Quality Improvement

The nurse organized a staff meeting to address morale issues and improve the level of care on the unit. Which assessment practice is the nurse demonstrating? A) Intraprofessional B) Interprofessional C) Utilization review D) Benchmarking

A) Intraprofessional Rationale: Intraprofessional assessment occurs within a group of individuals who have similar positions within a healthcare​ system, such as a group of nurses or a group of surgeons. Such an assessment is important for identifying areas of improvement at each level of care. Interprofessional assessment would take place if a different units provided feedback. Benchmarking is comparing outcomes of two different departments. A utilization review looks at areas of​ misuse, overuse, or underuse of​ resource, not a moral issue.

Governmental agencies and the healthcare industry have partnered to improve the quality of care. Which action should the nurse recognize is aimed at providing better care? A) Making healthcare more client-centered, reliable, accessible and safe B) Addressing behavioral, social, and environmental determinants of health C) Delivering care to underserved clients D) Reducing the cost of quality healthcare to all consumers

A) Making healthcare more client-centered, reliable, accessible and safe Rationale: To improve the health of the​ population, the U.S. Department of Health and Human Services​ (HHS) has developed the National Quality​ Strategy, which contains three broad aims. One of the aims is Better Care to improve the overall quality by making healthcare more client​ centered, reliable,​ accessible, and safe. The other two aims are Healthy​ People/Healthy Communities and Affordable Care.

Which statement correctly describes quality management? A) Quality management compares nursing processes to accepted standards to prevent errors in treatment. B) Quality management refers to systematic actions that lead to improvements in healthcare services C) Quality management is the degree to which health services increase the likelihood of desired health outcomes D) Quality management provides clients with appropriate service in a technically competent manner

A) Quality management compares nursing processes to accepted standards to prevent errors in treatment Rationale: Quality management includes evaluation of medical and nursing processes for quality and effectiveness compared to accepted standards in order to correct problems before they harm clients and to prevent errors in treatment. Quality improvement refers to systematic actions that lead to improvements in healthcare services. Quality is the degree to which health services increase the likelihood of desired health outcomes. High-quality care provides clients with appropriate service in a technically competent manner.

The nurse uses a checklist to look at the completeness of documentation of post-surgical pain relief for clients discharged after a specific surgical procedure. Which term best describes the nurse's activity of this review process? A) Retrospective audit B) Concurrent audit C) Utilization review D) Root cause analysis

A) Retrospective audit Rationale: The nurse is conducting a retrospective audit by looking back in time. A retrospective audit compares care provided to clients with similar​ conditions, and recommendations are made to change procedures if needed. A concurrent audit takes place when clients are still hospitalized. Utilization review looks at the use of​ resources, not documentation. A root cause analysis is triggered by a sentinel​ event, rather than by routine client care documentation.

The nurse manager calls for a meeting to identify and discuss the cause of a recent problem in the facility so that the incident does not happen again. Which term should the nurse use to describe this process? A) Root cause analysis B) Resource utilization C) Reducing medical errors D) Blame-free environment

A) Root cause analysis Rationale: Root cause analysis is the correct answer. The goals of the root cause analysis are to identify the reasons for failures or problems and to develop an action plan for improvement to decrease the likelihood of future adverse events. Reducing medication errors involves interventions specifically help nurses prevent medication errors. Resource utilization is increasing the value of healthcare by reducing costs. A​ blame-free environment is established to maintain or improve the quality of care in which healthcare providers can report errors or near misses without the fear of punishment.

The nurse is participating in a quality improvement process related to improving care for clients at risk for skin breakdown. Which best describes the purpose of this process? A) To improve client outcomes B) to advance the nurse's career C) To fulfill legal requirements D) To maintain accreditation

A) To improve client outcomes Rationale: Quality improvement is the name for the processes used by an agency to measure and improve aspects of client care, including overall outcomes. Participation may help the nurse advance in his or career, but that is usually accomplished by returning to school for a higher degree. Nurses are encouraged to participate in quality improvement programs but are not legally required to do so. Although maintaining accreditation is important, it is not the primary reason for engaging in quality improvement processes.

