NU280 Quiz # 4

What is information salience?

It assesses the quality, meaning, and clarity of the information. Diverse cultural, educational, and experiential backgrounds shape the meaning of information that is shared between the delegator and delegatee...It must be clearly understood!

What are some examples of individual approach to errors?

It blames individuals for forgetfulness, inattention, or moral weakness

What is information decay?

It is a characteristic of communication that interferes with the delegation process. It can occur when the patient's health status changes rapidly and specific information loses its value or becomes irrelevant to the patient's condition. It leads to poor clinical judgement that may have adverse effects on patient care

What is the basic foundation of the monitoring and evaluation process required by QM principles?

It is in the use of clinical indicators, measurable items that reflect the quality of care.

What was the point of TJC developing the Sentinel Event Standard?

It was developed as an accountability model, requiring organizations to carry out designated steps to fully understand the factors and systems associated with adverse patient events. The steps revolve around a root cause analysis.

The ability to transfer selected nursing activities in a given situation to a competent individual is known as:

Legal authority

Clinical indicators

Measurable items that reflect the quality of care provided and demonstrate the degree to which desired clinical outcomes are accomplished; help identify the goals od quality improvement

In the delegation process, all of the following factors need to be assessed EXCEPT:

Medical insurance of the patient

What is MERP?

Medication Errors Reporting Program...health care professionals across the nation voluntarily and confidentially report medication errors and hazardous conditions that could lead to errors

Is "just culture" the same as "no blame culture?"

NO...Just culture does not tolerate reckless behavior or a conscious disregard of risk to patients

Should a UAP, LPN, or LVN be assigned to a group of patients?

NO...but rather they should be assigned to an RN. The LPN/LVN may be assigned specific patients for whom to perform care, but the RN remains responsible for all nursing practice activities, including patient assessment, care planning, and patient teaching

Delegation, a multifaceted decision-making process, is implemented for all of the following reasons EXCEPT to

Decrease the registered nurses' accountability

Root cause analysis

Defined by TJC as a process for identifying the basic or casual factors that underlie variation in performance, including the occurrence or possible occurrence of a sentinel event. It focuses primarily on systems and processes, not individual performance

Sentinel event

Defined by TJC as an unexpected occurrence involving patient death or serious physical or psychological injury or the risk thereof. They signal the need for immediate investigation and response

Passive delegation

Delegation that does not require a decision-making process. The decisions derive from job descriptions or policies and thus the tasks are not actively delegated, they are assumed by virtue of the policy or job decription

What does the National Quality Indicators database collect? "Designated indicators that strongly affect patient clinical outcomes"

Patient falls and patient falls w/injury Pressure ulcers Skill mix (number of RN's, LPN's, ect. at a given time) Nursing hours per patient day RN surveys (job satisfaction, practice environment scale) RN education and certification Pediatric pain assessment cycle and IV infiltration rate Psychiatric patient assault rate Restraints prevalence Nurse turnover Nosocomial infections

What is the core competency for nursing practice?

Patient safety

What are informatics and IT links used to ensure?

Patient safety through improved information access and data management

Quality management (QM)

Philosophic framework for managing organizations that recognizes quality is determined by customer needs and expectations. Attention is paid to how the work is done, w/an emphasis on involving the people who best understand the detail of the work processes with which they are involved

Flowchart

Picture of the sequence of steps in a process. Different steps or actions are represented by boxes or other symbols.

Active delegation

Proactively making a decision about tasks and people to accomplish effective work

What is the difference between quality assurance and quality improvement?

QUALITY ASSURANCE: inspection oriented (detection), reactive, correction of special causes, responsibility of few people, narrow focus, leadership may not be vested, problem solving by authority QUALITY IMPROVEMENT: planning oriented (prevention), proactive, correction of common causes, responsibility of all involved w/the work, cross-functional, leadership actively leading, problem solving by employees at all levels

What are the cornerstones of quality management?

Quality, scientific approach, and "all one team"

What is considered the cornerstone of delegation?

Right communication and direction (1 of the 5 rights of delegation)

Which statement made by a nurse demonstrates the appropriate attitude regarding the implementation of evidence-based practice (EBP)?

"I lack direct experience with this type of problem, so I'll bring it up at the team meeting.

