Chapter 20: Managing Quality and Risk

The nurse manager is concerned about the negative ratings her unit has received on patient satisfaction surveys. The first step in addressing this issue from the point of view of quality improvement is to:

Identify a clinical activity for review.

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?

NDNQI The National Database of Nursing Quality Indicators is a national, nursing quality measurement program from the American Nurses Association that provides hospitals with unit-level performance reports with comparisons to national averages and rankings.

Healthcare organization X is committed to improving patient outcomes and, as part of the QI process, examines its executive structure and organizational design. This approach recognizes:

That structure influences nurse burnout and participation in quality improvement initiatives

A new RN staff member asks you about the difference between QA and QI. You explain the difference by giving an example of QI.

"At a staff meeting last year, two of our staff commented on the number of recent falls and asked, 'What can we do about it?'"

Your institution has identified a recent rise in postsurgical infection rates. As part of your QI analysis, you are interested in determining how your infection rates compare with those of institutions of similar size and patient demographics. This is known as:

Benchmarking. Benchmarking is a widespread search to identify the best performance against which to measure practices and processes.

A nursing-led classification system that has led to greater reliability and standardization in data utilized for QI processes is:

NANDA. NANDA has been developed by nurses and uses standardized terminology that enables study of health problems across populations, settings, and caregivers.

The nurse educator of the pediatric unit determines that vital signs are frequently not being documented when children return from surgery. According to quality improvement (QI), to correct the problem, the educator, in consultation with the patient care manager, would initially do which of the following?

Call a meeting of all staff to discuss this issue.

A method commonly used in Quality Assurance to monitor adherence to established standards is:

Chart audit. Chart audits are a common method of addressing process standards. Chart audits over time yield trend charts.

An example of an effective patient outcome statement is:

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.

Through the QI process, the need to transform and change the admissions process across administrative and patient care units is identified. In this particular situation, what method of data organization will be most effective?

Flowchart Flowcharts are useful in identifying and visualizing sequential steps, such as the admissions process.

Hospital ABCD is a Magnet™ hospital. This designation has been applied to Hospital ABCD because it:

Facilitates active staff participation in decision making related to quality nursing care.

A nursing unit is interested in refining its self-medication processes. In beginning this process, the team is interested in how frequently errors occur with different patients. To assist with visualizing this question, which organizational tool is most appropriate?

Histogram Histograms are bar graphs that are useful in outlining and identifying frequency.

With the rise of violence in the psychiatric department, the nurse manager decides that she should work with the risk manager in violence prevention. The nurse manager should:

Hold staff accountable for safe practices.

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:

Identify the standard. Before further action (data collection, decision making related to correction, and implementation of a plan) can occur, it is necessary to identify the standards against which data collection and decision making will occur. Institutions may or may not adopt standards that are already established by organizations such as the ANA.

A nurse is explaining the pediatric unit's quality improvement (QI) program to a newly employed nurse. Which of the following would the nurse include as the primary purpose of QI programs?

Improvement in patient outcomes

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? It:

Improves outcomes.

The outcome statement "Patients will experience a ten percent reduction in urinary tract infections as a result of enhanced staff training related to catheterization and prompted voiding" is:

Measurable and nursing-sensitive. Nursing-sensitive outcomes refer to outcomes that are affected by nursing activity and are precise, measurable, and patient-centered.

At Hospital Ajax, there has been a 20% increase in instruments and sponges being left in patients during surgery and surgeries on the wrong limbs. These are known as:

Never events. The NQF and CMS define never events as errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients and that indicate a real problem in the safety and credibility of a healthcare facility. Examples of never events include surgery on the wrong body part, foreign body left in a patient after surgery, mismatched blood transfusion, major medication error, severe pressure ulcer acquired in the hospital, and preventable postoperative deaths.

Before beginning a continuous quality improvement project, a nurse should determine the minimal safety level of care by referring to the:

Nursing care standards.

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:

Patients are reliable sources about their own experiences but are limited in their ability to gauge clinical competence of staff.

Patient perceptions are useful in:

Providing one source of data for QI initiatives.

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 total quality management philosophy by:

Recommending that a multidisciplinary team should assess the root cause of errors in medication. Quality management stresses improving the system, and the detection of staff errors is not stressed. If errors occur, reeducation of staff is emphasized rather than imposition of punitive measures such as disciplinary action or blaming.

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:

Risk management programs are not designed to assign blame.

Hospital Magnet™ decides against creating a separate department to lead and monitor quality activities because:

Total organizational involvement is critical to QI. Decentralized approaches are effective in developing unit-level solutions, as well as commitment to strategies and implementation of changes.

Examples of sentinel events include (select all that apply):

a. Forceps left in an abdominal cavity. b. Patient fall, with injury. d. Administration of morphine overdose. e. Death of patient related to postpartum hemorrhage.