*Possible Exam Question* Which of the following would be considered sentinel events? SATA A) Delivery of radiation to the wrong body region B) Invasive surgical procedure at the wrong site C) Homicide of a staff member while at the facility D) Homicide of a client while at the facility E) Administration of a compatible blood transfusion

A, B, C, D Rationale: A sentinel event is an unexpected occurrence causing serious injury or death. According to the Joint Commission, the following are sentinel events: delivery of radiation to the wrong body region, invasive surgery at the wrong site, and homicide of a staff member or client while at the facility. Administration of a compatible blood transfusion would be desired. Administration of an incompatible blood transfusion would be a sentinel event.

Several medication errors occurred at facility. Which method should the nurse anticipate being suggested to avoid future errors? SATA A) Double check the "seven rights" every time medication is administered B) Have a second nurse check the medication order C) Conduct a medication reconciliation at every transition in care D) Use smart infusion pumps for IV medications E) Combine medications with the same active ingredient

A, B, C, D Rationale: The correct answers to avoid such errors are​ (1) double-check the​ "seven rights" every time medication is​ administered, (2) conduct medication reconciliation at every transition in​ care, (3) use smart infusion pumps for intravenous​ medications, and​ (4) have a second nurse check the medication order. Combining medications with the same active ingredient is incorrect and is not a method in reducing medication errors.

As head of continuous quality improvement at a hospital, the nurse wants to interview external customers. Which customer should the nurse include? SATA A) Clients who seek healthcare B) Hospital volunteers C) Durable medical equipment suppliers D) Billing specialist E) Insurance companies

A, B, C, E Rationale: External customers include the individuals who seek healthcare as well as their family members and significant others. External customers also include other individuals and entities with which internal clients​ interact, such as insurance​ companies, managed care​ organizations, equipment or material​ suppliers, social service​ agencies, and law enforcement officials. Internal customers include employees of a healthcare​ organization, such as​ nurses, healthcare​ providers, therapists, medical records​ staff, billing​ specialists, and other employees.

The rehabilitation department is conducting an audit on the efficacy of a new treatment protocol by examining the client report and status upon discharge. Which type of audit is the department conducting? SATA A) Intraprofessional assessment B) Utilization review C) Retrospective audit D) Interprofessional assessment E) Concurrent audit

A, E -Intraprofessional assessment - Concurrent audit Rationale: An audit is an examination of records to verify accuracy and proper use. If the audit is focused on one​ discipline, it is an intraprofessional assessment. If the audit is focused on multiple​ disciplines, it becomes an interprofessional assessment. A concurrent audit is performed while the client is still undergoing care at the healthcare facility. A retrospective audit is performed after a​ client's discharge. A utilization review analyzes the use of resources to identify areas of​ overuse, misuse, and underuse.

The nurse is discussing the purpose of utilization review with colleagues. Which statement should the nurse include? A) Contacting the insurance company to facilitate payment for services B) Ensuring that the client's medications and treatments are appropriate for his or her diagnosis C) Working with members of the interdisciplinary team to provide comprehensive care for the client D) Working with a social worker to make sure the client's family has resources for care

B) Ensuring that the client's medications and treatments are appropriate for his or her diagnosis Rationale: The utilization review​ nurse's role is designed to ensure that a client is receiving the necessary treatments and procedures for his or her condition without undergoing any unnecessary therapies. By reviewing these​ terms, the utilization review nurse saves the healthcare center money by avoiding payments on expensive treatments that are unwarranted. The​ nurse's role also saves the client from undergoing possibly painful and expensive tests and procedures that are not needed. All the other options are not a part of the utilization review process.

The nurse is asked to participate in a record review to verify accuracy and proper use of certain interdisciplinary resources. Which best describes the nature of this process? A) Peer review B) Interdisciplinary audit C) Utilization review D) Benchmarking

B) Interdisciplinary audit Rationale: An audit is an examination of records to verify accuracy and proper use. Because this audit is focused on resources used by multiple disciplines, it would be classified as an interdisciplinary audit. A peer review is a professional critique of a colleague's work on the basis of predetermined standards. A utilization review analyzes the use of resources to identify areas of overuse, misuse, and underuse. Benchmarking is a method that is used to compare the performance of an individual or organization to industry standards.

