quality improvement
The graduate nurse understands that the five rights of medication administration are part of: Quality management Environmental safety Anticipatory guidance Care coordination
Quality management Feedback Rationale: Quality management includes the prevention of errors for client safety. Checking the five rights when administering medication has been shown to reduce medication errors. An example of environmental safety might include placing signs around a wet floor. Anticipatory guidance is the nurse working with the client to effect changes in the client's lifestyle. Care coordination is a method of preventing duplication of services, usually accomplished by a case manager. Nursing Process: Evaluation Client Need: Safe, Effective Care Environment Cognitive Level: Understanding
A client is being discharged to a rehabilitation facility and asks if nurses evaluate the quality of care that clients receive. The nurse responds that: "We each contribute by collecting data for evaluation." "The hospital administration is responsible for determining quality." "We have a quality management program here." "Nurses are responsible for monitoring nonprofessionals."
"We each contribute by collecting data for evaluation." Rationale: One role of nursing is collecting the data that is evaluated by the quality management team. Quality improvement is the responsibility of every employee of the agency, not just administration. Stating that there is a quality program does not answer the client's question. Nurses are responsible for monitoring nonprofessional caregivers but not other occupations of nonprofessionals such as engineers or housekeepers. Nursing Process: Implementation Client Need: Safe, Effective Care Environment Cognitive Level: Applying
The nurse working in the assisted living facility is reviewing the weekly report of the number of bedridden clients who developed pressure ulcers. The facility uses the Donabedian model of QI. Which standard is the nurse using with this data review? Process standard Structure standard Outcome standard Decubiti standard
Outcome standard Learning Objective Describe the process of quality improvement. Rationale The nurse is examining data about an outcome standard, pressure ulcers, which is a negative result of the care process. A process standard would look at steps to achieve a positive result. A structure standard would look at the organization. There is no decubiti standard.
A client mentions that having so many nurses in the unit must be increasing the cost of care because nurses get paid more. The client's nurse appropriately responds: "You are right. Care does cost more with RNs." "Costs rise because nurses waste supplies." "The cost of care is caused by decreased technology, not increased nurses." "Studies show that costs are decreased with an RN staff."
"Studies show that costs are decreased with an RN staff." Rationale: Studies show that lengths of stay decrease, which decreases overall costs, when more RNs are used for client care. The client is incorrect about RNs increasing the cost of care, and the nurse would provide appropriate information in a professional manner. Technology is on the rise and, in some cases, reduces cost by utilizing more efficient ways to deliver care, such as computer charting. Costs would rise if nurses waste supplies; however, many initiatives have been instituted in that area to contain costs. Nursing Process: Implementation Client Need: Safe, Effective Care Environment Cognitive Level: Applying
A nursing instructor is explaining quantitative systems in quality improvement. The students have understood the lecture when a student states that Six Sigma is: A process that uses quantitative data to monitor progress A process that determines waste in the agency An overall philosophy regarding quality A team designed to evaluate processes.
A process that uses quantitative data to monitor progress Rationale: Six Sigma is a process that uses quantitative data to monitor the progress of quality management. Lean Six Sigma is a process aimed at reducing a waste of resources. The team designated to evaluate the processes is the Continuous Quality Improvement team. TQM is the overall philosophy regarding quality management of an agency. Nursing Process: Evaluation Client Need: Safe, Effective Care Environment Cognitive Level: Remembering
An operating room nurse is present when a client is injured permanently during a procedure. The nurse expects to participate in: A root cause analysis The quality management program An increased number of nursing audits A criminal investigation
A root cause analysis Rationale: When a client experiences a permanent unexpected negative reaction due to an error, the Joint Commission requires that the healthcare agency perform a root cause analysis with a focus on the prevention of future such events. The nurse would expect to participate in the analysis because the nurse was present during the procedure. A quality management program is ongoing and is not the same as a root cause analysis. Nursing audits will not necessarily reveal the sentinel event error or prevent future incidents. A criminal investigation may or may not result from a root cause analysis. Nursing Process: Assessment Client Need: Safe, Effective Care Environment Cognitive Level: Understanding
The nurse is studying the National Patient Safety Goals to ensure that the nurse delivers safe care to assigned clients and is aware that these goals are revised: Every two years Once a month Annually Every five years
Annually Feedback Rationale: The Joint Commission is responsible for assessing and revising goals for client safety on an annual basis. Nursing Process: Assessment Client Need: Safe, Effective Care Environment Cognitive Level: Remembering
A newly hired nurse made a medication error in her first week on the job. The nurse soon learned that her facility had a strong policy in which errors or near misses could be reported without the fear of punishment. Which concept supports this attitude toward mistakes? Responsibility Blame-free environment Just culture Accountability
Blame-free environment Learning Objective Describe the process of quality improvement. Rationale In a blame-free environment, errors or near misses can be reported without fear of punishment. Just culture balances accountability with correcting system problems. Responsibility and accountability both call for admitting mistakes, but without guarantees of how they will be handled.
