Module 4: All quizzes and chapters
Audit Tool Process Diagram
1) Establish control criteria 2) Identify information relevant to criteria 3) Determine ways to collect the information 4) Collect and analyze the information 5) Compare collected information with established criteria 6) Make judgement about quality 7) Provide info and take corrective actions 8) Reevaluate
A nurse manager discusses with the healthcare team the importance of performing core measures for the designated areas of implementation. What should the manager be sure to inform the team may be the consequence of noncompliance?
A 2% reduction in the Medicare annual payment
Steps of Budgetary Process
Assess Diagnosis Plan Implementation Evaluation
Outcome Audits:
Determine results of specific nursing interventions for patients Outcomes are most valid indicators of quality care Many factors contribute to patient outcomes
The final step of quality improvement is___
Evaluation
Critical Event Analysis/Root Cause Analysis
Identify not only what event happened and how it happened, but also why it happened
TQM
Mindset and cultural approach to innovation by establishing mechanisms that encourage and rewarding innovative ideas
Healthcare shifted focus from patient care to issues of cost and quality.
True
Nurse leaders should understand the criteria or standards that are needed to establish effective quality control process.
True
Total quality management is referred to as continuous quality improvement and is used to meet the Healthy People Living 2020 goals.
True
6 Sigma Model
Uses statistical data to calculate degree of deviation from standard (TPS)
Fiscal planning is not intuitive; it is
a learned skill that improves with practice.
The budget's value is directly related to its
accuracy
Quality Control
activities that are used to evaluate, monitor, or regulate services rendered to consumers
Health Maintenance Organization Act of 1973
authorized spending $375 million over 5 years to set up and evaluate HMOs in communities across the country
Audits
determine point of focus
Capital budget
major equipment
Staff HMOs
physician providers are salaried by the HMO and under direct control of the HMO
Centers fro Medicare and Medicaid are the___
root influence for the quality management responsibility of providing easy to understand detain health care quality to all consumers
Next to personnel costs, _____are the second most significant component in the hospital budget.
supplies
The Joint Commission's creation of the National Patient Safety Guidelines is
the root influence for the quality management responsibility of proactivity creating an environment that minimizes risk for error
A nurse leader at a long term care facility wants to determine if VS are being checked according to policy. What can the leader do to measure this process of care?
A process audit
TQM
Also referred to as continuous quality improvement (CQI) Based on premise that individual performing the service is most informed and most empowered to make improvements Focus on problem prevention planning not inspective and reactive problem solving
_____ is the process of measuring products, practices, and services against best performing organizations.
Benchmarking
Noncontrollable expenses
Cannot be controlled by manager
Engage your staff in _____
Continual improvement
LEAN
Customer focused quality improvement model System built on complete elimination of waste or what is not value to customer Adopting Lean in an organization can require a substantial commitment of leadership time and resources
Which of the following is considered nursing leadership roles in regards to quality control?
Embraces, supports, and champions the quality improvement process
A nurse leader is performing a process audit. Which would be considered a process audit?
Ensuring the machines are recalibrated according to department policy Comparing a patients medication order to the medications the patients has been taking Checking the completeness of a patients medical record
Network HMOs
HMO contracts with multiple independent physician group practices.
Lean Model
Manufacturing and services industries and attempts to eliminate any part of a process that is not adding value to the customer
Errors reported existing in today's healthcare system:
Preventative errors, treatment errors, diagnostic errors, communication or equipment malfunction
Best Practices
The result of gathering data from multiple benchmarked entities
A nurse leader wants to ensure that the team is always practicing proper hygiene after caring for a patient. A complaint was filed against a nurse for not washing the hands before examining a wound on a child's knee. What is the nurse leader's control criteria?
Whether the team is practicing proper hygiene
Value
can be broadly defined as a function of quality, efficiency, safety, and cost. The idea behind changing the current payment system to one which focuses on value rather than volume was to remove incentives for redundant and inappropriate care
Responsibility Accounting
each of an organization's revenues, expenses, assets, and liabilities is someone's responsibilit
The largest of the budget expenditures is the workforce or personnel budget because health care is
labor intensive
The United States spends more of its GDP on ____ than any other nation in the world.
medical care
Goal: Create an environment that___
minimizes risk for error
Incremental budgeting
multiplying current year expenses by certain figure
Although outcomes are an important measure of quality care, it is dangerous to use them as the
only criteria for quality measurement.
