Module 50: Quality Improvement
Which statement regarding standards of care in the hospital setting is inaccurate? A) "Standards of care are based on models of high-quality performance." B) "Process standards focus on the steps used to lead to a particular outcome." C) "Process standards focus on human resources, and general organizational structure." D) "Outcome standards focus on the performance of a process."
C) "Process standards focus on human resources, and general organizational structure." "Process standards focus on human resources and general organizational structure" is incorrect, and indicates that the student needs further education. The rest of the statements are correct.
Which of the following would be considered sentinel events? Select all that apply. A) Delivery of radiation to the wrong body region B) Invasive surgical procedure at the wrong site C) Homicide of a staff member while at the facility D) Homicide of a client while at the facility E) Administration of a compatible blood transfusion
A) Delivery of radiation to the wrong body region B) Invasive surgical procedure at the wrong site C) Homicide of a staff member while at the facility D) Homicide of a client while at the facility A sentinel event is an unexpected occurrence causing serious injury or death. According to the Joint Commission, the following are sentinel events: delivery of radiation to the wrong body region, invasive surgery at the wrong site, and homicide of a staff member or client while at the facility. Administration of a compatible blood transfusion would be desired. Administration of an incompatible blood transfusion would be a sentinel event.
Which best describes the desired outcome of decreased readmission rates? A) An increased use of overtime B) A decrease in client satisfaction C) An increase in client care supplies D) A decreased cost of care
D) A decreased cost of care Research has shown that an increase in RN staff decreases a unit's readmission rate. Because readmission is reduced, cost of care is also reduced. Overtime is not necessarily reduced by an increase in staff, depending on the number of nurses available at any given time. Studies show that client satisfaction increases with an increase in RN staff. Decreasing readmission rates will likely decrease the use of client care supplies, not increase it.
Which statement correctly describes quality management? A) Quality management compares nursing processes to accepted standards to prevent errors in treatment. B) Quality management refers to systematic actions that lead to improvements in healthcare services. C) Quality management is the degree to which health services increase the likelihood of desired health outcomes. D) Quality management provides clients with appropriate service in a technically competent manner.
A) Quality management compares nursing processes to accepted standards to prevent errors in treatment. Quality management includes evaluation of medical and nursing processes for quality and effectiveness compared to accepted standards in order to correct problems before they harm clients and to prevent errors in treatment. Quality improvement refers to systematic actions that lead to improvements in healthcare services. Quality is the degree to which health services increase the likelihood of desired health outcomes. High-quality care provides clients with appropriate service in a technically competent manner.
The nurse is participating in a quality improvement process related to improving care for clients at risk for skin breakdown. Which best describes the purpose of this process? A) To improve client outcomes B) To advance the nurse's career C) To fulfill legal requirements D) To maintain accreditation
A) To improve client outcomes Quality improvement is the name for the processes used by an agency to measure and improve aspects of client care, including overall outcomes. Participation may help the nurse advance in his or career, but that is usually accomplished by returning to school for a higher degree. Nurses are encouraged to participate in quality improvement programs but are not legally required to do so. Although maintaining accreditation is important, it is not the primary reason for engaging in quality improvement processes.
In which order should the steps of the quality improvement process be reviewed to determine whether it was completed correctly? A) Research factors that contribute to better outcomes. B) Compare outcomes to benchmarks. C) Identify areas for improvement. D) Analyze current protocols of care and associated outcomes. E) Implement changes to improve outcomes. F) Analyze client outcomes to determine effectiveness of changes.
Answer: D, B, C, A, E, F Quality improvement involves analyzing current protocols of care and their associated outcomes, comparing those outcomes to leaders in high-quality care through benchmarking, identifying areas for improvement, researching factors that contribute to better outcomes, and implementing changes to improve outcomes. Client outcomes must then be analyzed to determine the effectiveness of the changes and identify areas for further improvement.
The nurse is asked to participate in a record review to verify accuracy and proper use of certain interdisciplinary resources. Which best describes the nature of this process? A) Peer review B) Interdisciplinary audit C) Utilization review D) Benchmarking
B) Interdisciplinary audit An audit is an examination of records to verify accuracy and proper use. Because this audit is focused on resources used by multiple disciplines, it would be classified as an interdisciplinary audit. A peer review is a professional critique of a colleague's work on the basis of predetermined standards. A utilization review analyzes the use of resources to identify areas of overuse, misuse, and underuse. Benchmarking is a method that is used to compare the performance of an individual or organization to industry standards.
A nurse is participating in an intradisciplinary assessment as part of a quality improvement process. Which of the following should the nurse anticipate will be included in this assessment? Select all that apply. A) Utilization reviews B) Peer review C) Audits D) Performance appraisals E) Outcomes management
B) Peer review C) Audits E) Outcomes management Intradisciplinary assessment occurs within a group of individuals with a similar position in the healthcare system, such as a group of nurses. An intradisciplinary assessment is important for identifying areas of improvement at each level of care and includes peer review, audits, and outcomes management. Utilization reviews are completed when conducting an interdisciplinary assessment. Performance appraisals are not a part of either intra- or interdisciplinary assessments.
