nursing quiz 4

Quality Improvement

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

medical errors

3rd leading cause of deaths

reckless behavior

conscious disregard of risk; a deliberate act

heath care quality

"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."

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

Response to Medical Error

-"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

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

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 )

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

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

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

roles and responsibilities

-Identify priority areas for health care quality -Establish national standards for quality measurement & accountability -Implement quality measurement & improvement activities -Communicate performance results to providers & consumers

leading organizations

-JC -NCQA AMA -ANA CMS -CDC IOM

health care quality

-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.

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

Health literacy affects patients ability to

-Navigate health care system Example: filling out forms, locating services -Communicate with health care professionals -Engage in self-care -Management of chronic diseases -Interrupt test results -Calculate medication dosages

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.

Ask me 3?

-What is my main problem? -what do I need to do? -Why is it important for me to do this?

Culture of safety

-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

Teach-back method

-ask patients to demonstrate understanding -chunk and check -do not ask "do you understand"

Key areas of quality

-effectiveness -efficiency -equity -patient centeredness -safety -timeliness

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

Nurses ensure patient safety...

-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

Improve Interpersoanl Communication

-use analogies and pictures -limit to most important concepts -repeat them -slow down -use plain non medical language

Patient safety is...

...an essential and fundamental component of quality nursing care

medical errors cost...

1 trillion/yr

how many die per year due to medical error

210,000 to 440,000 pts/year who seek care at a hospital die as a result of medical errors (

What percent of adults have the skills needed to use health information

10%

Health Literacy Impacts

Access Safety Quality Outcomes

A nurse is a...

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

response to human error

Console -educate,train -change, process/procedures -modify environment

response to reckless behavior

Correct -remedial action -disciplinary action

response to at risk behavior

Counsel -create incentives for healthy behaviors -increase awareness of risk

nurse quality indicators

Falls/Injury Pressure Ulcers Pain assessment Physical restraints Infection (health-care related) Staff mix Nurse:patient Nursing care hours per patient per day

patient safety movement

Goal: zero preventable deaths by 2020

Setting of goals of NPSG

Hospitals Ambulatory Health Care Behavioral Health Care Critical Access Hospital Home care

patient safety

IOM definition: "the prevention of harm to patients"

NPSG 2018

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

Whos at risk?

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

6 core competencies

Patient-centered care Evidence-based practice Safety Teamwork & collaboration Quality improvement Informatics

Goals of response to medical error

Protect the patient Improve systems Prevent further harm

JC: National Patient Safety Goals

Purpose: improve patient safety Goals focused on problems in health care safety and how to solve them

safety

Relates to actual or potential bodily harm

efficiency

Relates to maximizing the quality of health care delivered or of health benefit achieved for health care resources used

patient centeredness

Relates to meeting patients' needs and preferences and providing education and support

timeliness

Relates to obtaining needed care while minimizing delays

effectiveness

Relates to providing care processes and achieving outcomes as supported by scientific evidence

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

Quality and 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

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)

Quality of care

The standard of something as measured against other things of a similar kind; the degree of excellence of something.

Integrated approach

Today, a number of organizations have taken a leadership role in promoting quality measurement, improvement and accountability in health care.

patient safety

WHO definition: Prevention of errors and adverse effects to patients that are associated with health care

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

Just culture video

able to talk and understand and learn from medical errors

process

appropriate physician and other provider activities are carried out to deliver care.

At risk behavior

individuals choice: risk believed to be justified or insignificant

The Joint Commission (JC)

is recognized nationwide as a symbol of quality that reflects an organization's commitment to meeting certain performance standards

human error

result of current system design and behavioral choice

outcomes

the effect of the care on the health status of patients and populations.

structure

the resources and organizational arrangements are in place to deliver care