Chapter 23 Quality Control
What is the definition of a standard? A) A predetermined baseline condition or level of excellence that constitutes a model to be followed and practiced B) Diagnosis-based, step-by-step interventions for nurses to follow in an effort to promote evidence-based, high-quality care C) Process of measuring products, practices, and services against those of best- performing organizations D) Identify not only what and how an event happens but why it happens, with the end goal being to ensure that a preventable negative outcome does not recur
Ans: A Feedback: A standard is a predetermined baseline condition or level of excellence that constitutes a model to be followed and practiced. The remaining options all fail to accurately define a standard.
Which intervention is associated with the nursing leadership role? A) Inspiring staff to establish and maintain high standards regarding patient care B) Being aware of the changes in quality control regulations C) Reviewing research results upon which to base changes D) Identifying outcomes that support quality nursing care
Ans: A Feedback: Inspiring subordinates to establish and achieve high standards of care is a leadership skill. The remaining options are management roles.
What are the four evidence-based standards identified by the Leapfrog Group to reduce medical errors? A) Computerized physicianñprovider order entry, evidence-based hospital referral, ICU physician staffing, and the use of Leapfrog Safe Practices scores B) Computerized physicianñprovider order entry, evidence-based visiting nurse referral, ED physician staffing, and the use of Leapfrog Safe Practices scores C) Computerized primary care provider order entry, evidence-based hospital referral, ICU physician staffing, and the use of Leapfrog Safe Medication scores D) Computerized nurse practitionerñprovider order entry, evidence-based outpatient referral, ED physician staffing, and the use of Leapfrog Safe Medication scores
Ans: A Feedback: The Leapfrog Group identified four evidence-based standards that they believe will provide the greatest impact on reducing medical errors: computerized physicianñprovider order entry, evidence-based hospital referral, ICU physician staffing, and the use of Leapfrog Safe Practices scores.
Which practice has the U.S. Food and Drug Administration suggested in order to decrease the risk of medication errors? A) Computerized order entry with a drug bar code system B) Medications automatically dispensed to patients at predetermined times C) Use of medication nurses to administer all ordered medications D) Have patients' medications kept at the bedside for self-administration
Ans: A Feedback: The U.S. Food and Drug Administration has suggested that a drug bar code system coupled with a computerized order entry system would greatly decrease the risk of medication errors.
Which task is a management function associated with quality control? A) Periodic evaluation of unit mission and philosophy B) Making out the daily patient care assignments C) Creating a yearly budget D) Distributing holiday staffing policies
Ans: A Feedback: Unit mission, philosophy, goals, and objectives are the blocks on which policies and standards rest. All these must be in place to measure whether quality is being achieved on the unit. The other options are not related to quality control.
Who is involved in quality control measurement functions? Select all that apply. A) Facility staff B) Consumers C) All levels management D) Health-care professionals
Ans: A, B, C, D Feedback: Consumers, health professionals, staff, and all levels of management should be involved in quality control measurement. Community members become involved when they become health-care consumers.
Nursing students who scored in the top 5% on the examination studied in small groups, attended class 100% of the time, took frequent rest breaks during study sessions, and ate a balanced diet for 1 week before the examination. What type of audit provided this type of data? A) Structure B) Process C) Outcome D) Concurrent
Ans: B Feedback: A process audit assumes that a relationship exists between the process used and the quality of the result. This is the only option that fulfills that function.
Which statement is true regarding adverse drug events (ADEs)? A) They occur infrequently in accredited hospitals B) They are responsible for about 20% of hospitalized disabilities C) They usually involve either prescribing or pharmacy errors D) They occur because of individual recklessness
Ans: B Feedback: ADEs occur in all hospitals, are to blame for 20% of injury disabilities, and involve more than prescribing or pharmacy errors, but are rarely due to individual recklessness. They occur in both accredited and unaccredited facilities.
