NU471 Week 3 EAQ #2 Evolve Elsevier: Quality Improvement - 30 Questions

Which assessment(s) would the nurse perform while assisting an older adult with her or his living arrangements? Select all that apply. o Financial status o Meaningful activities and interest o Environmental hazards and support systems o Long-range plans such as wills and advance directives o Access to public transportation and community activities

o Financial status o Environmental hazards and support systems o Access to public transportation and community activities · When assisting an older adult with her or his living arrangements, the nurse would assess the client's financial status, environmental hazards, support systems, and access to public transportation and community activities. When an older adult is planning for retirement, the nurse would assess the client's meaningful activities and interest and long-range plans including wills and advance directives.

During a recent tornado the emergency department (ED) mishandled several client situations. In which order would the manager perform actions to improve the quality of care in the future? o Choose an approach to meet the expected quality indicators. o Assess client expectations for ED care. o Determine outcomes and quality indicators for ED services. o Collect data regarding the current status of ED services. o Analyze data collected to determine achievement of expected quality indicators. o Identify members of an interprofessional team to review client expectations.

1. Assess client expectations for ED care. 2. Identify members of an interprofessional team to review client expectations. 3. Collect data regarding the current status of ED services. 4. Determine outcomes and quality indicators for ED services. 5. Choose an approach to meet the expected quality indicators. 6. Analyze data collected to determine achievement of expected quality indicators. · The steps in the quality improvement process begin with assessing the needs most important to the consumer, or in this situation, client expectations for ED care. The second step is to assemble an interprofessional team to review client needs and expectations. The third step is to collect data regarding the current status of ED services. The fourth step is to determine measurable outcomes and quality indicators for the ED services. The fifth step is to choose an approach to meet the expected outcomes or quality indicators. And the final step is to collect data to determine if the implemented plan achieved the expected quality indicators.

The nurse manager asks the nurse, "How would you implement clinical decision-making in a group of clients?" Which answer(s) provided by the nurse show(s) effective critical thinking? Select all that apply. o "I will avoid involving clients as decision-makers and participants in care." o "I will discuss complex cases with other members of the health care team." o "I will identify the nursing diagnoses and collaborative problems of each client." o "I will consider the time it takes to care for clients whose problems have higher priority." o "I will decide to perform activities individually to resolve one client problem at a time."

o "I will discuss complex cases with other members of the health care team." o "I will identify the nursing diagnoses and collaborative problems of each client." o "I will consider the time it takes to care for clients whose problems have higher priority." · The nurse would discuss complex cases with the other members of the health care team. It ensures a smooth transition in the care requirements. As a part of effective critical thinking, the nurse would diagnose the collaborative problems of each client. The nurse would consider the care time for the clients having problems that require high priority. Effective critical thinking requires the nurse to involve clients as decision-makers or participants in care. The nurse would decide on combining activities to resolve more than one client problem at a time.

The registered nurse (RN) is teaching a nursing student about how to educate clients based on their developmental capacity. Which statements made by the nursing student are applicable for older adults? Select all that apply. o "I would encourage independent learning." o "I would keep the teaching sessions short." o "I would involve the client in any discussion or activity." o "I would encourage learning through pictures and short stories." o "I would teach the client psychomotor skills to maintain his or her health."

o "I would keep the teaching sessions short." o "I would involve the client in any discussion or activity." · The nurse would keep teaching sessions short to help the older adult learn easily. Older clients should also be involved in discussions or activities to further engage them. Younger or middle-aged adults are more receptive to being encouraged to learn independently. Teaching psychomotor skills and encouraging learning via pictures and short stories are more applicable to school-aged children.

