Chapter 24: Quality Management
3. What is one performance area where quality improvement (QI) is used to affect process and outcomes of health care? a. Provision of appropriate and effective care b. Elimination of access barriers c. Reduction of unjustified geographic variation in care d. Application of managed care to all citizens
ANS: C With the application of QI strategies, specific areas of performance can affect both process and outcomes of health. These include reducing unjustified geographic variation in care; consistently providing appropriate and effective care; eliminating avoidable mistakes; lowering access barriers; improving responsiveness to clients; and eliminating racial/ethnic, gender, socioeconomic, and other disparities and inequalities in access and treatment. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
13. A nurse is implementing a voluntary approach to quality control within the organization. Which of the following describes what the nurse is implementing? a. Accreditation b. Licensure c. Certification d. Credentialing
ANS: A Accreditation is an example of a voluntary approach to quality control used primarily for institutions. Licensure is a contract between the profession and the state that controls the quality of professional practice. Certification combines features of licensure and accreditation. Credentialing is the formal recognition of a person as a professional with technical competence, or of an agency that has met minimum standards of performance. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
16. A staff development program is used to teach nurses and other providers about how to reduce risk by properly documenting interventions provided. Which of the following levels of prevention is being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Quality care
ANS: A Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. In this case, prevention is aimed at reducing risk. Secondary prevention focuses on early detection and screening. Tertiary prevention focuses on treatment and rehabilitation. Quality care refers to providing the best services possible and is not a level of prevention. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
1. What is the purpose of implementing total quality management (TQM)? a. Provide quality care within an organization. b. Provide cost-efficient care across all age groups. c. Provide necessary care to clients in a cost-effective system. d. Provide efficient systems of primary care.
ANS: A TQM is a management philosophy that focuses on the statistical processes by which to assess work done with the goal of organization-wide quality effectiveness. TQM examines multiple aspects of an organization, more than only cost-efficient or cost-effective care, and looks at multiple aspects of care delivery. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
2. Which of the following statements about records are true? (Select all that apply.) a. Records provide complete information about the client. b. Records resolve legal issues in malpractice suits. c. Records provide information for education and research. d. Records allow anyone interested in a client's progress to view a chart. e. Records allow for easy documentation of the client's assessment.
ANS: A, B, C Records provide complete information about the client, resolve legal issues in malpractice suits, and provide information for education and research. Records are not available for anyone to view as that is a violation of client privacy. Depending on the record being used, assessment documentation may or may not be easy. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
MULTIPLE RESPONSE 1. A nurse is using a clinical practice guideline. Which of the following describes the situations that the nurse may be facing? (Select all that apply.) a. Recommending the administration of the influenza vaccination to a client b. Creating agency policies and procedures c. Developing a program targeting obesity prevention d. Researching interventions that would improve care for a tuberculosis client e. Documenting the assessment of a client with congestive heart failure
ANS: A, C, D Clinical practice guidelines are systematically developed statements to assist practitioner and client decisions about appropriate health care for specific clinical circumstances. Clinical practice guidelines are not used to create agency policies and procedures or to assist in documentation of assessment findings. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
4. A public health nurse (PHN) is providing the core function of assurance to the community. Which of the following describes what the nurse is doing? a. Providing the same services to all citizens b. Maintaining quality in the public health workforce c. Eliminating low-quality services d. Contracting with outside agencies to evaluate effectiveness
ANS: B Assurance relates to ensuring that there is quality in the workforce. Public health must maintain quality in its workforce and continually evaluate service effectiveness whether delivered to the individual, the community, or the population. Assurance does not address provision of the same services to all citizens or contracting with outside agencies to evaluate effectiveness. Assurance does not address elimination of low-quality services. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
23. A nurse records the number of clients seen daily as well as the mode of transportation and miles driven. Which of the following types of records is being used? a. Clinical record b. Provider service record c. Financial record d. Central index system
ANS: B Information about the number of clients seen daily, the immunizations given, home visits made daily, and transportation and mileage can be found in the provider service record. The clinical record is the client health record. The financial record is from the agency and contains information about the salaries, overhead, and transportation costs. The central index system is a data filing system that indicates the services requested, services offered, active and inactive clients of the agency, and a profile of the agency's clients. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
12. A nurse implements the Institute of Medicine's definition of quality health care when providing care. Which of the following describes this care? a. Licensed—all health care workers must have a license. b. Safe—avoiding injuries to patients from the care intended to help them. c. Timely—no waiting or delay for health care. d. Innovative—new innovations must be used when they become available.