Which activity should the nurse recognize as a way for state and local entities to make healthcare more affordable? A) Develop new healthcare delivery models B) Offer basic health coverage for all citizens living in their state C) Coordinate care through the use of effective communication D) Require hospitals to track readmission rates for low-income clients

B) Offer basic health coverage for all citizens living in their state Rationale: Developing new healthcare delivery models is a state and local initiative that can lower healthcare costs. Coordinating care through effective communication would be the responsibility of the healthcare institution. States and local entities are not required to provide affordable healthcare to all their citizens. Local hospitals are not just responsible to track the readmission​ rates, but are encouraged to actively try to reduce readmission rates through broad based teaching and​ follow-up as a way to lower costs.

The quality assurance officer notes that one particular nursing unit has received a higher-than-usual number of negative client responses about aspects of the nursing care during the previous quarter. Based on this data, to which benchmarking issue should the quality assurance officer pay particular attention during the review process? A) Structure B) Process C) Outcome D) Competency

B) Process Rationale: Process standards focus on the steps used to lead to a particular outcome, including whether a set of steps exists and whether those steps are being followed. Competency is not one of the components of quality assurance evaluation. Structure evaluation focuses on organizational structure and resources. Outcome evaluation focuses on the performance of a process, such as the number of bedridden clients who develop a pressure injury.

To address client complaints of disrupted sleep due to noise on the floor, the nurse manager formed three teams who implemented various processes to reduce the noise. Another team is collecting sleep data from the clients and analyzing the effectiveness of the solution, based on which they intend to develop better methods and improve the facility. Which quality improvement process is the manager implementing? A) Performance improvement B) Six Sigma C) Continuous quality improvement D) Benchmarking

B) Six Sigma Rationale: Six Sigma considers factors leading to client dissatisfaction as​ "defects." 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.

A hospital administrator wants to improve quality care and workflow process within the organization by involving the whole organization, suppliers, and customers in the process. Which quality management program should the nurse understand the manager is using? A) Continuous quality improvement B) Total quality management C) Six Sigma D) Lean Six Sigma

B) Total quality management Rationale: Total quality management​ (TQM) is a comprehensive management philosophy that is used to improve quality and productivity by using data and statistics to improve systems processes. TQM involves teamwork throughout the​ organization, involving all departments and employees and including both suppliers and customers. Its essential elements include​ communication, feedback,​ fact-based decision​ making, and a focus on continual improvement.

Which should the nurse recognize as being the best resource to keep abreast to the changes of the insurance and healthcare laws? A) American Medical Association B) U.S. Dept. of Health and Social Services C) Physician's groups D) American Nurses Association

B) U.S Dept of Health and Human services Rationale: Keep abreast of the changes in healthcare and insurance laws by visiting the U.S. Department of Health and Human Services.​ Physicians' groups, the American Nurses Association​ (ANA), and the American Medical Association​ (AMA) are not the best place to keep oneself​ up-to-date about the changes in insurance and healthcare laws.

Which National Quality Strategy should the nurse understand focuses on the community? SATA A) Client safety B) Healthy living C) Affordability D) Effective prevention and treatment E) Care coordination

B, C Healthy Living Affordability Rationale: Affordability covers the community as the healthcare industry works to make healthcare more affordable to​ individuals, families,​ employers, and governments. Healthy living also covers the community because this​ strategy's main aim is to work with communities to promote wide use of best practices to promote healthy living. Client​ safety, care​ coordination, and effective prevention and treatment are all more focused on the individual client.

