices

Question 18

EXAMPLES OF STANDARDIZATION

Answer 18

Clinical Processes

• ­90 min door to balloon or stent
• ­Blood cultures done prior to initial antibiotic (suspected pneumonia or sepsis)
• Discharge instructions for heart failure patients
• ­Initial nursing assessment with in 1 hour of admission.
• ­SCIP (surgical care improvement measures)
  
  • ­Prophylactic antibiotic given one hour prior to incision
  • ­Indwelling catheter removed POD 1 or 2
  • ­Prophylactic antibiotic discontinued 24 hr post-op
  • ­Venous thromboembolism prophylaxis ordered on surgical patients
  • ­Cardiac surgery patients with controlled blood glucose by 6am post-op
  • ­Discharge instructions for heart failure patients

Question 19

WHAT IS TOTAL QUALITY MANAGEMENT (TQM)

Answer 19

USES DATA AND STATISTICS TO IMPROVE SYSTEMS PROCESSES

Question 20

Institute for Healthcare Improvement (IHI)—a voluntary organization formed to assist leaders in all health care settings actively involved in improving quality, recommends a QI model that is composed of two parts.

*Part one asks three fundamental questions…

*Part two uses a sequence of steps…what are those steps?

Answer 20

PART ONE:

1. What are we trying to accomplish?
2. How will we know that a change is an improvement?
3. What changes can we make that will result in improvement?

PART TWO:

PDSA cycle

• Plan ^{(plan the test or observation, including a plan for collecting data)}
• Do ^{(Try out the test on a small scale)}
• Study^{(Set aside time to analyze the data and study the results.)}
• Act ^{(Refine the change, based on what was learned from the test)}

Question 21

Define the individual parts of the PDSA cycle

(4)

Answer 21

Question 22

A team of experienced nurses works together to develop algorithms that are converted into checklists to ensure the standardization of commonly performed procedures. The focus of this team is primarily on which Institute of Medicine (IOM) competency?

A. Patient-Centered Care

B. Timely

C. Safety

D. Timely

Answer 22

C. Safety

Question 23

FIVE (5) MANAGEMENT PRACTICES THAT HAVE BEEN IDENTIFIED TO CONSISTENTLY IMPROVE NURSES WORK ENVIRONMENTS AND ARE LINKED TO QUALITY AND SAFETY.

Answer 23

1. Balance productivity and reliability (safety)
2. Create and sustain trust relationships throughout the organization
3. Actively manage the process of change
4. Involve workers in decision making pertaining to work design and workflow
5. Establish the organization as a “learning organization”

Question 24

Institute for Safe Medication Practices (ISMP)

Who are they? what do they do?

Answer 24

• A non-Profit organization is known as an educational resource for the prevention of medication errors
  
  • Provides a review of the reported med errors that were received through the “Medication Errors Reporting Program” (MERP)
  • Nurses voluntarily and confidentially report med errors and hazardous conditions that could lead to errors.

^{<em><strong>**ISMP has also developed a “Medication Safety Self Assessment” which allows nurses and other health care professionals to assess the medication safety practices in their work setting</strong></em>}

Question 25

The “three” steps in the quality control process are:

Answer 25

1. Determine the criteria or standard
2. Information is collected to determine if the standard has been met
3. Education or corrective action is taken if the criteria / standard has not been met.

Question 26

Define “Sentinel event”

Answer 26

• Safety event that reaches a patient and results in death, permanent harm, or severe temporary harm which requires intervention to sustain life.
• They signal the need for immediate investigation and response.

Question 27

EXAMPLES OF SENTINEL EVENT

Answer 27

• Elopement (unauthorized departure) of pt that leads to death or harm
• Surgery to the wrong patient/site
• Retention of foreign objects during surgery (ie, 4x4’s, instruments)
• Blood product reactions

Question 28

After SENTINEL EVENT is reported, what happens…

Answer 28

• immediate investigation on how this can be prevented in the future
• Hospitals MUST complete a report and submit it to The Joint Commission (THJ) who oversees hospitals
• Documentation of the series of events
• MAY testify before internal boards
• MAY results in legal action against hospital, doctor, nurse
• Root Cause Analysis (RCA) completed

Question 29

What is “Root Cause Analysis” (RCA)

