Final Exam

-eliminate health disparities -achieve health equity -attain health literacy to improve the health and wellbeing of all

healthy people 2030's goals include...

the Quadruple Aim focuses on the health of the care team (nurses, physicians, staff) in the effort to improve patient health, quality of care, and cost reduction

how is Quadruple Aim different from Triple Aim?

-job duties change -changing patient population -safety and infection control -team training -adverse events -PI learning needs

why is ongoing education mandated?

root cause analysis (RCA)

-identify underlying system issues while avoiding the trap of focusing on mistakes by individuals -begins with data collection and reconstruction of the event through record review and participant interviews -leads to organization-wide improvements to safety

burnout

-emotional exhaustion -depersonalization -feeling of low personal accomplishment

extroversion

-focus externally -direct energy outward and receive energy from interacting with other people and from takin action which dichotomy is this?

swiss cheese model

-represents the organization safety system -each slice represents layers of defense against a potential hazard -the holes are active failures and opportunities for failure that lie dormant in the system

comprehensive unit-based safety program a toolkit that includes training tools to make care safer by improving the foundation of how physicians, nurses, and clinical staff work together

CUSP stands for...

categories

for RCA, put errors into _____________

Maslach Burnout Inventory (MBI)

gold standard for measuring burnout

-reward high performers -review standards of care -listen

3 aspects to improve performance appraisals

-improve culture of safety -identify/prevent patient harm -optimize patient experience

3 main goals of CUSP

-listen (what matters to you) -identify unique impediments to joy -commit to making joy in work a shared responsibility at all levels -use improvement science to test validated approaches in organization

4 steps to restoring joy

-science of safety (what leads to preventable harm?) -identify defects (how is this happening?) -engage an executive (keep open communication) -learning from deficits -improve teamwork and communication

5 steps of CUSP

-identify what happened -review what should/could have happened -identify cause -make a causal statement -list recommendation on how to prevent -write a summary and share

6 steps of a root cause analysis (RCA)

-skilled communication -true collaboration -effective decision making -appropriate staffing -meaningful recognition -authentic leadership

AACN standards for a healthy work environment include...

-leadership structures and systems -appropriate staffing and staff engagement -effective communication, knowledge management, learning and development and best practices -evidence-based practice and processes -outcome measurement

BEACON award incorporates...

-highest level of education completed -reading ability

health literacy CANNOT be determined solely by...

failure mode effect analysis PROSPECTIVELY identifies and eliminates known and/or potential failures, problems, and errors in systems, designs, and process

FMEA stands for...

-advanced practice nurses should practice to the full extent of their education and training -nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression -nurses should be full partners w/physicians -we need better data collection and information

IOM's 4 key messages include...

-manage clinical alarms -improve accuracy of patient identification -improve communication -improve reporting critical results -increase medication safety -decrease harm with anticoagulants -decrease harm with clinical alarms -decrease in HAI -decrease in harms r/t falls

JCAHO safety goals include...

safe attitude questionnaire a questionnaire that focused on how communication was in the hospital

SAQ stands for...

-Specific -Measurable -Achievable -Realistic -Timed

SMART (recommended actions) stands for...

-safe -timely -effective -efficient -equitable -patient centered

STEEEP stands for...

national nursing adverse event data base that distinguishes between human and system errors

TERCAP is

behaviors

_____________ are the result of our inborn tendencies and the way we use our minds

-acuity -skill mix

a concern with mandatory ratios is that they will not consider (2)

root cause

a latent vulnerability in a system that allows an incident to occur

broad and balanced

a system approach encourages a _____________ and _____________ look at the causes of errors

Carl Jung

a theory of personality was developed by...

-principles to guiding actions begin -mentor is key

advanced beginner stage

safety huddles

at a microsystem level, the use of _____________ _____________ has been demonstrated to engage frontline staff in improving patient safety

preferences

behaviors are based on...

better staffing and work environments

better _____________ and _____________ _____________ can improve patient survival

incremental budget

budget prepared using a previous periods budget or actual performance as a basis with incremental amount saws for new budget period

-increased turnover of nursing personnel -decreased quality of patient care

burnout and job dissatisfaction often lead to what 2 things?

patient-centered care

care that respects and responds to individual patient preferences, needs, and values, ensuring that patient values guide all clinical decisions

-2-3 years in the same situation -lacks speed, but does have a feeling of mastery

competent stage

-transformational leadership -structural empowerment -exemplary professional practice -new knowledge, innovations, improvements -empirical outcomes

components of a magnet hospital

-recording -reviewing -inclusion of staff, patients, and family members

data collection and reconstruction of an event in root cause analysis should include...

burnout

deep compassion is an antidote to...

no it had no statistically or clinically significant effect on fall-related events or physical restraint use (bed alarms don't lower rate of falls!)

did the intervention designed to increase bed alarm use have a statistically significant effect on fall-related events or physical restraint use?

no they come from contributory factors

do accidents in the healthcare stem from a single linear cause?

no!

do you float a RN to a unit where they are not experienced?

no

do you want to use individuals involved in incident in root cause analysis (RCA)?