A nurse on the quality improvement committee understands that the step of quality improvement which analyzes current protocols of care and their associated outcomes includes all except: An individual, unit, or facility must understand their baseline performance records. Can be used to discover areas for improvement and to analyze areas of excellence. Performance can be assessed on an intradisciplinary level or an interdisciplinary level. Peer review
Can be used to discover areas for improvement and to analyze areas of excellence. Rationale: Quality improvement is a continuous multi-step, multi-level process that identifies areas for improvement based on performance and industry standards. One step in quality improvement involves analyzing current protocols of care and their associated outcomes. This includes: an individual, unit, or facility must understand their baseline performance records; performance can be assessed on an intradisciplinary level or an interdisciplinary level; this includes peer review. Outcomes management, another step of quality improvement, can be used to discover areas for improvement and to analyze areas of excellence. Nursing Process: Evaluation Client Need: Safe, Effective Care Environment Cognitive Level: Applying
The nurse is discharging a client who has had an organ transplant. To accurately summarize the client's complex treatments, the nurse is carefully entering data into an electronic health record (EHR). How does that activity affect continuity of care? The EHR documents actions at the point of care. Clinical information is available to collaborating healthcare providers. The software will scan for grammatical errors. The nurse follows guidelines encouraging use of EHRs.
Clinical information is available to collaborating healthcare providers. Learning Objective Discuss the role of quality improvement initiatives in health care. Rationale Entering data into an EHR makes clinical information available to collaborators. It is not important that the software corrects grammatical errors. The EHR documents actions at the point of care. However, it is the availability of that information to others that affects the continuity of care, not its being recorded. Support for continuity of care is one reason, but not the only one, for encouraging the use of EHRs.
Continuous Quality Improvement (CQI) is a client-driven process. In a rehabilitation facility, which individuals are examples of internal clients who drive the CQI process? (Select all that apply.) Clinical nurse specialist Client after hip replacement Head of Management of Information Systems (MIS) department Physical therapist Parents of a child with spina bifida
Clinical nurse specialist Client after hip replacement Physical therapist Learning Objective Compare the components of various quality management programs. Rationale Internal clients are employees of the rehabilitation facility. They could be a physical therapist, the head of the MIS department, and a clinical nurse specialist. External clients include a client after hip replacement, and parents of a child with spina bifida.
The mental health nurse enjoys working at a community health center (CHC). Part of the nurse's satisfaction comes from helping provide the required services for CHC facilities. Which services are required? On-site pharmacy Comprehensive primary care Emergency Department (ED) Chemotherapy
Comprehensive primary care Learning Objective Discuss the role of quality improvement initiatives in health care. Rationale The regulations for CHCs require that they provide comprehensive primary care. They are not required to have an ED, offer chemotherapy, or stock an on-site pharmacy.
The nurse in the blood bank is part of a team effort to reduce the costs of collecting and storing blood components. The nurse conducts an inventory to check for expired sterile supplies. In seeking to reduce waste, which quality improvement (QI) method is the team using? Quality assurance Lean Six Sigma Root cause analysis Utilization review
Lean six sigma Learning Objective Compare the components of various quality management programs. Rationale The objective of Lean Six Sigma, the QI method used by the blood bank team, is to reduce waste. Quality assurance determines whether standards are met. Root cause analysis explores a sentinel event. Utilization review collects data about resource use.
