Nursing Quiz #4

Strategy: Improve interpersonal communication

Use analogies and pictures Charts; Models; Diagrams Limit to most important concepts Focus on 1-3 key messages Repeat them! Slow down take your time Use plain, non-medical language

reckless behavior

conscious disregard of risk deliberate ack remedial action disciplinary action

common medical errors

**Medication errors** Improper transfusions Too much oxygen for premature babies Health-care associated infections Central-line infections Falls Surgical errors Pharmacy errors Lab errors Treatment errors Birth injuries Restraint-related injuries or death Burns Pressure ulcers Mistaken patient identities

Key Areas of Quality in Health Care

1. Effectiveness Relates to providing care processes and achieving outcomes as supported by scientific evidence 2. Efficiency Relates to maximizing the quality of health care delivered or of health benefit achieved for health care resources used 3. Equity Relates to providing health care of equal quality to those who may differ in personal characteristics other than their clinical condition or preferences for care 4. Patient centeredness Relates to meeting patients' needs and preferences and providing education and support 5. Safety Relates to actual or potential bodily harm 6. Timeliness Relates to obtaining needed care while minimizing delays

health literacy impacts

Access Safety Quality Outcomes

Just Culture

Accountable, non-punitive environment Do not blame, shame Partnership of accountability Individuals should not be held accountable for a systems problem Recognizes that competent professionals make mistakes (note: does not tolerate reckless behavior!) Acknowledges that competent professionals will develop unhealthy norms (shortcuts, work-arounds) Supports a learning organization Leads to greater improvement in patient safety

Leading Organizations of Health Care Quality Include:

Accrediting bodies (ex. the Joint Commission, National Committee for Quality Assurance [NCQA], the American Accreditation Healthcare Organization [aka URAC]) Professional associations (ex. the American Medical Association [AMA], American Nurses Association [ANA]) Individual or group purchasers of care (ex. Centers for Medicare & Medicaid Services [CMS], the Leapfrog Group) Governmental agencies (ex. Centers for Disease Control & Prevention [CDC], CMS, AHRQ) Non-profit entities (ex. Institute of Medicine, National Quality Forum, the Institute for Health Improvement [IHI])

the joint commission

An independent, not-for-profit organization Accredits and certifies nearly 21,000 health care organizations and programs in the US Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization's commitment to meeting certain performance standards

Strategy: Use teach-back method

Ask patients to demonstrate understanding Chunk and check Do NOT ask . . . "Do you understand?"

A nurse is a:

Caregiver Critical thinker Client advocate Change agent Counselor/teacher Coordinator Colleague

health literacy is dependent on

Communication skills of patient and health care professionals Knowledge level of patient and health care professionals Culture Demands of the situation or context

Strategy: Create a shame-free experience

Convey an attitude of helpfulness, caring and respect—by all staff: Ask questions to help patients open up Listen Encourage patients to ask questions Remember non-verbal communication! Provide assistance Confidentially

Quality through history

Early quality improvements: Ignaz Semmelweis 19th-century obstetrician Championed the importance of hand washing in medical care -> one of the first to note a link between handwashing and the spread of disease Florence Nightingale Identified the association between poor living conditions and high death rates among soldiers treated at army hospitals Demonstrated that basic sanitation and hygiene standards led to decreased mortality

Red flags for low health literacy

Frequently missed appointments Incomplete registration forms Non-compliance with medication Unable to name medications, explain purpose or dosing Identifies pills by looking at them, not reading label Unable to give coherent, sequential history Ask fewer questions Lack of follow-through on tests or referrals

Health Care Quality: A Complex System

Health care quality is not a single product like a car Made up of diverse, complex and varying components Health care is ever-changing-> Due to innumerable advances in medicine and technology, delivery is becoming more complex. Health care quality is generally measured in three categories (developed by Avedis Donabedian, M.D., a pioneer in the science of measuring health care quality): Structure: the resources and organizational arrangements are in place to deliver care. Process: appropriate physician and other provider activities are carried out to deliver care. Outcomes: the effect of the care on the health status of patients and populations. (AHRQ)

patient safety

IOM definition: "the prevention of harm to patients" WHO definition: Prevention of errors and adverse effects to patients that are associated with health care Safety is what patients, families, staff, and the public expect from their health care system

safety and medical errors

IOM report: "To Err is Human: Building a Safer Health System" (1999) Noted 98,000 people die in US hospitals each year due to medical errors Highlighted issue of patient safety and quality -> public/ private policy makers, health care professionals, and consumers More-recent studies estimate much higher numbers 210,000 to 440,000 pts/year who seek care at a hospital die as a result of medical errors (Over 4 times the original IOM estimate)More than 1000 people each day Approximately 10,000 serious complications cases resulting from medical errors that occur each day Medical errors cost the nation an estimated $1 Trillion each year Numbers do not account for deaths that occur in outpatient clinics, nursing homes and other non-hospital settings where health care workers care for fragile patients who need complex care 210,000 to 440,000 deaths from medical errors...Would make medical errors the third leading cause of death behind heart disease and cancer according to statistics posted by the Center for Disease Control and prevention (CDC)