HROs
organizations that perform well (minimal catastrophic error) despite high levels of complexity and the existence of multiple risk factors that encourage error
Critical pathways are
predetermined courses of progress that patients should make after admission for a specific diagnosis or after a specific surgery.
Quality control efforts must be____, not solely as a reaction to a problem.
proactive
Moral hazard refers to the
propensity of insured patients to use more medical services than necessary because their insurance covers so much of the cost.
A nurse manager is implementing a quality control tool that is systematic and will allow the official examination of a record for patients with postoperative infections. What type of tool is the nurse manager using to collect and evaluate this data?
An audit
TPS
Find deviations from consistent quality and take action at root cause to prevent deviations from happening (6 Sigma Model)
Flexible Budget
Flex up and down over year depending on volume
According to the institute of medicine, which of theses sources caused the most deaths in 1999?
Medical errors
Healthcare quality
he degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge
All nurses need at least a basic understanding of
health-care costs as well as how reimbursement strategies directly and indirectly affect their practice
Spending more does not always equate to
higher quality health outcomes.
Forecasting
involves making an educated budget estimate by using historical data.
A nurse manager is attempting to ensure adequate resources are available in order to meet changing patient needs. What would be the best type of audit for the manager to perform?
A structure audit
There are hallmarks that are associated with effective quality control programs. Select those hallmarks from the following list:
Administration support, organizational support, process is ongoing
Structure Audits:
Assumes relationship between quality care and appropriate structure exists Does not address care provided, focuses on resources and environment Goal to ensure adequate resources are available to meet changing patient needs
A healthcare team has been challenged to determine what other facilities are doing to decrease the number of hospital acquired infections so that an action plan can be created to decrease the rate in their facility. What will the healthcare team do to achieve this challenge?
Benchmarking
A nurse manager would like to determine how well the team is doing in terms of meeting the hospital's goal of increasing patient satisfaction. What action should the manager take after determining the best practices?
Capture when the team is and is not using best practices and outcomes
National Patient Safety Goals (NPSG) include
Check ID bracelet before administering meds Have pt identify surgical site before going to preoperative suite Using SBAR layout when handing off report Use Braden scale to determine the patient's risk for impaired skin integrity
Controllable Expenses
Controlled or varied by manager
An older adult patient fell out of bed 2 days after a hip replacement and had to return to surgery. What process should be done in order to prevent future negative outcomes such as this?
Critical event analysis
A nurse is tasked with performing an audit on patients in the long term care facility who are developing pressure ulcers. After identifying the information relevant to the criteria, what is the nurse's next action?
Determine ways to collect data
Performance budget
Emphasizes outcomes and results instead of activities and outputs
The 6 aims for improving quality health care as directed by the institute of medicine include safe, effective, patient-centered, timely, efficient, and ___
Equitable
Quality control is the process of being reactive in order to minimize continued risks or hazards.
False
What are the focus areas of the To Err Is Human recommendations?
Implement safety systems Identify errors and provide solutions for prevention Set performance standards for safety Enhance knowledge Enhance leadership
Quality Management
Includes activities that are used to evaluate and monitor services rendered to consumers. Activities are for the purpose of increasing the quality of the consumer experience
A nurse leader is trying to bring about change on the unit. Which intervention is associated with the nurse leader role?
Inspiring staff to maintain high standards regarding patient care
Which state about total quality management is correct?
It considers individual as focal element on which production and service depend Organize The commit how it will the level of staff
A patient is planning to have a surgical procedure but is concerned about the poor patient care quality at the local hospital and performed a quality check and comparison of several hospitals. What conglomeration of non health care Fortune 500 companies defined quality measurements to allow consumers to compare hospitals?