What results from the development of plan of correction associated with health-care delivery errors? A) Sentinel event B) Root cause analysis C) Quality assessment (QA) program D) Failure mode and effects analysis (FMEA)
Ans: B Feedback: Another Joint Commission priority is the development of root cause analysis with a plan of correction for the errors that do occur. A sentinel event is likely the trigger of the root cause analysis. FMEA examines all possible failures in a designóincluding sequencing of events, actual and potential risk, points of vulnerability, and areas for improvement. QA is an ongoing process that focuses on continued delivery improvement.
What do clinical practice guidelines provide? A) A predetermined baseline condition or level of excellence that constitutes a model to be followed and practiced B) Diagnosis-based, step-by-step interventions for nurses to follow in an effort to promote evidence-based, high-quality care C) Process of measuring products, practices, and services against those of best- performing organizations D) Identify not only what and how an event happens but why it happens, with the end goal being to ensure that a preventable negative outcome does not recur
Ans: B Feedback: Clinical practice guidelines provide diagnosis-based, step-by-step interventions for nurses to follow in an effort to promote evidence-based, high-quality care and yet control resource utilization and costs. The remaining options all fail to accurately identify what a clinical practice guideline provides.
When working on clinical practice guidelines for a mental health unit, the nursing committee will implement which intervention initially? A) Assessing the medical psychiatric staff for practice suggestions B) Implementing a search of the literature for current related research results C) Reviewing patient satisfaction data to identify the unit's strengths and weaknesses D) In-servicing all unit nursing staff on the need to adhere to established guidelines
Ans: B Feedback: Clinical practice guidelines reflect evidence-based practice; that is, they should be based on cutting edge research and best practices. The other options may be helpful but should occur after the review of the research literature.
What is the greatest limitation of the Health Plan Employer Data Information Set (HEDIS)? A) Findings are not released to the public B) Only about half of managed care organizations have chosen to participate C) Performance indicators are process focused rather than outcome focused D) There are only 15 performance measures
Ans: B Feedback: The NCQA, a private nonprofit organization that accredits managed care organizations, has developed HEDIS. One of the most significant weaknesses of NCQA accreditation is that such accreditation is voluntary and only about half of managed care organizations currently undergo such review. The remaining options do not relate to the HEDIS
hirty-eight percent of the people who attended a smoking cessation clinic were not smoking 1 year after the clinic closed. What type of audit provided this type of data? A) Structure B) Process C) Outcome D) Concurrent
Ans: C Feedback: An outcome audit determines what outcomes resulted from specific nursing interventions for clients. That is the function of the remaining options.
Which statement is true regarding criteria for assuring that a quality control program will be effective? A) The primary purpose of the program is to satisfy various federal and state standards B) Developed standards should reflect minimally acceptable levels so the organization will score well on self-assessment audits C) A belief in the importance of quality control must be integrated through all levels of the organizational hierarchy D) The process should be reactive; in other words, quality improvement efforts should be initiated after problems are identified
Ans: C Feedback: For any quality control program to be effective, a belief in the importance of quality control must be integrated through all levels of the organizational hierarchy. The remaining statements are false.
What results from effective benchmarking? A) Two organizations become financially integrated under a capitated model B) Organizations compete for a ìbest practicesî label from the National Committee for Quality Assurance (NCQA) C) An organization compares its performance with that of ìbest-performing institutionsî D) Minimum practice guidelines are established for each health-care organization
Ans: C Feedback: In benchmarking, an organization compares its performance with that of ìbest- performing institutions.î Benchmarking is not associated with the other options.
What is the best course of action to stimulate staff nurses' involvement in quality control research on a nursing unit? A) Hire a well-qualified researcher to help staff design studies B) Create a joint medical/nursing staff research committee C) Provide staff with paid release time for research activities D) Ensure that research designs are well grounded and scientific
Ans: C Feedback: Staff should be involved in determining criteria or standards, reviewing standards, and collecting data. To stimulate staff nurses' involvement in quality control research, the best course of action would be to provide staff with paid release time for research activities. The other options fail to actually stimulate the nurse's involvement in the process.
