WEEK 1 NRSG 102 AQ safety and quality care
What is ADE?
Adverse Drug Effects
The nurse in the emergency care department at a hospital is a member of the Rapid Response Team (RRT). Who are other members of the RRT? Select all that apply.
An ICU nurse, a respiratory therapist, and an intensivist are the members of the Rapid Response Team. An intensivist is a physician who specializes in critical care.
What are IHI interventions to save patient lives? Table 1-1: IHI Interventions
Deploy RRT Provide reliable, evidence based care for acute myocardial infarction Prevent central line infections Prevent ADE Prevent SSI Prevent ventilator-associated pneumonia
Patient-centered care is about sharing the management of an illness between the patient and the health care provider. What is an example of knowledge needed to develop the Institute of Medicine (IOM)/Quality and Safety Education for Nurses (QSEN) initiative's Patient-Centered Care competency?
Describing how diverse backgrounds function as sources of patient, family, and community values is an example of the knowledge needed to develop the IOM/QSEN Patient-Centered Care competency. Knowledge is what the nurse knows; it is a sum total of the learning. Recognizing personally held attitudes about working with different ethnic, cultural, and social backgrounds is an attitude, as well as respecting and encouraging individual expression of the patient's values, preferences, and expressed needs. Attitude is how the nurse comes across to others while carrying out his or her tasks. Providing patient-centered care to the patient with sensitivity and respect for the diversity of human experience is a skill, which is how well the nurse performs his or her tasks.
Evidence-based practice is one of the core competencies of nurses. What best describes evidence-based practice?
Evidence-based practice is a problem-solving approach that integrates the best current evidence or facts to make decisions about the patient's care. It is not based on traditional beliefs and practices, but is based on current evidence and facts. It is not provided as per resources available at the healthcare facility, but based on verified evidence. It is not necessarily the practice embodied in literature and books, but based on the most current evidence.
Which principal nursing actions best support a focus on patient safety? Select all that apply.
Handwashing is the number-one way to prevent infection in patients. Checklists can help prevent mistakes in care for a surgical patient, thus ensuring a safe environment. Adhering to the five rights of medication administration helps to prevent errors in this important nursing care activity, providing for increased safety in patient care. .....Although restraints may help patients who are confused to keep from hurting themselves, they are potentially risky and are used infrequently because of the harm they can cause. Respect is an important element in patient care, but it is not directly tied to the provision of a safe care setting.
The nurse educator is instructing newly hired registered nurses about patient-centered care. Which competency categories are included in this content? Select all that apply.
Knowledge, skills, and attitudes are the patient-centered care competencies needed to ensure quality care. These characteristics, which were developed by the Institute of Medicine (IOM) and the Quality and Safety Education for Nurses (QSEN) groups, are the areas cited and enumerated by both groups. A delineation (and examples of each) of knowledge, skills, and attitudes constitutes competent nursing practice. Environment, values, and sound nursing judgments are important to the patient's care but are not included in the patient-centered care competencies
The nursing student has been assigned to the hospital's Rapid Response Team (RRT). Which statement by the student indicates a correct understanding of the RRT member's purpose?
Members of the RRT are critical care experts who are on site in the hospital and are available at any time. The RRT does not ride along in the ambulance; it is hospital-based. RRT members do not admit patients to the hospital. They do not replace the code team—they often precede it.
The Center for Transforming Health Care recommends targeted solutions to enhance successful hand-off communication using the acronym SHARE. What describes the targeted solution "reinforce quality and measurement?"
Monitoring compliance with the use of standardized forms describes the targeted solution of "reinforce quality and measurement." Providing details of the patient's history to the receiver of information is targeted at "standardizing critical content." Stating expectations about how to conduct a successful hand-off describes the targeted solution "hardwire within your system." Standardizing training on how to conduct a hand-off describes the targeted solution "educate and coach."
The nurse instructor is teaching nursing students about the knowledge, skills, and attitudes (KSAs) needed to develop core competencies based on the Institute of Medicine (IOM) and Quality and Safety Education for Nurses (QSEN) initiative. What KSAs are needed to develop the Quality Improvement competency? Select all that apply.
