Unit 12
CMS worked with the National Quality Forum (NQF) to identify _____ that were determined to be reasonably preventable and for which the additional cost of hospitalization for treating these conditions should not be paid.
CMS-identified "Hospital-Acquired Conditions"
A regulatory organization that administers the U.S. Medicare program and requires quality management in "Conditions of Participation." State licensing authorities require quality management activities and set quality standards.
Centers for Medicare and Medicaid Services (CMS)
belief in the people who are working to serve the customer
"all one team"
Total Quality Management (TQM) Continuous Quality Improvement (CQI) Continuous Process Improvement Statistical Process Control Performance Improvement (PI)
QI buzzwords
project created to support development of six competencies for nursing students and nurses: Patient-centered care Teamwork and collaboration Evidence-based practice Quality improvement Safety Informatics
QSEN (Quality and Safety Education in Nursing)
Minimizes the risk of harm to patients and providers through system effectiveness and individual performance Use national patient safety resources Effective use of technology and standardization practices Examine human factors and basic safety design Values standardization practices that support safety
Safety
Requires organizations to carry out designated steps to fully understand the factors and systems associated with adverse patient events.
TJC Sentinel Event Standard
STEEEP: Preventing waste, including waste of equipment, supplies, ideas, and energy.
efficient
The National Hospital Quality Measures are being used along with patient satisfaction scores and other select clinical measures. Based on the quality of care Offers incentive to deliver services designed to improve patient outcomes health plans pay physicians and hospitals more if they meet certain quality targets. Hospitals may earn back the reduced payments or even exceed the original payment amount based on their performance results
"pay for performance"
1.Care is based on continuous healing relationships. 2.Care is customized according to patient needs and values. 3.he patient is the source of control. 4.Knowledge is shared and information flows freely. 5.Decision making is evidence based. 6.Safety is a system priority. 7.Transparency is necessary. 8.Needs are anticipated. 9.Waste is continually decreased. 10.Cooperation among clinicians is a priority.
10 Rules Guiding Improvement Initiatives
The Quality Chasm reported: ~ _____of Americans failed to receive recommended care in 2010 On average, patients are subjected to at least _____ each day with high costs to patients, families, health care professionals, hospitals, and insurance companies
30% one medication error
Serious, costly errors in health care that should NEVER happen Can cause serious injury or death to the patient. now known as "serious reportable events" [SRE] 29 grouped into 7 categories
CMS "Never Events"
Following the To Err Is Human: Building a Safer Health System report, the IOM released _____ to design a vision for improving the quality of our nation's health care. "The U.S. health care delivery system does not provide consistent, high quality medical care to all people. Americans should be able to count on receiving care that meets their needs and is based on the best scientific knowledge—yet this frequently is not the case. Health care harms too frequently and routinely fails to deliver its potential benefits. Indeed, between the health care that we now have and the health care that we could have lies not just a gap, but a chasm" (p. 1).
Crossing the Quality Chasm: A New Health System for the 21st Century
Integrate best current evidence with clinical expertise and patient/family preferences and values Knowledge of basic scientific methods and processes Participate in data collection and other research activities Consult with clinical experts
Evidence-Based Practice
Use information and technology to communicate Manage knowledge, mitigate error, support decision making Navigate the electronic health record Respond to clinical decision-making supports and alerts
Informatics
Nonprofit organization Education resource for the prevention of medication errors Provides independent, multidisciplinary, expert review of reported errors Health care professionals across the nation voluntarily and confidentially report medication errors and hazardous conditions that could lead to errors Offers Medication Safety Self Assessments® to allow nurses and other healthcare professionals to assess the medication safety practices in their work setting
Institute for Safe Medication Practices [ISMP]
The governing body of the American Nurses Association (ANA) established _____ which: Voluntary database, collects national data link between nurse staffing and patient outcomes Measurement program that allows comparison measures of nursing quality among national, regional, and state hospitals of similar type and size
National Database of Nursing Quality Indicators® (NDNQI®)
The Joint Commission and the Centers for Medicare and Medicaid Services were working together to align current and future measures common to both organizations. These standardized measures are now referred to as _____.
National Hospital Quality Measures
Foreign object retained after surgery Air embolism Blood incompatability Stage III and IV pressure ulcers Falls and trauma Catheter-associated urinary tract infection Vascular catheter-associated infection Surgical site infection- mediastinitis after coronary artery bypass graft Manifestations of poor glycemic control (deep vein thrombosis/pulmonary embolism with total knee or hip replacement) Surgical site infection-bariatric surgery Surgical site infection following certain orthopedic procedures of spine, shoulder, and elbow Surgical site infection following cardiac implantable electronic device procedures Iatrogenic pneumothorax with venous catheterization
Never Events: The Centers for Medicare and Medicaid Services Listing of Hospital-Acquired Conditions for 2018
Patient is source of control Patient values Patient preferences Diverse cultures, ethnic, & social backgrounds Respect & encourage individual expression
Patient-Centered Care
Use data to monitor the outcomes of care processes Use improvement methods to design and test changes Continually improve the quality and safety in healthcare Describe approaches for changing processes of care
Quality Improvement
Assessment and improvement of work processes while focusing on what customers need and want.