Which statement made by an unlicensed assistive personnel (UAP) would cause the registered nurse team leader the most concern?

"It's good to know that the nurse is really the one responsible for the clients care."

When delegating a task, the RN may be at risk if what occurs?

-Delegated task can be performed ONLY by the RN -Delegated task could involve risk or harm to a patient -RN knowingly delegates a task to a person who has not had the appropriate training or orientation RN fails to adequately supervise the delegated activity and does not evaluate the delegated action by reassessing the patient

In the QSEN project, how are safety and quality defined as?

Separate competencies to emphasize patient safety as the new standard of care

Never events

Serious adverse events during an inpatient stay that should never occur or are reasonably preventable through adherence to evidence-based guidelines. The Centers for Medicare and Medicaid Services, through revisions in coverage and payment policies, provide hospitals w/financial incentives to reduce their occurrence

Which example of discharge teaching addresses a never event as identified by The Centers for Medicare and Medicaid Services?

Signs and symptoms of both hypo- and hyperglycemia

What are some characteristics of common cause variations?

Stable, predictable, and statistically in control

Unsupervised

1 RN is working w/another RN in a collegial relationship, and neither RN is in the position of supervising the other. Each RN is responsible and accountable for his/her own practice

Core measures

Standardized sets of valid, reliable, and evidence-based quality measures used by The Joint Commission to integrate performance measures into the accreditation process and overall quality improvement processes

It is important for the nurse to remember that the legal requirements related to delegation...

Supercede any organizational requirement or policy!

What are the four steps in the delegation process?

1. Assessment and planning 2. Communication 3. Surveillance and supervision 4. Evaluation and feedback

What should organizations do to transform the work environment of nurses and achieve safety targets?

1. Balance the tension between efficiency and reliability 2. Support the development and maintenance of trusting relationships throughout work areas 3. Actively manage the process of change 4. Involve workers in decision making pertaining to work design and work flow 5. Use knowledge management practices to establish a "learning organization"

What are the 10 simple rules that the authors of the quality chasm say will help accomplish the redesign of the health care system?

1. Care is based on continuous healing relationships 2. Care is customized based on the patients needs and values 3. Knowledge is shared and information flows freely 4. The patient is the source of control 5. Decision making is evidence based 6. Safety is a system property 7. Transparency is necessary 8. Needs are anticipated 9. Waste is continually decreased 10. Cooperation among clinicians is a priority

What 10 essential elements relating to delegation are contained in The Nurse Practice Act?

1. Definition of delegation 2. Items that can not be delegated 3. Items that can not be routinely delegated 4. Guidelines for the RN about what can be delegated 5. Description of professional nursing practice 6. Description of LPN/LVN & nursing assistive personnel roles 7. Degree of supervision required 8. Guidelines for decreasing the risks associated w/delegation 9. Warnings about inappropriate delegation 10. Restricted use of the word "nurse" to licensed nurses only

What is on the listing of hospital-acquired never events?

1. Foreign body retained after surgery 2. Air embolism 3. Blood incompatibility 4. Pressure ulcers stages III & IV 5. Falls and trauma 6. Catheter-associated urinary tract infection 7. Vascular catheter-associated infection 8. Manifestations of poor glycemic control 9. Surgical site infection, mediastinitis, following coronary artery bypass graft, certain orthopedic procedures, and bariatric surgery for obesity 10. DVT and pulmonary embolism following certain orthopedic procedures

What are the current National Patient Safety Goals?

1. Improve the accuracy of patient identification 2. Improve the effectiveness of communication among caregivers 3. Improve the safety of using medications 4. Reduce the risk of health care-associated infections 5. Reduce the risk of patient harm resulting from falls 6. Prevent health care-associated pressure ulcers 7. The organization identifies safety risks inherent in its patient population 8. Universal protocol for preventing wrong site, wrong procedure, and wrong person surgery

Which 6 core competencies have the IOM declared as being the major components necessary for the healthcare redesign and should form the practice base for all health professionals?

1. Patient-centered care 2. Teamwork collaboration 3. Evidence-based practice 4. Quality improvement 5. Safety 6. Informatics

What are the benefits to utilizing clinical pathways or critical pathways?