In which order would the nurse prioritize statements when teaching the client the supraglottic method of swallowing? o "Swallow twice." o "Hold your breath." o "Clear your throat." o "Take a deep breath." o "Place yourself in an upright position." o "Place a half to 1 teaspoon of food into your mouth."

o "Place yourself in an upright position." o "Clear your throat." o "Take a deep breath." o "Place a half to 1 teaspoon of food into your mouth." o "Hold your breath." o "Swallow twice." · The order of steps to be followed in instructing the client in the supraglottic method of swallowing is first to place the client in an upright position, second to tell the client to clear the throat, and then to take a deep breath. The fourth step is for the client to place a half or one teaspoon of food into the mouth. The client should hold his or her breath and then swallow twice. This method exaggerates the normal protective mechanisms with cessation of respiration during the swallow.

The nurse leader is calculating the nonproductive hours of the staff nurse for that year. The nurse took 10 vacation days, 8 general holidays, and 5 sick days. Assuming an 8-hour workday, what are the nonproductive hours of the staff nurse? Record your answer using a whole number. _____ hours

o 184 · 10 days * 8 hours/day = 80 hours · 8 days * 8 hours/day = 64 hours · 5 days * 8 hours/day = 40 · 80 + 64 + 40 = 184 · The full-time equivalent is a total of 2080 hours of work paid per year and 8 hours per day. The staff nurse took 23 leaves. So (Total leave x Full-time equivalent per day = Nonproductive hours), or 23 x 8 = 184.

The client complains of pain in her or his abdomen and nausea at mealtime. An x-ray technician also approaches at the same time for a routine x-ray. Which order of nursing actions is correct? o Assisting the client with feeding o Assisting the x-ray technician for the x-ray o Administering the analgesic as prescribed o Administering medications to decrease nausea

o Administering the analgesic as prescribed o Administering medications to decrease nausea o Assisting the client with feeding o Assisting the x-ray technician for the x-ray · The client may feel uncomfortable with pain and may not cooperate in any activities. The nurse would first administer analgesics to decrease the pain. The next step should be administering medications to decrease nausea. When pain and nausea subside, the client may feel comfortable and may need assistance with feeding. Because the x-ray is a routine one and not urgent, this intervention can be withheld until the client becomes comfortable.

Which activity mentioned by the nurse is an example of a performance improvement measure? o Installing new nurse call bells beside every bed in the health care facility o Evaluating the effectiveness of client-teaching programs conducted before discharge o Initiating new strategies to speed up the process of obtaining consent forms from clients o Analyzing the new technique for counting sponges and instruments in the operating room

o Analyzing the new technique for counting sponges and instruments in the operating room · Performance improvement focuses on analyzing and evaluating the current performance of health care workers to bring about a qualitative change. In the given situation, a new technique for performing sponge and instrument counts in the operating room is being analyzed to help understand the degree of qualitative change in the system. This is an example of a performance improvement. Quality improvement focuses on the continuous study and improvement of the processes of providing health care services to clients. Installing new call bells, conducting client teaching programs before discharge, and speeding up the process of obtaining consent forms from clients are examples of quality improvements.

Which actions demonstrate the "analyticity" concept of a critical thinker? Select all that apply. One, some, or all responses may be correct. o The nurse is organized and focused. o The nurse trusts his or her own reasoning process. o The nurse accepts multiple solutions to a problem. o The nurse uses evidence-based knowledge for clinical decision-making. o The nurse anticipates possible results or consequences in a given situation.

o The nurse uses evidence-based knowledge for clinical decision-making. o The nurse anticipates possible results or consequences in a given situation. · Analyticity is one of the concepts of a critical thinker and involves the use of evidence-based knowledge for clinical decision-making. This skill may also help in anticipating the possible results or consequences of a procedure or a given situation. Being organized and focused reflects systematicity. Trusting one's own reasoning process reflects self-confidence. Accepting multiple solutions to a problem reflects maturity.