NPSGs: 2019 (Hospital)

Identify patients correctly Improve staff communication Use medicines safely Use alarms safely Prevent infection Identify patient safety risks Prevent mistakes in surgery

Culture of Safety: A Commitment to Safety at All Levels

Key Features: acknowledgment of the high-risk nature of an organization's activities and the determination to achieve consistently safe operations a blame-free environment where individuals are able to report errors or near misses without fear of reprimand or punishment encouragement of collaboration across ranks and disciplines to seek solutions to patient safety problems organizational commitment of resources to address safety concerns

Nurse-Sensitive Quality Indicator

Measures and indicators that reflect the impact of nursing care and outcomes The National Database of Nursing Quality Indicators (NDNQI) provides quarterly and annual reports on structure, process, and outcome indicators to evaluate nursing care at the unit level Nurse Quality Indictors: Falls/Injury Pressure Ulcers Pain assessment Physical restraints Infection (health-care related) Staff mix Nurse:patient Nursing care hours per patient per day

health literacy affects patients ability to

Navigate health care system Communicate with health care professionals Engage in self-care Management of chronic diseases Interrupt test results Calculate medication dosages

who is at risk for health literacy

Older adults Ethnic and racial minorities Limited education (less than high school degree or GED) Non-native English speakers Low socioeconomic status People with chronic disease

Nursing and Patient Safety

Patient safety is an essential and fundamental component of quality nursing care Nurses play a vital role in ensuring patient safety by: monitoring patients for clinical deterioration detecting errors and near misses understanding care processes and weaknesses inherent in some systems coordinating high-quality care through collaboration with physicians, pharmacists, families, and all other members of the health care team Promoting safe patient care is important in all areas of nursing practice (clinical, management, education, research, etc.) Being the patient's advocate is an integral part of nursing practice

Nursing Activities

Professional nurses use cognitive, communication, clinical skills when working as partners with clients and in multidisciplinary teams. Data collection done by nurses as part of routine care delivery sometimes identifies a quality initiative. Client outcomes that arise directly from nursing assessment and intervention are known as nursing-sensitive outcomes.

joint commission: national patient safety goals

Program established in 2002 -> first set of NPSGs put into effect January 1, 2003 Help accredited organizations address specific areas of concern in regard to patient safety Purpose: improve patient safety Goals focused on problems in health care safety and how to solve them Goals specific to setting: Hospitals Ambulatory Health Care Behavioral Health Care Critical Access Hospital Home care

Quality Improvement (QI)

QI generally refers to a range of activities conducted to assess, analyze, critique, and improve current processes of health care delivery in an institutional setting

response to a medical error

Serious adverse events require an immediate investigation and response Accredited organizations are expected to use a "thorough and credible Root Cause Analysis (RCA) and action plan" Organizations should disclose the error and apologize to the patient, report the event, and waive all costs associated with the event Goals Protect the patient Improve systems Prevent further harm

Quality & Safety in Nursing Education (QSEN)

The American Association of Colleges of Nursing (AACN) led an effort to promote quality and safety competencies within nursing programs. Coursework is interactive and focuses on the following six core competencies: Patient-centered care Evidence-based practice Safety Teamwork & collaboration Quality improvement Informatics

health literacy

The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions

medical error

The failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim (IOM) Errors can include problems in practice, products, procedures, and systems Sentinel event -> a patient safety event (not primarily related to the natural course of the patient's illness or underlying condition), that reaches a patient and results in any of the following: Death Permanent harm (serious physical or psychological injury) Severe temporary harm and intervention required to sustain life

What Is Quality of Care?

The standard of something as measured against other things of a similar kind; the degree of excellence of something. (Oxford Dictionary) The term "quality" suggests striving for excellence and value (AHRQ) The Institute of Medicine (IOM) defines health care quality as "the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge."

at risk behaviors

individuals choose: risk believed to be justified or insignificant create incentives for healthy behaviors increase awareness of risk

human error

result of current system design and behavioral choice educate train change process/ procedures modify environment