1. Reduction in variation of the care provided 2. Facilitation and achievement of expected outcomes 3. Reduction in care delays and lengths of stay 4. Improvements in cost-effectiveness of the care delivered while maintaining or increasing patient/family satisfaction

What are the IOM's six guiding aims for improvement (STEEP)?

1. Safe: preventing injuries to patients from the care that is intended to help them 2. Timely: Reducing waits and sometimes harmful delays for both those who receive and those who give care 3. Effective: providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit 4. Efficient: preventing waste, including waste of equipment, supplies, ideas, and energy 5. Equitable: providing care that does not vary in quality because of personal characteristics, such as gender, ethnicity, geographic location, and socioeconomic status 5. Patient centered: providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions

What is the premise behind breakthrough thinking?

1. Substantial knowledge exists about how to achieve better performances than currently prevails 2. strong examples already exist of organizations that have applied that knowledge and broken through to substantial improvements 3. the stakes are high and relevant to the most crucial strategic needs of health care

The RN is guided to safe, effective delegation and supervision through an assessment of...

1. The clinical situation 2. Patient needs 3. The job descriptions and competencies of the assistive and vocational personnel 4. The health care organization's policies and procedures 5. Nurse practice acts and other regulations and applicable state laws 6. Professional standards of nursing practice

What are the 5 rights of delegation?

1. The right task: delegated task must conform to the established guidelines 2. The right circumstances: Delegate tasks that do not require independent nursing judgement 3. The right person: Delegate to someone who is qualified and competent 4. The right direction and communication: Give clear explanation about the task and expected outcomes, and indicate when the delegatee should report back to the RN 5. The right supervision and evaluation: Invite feedback to assess how the process is working and how to improve the process. Also evaluate the patient's outcomes and results of the tasks

What do most improvement models have in common?

1. They analyze and clearly understand the process 2. They select key aspects of the process to improve 3. They establish trial targets to guide improvement measures 4. They collect and plot data 5. They interpret the results 6. They implement improvement actions and evaluate their effectiveness

The model that The Institute for Healthcare Improvement contains 2 parts. Part one asks 3 fundamental questions. What are they?

1. What are we trying to accomplish? 2. How will we know that a change is an improvement? 3. What changes can we make that will result in an improvement?

A widely used approach to encouraging team training in the health care professions is the use of:

Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS)

What did the statement published by the ANA and NCSBN explain?

That the authority for delegation resides within the Nurse Practice Act of each state, examines the value of unlicensed personnel in patient care delivery, and declares that the importance of delegation decisions is safety and welfare of the public

Who published a joint statement that serves as general guidelines for delegation decisions for RN practice?

The American Nurses Association (ANA) & National Council of State Boards of Nursing (NCSBN)

Which accreditation agency was one of the first to embrace quality improvement principles in hospital-based settings?

The Joint Commission (TJC)

Who introduced ORYX?

The Joint Commission; intended to support organizations in their quality improvement efforts as well as supplement their accreditation process.

Continuous supervision

The RN has determined that the delegatee will need frequent to continual support and assistance

Initial direction and/or periodic inspection

The RN supervises a licensed or unlicensed caregiver, knows the person's training and competencies, and has developed a working relationship w/the staff member

SBAR (situation-background-assessment-recommendation)

The SBAR technique provides a succinct, structured framework for communication among members of the health care team about a patient's condition

Competency

The ability of an individual to perform defined behaviors proficiently by demonstrating the appropriate knowledge, skills, attitudes, and professional judgement required for a specific role or setting

What are the core competencies of a situational leader?

The ability to diagnose the performance, competence and commitment of others, to be flexible and to partner for performance

Organizational accountability

The accountability for the system or operations; the prime accountability of organizations is patient safety. Organizations are accountable for adequate resources to deliver safe care

What is the RN delegator held accountable for?

The act of delegation Assessment and follow-up evaluation Any interventions or corrective actions that may be required to ensure safe and effective care

Supervision

The active process of directing, guiding, and influencing the outcome of an individual's performance of an activity or task

After first having a strong understanding of the standards of practice that govern delegation, the registered nurse must know the:

The condition and needs of the patient whose care is being delegated

Process variation

The differences in how the steps in a work process might be accomplished and/or the variables that may effect each step in the process. Variation results from the lack of perfect uniformity in the performance of any process. Understanding variation in a process is necessary to determine the direction that improvement efforts must take

What are some examples of system approach to errors?