A client says, "None of the medications will work on me because I am away from my holy land." Which course of action would the nurse take to comply with teamwork and collaboration competency according to the Quality and Safety Education for Nurses (QSEN)? o Provide care to the client with respect to his or her diversity, values, and beliefs. o Approach the agency chaplain to discuss the spiritual needs of the client. o Conduct thorough research on the effect of emotional distress on the client's health. o Use the flow chart data to provide the best care and monitor the outcome of care processes.

o Approach the agency chaplain to discuss the spiritual needs of the client. · According to Quality and Safety Education for Nurses (QSEN) competency, the nurse complies with teamwork and collaboration competency to function effectively within the nursing and interprofessional teams. In the given scenario, the nurse would collaborate with the agency chaplain to discuss the client's spiritual needs. The nurse complies with the patient-centered care competency by providing care to the client with respect to his or her diversity, values, and beliefs. The nurse complies with the evidence-based practice competency by conducting thorough research on the effect of emotional distress on the client's health. The nurse complies with the quality improvement competency by using the flow chart data to provide the best possible care and monitor the outcome of care processes.

The nurse is changing the dressing of a postoperative client. Another client has fallen near the nursing station and is unconscious. Which is the priority nursing action in this situation? o Attend to the client who lost consciousness. o Delegate the dressing change to the nursing assistant. o Delegate the care of the unconscious client to the nursing assistant. o Complete the dressing, because the open wound may increase infection risk.

o Attend to the client who lost consciousness. · Loss of consciousness may pose a threat to the client's safety and survival and is a high-priority need. The nurse would attend to the unconscious client. The nursing assistant may not have the required knowledge and skills to perform a dressing change. The care of an unconscious client may need critical nursing assessments and clinical decision-making and should not be delegated to the nursing assistant. Risk of infection is not a threat to survival and is considered an intermediate need.

Which are levels of critical thinking in nursing? Select all that apply. o Basic o Analyze o Evaluate o Complex o Commitment

o Basic o Complex o Commitment · The three levels of critical thinking in nursing are basic, complex, and commitment. Analyzing and evaluating are skills associated with critical thinking, not levels.

A client has a large, open abdominal wound. The health care provider's prescription states to cleanse the wound with normal saline, pack it with damp gauze, cover with abdominal pads, and secure with Montgomery straps twice a day. Which step would the nurse take to maintain sterility when changing the dressing? o Use two square gauze pads to cleanse the wound, one for each half of the wound. o Apply new Montgomery straps each time the dressing is changed. o Hold the wet gauze with the tips of the forceps higher than the wrist. o Cleanse the wound with wet, sterile gauze from the center of the wound outward

o Cleanse the wound with wet, sterile gauze from the center of the wound outward · Wounds should be cleansed from the center outward or from the top to the bottom; this ensures that cleansing is done from the least to the most contaminated area. A new sterile gauze square should be used for each swipe of the wound. More than two gauze squares will be needed to cleanse a large abdominal wound. Using the same gauze square again will contaminate the wound. Montgomery straps are changed only when they become soiled or begin to loosen from the client's skin. Montgomery straps are applied to each side of a wound. The central sections are folded back when the dressing is changed. When folded back in place over the new dressing and secured with a tie, they keep the dressing in place without having to replace the tape each time the dressing is changed. Forceps should always be held with the tips lower than the wrist. If they are held with the wrist lower than the tips of the forceps, cleansing solution can flow down the instrument and the hand and arm of the nurse, contaminating the fluid. When the wrist is then raised above the forceps, the contaminated fluid will flow back down the forceps into the wound.

The nurse is reviewing the case history and disease prognosis of various clients. Which would the nurse consider as a near-miss event? o Client A o Client B o Client C o Client D

o Client A · A near-miss is an error that could have caused harm to a client but did not because of some intervention that saved the client from the effect of the error. Client A was rescued from respiratory arrest because of timely intubation. This is an example of a near-miss event. Client B, who had a stroke, had developed pressure sores resulting from poor-quality care. This is an example of an adverse event. Client C, who had deep vein thrombosis, had developed pulmonary embolism, which is a life-threatening complication. This is a type of sentinel event. Client D, who had fever, had developed febrile seizures, which may have resulted because of inappropriate management. This is also a type of adverse event.