Answer 29

1. The structured method used to analyze serious adverse events
2. IF NO HARM TO PATIENT- this is considered “Process Oriented”
3. Investigates the consequence, possible causes, and relationships that may exist.
4. Emphasis on improving delivery of care

Question 30

Federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program

Answer 30

The Centers for Medicare and Medicaid Services

(CMS)

Question 31

^{<em>(TRUE/ FALSE)</em>}

STATE LICENSING AUTHORITIES REQUIRE QUALITY MANAGEMENT ACTIVITIES AND SET QUALITY STANDARDS

Answer 31

TRUE

Question 32

The Joint Commission (TJC)

Answer 32

• Formerly JCAHO
• an organization that offers voluntary accreditation for health care organizations.
• TJC accreditation achieves a “gold seal of approval”
• TJC standards address performance in the following areas:
  
  • Patient Safety
  • Patient Rights
  • patient treatment
  • infection control

Question 33

The purpose of the National Patient Safety Goals

Answer 33

• Promote specific improvements in:
  
  • PATIENT SAFETY
  • GOALS HIGHLIGHTING PROBLEMATIC AREAS
  • EVIDENCE-BASED SOLUTIONS TO THE PROBLEMS WITH SYSTEM-WIDE SOLUTIONS WHEREVER POSSIBLE
• Goals are based on the analysis of reported sentinel events and the identified root causes of these events. Reviewed Annually

Question 34

SERIOUS AND COSTLY ERRORS IN HEALTH CARE DELIVERY THAT SHOULD NEVER HAPPEN AND ARE DEEMED “REASONABLY PREVENTABLE”

Answer 34

NEVER EVENTS

Question 35

medicare will no longer pay the additional cost of hospitalization

related to these conditions

Answer 35

NEVER EVENTS

Question 36

To date, there are __________ NEVER EVENTS

Answer 36

28

Question 37

Examples of “12” NEVER EVENTS

Answer 37

HINT: MAGIC SPUD DID

Mediastinitis (chest wall inflammation) following CABG

Air Embolism

Glycemic Control (Poor)

Infant d/c to the wrong person

CAUTI (Cath. Assoc UTI)

Surgery on the wrong person/body part

PE / DVT following ORTHO procedures

Ulcers (pressure ulcers Stage 3 or 4)

Death associated with fall

Death/Disability associated with med error/blood transfusion

Incompatibilities of the blood

Question 38

Systematic and official examination of a record, process, structure or environment to evaluate the performance

Answer 38

AUDITS

Question 39

Standards provide the yardstick for measuring quality care, _____________ are the measurement tool.

Answer 39

AUDITS

Question 40

What is an AUDIT?

^{<em><strong>2 TYPES?</strong></em>}

Answer 40

Systemic and official examination of a record, process, structure, environment, or account to evaluate performance.

RETROSPECTIVE AUDIT= performed after the patient receive the service

CONCURRENT AUDIT= performed while the patient is receiving the care

Question 41

The audits most frequently used in quality control include the _______, _________, and __________ audits.

Answer 41

OUTCOME

PROCESS

STRUCTURE

Question 42

Three (3) types of audits

Answer 42

OUTCOME AUDIT

• outcomes occurred as a result of specific nursing interventions.
• End result of care. How did the patient’s health status change as a result of an intervention?
• EXAMPLE: ^{pt fall rates, nosocomial infection rates, the prevalence of pressure sores, restraint use, pt satisfaction rates}

PROCESS AUDIT

• They measure how nursing care is provided.
• Task-oriented. focus on whether practice standards are being fulfilled.
• EXAMPLE: ^{<em>did parents receive instruction about newborn during the first postpartum visit?</em>}

STRUCTURE AUDIT

• Review the relationship between quality of care and resource input
  
  • ^{<em>the environment in which health care is delivered</em>}
  • ^{<em>staffing ratios</em>}
  • ^{<em>staffing mix</em>}
  • ^{<em>Emergency Department wait times</em>}
  • ^{<em>availability of fire extinguishers</em>}
• EXAMPLE: ^{pt call lights in place? can the pt reach their water pitcher? Is the staffing pattern sufficient to meet pt needs?}

Question 43

WHICH QUESTION IS ASKED MORE THAN ANY OTHER ROOT CAUSE ANALYSIS ACTIVITY?

a. WHAT?
b. WHY?
c. WHO?
d. WHEN?