A nurse is participating in an intradisciplinary assessment as part of a quality improvement process. Which of the following should the nurse anticipate will be included in this assessment? SATA A) Utilization reviews B) Peer review C) Audits D) Performance appraisals E) Outcomes management

B, C, E Rationale: Intradisciplinary assessment occurs within a group of individuals with a similar position in the healthcare system, such as a group of nurses. An intradisciplinary assessment is important for identifying areas of improvement at each level of care and includes peer review, audits, and outcomes management. Utilization reviews are completed when conducting an interdisciplinary assessment. Performance appraisals are not a part of either intra- or interdisciplinary assessments.

the nurse is discussing social determinants addressed by Healthy People/Healthy Communities. Which factor should the nurse include? SATA A) Exposure to toxic substances and other physical hazards B) Public safety C) Physical barriers, especially for people with disabilities D) Availability of resources to meet daily needs E) Social norms and attitudes, such as discrimination

B, D, E Rationale: Healthy​ People/Healthy Communities is another aim the U.S. Department of Health and Human Services​ (HHS) has developed to improve the health of the population. The​ aim's focus is to health. Examples of social determinants​ include, but, are not limited​ to: (1) availability of resources to meet daily​ needs, such as educational and job​ opportunities, living​ wages, or healthful​ foods; (2) social norms and​ attitudes, such as​ discrimination; (3) social support and social​ interactions; (4) socioeconomic​ conditions, such as concentrated​ poverty; (5) quality​ schools; (6) transportation​ options; and​ (7) public safety.

The nurse is responsible for continuous quality improvement at a rehabilitation hospital. Which internal client should the nurse interview for suggestions? SATA A) Client after hip replacement B) Parents of a child with spina bifida C) Physical therapist D) Clinical nurse specialist E) Head of Management of Information Systems

C, D, E 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.

Which statement regarding standards of care in the hospital setting is inaccurate? A) "Standards of care are based on models of high-quality performance." B) "Process standards focus on the steps used to lead to a particular outcome." C) "Process standards focus on human resources, and general organizational structure." D) "Outcome standards focus on the performance of a process."

C) "Process standards focus on human resources, and general organizational structure." Rationale: "Process standards focus on human resources and general organizational structure" is incorrect, and indicates that the student needs further education. The rest of the statements are correct.

The client satisfaction rate is at 60% for two consecutive months, and staff morale is at its lowest. The nurse manager decides to plan changes that will improve conditions on the unit. Which should be the priority action? A) Ignoring the issues since these will be resolved naturally B) Developing a strategic action on how to deal with these concerns C) Calling for a staff meeting placing this issue on the agenda D) Seeking help form another manager

C) Calling for a staff meeting placing this issue on the agenda Rationale: Calling for a staff meeting to address the issue will allow for the participation of every staff member in the unit. If they contribute to the solutions of the​ problem, they will own the​ solutions; hence the chance for compliance would be greater. Ignoring the issue with a perception that these will be naturally resolved is not a correct approach. Developing strategic action on dealing with these concerns and seeking help from his manager will be the next​ steps, or can wait for some time at this juncture.

What major nursing concept has the strongest relationship to the identification of areas for quality improvement, such as tracking data on healthcare-associated infections? A) Ethics B) Safety C) Informatics D) Evidence-based practice

C) Informatics Rationale: Informatics can be used to identify areas for improvement, such as tracking healthcare-associated infections. Without informatics, tracking adverse outcomes would be time-consuming and potentially cost-prohibitive. With the advent of technology and informatics, statistics and client outcomes are easier to track, making quality improvement more efficient. Ethics, safety, and evidence-based practice can all contribute to quality improvement, but not by easily tracking poor client outcomes.