Care of which client admitted with fluid overload would be considered a priority requiring immediate care based on age and condition? o Client A o Client B o Client C o Client D

o Client A · Client A is an older adult who presents with a bounding pulse rate because of fluid overload in the body. Care should be prioritized in this client because the condition of the client indicates increasing fluid overload and needs immediate treatment. Vital signs should be monitored properly to identify other associated risks. Client B has pale skin with pitting edema, so this client should be given second priority for treatment and an oxygen mask or nasal cannula should be provided. Client C can be given medications to relieve the headache resulting from fluid overload. Client D should be given nutritional therapy to treat fluid overload.

Which client in the emergency department would the nurse assess first? o Client with chest pressure and ST segment elevation on the electrocardiogram o Client who reports a sharp chest pain with deep inspiration for the past week o Client who has history of heart failure with ascites and bilateral 4+ ankle swelling o Client with palpitations and paroxysmal atrial fibrillation at a rate of 136 beats/minute

o Client with chest pressure and ST segment elevation on the electrocardiogram · The client with chest pressure and ST segment elevation on the electrocardiogram will need emergency treatment for ST segment elevation myocardial infarction (STEMI), including transport to the cardiac catheterization laboratory for percutaneous coronary intervention within 90 minutes, and should be seen first. The client with sharp pain with deep inspiration has symptoms consistent with pericarditis or pleural effusion and does need rapid assessment and treatment, but is not at risk for life-threatening complications. The client with heart failure and ascites and ankle swelling has symptoms of right ventricular failure that are not life-threatening. The client with palpitations and rapid atrial fibrillation will need assessment and evaluation, but the client experiencing myocardial infarction has a more life-threatening diagnosis.

The nurse is caring for a client with diabetes mellitus who is on insulin therapy. After the client experiences a cardiac arrest, the client is transferred to the intensive care unit (ICU). Which nursing interventions are the major attributes that affect the quality of care provided to the client? Select all that apply. o Develop a diet plan according to the client's food preference. o Coordinate with the members of the ICU while transferring the client. o Provide cardiopulmonary resuscitation before transferring the client. o Encourage the client's family members to visit the client frequently. o Administer digoxin (Cardoxin) to the client according to the prescription.

o Coordinate with the members of the ICU while transferring the client. o Provide cardiopulmonary resuscitation before transferring the client. o Administer digoxin (Cardoxin) to the client according to the prescription. · The major attributes that affect the quality of care are coordinating with the members of different departments during transitions, providing the most important services, and acting within the scope of practice. Coordinating with the members of the ICU while transferring the client, providing cardiopulmonary resuscitation, and administering digoxin (Cardoxin) are the major attributes. Considering the client's preference is a minor attribute that affects the quality of care and helps provide patient-centered care. Developing a diet plan according to the client's food preference is a minor attribute. The nurse would take measures to prevent the risk of infection. The nurse would not ask the family members to visit the client frequently because it increases the risk of infection.

The nurse is caring for an obese client with diabetes mellitus. Which nursing actions satisfy the Quality and Safety Education for Nurses (QSEN) competency called teamwork and collaboration? o Engaging the physical therapist in managing the client's condition o Explaining the client's medication routine to the next shift nurse o Consulting with the dietician to help manage the client's condition o Consulting old records of similar client cases before preparing a care plan o Documenting in the electronic health record after administering every medication

o Engaging the physical therapist in managing the client's condition o Explaining the client's medication routine to the next shift nurse o Consulting with the dietician to help manage the client's condition · To satisfy the Quality and Safety Education for Nurses (QSEN) competency called teamwork and collaboration, the nurse would be able to work effectively within the nursing and interprofessional teams by promoting open communication, mutual respect, and shared decision-making. The nurse would collaborate with the physical therapist to provide quality care. By communicating essential details of client care (such as the medication administration routine), the nurse satisfies the teamwork and collaboration competency. The nurse consults with the dietician to take a shared decision in the interests of the client. The nurse satisfies the evidence-based practice competency by integrating best current evidence with clinical expertise. In the given situation, the nurse integrates the result of case studies with the care plan to achieve optimal client care. Documenting the medications administered to the client in the electronic health record for future reference satisfies the informatics competency.

