ATI: The Leader: Case 4

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​The quality improvement committee is ready to begin the root cause analysis process. Which of the following is the first step the staff members should take in relation to identifying the root cause of the increased incidence of falls on their unit?

Examine the circumstances related to each fall.

​The quality improvement team is reviewing a graph which depicts the rate of client falls on their unit for the last fiscal year. In which quarter was the fall rate the highest?

Fourth quarter

​Anna is discussing the Magnet Recognition Program® with the team. Which of the following information should Anna include?

Magnet health care organizations must collect data about nursing sensitive outcomes.

​The quality improvement team is planning to conduct a post-fall root cause analysis. Which of the following should Anna include in her explanation of root cause analysis?

Root cause analysis is a way to determine the origin of a problem.

​Anna is explaining how to measure the rate of falls for a specific unit. When reporting fall rates which of the following is an appropriate way to calculate this number?

The number of client falls per 1,000 client days.

Anna and the staff at the quality improvement meeting are discussing the increase in the rate of falls on their unit. Which of the following is an iatrogenic risk factor that can increase a client's risk for falls?

Type and number of medications prescribed for the client

​Beverly is asking Cynthia to identify the steps in the audit process. Cynthia states that, after determining the topic to study, the next step is to

establish criteria for quality care.

​Cynthia is explaining her understanding of quality improvement to Beverly. Which of the following statements by Cynthia requires further teaching?

​"Quality improvement measures the degree to which an agency has met a criterion."

​Cynthia responds when Anna, the risk manager, asks the quality improvement team to list nursing-sensitive outcomes. Which of the following examples indicates a need for further teaching?

​Primary cesarean birth rates

​Beverly is explaining to Cynthia that a quality improvement team can conduct a structure audit to measure the quality of care. Which of the following fall-related factors are appropriate to include in a structure audit?

​The nurse-client ratio at the time of the fall.


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