Participating in root cause analyses of issues and implementing activities to improve care processes are KSAs needed to develop the QSEN Quality Improvement core competence. To meet the Quality Improvement competency, nurses are expected to "use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems." .......Patient education and empowerment is a KSA needed for Patient-Centered Care competency and preparing an interdisciplinary plan of care is needed for Teamwork and Collaboration competence. Using tools to reduce reliance on memory is a Safety core competence.
What are IHI interventions to prevent patient harm? Table 1-1: IHI Interventions
Prevent harm High-Alert Drugs (anticoagulant, insulin, opioids) Reduce surgical complications Prevent pressure ulcers Reduce MRSA infections Provide reliable, evidence based care for congestive heart failure get board of health care organizations to support measures to promote safe patient care.
Per the Institute of Healthcare Improvement (IHI) interventions, which is one of the nursing interventions that seek to save a patient's life?
Preventing ventilator-associated pneumonia is one of the IHI interventions recommended to help save patients' LIVES. ....The nurse prevents patient HARM from high-alert drugs such as anticoagulants and opioids, reduces methicillin-resistant Staphylococcus aureus infections, and provides reliable, evidence-based care for congestive heart failure.
What is RRT?
Rapid response team
Which important aspect of coordinating care within the interdisciplinary team is facilitated by use of the "SBAR" and "PACE" procedures?
SBAR and PACE are acronyms for "hand-off" methods of communication used by health care organizations to share information between shifts and between departments. SBAR and PACE are not types of implementation (of patient care). Implementation, the fourth step of the nursing process, is an action rather than a coordination of care. SBAR and PACE are not types of policymaking or protocol development.
To improve communication between staff members and health care agencies, certain procedures for hand-off communication were established. What are the acronyms that refer to popular methods of communication used in nursing practice? Select all that apply.
SBAR, I-SBAR, and SHARE are acronyms referring to popular methods of communication used in nursing practice. SBAR includes communication about the situation, background, assessment, and recommendation. I-SBAR is a modification of SBAR. The 'I' reminds the individual to identify himself or herself. SHARE is used in hand-off communication and reminds the nurses to standardize critical content, hardwire within their system, and allow the opportunity to ask questions, reinforce quality and measurement, and to educate and coach.
What targeted solutions featured in the acronym SHARE enhance successful hand-off communication? Table 1-4 Communication and collaboration: SHARE
Standardize critical content Hardwire within your system Allow opportunity to ask questions Reinforce quality and measurement Educate and coach
What is SSI?
Surgical Site Infections
One of the most important members of the interdisciplinary team is the case manager (CM). Which statements about the CM are correct? Select all that apply.
The CM coordinates inpatient and community-based care before discharge and may coordinate with other CMs employed by third-party health care payers. The work of the CM is to provide quality and cost-effective services and resources to achieve positive patient outcomes through collaboration and coordination. In acute care hospitals, the CM is not always an RN; he or she may also be a social worker. The CM is not part of the RRT; members of an RRT are critical care experts, while a CM simply coordinates cases and collaborates with patients and caregivers. The CM may not be called in to manage a critical case before a cardiac arrest-the RRT is called in for that.
One of the most successful initiatives of the Institute for Healthcare Improvement (IHI) was the creation of the Rapid Response Team (RRT). Which statement about the RRT is correct?
The RRT is also called the medical emergency team (MET), as they respond to medical emergencies. The RRT provides care to patients before a cardiac arrest.
When developing a standardized plan of care for patients with a diagnosis of pneumonia, how does the nurse find the best information about providing optimal nursing care?
The best evidence based nursing practice will be developed by using information from randomized controlled studies testing the impact of various nursing interventions on outcomes for patients with pneumonia. This type of data collection is the most scientifically based approach listed here. Articles in nursing magazines are likely to be researcher-biased. They are also unlikely to be controlled. Chart review serves as a limited source of data and cannot be generalized for a standard. Also, regional practices may tend to skew the data. Data from nurses, although valuable, are likely to be biased; data collection would not be well-controlled.
The Quality and Safety Education for Nurses (QSEN) initiative team has created specific knowledge, skills, and attitudes (KSAs) needed to develop each core competency. What do the KSAs for Informatics competence emphasize? Select all that apply.
