Quality Improvement (Pearson)
The nurse manager is reviewing a quality improvement study conducted on a client care issue. List the order in which the steps should be evaluated to determine that the study was completed correctly. 1. Research factors that contribute to better outcomes. 2. Compare outcomes to benchmarks. 3. Identify areas for improvement. 4. Analyzing current protocols of care and associated outcomes. 5. Implement changes to improve outcomes. 6. Analyze client outcomes to determine effectiveness of changes.
Answer: 4, 2, 3, 1, 5, 6 Explanation: 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 on a medical-surgical unit is asked to participate in data collection on skin care for the unit. What purpose will it serve for the nurse to cooperate with this request? A) Participate in the quality improvement process B) Advance the nurse's practice C) Prevent problems from arising in the unit D) Fulfill legal requirements
Answer: A Explanation: A) Quality improvement is the name for the processes used by an agency to measure and improve aspects of client care. The nurse may advance practice, but that is usually accomplished by returning to school for a higher degree. Preventing problems from arising is only one benefit of quality management. Nurses are encouraged to participate in quality improvement programs but are not legally required to do so.
The nurse conducting nursing audits to help increase efficiency and reduce costs wants to suggest a better contribution to quality care. What should the nurse suggest be performed instead? A) Conduct a wound care study to enhance client outcomes. B) Install cameras to detect abuse of the clients. C) Acquire new client care equipment. D) Decrease staffing on the unit.
Answer: A Explanation: A) The top goal of any quality improvement program is to improve client outcomes of care. Increasing the RN staff, purchasing new equipment, and installing cameras may be found to be means to reach that goal, but studies must first be conducted to identify those means.
The nurse manager at an acute care facility is educating her staff nurses on the definition of a sentinel event and providing examples. Which would be appropriate for the nurse manager to present to the staff nurses as examples of a sentinel event? 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 patient while at the facility E) Administration of a compatible blood transfusion
Answer: A, B, C, D Explanation: A) 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, homicide of a staff member or patient while at the facility. Administration of a compatible blood transfusion would be desired. Administration of an incompatible blood transfusion would be a sentinel event.
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. To which component of care should the quality assurance officer pay particular attention when benchmarking this issue? A) Structure B) Process C) Outcome D) Competency
Answer: B Explanation: B) Process evaluation focuses on how the care was given in regard to relevance, appropriateness, completeness, and timeliness. Process standards focus on the manner in which the nurse uses the nursing process. Competency is not one of the components of quality assurance evaluation. Structure evaluation focuses on the setting in which the care is given. Outcome evaluation focuses on demonstrable changes in the client's health status as a result of nursing care.
The nurse instructor is preparing a teaching session for staff nurses on intradisciplinary assessments. Which information should the instructor consider when preparing this presentation? Select all that apply. A) Utilization reviews B) Peer review C) Audits D) Performance appraisals E) Outcomes management
Answer: B, C, E Explanation: B) 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 nursing instructor is speaking to a group of nursing students about standards of care. Which comment made by the nursing student indicates the need for further education about the standards of care? 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."
Answer: C Explanation: C) "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.
A newly licensed nurse is passing medications with a nurse preceptor. Which action taken by the newly licensed nurse would be inappropriate and require the nurse preceptor to intervene? A) The newly licensed nurse verifies tube placement prior to administering medications. B) The newly licensed nurse checks for known allergies prior to administering medication. C) The newly licensed nurse combines medications with the same active ingredient. D) The newly licensed nurse has a second nurse check the medication order.
Answer: C Explanation: C) It is not an appropriate action to combine medications with the same active ingredient. Combining medications with the same active ingredient is not considered a method to reduce medication errors. Verifying tube placement prior to administering medications is an appropriate action and is considered a method to reduce medication errors. Checking for known allergies prior to administering medications is an appropriate action and is considered a method to reduce medication errors. Having a second nurse check the medication order is an appropriate action and is considered a method to reduce medication errors.
A client who has read several articles about the need to contain healthcare costs asks how a quality improvement program can contain cost of care. What should the nurse respond to this client's question? 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 length of stay." D) "Increased nursing staff has been linked to decreased infection rates." E) "Use of computers increases the number of lawsuits."
Answer: C, D Explanation: C) Studies have shown that increasing the nurse-to-client ratio can decrease overall cost because the length of stay, as well as mortality rate, is reduced with RN care. Other studies have shown that increased nursing staff has been linked to a decrease in client infection rates. 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.
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. What sentinel event should the "time out" procedure prevent? A) Ineffective control of the client's pain B) The lack of healing of the stump C) The client being mildly over-sedated D) The removal of the wrong arm
Answer: D Explanation: D) 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 over-sedation 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 a diabetic client. Pain control is individual and is not a sentinel event.
The nurse manager is planning to implement the Lean Six Sigma system on the care area to improve the quality of care. When following this model, what should the manager implement? A) Shortening break time B) Ordering more supplies than needed on the unit to ensure they never run out C) Replacing a licensed staff member with unlicensed assistive personnel D) Decreasing staff when the census is low
Answer: D Explanation: D) Lean Six Sigma focuses on eliminating waste and improving process flow. When the census decreases, the nurse manager should also decrease the number of staff. Replacing licensed staff members with unlicensed assistive personnel may not be safe. The nurse manager would cut back on ordering supplies that are not needed when following this model. A shortened break time would not be considered as reducing waste.
The nurse manager is considering increasing the number of RN staff because studies have shown that it decreases infection rates. What purpose will decreasing infection rates serve? 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
Answer: D Explanation: D) Research has shown that an increase in RN staff decreases a unit's infection rate. Because infection 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 of RN staff. There is no research that suggests that decreased infection rates will increase the need for client care supplies.
The nurse 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. What should the risk management team do? A) Discipline the nurse appropriately. B) Report the nurse to the board of nursing. C) Monitor all nurses on the unit to ensure this does not occur again. D) Attempt to implement policy changes to prevent future errors.
Answer: D Explanation: D) 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.