Which is a true statement regarding TQM? A) It is based on the premise that the organization knows what is best for the consumer B) Its guiding purpose is to save the organization money C) It is based on the premise that the customer is the focal element on which production and service depend D) It assumes that inspection and removal of errors lead to the delivery of quality services
Ans: C Feedback: TQM is based on the premise that the customer is the focal element on which production and service depend. The other options are false statements.
What role has the Joint Commission assumed in ensuring quality at the organizational level? A) Establishing clinical practice guidelines B) Reducing diagnosis-related group reimbursement levels C) Standardizing clinical outcome data collection D) Assessing monetary fines for hospitals that fail to meet standards
Ans: C Feedback: The Joint Commission ensures quality at the organizational level by requiring participating organizations to choose from among 60 acceptable performance measurement systems. The Joint Commission is not actively involved in any of the other options.
What is the first step in quality control? A) To take corrective action when standards have not been met B) To collect data to determine whether standards have been met C) To determine criteria and standards D) To determine who will measure the standard
Ans: C Feedback: The first step in quality control is to determine criteria and standards. Measuring performance or making corrections is impossible if standards have not been clearly established.
What is the function of a nursing minimum data set? A) Compares the quality of nursing care and medical care B) Identifies minimal levels of quality necessary for nurses to maintain licensure C) Standardizes the collection of nursing data for use by multiple data users D) Identifies only ìnursing-sensitiveî patient outcome measures
Ans: C Feedback: The nursing minimum data set standardizes the collection of nursing data for use by multiple data users. None of the remaining options accurately describes the function of such a data set.
What is the guiding principle when attempting to address errors made in the delivery of health care? A) Reporting of errors must be both mandatory and voluntary B) Errors are a result of faulty organizational processes C) People are the root cause of health delivery errors D) Errors are either unavoidable or result from reckless behavior
Ans: D Feedback: A just organizational culture emphasizes the finding of the middle ground between the two extremes of error cause (people or system). It seeks to separate unavoidable error from reckless behavior and unjustifiable risk. Reporting of errors can be both mandatory and voluntary but this factor has less importance than the organization attitude regarding the cause of errors.
What do the critics of prospective payment system argue? A) Diagnosis-related groups have not helped to contain rising health care costs B) The system has increased the length of hospital stay C) Services provided under this system have only slightly increased D) On the whole quality of care has declines since its implementation
Ans: D Feedback: Critics of the prospective payment system argue that although DRGs may have helped to contain rising health-care costs, the associated rapid declines in length of hospital stay and services provided have resulted in declines in the quality of care.
An RN is a supervisor in an organization that has total quality management (TQM) as the backbone of its organizational goals and objectives for quality control. How does the RN practice TQM on the unit? A) Encouraging employees to think of a unit slogan B) Developing a quota system for number of patients cared for C) Explaining to the staff that ìif it's not broke, don't fix itî D) Promoting teamwork rather than individual accomplishments
Ans: D Feedback: In TQM, team efforts are favored over individual accomplishments. Slogans, quota systems, and maintaining the status quo work against quality in this philosophy.
What is the best qualitative measurement in determining quality control for marketing? A) Morbidity and mortality rates B) Nursing care hours per patient day C) Average length of stay D) Patient surveys of general satisfaction
Ans: D Feedback: In determining quality control for marketing, the best qualitative measurement would be patient surveys. The other options are not necessarily qualitative measurements.
Which statement is true regarding the factors that impact patient satisfaction with a hospitalization? A) The quality of care delivered is the primary factor related to B) The patient's understanding of his/her condition influences satisfaction C) The length of the hospital stay is the deciding influence on satisfaction D) The patient's satisfaction has little to do with actual health improvement
Ans: D Feedback: Patient satisfaction often has little to do with whether a patient's health improved during a hospital stay. It is important to remember that quality care, length of stay, and patient perception do not always equate with patient satisfaction.