The nurse is heading a performance improvement team. The nurse collects records of needlestick injuries caused by improper needle recapping techniques during medicine administration. Which is the next step to be followed by the nurse if he or she is using the plan, do, study, act (PDSA) model? o Evaluate data regarding the number of needlestick injuries after providing proper training. o Conduct training programs to teach proper needle recapping techniques on a weekly basis. o Implement new training programs on needle recapping techniques in all units of the hospital. o Facilitate a training program for all nurses to teach the proper technique of recapping needles.

o Facilitate a training program for all nurses to teach the proper technique of recapping needles. · The PDSA model includes the steps plan, do, study, and then act. In this case the nurse performs the "plan" step by collecting the records of needlestick injuries that occur because of improper needle recapping techniques. After this, the nurse moves on to the "do" step. At this stage, the nurse chooses an intervention on the basis of the data and implements the change. In the given situation, all nurses are given training on the proper technique of recapping needles. The "study" step involves the nurse evaluating the data regarding the number of needlestick injuries after training has been given. The last step of the PDSA cycle is the "act" stage. At this stage, the training programs are implemented on a weekly basis. In addition, new training programs on needle recapping techniques are implemented in all units of the hospital.

A nonprofit organization has conducted a survey on statewide primary health care facilities. The members of the organization provided feedback on the methods used by their facility's health care professionals to deliver high-quality care. Which health care facility provides highest quality care and is probably preferred by most clients? o Health care facility A o Health care facility B o Health care facility C o Health care facility D

o Health care facility A · The quality of care provided by the health care professionals can be measured and graded based on the attributes they follow. Based on the grades, the clients prefer to consult high-quality providers and primary health care providers for obtaining treatment. The primary health care providers who monitor costs and follow interventions to reduce hospital stay and cost of treatment provide efficient care to the clients. Most clients would prefer health care facility A. When the primary health care providers offer services that address the most critical conditions, it helps them provide effective care. If health care professionals act within the scope of their certifications or practice licenses, they provide safe care. If the health care facility follows interventions to prevent injuries and risk of fall, it helps them provide safe care. Health care facilities B, C, and D may not be able to provide the highest quality care to the client and may not be preferred by most clients.

A client with burns over 35% of the body reports chilling. Which action will the nurse take to promote client comfort? o Limit room drafts. o Place a sterile top sheet over the client. o Decrease the room humidity to less than 10%. o Maintain an 80°F (26.7°C) room temperature.

o Limit room drafts. · Limiting drafts minimizes body heat lost by convection; the loss of body heat increases when moistened skin is exposed to slightly moving air. A sterile sheet is not necessary; some clients may be treated by the open method and have burns exposed. Maintaining humidity in the air holds in heat; decreasing the humidity will cool the room and increase chilling. The room temperature should be kept at approximately 85°F (29.4°C), because heat is lost from burned areas.

Which are the similarities between evidence-based practice and quality improvement? Select all that apply. One, some, or all responses may be correct. o Nurses conduct the activities in both. o Funding resources are internal in both. o The effects of the practice are measured in both. o Expert opinions are the data resources in both. o Institutional Review Board approval is needed for both.

o Nurses conduct the activities in both. o Funding resources are internal in both. · In both evidence-based practice and quality improvement, practicing nurses conduct the activities. The funding resources in evidence-based practice and quality improvement are internal, that is, from the health care agency itself. The measurement of the effects of practice or any change in practice regarding clients is done in quality improvement only. Data resources in evidence-based practice are based on expert opinions, personal experience, and clients. In quality improvement, the data is collected from client records or clients from a specific area such as the intensive care unit. Institutional Review Board approval is only needed for evidence-based practice.