Quality Improvement [QI]
The Quality Chasm report provides guiding aims for improvement referred to the acronym _____.
STEEEP
Purpose: promote specific improvements in patient safety with the goals highlighting problematic areas and evidence-based solutions to the problems with system-wide solutions wherever possible 1. Identify patients correctly 2. Improve staff communication 3. Use medicines safely 4. Use alarms safely 5. Prevent infection 6. Identify patient safety risks 7. Prevent mistakes in surgery
TJC National Patient Safety Goals
Programs Initiated in Response to Imperative to Improve Patient Safety?
TJC Sentinel Event Standard TJC National Patient Safety Goals
Developed as an evidence-based teamwork system aimed at optimizing patient outcomes Helps improve communication and teamwork skills among health care professionals
Team Strategies and Tools to Enhance Performance and Patient Safety [TeamSTEPPS]
Foster open communication Mutual respect Shared decision making Awareness of strengths and limitations as a team member Minimize risks associated with hand-off among providers
Teamwork & Collaboration
One of the first accreditation agencies to embrace QI principles as an accreditation requirement in hospitals. Accredits more than 20,500 health care organizations. Health care organizations voluntarily seek this accreditation to demonstrate that they have achieved a "gold seal of approval" in quality and safety standards. Organizations accredited by this organization receive deemed status to automatically meet foundational approval from CMS. Address the organizations level of performance in key areas which are patient safety, patient rights, patient treatment, and infection control.
The Joint Commission
Answers for improved patient safety require all care providers to pull together to review critical circumstances and learn from key events Nurses' challenge is to make patient safety a personal priority
The Professional Nurse and Patient Safety
Assault/Injury Assault Rates Catheter-Associated Urinary Tract Infection Rates Central Line-Associated Blood Stream Infection Rates Fall/Injury Fall Rates Hospital/Unit Acquired Pressure Ulcer Rates Pain Assessment/Intervention/Reassessment Cycles Completed Peripheral IV Infiltration Rate Physical Restraint Prevalence Ventilator-Associated Pneumonia Rates Falls in Ambulatory Settings Pressure Ulcer Incidence Rates from Electronic Health Records Hospital Readmission Rates Nursing Staff Skill Mix Nursing Hours per Patient Day Nurse Turnover Rate RN Education/Certification Nursing Care Hours in Emergency Departments, PeriOperative Units and Perinatal Units Skill Mix in Emergency Departments, PeriOperative Units and Perinatal Units
The Professional Nurse and Patient Safety NDNQI® Safety benchmarks
In an alarming 2000 report titles ______ by the Institute of Medicine, ~ 98,000 patients die each year from preventable medical errors poor quality of care is a major problem in the United States updated estimate validated these original IOM statistics
To Err Is Human: Building a Safer Health System
Monitoring for early recognition of adverse events, complications, and errors Initiating deployment of appropriate care providers for timely intervention and response/rescue of patients in these situations
Two significant nursing functions
Hospital inpatient Medicare payments are reduced annually by 1-2% Hospitals can be reimbursed based on performance results Value = quality measures + Patient experience + Cost of care
Value-Based Purchasing
Overuse of expensive invasive technology Underuse of inexpensive care services Error-prone implementation of care that could harm patients and waste money
contributing factors cited in the original IOM report
STEEEP: Providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit.
effective
STEEEP: Providing care that does not vary in quality because of personal characteristics, such as gender, ethnicity, geographic location, and socioeconomic status.
equitable
The Quality Chasm report details _____: Unprecedented advancement of science and technology, Growing complexity of health care, Changing public health care needs, and a Poorly organized and uncoordinated health care delivery system
number of factors that have contributed to this chasm
Support overall management of patient care throughout length of stay Collaborate with other healthcare professionals to initiate changes Monitor ongoing effectiveness of care provided
nurses awareness
STEEEP: Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.
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" Nurses, physicians, and other health professionals partner with patients and families to ensure that health care decisions respect patients' wants, needs, and preferences
patient centered care
Quality Improvement is essential to improve safety and reduce health care errors.
patient safety
Not a nursing care delivery model but a _____ Should be incorporated as an essential component of any nursing care delivery model
philosophy of care
Developing care plans/discharge plans Providing education to make informed decisions Establishing "family advisory councils" to engage decision making Incorporating user friendly technology to support patient education
practical methods for engaging in patient-centered care
customer defines quality
quality
Cornerstones of Quality Management?
quality, scientific approach, and all one team
conducted to understand the systems at fault within the organization so that improvements can be determined and implemented to prevent future occurrences
root cause analysis
STEEEP: Preventing injuries to patients from the care that is intended to help them.
safe
S: T: E: E: E: P:
safe timely effective efficient equitable patient centered
organizational support for all employees to develop knowledge and skills in the science of QI
scientific approach
STEEEP: Reducing wait and delays.
timely