Answer 43

B. WHY

• Root cause analysis activities ask “WHY”, rather than “WHO”, which would place blame on a person or group of people:
• WHAT? WHEN? are barely every asked

Question 44

Two (2) significant nursing

functions that mostly affect

• Patient safety
• quality of care
• resulting outcomes

Answer 44

1. The nurse’s ability to monitor for early recognition of adverse events, complications, and errors
2. Nurses’ ability to initiate deployment of appropriate care providers for timely intervention, response, and rescue of patients in these situations. ^{(ie, rapid response team)}

Question 45

National Database of Nursing Quality Indicators (NDNQI) established a list of nursing “quality indicators” that strongly affect patient clinical outcomes for two (2) purposes.

Answer 45

1. to provide comparative data to health care organizations to support QI activities
2. to develop national data to better understand the link between nurse staffing and patient outcomes

Question 46

National Database of Nursing Quality Indicators (NDNQI) established a list of nursing “quality indicators” that strongly affect patient clinical outcomes. What are these Quality Indicators?

Answer 46

HINT: MESSIAH UTI

Mix of Staff ^{(RN, LPN, UAP)}

Education/certification of RN

Staff Satisfaction

Injury resulting from falls

Assault ^{<em>(sexual/physical</em>)}- ^{Psych only}

Hours worked per day

Ulcers ^{(hospital-acquired)}

Turnover ^{(nurse turnover)}

Infections ^(nosocomial)

Question 47

What is the nurse’s role in quality improvement?

What can you do to help?

Answer 47

• Serve as Unit rep on a committee developing policies/procedures - ^{<em><strong>use Evidence-Based Research</strong></em>}
• Enhance knowledge and understanding of the facilities policies/procedures
• Document client care thoroughly-according to facility guidelines
• Serve as a Role model

Question 48

WHO SHOULD BE INVOLVED IN QUALITY CONTROL?

Answer 48

EVERYONE!

Staff

Safety Officers

Multidisciplinary Team

Patient

Question 49

THE PRIMARY PURPOSE OF ROOT CAUSE ANALYSIS IS TO:

A. Discover a process flaw

B. Determine who erred

C. Discover environmental hazards

D. Determine basic client needs

Answer 49

A. discover a process flaw

Question 50

What is the term that is used to describe a healthcare-related incident or accident that may have possibly led to client harm?

A. Adverse Event

B. Root Cause

C. Healthcare acquired event

D. Sentinel event

Answer 50

D. Sentinel Event

Question 51

The current focus of performance improvement activities is to facilitate and address:

A. Sound structures like policies and procedures

B. Processes and how they are being done

C. Optimal client outcomes

D. Optimal staff performance

Answer 51

C. Optimal client outcomes

^{**throughout the last several decades performance improvement activities have evolved from a focus on structure to a focus on process and now, to a focus on outcomes}

Question 52

___________is an individual or group who seek a product or service and whose needs and expectations to determine the quality of the service.

Answer 52

Customer

^{<em>“A customer is an individual or group who relies on an organization to provide a product or service to meet some need or expectation. It is these customer needs and expectations that determine quality.”</em>}

Question 53

What action demonstrates a nurse’s correct understanding of patient-centered care?

1.) ^{Being careful to use costly dressing supplies appropriately but with their cost in mind}

^{2.) Discussing the client’s wish to include herbal preparations to treat an illness}

^{3.) Referring to evidence-based practice when planning client care}

^{4.) Promptly medicating clients when they request their PRN analgesic}

Answer 53

2.) Discussing the clients wish to include herbal preparations to treat an illness

^{“Patient-centered care involves providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions. Efficient care includes avoiding waste, effective care is based on scientific knowledge, and timely care focuses on reducing waits and delays in care delivery.”}

Question 54

Which nursing activity best demonstrates the quality management principle of “all one team?”