ANS: B The Institute of Medicine states that quality health care is safe—avoiding injuries to patients from the care that is intended to help them. The other parts of this definition are effective, timely, client centered, equitable, and efficient. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
7. A public health agency is transitioning from a traditional management model for quality assurance to a total quality management (TQM) approach. Which of the following changes will occur within the agency? a. Increased administrative authority b. Increased participation by all staff c. Additional focus on quality assurance d. Specialized accountability for services provided
ANS: B The TQM approach includes increased participation by all staff, process accountability (rather than specialized accountability), and focus on continuous improvement (rather than quality assurance). Administrative authority is part of the traditional management model. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
19. A nurse is using the specific approach to quality improvement (QI). Which of the following describes the action that would be taken by the nurse? a. Evaluate an agency's ability to meet criteria or standards. b. Implement the plan-do-check-act cycle. c. Provide care to individual citizens. d. Use criteria set forth by regulatory agencies.
ANS: B The specific approaches to QI are methods used to manage a specific health care delivery system in an attempt to deliver care with outcomes acceptable to the consumer. Evaluating an agency's ability to meet criteria, providing care to individual citizens, and using criteria set forth by regulatory agencies are not specific approaches to QI. DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
15. An elderly client was receiving home care after hospitalization for a cerebrovascular accident. After several weeks of physical and speech therapy, the client showed few signs of progress. The utilization review committee considered the client's condition to be stable and declined reimbursement for further home care. Which of the following describes the process that could be used by the client to reverse the decision? a. Prospective utilization review b. Retrospective utilization review c. Concurrent utilization review d. Medicare reversal process
ANS: C A concurrent utilization review is the review of the necessity of services while care is being given. Doing an assessment of the necessity of care before giving service is called a prospective utilization review. A retrospective utilization review is an analysis of the necessity of the services received by the client after the care has been given. This is not an example of the Medicare reversal process. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
14. A nurse assesses the necessity of receiving care before providing services. Which of the following describes what is being implemented? a. Concurrent audit b. Retrospective audit c. Prospective utilization review d. Retrospective utilization review
ANS: C Doing an assessment of the necessity of care before giving service is called a prospective utilization review. A concurrent audit evaluates the quality of ongoing care by looking at the nursing process. A retrospective audit evaluates quality of care through evaluation of the nursing process at the end of a program or as an audit of the long-term impact of a program within the health care system. A retrospective utilization review is an analysis of the necessity of the services received by the client after the care has been given. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
10. A student has obtained a Bachelor of Science in Nursing degree. Which of the following describes why the student must be licensed as a registered nurse before beginning practice? a. To formally recognize the student as a competent professional b. To define the scope of professional practice c. To control the quality of professional practice d. To establish standards for educational programs
ANS: C Individual licensure is a contract between the profession and the state. Under this contract, the profession is granted control over entry into, and exit from, the profession and over quality of professional practice. The licensing process requires that written regulations define the scope and limits of the professional's practice. DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
21. A nurse is developing a quality improvement (QI) program. Which of the following would be the most important aspect of the program that should be considered? a. Vision and values of the agency b. Standards used to provide care c. Results of nursing care d. Evaluation of process changes
ANS: C Outcome (results of nursing care) is the most important part of a QI program because it is the key to evaluating providers and agencies by accrediting bodies, by insurance companies, and by Medicare and Medicaid through PROs, report cards, and other accrediting agencies. Vision and values of the agency, care standards, and evaluation of process changes are not as important as the outcomes that are demonstrated. DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care
5. Which statement about the quality assurance process is accurate? a. Processes are implemented to maintain quality. b. Community needs are assessed while implementing quality programs. c. Accountability of the provider is the primary concern. d. Standards for care are established and evaluated.
ANS: C Quality assurance is concerned with the accountability of the provider, and it is only one tool in achieving the best client outcomes. QI refers to actions that lead to measurable improvement in health care services and health status. Community needs are not assessed nor are standards for care established and evaluated through the quality assurance process. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
22. A nurse is implementing plan-do-check-act. Which of the following actions is the nurse going to perform? a. Documentation of client care. b. Obtain certification in a specialty area. c. Review data after changing practice. d. Provide equal access to care.
ANS: C Reviewing data is part of the "Check" step, where data is reviewed, results are analyzed, and what has been learned through the process change is identified. Documentation of client care, obtaining certification, and providing equal access to care are not part of the plan-do-check-act process. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
18. A nurse is working with a team to learn more about what its most important accomplishments have been and to identify what changes are desired. Which of the following would be the method used to accomplish this task? a. Compare job descriptions b. Analyze mission and goals c. Brainstorm d. Develop charts and diagrams
ANS: C The best method of discovering what could be the most important accomplishments of the team and what changes are desirable is brainstorming. Brainstorming involves getting everyone's input about a possible process situation, with no team member criticizing the suggestion. Comparing job descriptions, analyzing mission and goals, and developing charts and diagrams would not lead to as much discovery as brainstorming. DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
11. A nurse is given formal recognition as a professional with technical competence in a certain area of nursing practice. Which of the following terms describes what has happened? a. Licensure b. Accreditation c. Recognition d. Credentialing
ANS: D Credentialing is the formal recognition of a person as a professional with technical competence, or of an agency that has met minimum standards of performance. Licensure is a contract between the profession and the state which controls the quality of professional practice. Accreditation is a voluntary approach to QI used by institutions. Recognition is a process, whereby one agency accepts the credentialing status of and the credentials conferred by another. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
17. A nurse is using a concurrent audit to review documentation following home health visits. Which of the following statements describes why this type of audit is most appropriate in this situation? a. It is less costly than a retrospective audit. b. It represents the total picture of care that the client receives. c. It provides more accurate data for planning corrective action. d. It identifies problems at the time that care is given.