?It examines conditions under which individuals work and sets up defenses to avert errors or mitigate their effects

Six Sigma

A concept for company-wide quality improvement that is characterized by its customer-driven approach, emphasis on decision making based on careful analysis of quantitative data, and a priority on cost reduction

Error reporting system

A formal system, either voluntarily or mandatory, that collects data pertaining to adverse events for purposes of learning, accountability, or effecting change

Pareto charts

A graphic tool that helps break down a big problem into its parts and then identifies which parts are the most important

Delegation is....

A management strategy when used appropriately

What is Hersey's Situational Leadership Model?

A model to follow which provides a solid foundation for delegation decisions

The Joint Commission (TJC)

A national agency that conducts surveys of inpatient and ambulatory facilities and certifies their compliance w/established quality standards

Quality and Safety Education for Nurses (QSEN)

A national program w/the goal of preparing future nurses w/the knowledge, skills, and attitudes necessary to continually improve the quality and safety of the health care systems in which they work

ISMP (Institute for Safe Medication Practices)

A nonprofit organization that is well known as an education resource for the prevention of medication errors

IOM (National Academy of Sciences Institute of Medicine)

A nonprofit organization w/a mission of advancing and disseminating scientific knowledge to improve human health...they provide objective, timely, authoritative information and advice concerning health and science policy to the government, the corporate sector, the professions, and the public

What does part 2 of the model consist of?

A sequence of steps, starting with developing an action plan based on the 3 questions, taking actions to test the action plan, making refinements as needed, and implementing the resulting changes in real work settings (the plan-do-check-act cycle)

Failure mode and effects analysis (FMEA)

A systemic process for identifying potential design and process failures before they occur, with the intent to eliminate them or minimize the risk associated with them

HAC (Hospital-acquired condition)

A term used to indicate an unintended and typically adverse patient-acquired condition occurring as a result of being cared for in a hospital

Patient care associate (PCA)

A title given to individuals who are employed as unlicensed nursing personnel. Formerly nurse aide

Assignment

The distribution of work that each staff member is responsible for during a given work period; when making assignments, the RN supervisor directs a staff member to do something that he or she is authorized to do and is within the staff' member's scope of practice and/or job description

Standard of Care

The expected level and type of care based on the knowledge and skill the average prudent clinician would possess and exercise in the same or similar circumstances based on evidence; standards are based on expert consensus derived from research or documentation in scientific literature

Incident reporting

The identification and reporting of occurrences that could have led, or did lead, to an undesirable outcome

Individual accountability

The individuals' ability to explain their actions and results

A top-down flowchart lists what?

The main steps and substeps of a process in a linear fashion

What is "Span of control"?

The number of individuals you are ultimately responsible for...If you have responsibility for 5 staff members, each of whom cares for 10 patients, you would be responsible for 55 individuals

Authority

The power to make decisions which often derives from policies, laws, and job descriptions

A deployment flowchart maps out what?

The steps of a process under headings designating people or departments who actually carry out each step

Human factors

The study of human abilities and characteristics as they affect the design and smooth operation of equipment, systems, and jobs

How are clinical protocols or algorithms different from clinical pathways?

They represent more of a decision path that a practitioner might take during a particular episode or need

Why did the CMS develop "Never Events?"

To decrease or eliminate serious and costly errors in health care delivery that should never happen

What is the point of TJC's national patient safety goals?

To help accredited organizations address specific areas of concern in regards to patient safety. It's based on an ongoing analysis of reported sentinel events and the identified root causes of these events.

Cause-and-effect diagram

Tool that is used for identifying and organizing possible causes of a problem in a structured format (fishbone diagram)

Delegation

Transferring to a competent staff member the authority and responsibility to perform a selected nursing task that the staff member would not normally be allowed to perform; the RN attains accountability for the delegated task

Delegation occurs only when....

Two people are involved in a mutual work situation and one of the individuals has accountability and the other has some authority to perform the specific tasks

What should the RN do when delegating tasks?

Understand the delegatee's competencies Communicate succinctly Offer clear guidelines in advance Monitor progress Remain accountable for the final outcomes of care

Adverse event

Unintended harm caused by medical care, not by the underlying condition of the patient. A preventable adverse event is one that under the circumstances could have been avoided

What are some characteristics of special cause variations?