The emphases of the KSAs for Informatics include documentation, electronic data access, and data utilization. Informatics involves using information and technology to communicate, manage knowledge, mitigate error, and support decision-making.
Bedside computers are an example of informatics used in health care primarily for which purpose?
The largest application of health care informatics is the growing trend of the use of electronic medical records (EMRs) for documenting interdisciplinary care. Computers may be located at the patient's bedside or in the treatment room for ease of access for documentation. Computers allow quick communication among health care professionals to enhance collaboration and coordination of care; however, this type of communication typically would not take place at the patient's bedside. Bedside computers in the health care setting are not intended for patient use. The Internet provides ways to search multiple sources of information and retrieve data efficiently; however, this would not be done at the patient's bedside.
I-SBAR-R is a modification of the SBAR method of communication. What additional step has been included in the I-SBAR-R method compared to the SBAR method?
The last 'R' in the modified I-SBAR-R method of communication refers to the response of the receiver based on the information provided. The 'I' at the beginning reminds the individual to identify him or herself.
Nurses have six core competencies based on the Quality and Safety Education for Nurses (QSEN) initiative. What specific knowledge, skill, and attitude (KSA) does the nurse need to develop for the Quality Improvement competency?
The nurse accesses and evaluates data to monitor the effectiveness of the health care provided as part of the QSEN competency for Quality Improvement. ..........The nurse respects the patient's preferences for active engagement in care processes as part of the Patient-Centered Care competency. Following the documentation and reporting protocols established for the health care agency is a communication skill developed for the Teamwork and Collaboration competency. The use of checklists to reduce reliance on memory when administering medications to the patient is part of the Safety competency.
Nurses require core competencies related to the Quality and Safety Education for Nurses (QSEN) initiative to provide quality and safe care across all settings. What skill does the nurse need to master competence in Informatics?
The nurse documents and plans patient care in an electronic health record as part of the Informatics competency. Informatics involves using information and technology to communicate, manage knowledge, mitigate error, and support decision-making. Participating in the root cause analysis of a sentinel event is part of the Safety competency. Basing an individualized care plan on patient values, one's own clinical expertise, and evidence is part of the Evidence-Based Practice competency. Eliciting information about the patient's values, preferences, and expressed needs is a skill that is part of the Patient-Centered Care competency.
The nurse has recently been assigned to a medical-surgical clinical rotation. According to the scope of medical-surgical nursing, what type of patient assignments does the nurse expect to see?
The scope of medical-surgical nursing, sometimes called adult health nursing, is to promote health and prevent illness or injury in patients from 18 to 100 years of age or older. The most common practice setting is the acute care hospital.
The critical care nurse uses a computerized decision support system to position a patient correctly to prevent ventilator-assisted pneumonia. This is an example of which Quality and Safety in the Education of Nurses (QSEN) competency?
Using computerized technology to support decision-making is an example of the QSEN competency related to Informatics. The nurse is competent in Patient-Centered Care when the nurse recognizes the patient or designee as a source of control and a partner in providing care, and respects the patient's preferences, values, and needs. The nurse is competent in Quality Improvement when the nurse uses data to monitor the outcomes of care processes and uses improvement methods to design and test changes to continuously improve the quality and safety of health care systems. The nurse is competent in Evidence-Based Practice when the nurse integrates the best current evidence to make decisions about the patient's care.
What is VAP?
Ventilator associated pneumonia
The nurse delegates recording of a patient's vital signs to a patient care technician (PCT). What must the nurse ensure when delegating the selected nursing task to the PCT? Select all that apply.
When delegating and supervising a nursing task to a PCT, the nurse ensures the right task, right circumstances, and right communication. The task delegated should be within the scope of practice and competence of the PCT (right task). The patient care setting should be appropriate for the delegation (right circumstances). The nurse must provide a clear and concise explanation of the task (right communication). PCTs are considered unlicensed assistive personnel (UAP) and do not require a license to perform a nursing task delegated and supervised by the nurse. The PCT's desire to learn how to do the task is not enough; he or she should be competent to perform the task and the task should be within his or her scope of practice and competence.