ANS: D One reason for using a concurrent audit rather than a retrospective audit is that it identifies problems at the time that care is given. A concurrent audit is costlier to implement than a retrospective audit. Because the intervention is ongoing, it does not present the total picture of the outcomes of the intervention that the client will ultimately receive. A retrospective audit provides more accurate data for planning corrective action. DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
9. A PHN in the 1960s is measuring quality assurance. Which of the following resources would the nurse most likely have used? a. American Nurses Association (ANA) Standards of Practice b. Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Nursing Audit Criteria c. Community Health Nursing Practice Standards d. Phaneuf nursing audit method
ANS: D Phaneuf's nursing audit method was one of the first tools, developed in 1965, which has been used extensively in population-centered nursing practice. The ANA's Divisions on Practice was created in 1966; however, this did not provide practice standards. The JCAHO began developing its standards in the mid-1980s. The Community Health Nursing Practice Standards was developed in 1973. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
8. Which of the following monitors access to care, the cost of care, and protects the Medicare Trust? a. Professional Review Organizations (PROs) b. Joint Commission on Accreditation of Healthcare Organizations (JCAHO) c. National Health Quality Improvement Act d. Quality Improvement Organizations (QIOs)
ANS: D QIOs monitor access to care and cost of care and protect the Medicare Trust. The QIO replaced the previous PRO. JCAHO developed quality control standards for hospital and home health nursing. The National Health Quality Improvement Act encourages consumers to become informed about their practitioner's practice record and created a national clearinghouse of information on the malpractice records of providers. DIF: Cognitive level: Understanding TOP: Nursing process: Assessment MSC: NCLEX: Safe and Effective Care Environment: Management of Care
6. A nurse is concerned that there is an overuse of services by clients receiving care from a local physician. Which of the following statements describes what is occurring in this situation? a. Treatment decisions are made conservatively. b. Disability and mortality are being reduced. c. Disparities in quality of care provided are increasing. d. Unnecessary tests, surgeries, and treatments are being ordered.
ANS: D The "overuse of service" category in the Agency for Healthcare Research and Quality (AHRQ) problems of quality of care refers to the ordering of unnecessary tests, surgeries, and treatments. Overuse of services does not mean that treatment decisions are made conservatively; rather, services are being used more than they should. Disability and mortality may not be reduced through overuse of service. Disparities in quality of care do not match the definition of overuse of services. DIF: Cognitive level: Applying TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
2. What is the purpose of the National Health Quality Report (NHQDR)? a. Report on the Agency for Healthcare Research and Quality's goals for the year. b. Describe the yearly activities of the agency. c. Ensure national quality of services. d. Document whether health care quality is stable, improving, or declining over time.
ANS: D The NHQDR is intended to serve several purposes, including the documentation of whether health care quality is stable, improving, or declining over time; demonstrating the validity (or lack) of concerns about quality; and providing national benchmarks against which specific states, health plans, and providers can compare their performance. The NHQDR reports on health care quality and is written by the Agency for Healthcare Research and Quality. DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
24. A nurse is profiling the clients who are served by an agency as well as documenting services requested and provided. Which of the following describes the type of record that would be appropriate to use? a. Clinical record b. Provider service record c. Financial record d. Central index system
ANS: D The central index system is a data filing system that indicates the services requested, services offered, active and inactive clients of the agency, and a profile of the agency's clients. Information about the number of clients seen daily, the immunizations given, home visits made daily, and transportation and mileage can be found in the provider service record. The clinical record is the client health record. The financial record is from the agency and contains information about the salaries, overhead, and transportation costs. DIF: Cognitive level: Applying TOP: Nursing process: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care
20. A quality assurance manager does an audit and 6 months later returns to see if the problem has been eliminated. Which of the following describes this step? a. It involves selecting explicit criteria for quality care. b. It includes the review of records. c. It requires a peer review of all cases that do not meet criteria. d. It completes the audit process.
ANS: D The final step in the audit process involves determining whether problems uncovered in an audit have been eliminated. Selecting explicit criteria for quality care is the second step of the process. Reviewing the records is the third step of the process. Completing a peer review for all cases that do not meet criteria is the fourth step of the process. DIF: Cognitive level: Analyzing TOP: Nursing process: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care