The hospital management team has conducted a randomized controlled trial to decrease the occurrence of ventilator-associated pneumonia. The trial was successful and had positive outcomes. The nurse manager, in collaboration with other hospital management staff, conducted the same trial in another hospital, but the results were different. Which research strategy implementation would the nurse manager consider to be beneficial in preventing dramatic differences in trial results? o Evidence-based practice (EBP) o Practice-based evidence (PBE) o Client-centered outcomes research o Comparative effectiveness research (CER)

o Practice-based evidence (PBE) · PBE is a research methodology that helps inform practice. It uses an observational cohort study design that compares clinically relevant interventions, includes diverse study participants, uses heterogeneous practice settings, collects data on a broad range of health outcomes, and includes frontline clinicians in study development. EBP is the integration of the best research evidence with clinical expertise and the client's unique values and circumstances in making decisions about the care of individual clients. Client-centered outcomes researchers conduct research to provide information about the best available evidence to help clients and their providers make decisions that are more informed. CER is the generation and synthesis of evidence that compares the benefits and harms of alternative methods.

A nursing student is noting information about the National Database of Nursing Quality Indicators (NDNQI). Which point noted by the nursing student needs correction? o Developed by the American Nurses Association (ANA) o Reports quarterly results on nursing outcomes at the nursing unit level o Provides a database for individual hospitals to compare their performance against nursing performance internationally o Measures and evaluates nursing-sensitive outcomes with the purpose of improving client safety and quality care

o Provides a database for individual hospitals to compare their performance against nursing performance internationally · National Database of Nursing Quality Indicators (NDNQI) reports provide a database for individual hospitals to compare their performance against nursing performance nationally. The American Nurses Association (ANA) developed NDNQI with the aim of bringing about quality improvement in client care. NDNQI reports quarterly results on nursing outcomes at the nursing unit level. NDNQI is used to measure and evaluate nursing-sensitive outcomes. This evaluation helps improve client safety and quality care.

The nurse is collecting case reports that can be analyzed using the failure mode effective analysis (FMEA) tool. Which case files would the nurse collect? Select all that apply. o A coma due to severe hemolytic transfusion reaction o Depression committed suicide by falling off the terrace of the hospital o Retained foreign body left during surgery that was removed immediately o Wheelchair-bound client rescued from falling in the corridor of the hospital o Urinary tract infection after 4 days of continuous catheterization

o Retained foreign body left during surgery that was removed immediately o Wheelchair-bound client rescued from falling in the corridor of the hospital o Urinary tract infection after 4 days of continuous catheterization · The failure mode effective analysis (FMEA) tool is used to analyze the cause of near-miss events and adverse events. A retained foreign body after surgery if removed immediately is a type of near-miss event. A client developing a urinary tract infection after catheterization is a type of adverse event. A wheelchair-bound client was rescued from falling in the hospital corridor is a type of near-miss event. The cause of these events can be analyzed using the FMEA tool. A client in a coma due to severe hemolytic transfusion reaction and a depressed client who committed suicide are types of sentinel events. The cause of these events can be assessed by using the root cause analysis tool.

Arrange the steps involved in the PDSA cycle for implementing the quality improvement process. o Establishing an electronic health record system in the hospital o Incorporating the electronic health record system into daily practice o Review the available data and plan on the measures to be taken o Measuring the improvement in client care

o Review the available data and plan on the measures to be taken o Establishing an electronic health record system in the hospital o Measuring the improvement in client care o Incorporating the electronic health record system into daily practice · The first step in the PDSA cycle is "plan," which involves reviewing the available data to understand the existing practice conditions or problems. The next step is "do," which involves selecting an intervention based on the review and implementing the change. Establishing an electronic health record system in the hospital is the second step of the quality improvement process. The next step is "study," which involves evaluating the results of the change by measuring the improvement in client care after implementing the electronic health record system. The final step of PDSA cycle is "act." In this stage, the practice is incorporated into daily practice if the outcomes of the implementation were positive.