*Possible Exam Question* The nurse is reviewing yearly national patient safety goals. For which organization is the nurse retrieving this information? A) Institute for Safe Medical Practices B) The Food and Drug Administration C) The Joint Commission D) The American Medical Association

C) The Joint Commission Rationale: The Joint Commission is the organization that identifies client safety goals every year for medical facilities to focus on. The goals​ include, but are not limited​ to, ensuring clients are identified​ safely, improving staff​ communication, using alarms​ safely, and preventing infections. The American Medical Association​ (AMA) promotes the betterment of public health by enhancing the delivery of care and enabling physicians and healthcare teams to partner with clients to achieve better health. The Institute for Safe Medication Practice​ (ISMP) maintains a list of high alert medications such as​ look-alike, sound-alike medications to assist clinicians with identifying medications that can either look similar or have similar​ names, but that have very different chemical properties that can cause harm to the client if the medications are mixed up. The Food and Drug Administration​ (FDA) is responsible for advancing the public health by helping to speed innovations that make medical products more​ effective, safer, and more affordable and by helping the public get the​ accurate, science-based information they need to use medical products and foods to maintain and improve their health.

The nurse is administering medications to a client. Which action is most likely to lead to an adverse event? A) The nurse verifies tube placement prior to administering the medications B) The nurse checks for known allergies prior to administering the medications C) The nurse combines medications with the same active ingredient D) The nurse has a second nurse check the medication order

C) The nurse combines medications with the same active ingredient Rationale: It is not appropriate to combine medications with the same active ingredient, as this is likely to increase medication errors. Verifying tube placement prior to administering medications, checking for known allergies prior to administering medications, and having a second nurse check the medication order are all appropriate actions and are considered methods to reduce medication errors.

Which statements best describe how a quality improvement process can contain healthcare costs? SATA A) "Promoting safety increases the cost of care." B) "Medication errors decrease the cost of care." C) "High nurse-to-client ratios result in decreased readmission rates." D) "Increased nursing staff has been linked to decreased infection rates." E) "Use of computers increases the number of lawsuits."

C, D Rationale: Studies have shown that increasing the nurse-to-client ratio can decrease overall cost because readmission rates and infection rates, as well as client mortality, are reduced with RN care. Medication errors increase cost due to harm to the client and increased length of stay. Promoting safety is a cost-containment measure because it decreases injury to the client and the consequent risk of lawsuits. Computers increase efficiency and reduce cost as a result. Lawsuits do not increase because of computer use; they increase when computers are used improperly.

An organization is using Six Sigma to determine why discharge instructions given to a group of clients were below national standards. Which step should the nurse understand applies to this quality management process? A) Standardizing the discharge process with the healthcare providers B) Meeting with the discharge planners C) Improving the knowledge level of the staff unit-by-unit D) Improving the knowledge level of the staff with one-on-one training E) Standardizing and simplifying the discharge instruction process

C, D, E Rationale: Six Sigma is a quality improvement program that aims to produce a​ near-perfect product. Sigma is used to measure deviation from a standard. In this​ system, a defect is defined as anything that could lead to client dissatisfaction. Defects in healthcare could range from relatively minor problems to major problems. Six Sigma primarily uses the​ Define, Measure,​ Analyze, Design, and Verify system to improve outcomes. For this​ instance, the organization is aiming to increase the percentage of heart failure clients for compliance.

The nurse is preparing to present the goals of risk management. Which should the nurse include? SATA A) Occurs on a monthly basis B) Prevent breach of care C) Minimize damage from adverse events D) Conduct root cause analysis E) Prevent adverse events

C, E -Minimize damage -Prevent adverse events Rationale: Risk management is the process of identifying vulnerabilities to minimize the consequences of adverse client outcomes. Risk management includes both proactive components to prevent adverse events and reactive components to minimize damage from adverse events. Risk assessment must occur​ daily, and all individuals must be dedicated to keeping clients safe from harm.

Which best describes the desired outcome of decreased readmission rates? A) An increased use of overtime B) A decrease in client satisfaction C) An increase in client care supplies D) A decreased cost of care

D) A decreased cost of care Rationale: Research has shown that an increase in RN staff decreases a unit's readmission rate. Because readmission is reduced, cost of care is also reduced. Overtime is not necessarily reduced by an increase in staff, depending on the number of nurses available at any given time. Studies show that client satisfaction increases with an increase in RN staff. Decreasing readmission rates will likely decrease the use of client care supplies, not increase it.