The quality assurance officer notes that one particular nursing unit has received a higher-than-usual number of negative client responses about aspects of the nursing care during the previous quarter. Based on this data, to which benchmarking issue should the quality assurance officer pay particular attention during the review process? A) Structure B) Process C) Outcome D) Competency
B) Process Process standards focus on the steps used to lead to a particular outcome, including whether a set of steps exists and whether those steps are being followed. Competency is not one of the components of quality assurance evaluation. Structure evaluation focuses on organizational structure and resources. Outcome evaluation focuses on the performance of a process, such as the number of bedridden clients who develop a pressure injury.
Which statements best describe how a quality improvement process can contain healthcare costs? Select all that apply. A) "Promoting safety increases the cost of care." B) "Medication errors decrease the cost of care." C) "High nurse-to-client ratios result in decreased readmission rates." D) "Increased nursing staff has been linked to decreased infection rates." E) "Use of computers increases the number of lawsuits."
C) "High nurse-to-client ratios result in decreased readmission rates." D) "Increased nursing staff has been linked to decreased infection rates." Studies have shown that increasing the nurse-to-client ratio can decrease overall cost because readmission rates and infection rates, as well as client mortality, are reduced with RN care. Medication errors increase cost due to harm to the client and increased length of stay. Promoting safety is a cost-containment measure because it decreases injury to the client and the consequent risk of lawsuits. Computers increase efficiency and reduce cost as a result. Lawsuits do not increase because of computer use; they increase when computers are used improperly.
What major nursing concept has the strongest relationship to the identification of areas for quality improvement, such as tracking data on healthcare-associated infections? A) Ethics B) Safety C) Informatics D) Evidence-based practice
C) Informatics Informatics can be used to identify areas for improvement, such as tracking healthcare-associated infections. Without informatics, tracking adverse outcomes would be time-consuming and potentially cost-prohibitive. With the advent of technology and informatics, statistics and client outcomes are easier to track, making quality improvement more efficient. Ethics, safety, and evidence-based practice can all contribute to quality improvement, but not by easily tracking poor client outcomes.
The nurse is administering medications to a client. Which action is most likely to lead to an adverse event? A) The nurse verifies tube placement prior to administering the medications. B) The nurse checks for known allergies prior to administering the medications. C) The nurse combines medications with the same active ingredient. D) The nurse has a second nurse check the medication order.
C) The nurse combines medications with the same active ingredient. It is not appropriate to combine medications with the same active ingredient, as this is likely to increase medication errors. Verifying tube placement prior to administering medications, checking for known allergies prior to administering medications, and having a second nurse check the medication order are all appropriate actions and are considered methods to reduce medication errors.
The nurse is working in a healthcare setting that has implemented Lean Six Sigma. Which of the following should the nurse anticipate with regard to this model? A) Shorter breaks B) Ordering extra supplies C) Replacing licensed with unlicensed personnel D) Decreasing staff when the census is low
D) Decreasing staff when the census is low Lean Six Sigma focuses on eliminating waste and improving process flow. Thus, when a unit's census decreases, the unit's manager would decrease the number of staff. Replacing licensed staff members with unlicensed personnel may not be safe. The unit would cut back on ordering supplies that are not needed when following this model. A shortened break time would not be considered reducing waste.
Which federal initiative contains the three broad aims of better care, healthy people/healthy communities, and affordable care? A) National Database of Nursing Quality Indicators B) Patient Safety and Quality: An Evidence-Based Handbook for Nurses C) National Patient Safety Goals D) National Quality Strategy
D) National Quality Strategy To improve the health of the population, the USDHHS has developed the National Quality Strategy, which contains three broad aims: better care, healthy people/healthy communities, and affordable care. The National Database of Nursing Quality Indicators (NDNQI), Patient Safety and Quality: An Evidence-Based Handbook for Nurses, and the National Patient Safety Goals by the Joint Commission aim to collect and provide data that identify areas for improvement and encourage facilities to meet quality goals.
The nurse working in a blame-free environment provides medication to a client at the wrong time. No harm came to the client as a result of the nurse's error, and the nurse files a report about the medication error. Which action by the risk management team should the nurse anticipate? A) Taking disciplinary action B) Reporting to the board of nursing. C) Monitoring all nurses on the unit. D) Suggesting system changes to prevent future errors
D) Suggesting system changes to prevent future errors When a nurse makes an error and reports it, the risk management team will investigate to discover causes for the error and effect policy changes that can prevent future errors, improving the level of client care. The situation does not warrant reporting the nurse to the board of nursing. The risk management team would not be responsible for implementing any disciplinary actions. It is not prudent for the risk management team to monitor all nurses who administer medications on the unit.
While preparing a client for surgery, the nurse marks the arm that is to be amputated and participates in a "time out" procedure before the surgery begins. Which sentinel event is this action intended to prevent? A) Ineffective control of the client's pain B) The lack of healing of the stump C) The client being mildly oversedated D) The removal of the wrong arm
D) The removal of the wrong arm A sentinel event is an unexpected event that causes death or severe physical or psychological injury. The removal of the client's incorrect arm would be a sentinel event. Mild oversedation is not a sentinel event, as the client is most likely on a ventilator during surgery. The inability to heal properly is an expected event in some clients, such as clients with diabetes. Pain control is individual and is not a sentinel event.