Which Quality and Safety Education for Nurses (QSEN) competency is involved in the situation where the nurse coordinates care with a dietician and a certified diabetes educator (CDE)? o Safety o Patient-centered care o Evidence-based practice o Teamwork and collaboration

o Teamwork and collaboration · The nurse recognizes the contributions of other health team members and coordinates effectively with them to ensure quality care for the client. This intervention involves the QSEN competency of teamwork and collaboration. The nurse values his or her own role in providing safety by minimizing the risk of harm to clients and health care providers through system effectiveness. The nurse provides patient-centered care by recognizing the client as the source of control and full partner in health care. The nurse applies evidence-based practice by integrating best current evidence with clinical expertise and client preferences and values to deliver optimum health care.

The nurse finds that a postpartum client who underwent a vaginal delivery believes that she has received high-quality care in the health care facility according to Meade. Which client response supports the nurse's conclusion? o Relief that she had no postpartum complications o Thankful for the nurse for providing extraordinary service o Grateful to the nurse for discharging her within 72 hours after delivery o Client promises to follow all the suggestions given by the primary health care provider

o Thankful for the nurse for providing extraordinary service · The meaning of quality differs for individuals based on their perception. According to Meade, when health care professionals provide extraordinary services to clients, they believe that they have received high-quality care. The primary health care providers may consider high quality to be providing cost-effective treatment to the client without any complications. Usually, postpartum clients would be discharged 2 to 3 days after delivery if they undergo vaginal delivery without any complications. The client may not be happy with a long hospital stay. If the client promises to follow all the suggestions given by the primary health care provider, it indicates that the client would adhere to the treatment regimen. It does not mean that the client believes that she has received high-quality care in the hospital.

The nurse is working in a hospital that receives most of its payment from Medicare and Medicaid services. In the annual assessment of The Joint Commission, the hospital had not met all the standards set forth in the Centers of Medicare and Medicaid Services. Which action would the nurse expect to be taken? o The Centers of Medicare and Medicaid Services will stop paying the hospital. o The hospital will lose its accreditation given by The Joint Commission. o The Joint Commission would conduct an unannounced follow-up survey in the hospital. o The Centers of Medicare and Medicaid Services will conduct a follow-up survey in the hospital.

o The Joint Commission would conduct an unannounced follow-up survey in the hospital. · The hospital has failed to meet the standards of the Centers of Medicare and Medicaid Services. Before any action is taken, The Joint Commission performs an unannounced follow-up assessment. The hospital accreditation may be lost if the hospital fails to meet the standards during the follow-up survey. The hospital may also stop receiving its payment from the Centers of Medicare and Medicaid Services if the hospital does not follow the standards during the follow-up survey. The Centers of Medicaid and Medicare Services do not analyze the quality of care provided by hospitals.

Which goal would meet S.M.A.R.T. criteria? Select all that apply. o Central-line associated blood stream infections (CLABSIs) will decrease by 50% across all units. o The facility will offer quality improvement training opportunities to all nursing staff within 6 months of hire. o All nursing staff will understand new handoff communication policies and procedures before implementation. o Nurses will maintain current licensure and/or certifications and meet all continuing education requirements ongoing. o The facility will provide funding to all associate degree nurses to support attainment of a baccalaureate degree within 5 years from the date of hire.

o The facility will provide funding to all associate degree nurses to support attainment of a baccalaureate degree within 5 years from the date of hire. · Goals written using the S.M.A.R.T. guidelines must be specific, measurable, achievable, realistic, and timely. The facility goal of funding all associate degree nurses in attaining a baccalaureate degree within 5 years of hire includes all elements of a S.M.A.R.T. goal. The goal of decreasing central-line associated blood stream infections (CLABSIs) by 50% across all units does not include a time frame. The facility goal of offering quality improvement training opportunities to nursing staff within 6 months of hire does not include a measurable outcome. The goal of all nursing staff understanding new handoff communication policies and procedures before implementation does not use a measurable verb. The goal of nurses maintaining current licensure and/or certifications and meeting all continuing education requirements ongoing includes more than one result, but a specific goal should only have one result.