The nurse manager is proactive when conducting risk management for a unit. Which key factor of risk management should be the nurse's primary concern? A) Proper care and treatments B) Affordable care C) Client communication D) Client satisfaction

D) Client satisfaction Rationale: Client satisfaction is a key factor in risk management because a dissatisfied client presents a higher risk for liability than a satisfied​ client, which should be the concern for a manager. A nurse who becomes aware of client dissatisfaction should take steps to communicate with the client to clarify​ misunderstandings, advocate for the client to receive better​ care, and notify a supervisor about potential problems. Client​ communication, proper care and​ treatment, and affordable care are the concerns of the healthcare providers and respective departments.

The nurse is working in a healthcare setting that has implemented Lean Six Sigma. Which of the following should the nurse anticipate with regard to this model? A) Shorter breaks B) Ordering extra supplies C) Replacing licensed with unlicensed personnel D) Decreasing staff when the census is low

D) Decreasing staff when the census is low Rationale: Lean Six Sigma focuses on eliminating waste and improving process flow. Thus, when a unit's census decreases, the unit's manager would decrease the number of staff. Replacing licensed staff members with unlicensed personnel may not be safe. The unit would cut back on ordering supplies that are not needed when following this model. A shortened break time would not be considered reducing waste.

*Possible Exam Question* Which federal initiative contains the three broad aims of better care, healthy people/healthy communities, and affordable care? A) National Database of Nursing Quality Indicators B) Patient Safety and Quality: An Evidence-Based Handbook for Nurses C) National Patient Safety Goals D) National Quality Strategy

D) National Quality Strategy Rationale: To improve the health of the population, the USDHHS has developed the National Quality Strategy, which contains three broad aims: better care, healthy people/healthy communities, and affordable care. The National Database of Nursing Quality Indicators (NDNQI), Patient Safety and Quality: An Evidence-Based Handbook for Nurses, and the National Patient Safety Goals by the Joint Commission aim to collect and provide data that identify areas for improvement and encourage facilities to meet quality goals.

The nurse working in a blame-free environment provides medication to a client at the wrong time. No harm came to the client as a result of the nurse's error, and the nurse files a report about the medication error. Which action by the risk management team should the nurse anticipate? A) Taking disciplinary action B) Reporting to the board of nursing C) Monitoring all nurses on the unit D) Suggesting system changes to prevent future errors

D) Suggesting system changes to prevent future errors Rationale: When a nurse makes an error and reports it, the risk management team will investigate to discover causes for the error and effect policy changes that can prevent future errors, improving the level of client care. The situation does not warrant reporting the nurse to the board of nursing. The risk management team would not be responsible for implementing any disciplinary actions. It is not prudent for the risk management team to monitor all nurses who administer medications on the unit.

*Possible Exam Question* While preparing a client for surgery, the nurse marks the arm that is to be amputated and participates in a "time-out" procedure before the surgery begins. Which sentinel event is this action intended to prevent? A) Ineffective control of the client's pain B) The lack of healing in the stump C) The client being mildly over-sedated D) The removal of the wrong arm

D) The removal of the wrong arm Rationale: A sentinel event is an unexpected event that causes death or severe physical or psychological injury. The removal of the client's incorrect arm would be a sentinel event. Mild oversedation is not a sentinel event, as the client is most likely on a ventilator during surgery. The inability to heal properly is an expected event in some clients, such as clients with diabetes. Pain control is individual and is not a sentinel event.

*Possible exam question* In which order should the steps of the quality improvement process be reviewed to determine whether it was completed correctly? A) Research factors that contribute to better outcomes B) Compare outcomes to benchmarks C) Identify areas for improvement D) Analyze current protocols of care and associated outcomes E) Implement changes to improve outcomes F) Analyze client outcomes to determine effectiveness of changes

D, B, C, A, E, F Rationale: Quality improvement involves analyzing current protocols of care and their associated outcomes, comparing those outcomes to leaders in high-quality care through benchmarking, identifying areas for improvement, researching factors that contribute to better outcomes, and implementing changes to improve outcomes. Client outcomes must then be analyzed to determine the effectiveness of the changes and identify areas for further improvement.