• ^{1.) Doing a search of the literature regarding the prevention of postoperative bleeding in smokers}*
• ^{2.) Asking a wound care team nurse how to best educate a client on wound prevention}*
• ^{3.) Encouraging clients to determine when they want their daily bath}*
• ^{4.) Attending a seminar on the latest recommended therapy to reinforce cognitive function in the elderly}*

Answer 54

2.) Asking a wound care team nurse how to best educate a client on wound prevention

^{<em>“Demonstrating faith in the people who comprise the health care team and recognizing the expertise of particular team members reflects the “all one team” principle. Quality is demonstrated by considering clients as those who define whether their care is appropriate and of high value. Knowledge, especially when evidence-based, demonstrates the scientific approach to client care.”</em>}

Question 55

How can a nurse manager best foster high-quality and safe nursing care among the nursing staff?

• ^{1.) Praise the staff’s efforts to provide care that is both safe and of high quality.}*
• ^{2.) Place great emphasis on how important safe, high-quality nursing care is to the client’s health.}*
• ^{3.) Create a unit culture where asking questions about health care interventions is encouraged.}*
• ^{4.) Offer incentives to those providing specific interventions that are safety and quality-focused.}*

Answer 55

3.) Create a unit culture where asking questions about health care interventions is encouraged.

^{<em>“Health care organizations focusing on quality and safety encourage inquiry, making it okay to ask questions and providing resources to access information needed through various means, including informatics. Although praise and incentives are appropriate, they are not effective if the unit culture is not accepting. Placing emphasis on such interventions alone will not be successful if not supported by nursing managers and leaders.”</em>}

Question 56

Health care institutions are automatically approved by The Centers for Medicare & Medicaid Services (CMS) under what circumstance?

^{<em>1.) The institution has earned The Joint Commission (TJC) accreditation.</em>}

^{<em>2.) The institution has demonstrated their commitment to quality improvement.</em>}

^{<em>3.) The institution has provided care to a substantial number of Medicare and Medicaid clients.</em>}

^{<em>4.) The institution has incorporated ORYX® performance measurements into their goals.</em>}

Answer 56

1.) The institution has earned The Joint Commission (TJC) accreditation.

^{<em>“Health care organizations that are accredited by TJC automatically meet foundational approval from the CMS. The other options are not true regarding CMS approval.”</em>}

Question 57

Which example of discharge teaching addresses a never event as identified by The Centers for Medicare & Medicaid Services?

^{<em>1.) Signs and symptoms of both hypo- and hyperglycemia</em>}

^{<em>2.) Need for good medication compliance in managing schizophrenia</em>}

^{<em>3.) Suggested exercise options for the immediate postdelivery period</em>}

^{<em>4.) Food choices for a low-fat, low-carbohydrate diet</em>}

Answer 57

1.) Signs and symptoms of both hypo- and hyperglycemia

^{<em>“The manifestations of poor glycemic control have been identified as a never event by The Centers for Medicare & Medicaid Services. The other options, although they are appropriate subjects for discharge education for specific clients, do not address never events.”</em>}

Question 58

What is a widely used approach of encouraging cooperation between the health care professions?

^{<em>1.) SBAR (Situation; Background; Assessment; Recommendation)</em>}

^{<em>2.) Quality and Safety Education for Nurses (QSEN)</em>}

^{<em>3.) Team Strategies and Tools to Enhance Performance and Patient Safety (Team STEPPS)</em>}

^{<em>4.) The Robert Wood Johnson Pilot School Collaboration</em>}

Answer 58

3.) Team Strategies and Tools to Enhance Performance and Patient Safety (Team STEPPS)

^{<em>“A widely used team training approach for health care teams is Team STEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety). Team STEPPS acknowledges that team training and enhanced communication are among the essential components of a comprehensive patient safety system. The SBAR technique provides a succinct, structured framework for communication among members of the health care team about a patient’s condition. QSEN is a national program with the goal of preparing future nurses with the knowledge, skills, and attitudes (KSA) necessary to continually improve the quality and safety of the health care systems in which they work. The Robert Wood Johnson Foundation supported the Pilot School Collaborative to model how faculty could include the six competencies in prelicensure programs.”</em>}

Question 59

Which actions demonstrate a nurse’s understanding and implementation of QSEN’s competencies? (Select all that apply.)