Leapfrog
Process Audits
Measure how nursing care is provided against standard guidelines Task oriented Documented in patient care plans Medication reconciliation: Comparing patient orders to all meds patient is taking
Staffing Mix
Mix (percentages) or licensed and unlicensed assistive personnel working at a given time
Nurse leaders need to understand that in order to be effective, the quality control process must be____
Ongoing
____reflect the end result of care or how the patient's health status changed as a result of an intervention.
Outcomes
____ often has little to do with whether a patient's health improved during a hospital stay.
Patient satisfaction
____are used to measure the process of care or how the care was carried out and assume that a relationship exists between the process used by the nurse and the quality of care provided.
Process audits
Quality control tools used by the nurse leader include which of the following?
Process audits and structure audits
Benchmarking
Process of looking at practices of high performing organizations or department to determine what they are doing that contributes to the success
A nurse leader works at a facility that has TQM as the backbone. Which activity reflects the use of TQM in their unit?
Promote teamwork rather than individual accomplishments
An older adult patient recently had a hip replacement with an indwelling catheter inserted. The patient developed symptoms of a UTI postoperatively and the nurse placing the catheter was reeducated by the nurse leader regarding avoidance of UTIs when inserting catheters. Which quality approach did the nurse leader use?
Quality assurance techniques
Zero Based Budgeting
Rejustifying program or needs every budget cycle
TQM In Action
Step 1: Identify focus of improvement Step 2: Organize TQM Team Step 3: Diagram the Process Step 4: Identify variations Step 5: Select improvement strategies Step 6: Implement Step 7: Check Results Step 8: Innovate (start cycle again)
____is based on the premise that the individual is the focal element on which production and service depend (i.e., it must be a customer-responsive environment) and that the quest for quality is an ongoing process.
TQM
A new graduate asks the nurse manager what organization develops the standards of nursing profession so that the quality of practice can be measured. What is the best response by the manager?
The American Nurses Association (ANA)
After a patient had a negative outcome related to medical error the nurse follows the policy for sentinel events. What organization does the nurse recognize monitors the adherence to this type of policy accreditation?
The Joint Commission
One of the Nurse Leaders quality management responsibilities is using standard quality measurement tools. Which one of the following is the root influence for this responsibility?
The National Quality Forum
Quality Control Process (3 steps)
The criterion or standard is determined. Information is collected to determine if the standard has been met. Educational or corrective action is taken if the criterion has not been met.
What concern launched the health care industry's focus on quality control?
The efforts fo a group of healthcare providers to improve healthcare for all people worldwide Patient consumer concern for skyrocketing costs Insurance companies wanting to justify the need for services The governments desire to monitor quality of service
Patients want_____
The highest care they can afford
One of the Nurse leaders quality management responsibilities is reporting on near misses of medical errors. Which one of the following is the root influence for this responsibility?
The institute of Medicine's 1999 Report to Err is Human
The safety record in health care is a far cry from the enviable record of the similarly _____
complex aviation industry.
Your choice of health plan and associated network of physicians and hospitals may influence the outcome of your care. Make your decision count by looking at____
complication and mortality rates and other quality information first.
CPGs reflect evidence-based practice; that is, they should be based on ____
cutting- edge research and best practices.
TQM is ____
cyclical
Critics of the PPS 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 likely resulted in ___
declines in quality of care.
As a result of the PPS and the need to contain costs, the length of stay for most hospital admissions has ____
decreased greatly.
Ignoring the problem of medical errors, denying their existence, or blaming the individuals involved in the processes does nothing to_____
eliminate the underlying problems.
Quality assurance models seek to:
ensure that quality currently exists, whereas QI models assume that the process is ongoing and quality can always be improved.
A budget that is predicted too far in advance has greater probability for
error
Patient Outcome
isolates outcomes that are specifically related to something the nurse does
The CMS is now the largest purchaser of _____ in the country.
managed care
Cost-effective
producing good results for the amount of money spent; in other words, the product is worth the price
The ANA has played a key role in developing standards for the____.
profession
Cost containment
refers to effective and efficient delivery of services while generating needed revenues for continued organizational productivity. is the responsibility of every health-care provider, and the viability of most health-care organizations today depends on their ability to use their fiscal resources wisely.
Provision of service no longer guarantees ____
reimbursement.
