Week 6: Chapter 22- Understanding Quality, Risk and Safety Flashcards
A new graduate is asked to serve on the hospital’s quality improvement (QI) committee. The nurse understands that the first step in quality improvement is to:
a. Collect data to determine whether standards are being met.
b. Implement a plan to correct the problem.
c. Identify the standard.
d. Determine whether the findings warrant correction.
ANS: C
Identifying standards most important to the user of health care services is the first step in a six-step process for quality improvement.
The chief executive officer asks the nurse manager of the telemetry unit to justify the disproportionately high number of registered nurses on the telemetry unit. The nurse manager explains that nursing research has validated which statement about a low nurse-to-patient ratio?
a. “It promotes teamwork among health care providers.”
b. “It increases adverse events.”
c. “It improves outcomes.”
d. “It contributes to duplication of services.”
ANS: C
Findings related to staffing and patient outcomes suggest that patient outcomes are improved with a low ratio of nurses to patients and especially with a low ratio of registered nurses to patients.
A nurse manager wants to decrease the number of medication errors that occur in her department. The manager arranges a meeting with the staff to discuss the issue. The manager conveys a philosophy of total quality management (QM) by:
a. Explaining to the staff that disciplinary action will be taken in cases of additional
errors.
b. Recommending that a multidisciplinary team assess the root cause of errors in
medication.
c. Suggesting that the pharmacy department explore its role in the problem.
d. Changing the unit policy to allow a certain number of medication errors per year
without penalty.
B
The nurse educator of the pediatric unit determines that vital signs are frequently not being documented when children return from surgery. According to QI, to correct the problem the educator, in consultation with the patient care manager, would initially do which of the following?
a. Talk to the staff individually to determine why this is occurring.
b. Call a meeting of all staff to discuss this issue.
c. Have a group of staff nurses review the established standards of care for
postoperative patients.
d. Document which staff members are not recording vital signs, and write them up.
ANS: B
Leaders must identify safety shortcomings and must locate resources at patient care levels to identify and reduce risks. One method of doing this is to invite all staff into a discussion related to solutions to an identified concern. This approach encourages teamwork.
A nurse is explaining the pediatric unit’s QI program to a newly employed nurse. Which of the following would the nurse include as the primary purpose of QI programs?
a. Evaluation of staff members’ performances.
b. Determination of the appropriateness of standards.
c. Improvement in patient outcomes.
d. Preparation for accreditation of the organization by The Joint Commission.
C
The primary purpose of QI is improvement of patient outcomes. Quality improvement refers to an ongoing process of innovation, prevention of error, and staff development that is used by institutions that adopt the QM philosophy.
Before beginning a continuous QI project, a nurse should determine the minimal safety level of care by referring to which of the following?
a. The procedure manual.
b. Nursing care standards.
c. The litigation rate of unsafe practice.
d. Job descriptions of the organization.
B
The nurse gives an inaccurate dose of medication to a patient. After assessment of the patient, the nurse completes an incident report. The nurse notifies the nursing supervisor of the medication error and calls the physician to report the occurrence. The nurse who administered the inaccurate medication understands that:
a. The error will result in suspension.
b. An incident report is optional for an event that does not result in injury.
c. The error will be documented in her personnel file.
d. Risk management programs are not designed to assign blame.
ANS: D
QM emphasizes improving the system, rather than focusing on staff errors. If errors occur, reeducation of staff is emphasized rather than imposition of punitive measures such as disciplinary action or blaming.
The nurse manager is concerned about the negative ratings that her unit has received on patient satisfaction surveysN. The first step in addressing this issue from the point of view of
quality improvement is which of the following?
a. Assemble a team.
b. Establish a benchmark.
c. Identify a clinical activity for review.
d. Establish outcomes.
C
With the rise of workplace violence in the emergency department, the nurse manager decides that she should work with the risk manager in violence prevention. The nurse manager should:
a. Request all staff to accept new risk management practices.
b. Hold staff accountable for safe practices.
c. Document inappropriate behaviour.
d. Hire more police security.
B
The nurse manager is performing a root-cause analysis related to medication administration errors with insulin. A root-cause analysis is very similar to the QI process except that a root-cause analysis is:
a. Retrospective.
b. Prospective.
c. Legislated for completion with all near-miss events.
d. Conducted by only one person.
ANS: A
A root-cause analysis is very similar to the QI process described in this chapter except that the root-cause analysis is a retrospective review of an incident to identify the sequence of events with the goal of identifying the root causes of the incident and may lead to the development of specific risk-reduction strategies.
In determining the relationship between injury-producing falls and proposed preventive measures as part of the QI process, a QI team might turn to which of the following for confirmatory evidence?
a. Best Practice Guidelines (BPGs).
b. North American Nursing Diagnosis Association (NANDA).
c. National Quality Institute.
d. Agency for Healthcare Research and Quality.
A
The Registered Nurses’ Association of Ontario launched the Nursing Best Practice Guidelines (BPGs) program. To date, the program team has developed and disseminated 50 guidelines covering clinical topics in five broad areas: gerontology, primary health care, home health care, mental health care, and emergency care.
As a nurse manager, you know that the satisfaction of patients is critical in making QI decisions. You propose to circulate a questionnaire to discharged patients, asking about their experiences on your unit. Your supervisor cautions you to also consider other sources of data for decisions because:
a. The return rate on patient questionnaires is frequently low.
b. Patients are rarely reliable sources about their own hospital experiences.
c. Hospital experiences are frequently obscured by pain, analgesics, and other factors
affecting awareness.
d. Patients are reliable sources about their own experiences, but are limited in their
ability to gauge clinical competence of staff.
ANS: D
Patients are reliable and motivated sources of their own experience but often do not have sufficient knowledge of clinical procedures to provide feedback about clinical competence.
An example of an effective patient outcome statement is:
a. “Eighty percent of all patients admitted to the emergency department will be seen by a nurse practitioner within 3 hours of presentation in the emergency department.”
b. “Patients with cardiac diagnoses will be referred to cardiac rehabilitation programs.”
c. “The hospital will reduce costs by 3% through the annual budget process.” d. “Quality is a desired element in patient transactions.”
ANS: A
Statements about patient outcomes must include measurable, specific, and patient-centred information.
Patient perceptions are useful in:
a. Determining disciplinary actions in QI.
b. Establishing the competitive advantage of QI decisions.
c. Establishing priorities among possible changes to care identified in QI.
d. Establishing blame for poor-quality care.
C
The outcome statement “Patients will experience a 10% reduction in urinary tract infections as a result of enhanced staff training related to catheterization and prompted voiding” is:
a. Physician sensitive and nonmeasurable.
b. Measurable and nursing sensitive.
c. Precise, measurable, and physician sensitive.
d. Patient care centred and nonmeasurable.
ANS: B
Nursing-sensitive outcomes are outcomes that are affected by nursing activity and are precise, measurable, and patient centred.