^{<em>1.) Asks for assistance when transferring a large patient onto a stretcher</em>}

^{<em>2.) Attends an in-service on a piece of equipment new to the unit</em>}

^{<em>3.) Deviates from the facility’s hand hygiene practice policy only when caring for noninfectious patients</em>}

^{<em>4.) Encourages a patient newly diagnosed with terminal cancer to talk about their end-of-life concerns</em>}

^{<em>5.) Shares a patient’s religious food preferences with members of the health care team</em>}

Answer 59

1.) Asks for assistance when transferring a large patient onto a stretcher

^{<em>“QSEN competencies are demonstrated in the sharing of patient preferences and encouraging the patient to express their needs and values (patient-centered care); asking for assistance from team members (teamwork and collaboration); learning to use equipment properly (safety). Deviating from policies and practices based on evidence-based practice without first consulting clinical experts on the subject is clearly not demonstrating EBP.”</em>}

2.) Attends an in-service on a piece of equipment new to the unit

^{<em>“QSEN competencies are demonstrated in the sharing of patient preferences and encouraging the patient to express their needs and values (patient-centered care); asking for assistance from team members (teamwork and collaboration); learning to use equipment properly (safety). Deviating from policies and practices based on evidence-based practice without first consulting clinical experts on the subject is clearly not demonstrating EBP.”</em>}

4.) Encourages a patient newly diagnosed with terminal cancer to talk about their end-of-life concerns

^{<em>“QSEN competencies are demonstrated in the sharing of patient preferences and encouraging the patient to express their needs and values (patient-centered care); asking for assistance from team members (teamwork and collaboration); learning to use equipment properly (safety). Deviating from policies and practices based on evidence-based practice without first consulting clinical experts on the subject is clearly not demonstrating EBP.”</em>}

5.) Shares a patient’s religious food preferences with members of the health care team

^{“QSEN competencies are demonstrated in the sharing of patient preferences and encouraging the patient to express their needs and values (patient-centered care); asking for assistance from team members (teamwork and collaboration); learning to use equipment properly (safety). Deviating from policies and practices based on evidence-based practice without first consulting clinical experts on the subject is clearly not demonstrating EBP.”}

Question 60

Which infections are currently considered a Never Event by Medicare and Medicaid? (Select all that apply.)

^{<em>1.) Coronary artery bypass graft site</em>}

^{<em>2.) Eye infection postcataract surgery</em>}

^{<em>3.) Site of the implanted cardiac electronic device (CIED)</em>}

^{<em>4.) Abdominal incision site associated with bariatric surgery</em>}

^{<em>5.) Catheter-associated urinary tract infection</em>}

Answer 60

1.) Coronary artery bypass graft site

3.) Site of the implanted cardiac electronic device (CIED)

4.) Abdominal incision site associated with bariatric surgery

5.) Catheter-associated urinary tract infection

^{<em>“Never Events currently include infections associated with the surgical site following coronary artery bypass graft; certain orthopedic procedures; bariatric surgery for obesity; cardiac implantable electronic device (CIED). Postcataract surgery infection is not included.”</em>}

Question 61

According to the National Patient Safety goals, how can nursing reduce the risk of patients developing associated infections? ^{(Select all that apply.)}

^{<em>1.) Creating mandatory competencies associated with the care of surgical incisions</em>}

^{<em>2.) Implementing current WHO handwashing guidelines</em>}

^{<em>3.) Instituting sterile technique policies related to the care of central lines</em>}

^{<em>4.) Ambulating postsurgical patients as soon as their physical condition allows</em>}

^{<em>5.) Striving to remove indwelling urinary catheters as soon as possible</em>}

Answer 61

1.) Creating mandatory competencies associated with the care of surgical incisions

2.) Implementing current WHO handwashing guidelines

3.) Instituting sterile technique policies related to the care of central lines

5.) Striving to remove indwelling urinary catheters as soon as possible

^{<em>“safety goals to reduce the risk of health care-associated infections include complying with either the current Centers for Disease Control and Prevention (CDC) hand hygiene guidelines or the current World Health Organization (WHO) hand hygiene guidelines; implementing evidence-based practices to prevent health care–associated infections caused by multidrug-resistant organisms in acute care hospitals; implementing evidence-based practices to prevent central line-associated bloodstream infections; implementing evidence-based practices for preventing surgical site infections; and implementing evidence-based practices to prevent indwelling catheter-associated urinary tract infections (CAUTIs). Early ambulation is not a current goal related to infection risk management.”</em>}