The emergency department nurse manager is sharing the most recent client satisfaction data and statistics with the evening shift staff. As a team, they are using the total quality management (TQM) approach. Which process organizes their efforts? DMADV DMAIC LEED PDSA
PDSA Learning Objective Compare the components of various quality management programs. Rationale TQM uses the PDSA approach of Plan-Do-Study-Act. The DMAIC and the DMADV methods are used in Six Sigma. LEED is not a QI method.
The dialysis nurse manager decides to evaluate the sterility processes the renal unit staff follows, compared to accepted standards of care. Which term best describes that effort? Performance improvement Quality improvement Process standards Quality management
Quality management Learning Objective Discuss the role of quality improvement initiatives in health care. Rationale Quality management compares specific nursing processes, like sterilization, to accepted standards of care. Quality improvement is one method of improving the processes of care. Performance improvement matches positive changes with participating staff. Process standards record step-by-step client care activities.
The nurse manager conducts nurse evaluations based on standards of care. The manager understands that standards of care are based on established models of high-quality performance and may reflect all except: Recommendations of professional organizations Scientific or clinical research Recommendations of hospital physicians The performance of industry leaders
Recommendations of hospital physicians Rationale: Benchmarking is a method used to compare the performance of an individual or organization to industry standards. Standards of care are based on established models of high-quality performance and may reflect the performance of industry leaders, scientific or clinical research, or recommendations of professional organizations such as the ANA. Recommendations of hospital physicians are not necessarily standards of care. Nursing Process: Evaluation Client Need: Safe, Effective Care Environment Cognitive Level: Understanding
The urology nurse is reviewing medical records of the last five clients discharged after transurethral resection of the prostate (TURP). The nurse uses a checklist to look at the completeness of documentation of postsurgical pain relief. Which activity is the nurse participating in with this review process? Utilization review Concurrent audit Retrospective audit Root cause analysis
Retrospective audit Learning Objective Describe the process of quality improvement. Rationale The nurse is conducting a retrospective audit, looking back in time. A concurrent audit takes place when clients are still hospitalized. Utilization review looks at use of resources, not documentation. A root cause analysis is triggered by a sentinel event, rather than by routine client care documentation.
A client called Patient Relations after being discharged to report that a skin infection developed around the IV catheter insertion site on the client's right arm. Which process would likely prevent a similar recurrence in the future? Peer review Utilization review Root cause analysis Risk management
Risk management Learning Objective Describe the process of quality improvement. Rationale Risk management could add this complaint to its data about client satisfaction/outcomes, and work with the relevant clinical unit about prevention. A skin infection is not a sentinel event, so no root cause analysis needs to be initiated. An isolated event would not prompt peer review. Utilization review looks at resource use, not postdischarge outcomes.
The oncology nurse is reviewing the Department of Health and Human Services (HHS) National Strategy for Quality Improvement in Health Care. In evaluating the nurse's cancer center facility, which descriptions of that healthcare system fit the HHS criteria? (Select all that apply.) Safe Compliant Reliable Sensitive Accessible
Safe Reliable Accessible Learning Objective Discuss the role of quality improvement initiatives in health care. Rationale The HHS criteria expect the healthcare system to be client-centered, reliable, accessible, and safe. The HHS does not discuss compliance or sensitivity.
The nurse manager complimented the night staff on recent data about reducing noise. The day shift nurses asked each client about obstacles to sleep the previous night. They recorded the clients' responses as either achieving the goal of sleep or being disrupted by the defect of loud sounds or other obstacles. Which kind of quality improvement activity is taking place? Six Sigma Performance improvement Continuous quality improvement Benchmarking
Six Sigma Learning Objective Compare the components of various quality management programs. Rationale Six Sigma considers factors leading to client dissatisfaction as open double quote"defects.close double quote" Disrupted sleep qualifies as a defect. Defect is not a concept used in continuous quality improvement or performance improvement. Benchmarking uses industry standards, which do not exist for disrupted sleep.