Unstable, unpredictable, and not in statistical control

According to Hersey's model, what two factors need to be assessed to determine the level of a followers readiness?

Ability and willingness...ability relates to knowledge and skills in a specific situation and willingness relates to the individuals attitude, confidence, and commitment toward the specific situation

What should the RN not delegate?

Activities that require the core of the nursing process and require specialized knowledge, judgement, and/or skill including: initial nursing assessment, determination of nursing diagnoses, establishment of nursing care goals, development of the nursing plan of care, and evaluation of the patient's progress, and any nursing intervention that requires professional knowledge, judgement, and skill

NCQA (National Committee for Quality Assurance)

An accreditation body that has become the primary group that accredits health plans

Lean methodology

An integrated system of principles, practices, tools, and techniques focused on reducing waste, synchronizing workflows, and managing variability in production flows.

Just culture

An organizational culture that promotes patient safety by acknowledging that competent health care professionals may make mistakes; incidents are analyzed through root cause analysis to determine where system changes can prevent future occurrences

Unlicensed assistive personnel (UAP)

An unlicensed individual who is trained to function in an assistive role to the RN by performing patient care activities as delegated by the nurse ; may include nursing assistants, clinical assistants, orderlies, health aides, or other titles designated within the work setting

Standardization

Approach to process improvement that involves developing and adhering to best-known methods and repeating key tasks in the same way, time and time again, until a better way is found, thereby creating exceptional service with maximal efficiency

Which nursing activity best demonstrates the quality management principle of "All One Team?"

Asking a wound care team nurse how to best educate a client on wound prevention

When would a pareto chart be an appropriate tool?

When needing to select key aspects on which to focus within the process

When considering supervisory responsibilities, the registered nurse (RN) must recognize that:

When two RN's work together to move a client, neither nurse is in a supervisory position

What factor has the greatest impact on whether safe delegation of nursing tasks is possible?

Whether the clients physical condition is considered stable at the time

checklist

algorithmic listing of actions to be performed for a specific procedure or process designed to ensure that no step will be overlooked

Benchmark

an attribute or achievement that serves as a standard for other providers or institutions to emulate

To best address safety issues (sentinel events) that can negatively impact client health and recovery, the individual nurse must initially:

be well aware of the various types and sources of sentinel events

The nurse demonstrates an understanding of patient-centered care when:

discussing the client's wish to include herbal preparations to treat an illness

To best provide patient-centered care (PCC), especially when working with diverse populations, the nurse must initially:

engage in self-reflection about personal values and beliefs

Health care institutions are automatically approved by The Centers for Medicare & Medicaid Services (CMS) when they:

have earned The Joint Commission (TJC) accreditation

It is true that quality improvement:

is proactive rather than reactive

Run chart

Graph of data in time order that help identify any changes that occur over time; also called a time plot

What is the delegatee held accountable for?

His/her own actions Accepting delegation within the parameters of his/her training and education Communicating the appropriate information to the delegator Completing the task

What factors contribute to health care errors?

Human factors such as circumstances in the workplace, provider characteristics and training, and interactions among providers

Health care professionals with a focus on patient safety and error prevention apply the knowledge of...

Human factors, value learning from adverse events through event reporting and analysis, and promote and support a "just culture".

Accountability

In the context of delegation, it means bearing responsibility for both the action and inaction of the nurse and those to whom he or she delegates tasks

In regards to TeamSTEPPS, Which acronym should nurses utilize to communicate concerns without alarm in a calm manner?

CUS...stands for "I need clarity"; "I am uncomfortable"; and "I see a safety issue"...Clarity, Uncomfortable, and Safety issue

Ms. Viola questioned if her staffing ratios demand the use of high-level delegation strategies. What "delegation right" is she assessing?

Circumstances

What is the key to successful delegation?

Clear communication

What are the two types of of variation in processes?

Common cause variation and special cause variation

The most basic factor contributing to the effective supervision of unlicensed assistive personnel (UAP) is the nurse's:

Confidence in his/her ability to delegate appropriately

How can a nurse manager best foster high-quality and safe nursing care among the nursing staff?

Create a unit culture where asking questions about health care interventions is encouraged