-highly proficient (5 years) -easily distinguishes poor diagnosis/solutions

expert stage

-FATIGUE -distraction -interruptions

human factors that affect safety

-make it clear that you are asking them to reiterate what you said to ensure you explained clearly (takes pressure off the patient) -limit teaching to 2-3 main points -if unwilling to teach back, have patient teach to student or family -avoid asking "yes" or "no" questions -avoid situational health literacy

important considerations for teach back method

self-scheduling

individuals schedule themselves and managers work with staff to fill in holes

restores joy

leaders of the hospital need to foster an environment that...

everyone's

managing cost is _____________'s responsibility

-rules guide performance -"just tell me what I need to do"

novice stage

worked hours per patient day (WHPPD)

number of hours per day that nursing personnel spend caring for patients

-12x an hour -while administering medications

on average, nurses are interrupted _______ times an hour and usually while doing what?

behaviors

personality is framed by our...

-able to anticipate needs -has a holistic understanding

proficient stage

analyze adverse events -5 "whys"

root cause analysis (RCA) is a structured method used to...

-what happened? -why did it happen? -how can we prevent this from happening again? -did our change prevent it from happening again?

root cause analysis (RCA) seeks to answer what 4 questions?

interprofessional 4-6 people

root cause analysis (RCA) teams should be... and how big?

system, not the individual

root cause analysis identifies issues with the _____________, not the _____________

interlocking factors

root causes may have several...

root cause analysis (RCA)

seeks to understand and respond to root causes to prevent future harm

yes they need to know what is going on and be part of the process to ensure this never happens again

should you disclose errors to patients and/or their families?

-census -acuity

staffing needs to be based on what 2 things?

it was the first study that showed changing culture in the hospital can improve pt safety and care using the SAQ (safe attitude questionnaire)

the Keystone ICU (2008) is important because...

-authority, power, and composition of a board of nursing -education program standards -standards and scope of nursing practice -types of titles and licenses -requirements for licensure -grounds for disciplinary action, violations, possible remedies

the NPA (nurse practice act) includes...

-enhancing patient experience -improving population health -reducing costs -improving the work life of healthcare providers (nurses, physicians, staff) in the effort to improve patient health, quality of care, and cost reduction

the Quadruple Aim includes...

-enhancing patient experience -improving population health -reducing costs

the Triple Aim includes...

awareness of ones own emotions and those of others

the ability to make wise choices depends on (mindfulness)

teach back method

the best method in education/health literacy to use to see how much patient knows

self-scheduling

the best staffing system to use is...

a flowsheet

the best tool used to identify what happened in a root cause analysis (RCA) is...

team training

the biggest aspect of ongoing education is...

personnel costs

the biggest cost in a budget is...

provide safe parameters within which to work as well as protect patients

the goal of NPA (nurse practice act) is to...

-quality patient care -nursing excellence -innovations in professional nursing practice

the magnet recognition program recognizes healthcare organizations for...

-root causes -contributory factors

to determine causes, you want to look at what 2 things?

staffing

variance analysis focuses on...

-reduce admissions -develop low health literacy tools -redesign from "disease management" to "healthcare system"

ways to reduce costs in hospitals

-concierge team that answers questions about their health insurance and helps schedule provider appointments -screening tool to review all information to make sure that it is written in a way that is understandable -brochures, DVDs, online interactive tools

what are some best practices to enhance health literacy?

-leader -advisor -recorder -team members

what are the 4 roles of the root cause analysis (RCA) group?

-extroversion or introversion (E or I) -sensing or intuition (S or N) -thinking or feeling (T or F) -judging or perceiving (J or P)

what are the MBTI different dichotomies?

-expanded the FDA's authority to regulate medical devices -must be reported when there are incidents involving medical devices that attributed to an injury or death

what did the SAFE Medical Device act do?

-workarounds should NOT be met with punitive action (punishment) -can't implement a process and expect to collect data based on 1 incident report -continuous post-implementation evaluation is necessary

what does the "Creating a Culture of Safety around Bar-Code Med Admin" article talk about?

-more walk rounds were associated with better safety culture result and lower burnout -leaders need to give feedback, be engaged, and follow up

what does the "Exposure to Leadership Walk Rounds" article talk about?

-alarms are ineffective -alarms must include TRENDS, CLINICAL PATTERNS, and DEVIATION FROM BASELINE (customized)

what does the "Redesigning Hospital Alarms for Patient Safety" article talk about?

60% of errors are due to faulty communication

what does the "Silence Kills" article talk about?

relationship-focused

what focused leadership style is linked to better outcomes for nurses? (related to their work environment, perception of and performance in their workplace, and personal health and wellbeing)

ineffective communication

what is a common maladaptive behavior that leads to burnout and job dissatisfaction?

preceptors

what is an essential part of transitioning for someone who is at a novice stage?

flexibility!

what is key in regards to staffing?

a mentor

what is key in the advanced beginner stage?

-little problems that become familiar so people start assuming these problems are completely normal -NOT OKAY!

what is normalizing deviance? is this practice okay?

-providing an environment that allows for nurse autonomy in decision-making -participation in unit and hospital governance -participative management

what is the best strategy for retaining nurses in a hospital setting?

novice --> advanced beginner --> competent --> proficient --> expert

what is the order of staff development?

-to increase self awareness -to increase understanding of others -its purpose is NOT to label people

what is the purpose of MBTI (Myers-Brigss Type Indicator)?

total patient care hours

what is used to determine FTE (fill time equivalents)/ number of employees

EXPERIENCE!

what needs to be taken into account when staffing nurses?

-huddles -briefing -debriefing -SBAR

what types of communication methods work?

-errors -injuries

when a shift goes over 12 consecutive hours, there is an increase in what 2 things?