Chapter 23: Quality Control
A client was treated in the hospital for a stroke and was the client's family members assert that the client was discharged too early and did not receive sufficient rehabilitation. The client's early discharge may have been attributable to: a. the effect of diagnosis-related groups. b. a sentinel event. c. the application of total quality management. d. deliberate malpractice.
ANS: A Feedback: As a result of DRGs, hospitals became part of the prospective payment system (PPS), whereby providers are paid a fixed amount per patient admission regardless of the actual cost to provide the care. This system has been criticized as promoting abbreviated hospital stays. Early discharge would most likely be incompatible with the principles of TQM. Deliberate malpractice would be highly unlikely. The client's early discharge would only be considered to a sentinel event if it were an overt error.
A nurse-manager is focusing on management controlling functions that are associated with quality control. What task best addresses this goal? a. Periodically evaluating the unit mission and philosophy b. Creating the daily client care assignments to distribute workload evenly c. Contributing to the development of the annual budget d. Distributing staffing policies related to the choice of vacation time
ANS: A Feedback: Examples of management controlling functions include the periodic evaluation of unit philosophy, mission, goals, and objectives; the measurement of individual and group performance against preestablished standards; and the auditing of patient goals and outcomes. Scheduling and budgeting are less directly related to controlling functions related to quality control.
Which action is associated with the nursing leadership role in quality improvement? a. Inspiring staff to establish and maintain high standards regarding patient care b. Being aware of the changes in quality control regulations c. Reviewing research results upon which to base changes d. Identifying outcomes that support quality nursing care
ANS: A Feedback: Inspiring subordinates to establish and achieve high standards of care is a leadership skill. The remaining options are management roles.
Which practice has the U.S. Food and Drug Administration (FDA) suggested in order to decrease the risk of medication errors? a. Computerized order entry with a drug bar code system b. Medications automatically dispensed to clients at predetermined times c. Use of medication nurses to administer all ordered medications d. Have clients' medications secured at the bedside for self-administration
ANS: A Feedback: The FDA has suggested that a drug bar code system coupled with a computerized order entry system would greatly decrease the risk of medication errors. The FDA has not promoted automatic distribution or the use of dedicated medication nurses. Storing medications at clients' bedsides is unsafe.
A hospital system is trying to address some of the deficits in care that were described in To Err Is Human. When addressing the errors that this report identified, the hospital's leaders should focus on what factor? a. Systemic flaws in health-care delivery b. Malice on the part of some health-care providers c. Lack of education for health-care workers d. Increased use of nursing assistive personnel
ANS: A Feedback: This IOM report concluded that most errors did not occur from individual recklessness. Instead, they occurred because of basic flaws in the way that the health delivery system is organized and delivered. This report did not highlight lack of education, use of NAP, or malice.
A health-care organization has experienced a rise in medical errors and has committed to implementing Leapfrog initiatives. What aspects of health care should the organization address? Select all that apply. a. Expanding the use of computerized physician-provider order entry b. Increasing the budget for continuing education for nurses c. Ensuring that hospital referrals are evidence-based d. Utilizing the National Quality Forum-endorsed Safe Practices scores e. Ensuring that adequately trained intensive care physicians are easily accessible
ANS: A, C, D, E Feedback: The Leapfrog Group identified four evidence-based standards that they believe will provide the greatest impact on reducing medical errors: computerized physician-provider order entry, evidence-based hospital referral, ICU physician staffing, and the use of National Quality Forum-endorsed Safe Practices scores. Continuing education for nurses is not specifically addressed.
The nurse is admitting a new client and is reviewing the results of the medication reconciliation. What data will be included in the client's medication reconciliation? Select all that apply. a. The medications that the client was taking prior to admission b. The client's expectations for treatment with medications during admission c. The client's medication administration record from any previous admissions d. The results of the nurse-manager's review of the client's treatment plan e. The list of medications the client has been prescribed by the admitting physician
ANS: A, E Feedback: Medication reconciliation is the process of comparing the medications a patient is taking (or should be taking) with newly ordered medications. It does not involve a manager's review of treatment, the client's expectations, or medications from previous admissions.
High-achieving nursing students were found to have studied in small groups, attended class 100% of the time, took frequent rest breaks during study sessions, and ate a balanced diet for 1 week before the examination. What type of audit provided data about the students' preparation? a. Structure b. Process c. Outcome d. Concurrent
ANS: B Feedback: A process audit assumes that a relationship exists between the process used and the quality of the result. The details of the students' preparation are not an outcome or a structure. These data are retrospective and not concurrent.
A nurse-manager has referred staff members to a clinical practice guideline (CPG) that addresses the prevention of pressure ulcers. What is a characteristic of this CPG? a. The CPG will lay out the criteria that the health-care organization must meet in order to be reimbursed for treating a client's pressure ulcer. b. It will describe interventions for nurses to follow in an effort to provide evidence-based care. c. It will describe the treatment for pressure ulcers that is provided at the best performing organizations. d. The CPG will summarize the etiology and diagnosis of pressure ulcers.
ANS: B Feedback: CPGs provide diagnosis-based, step-by-step interventions for nurses to follow in an effort to promote evidence-based, high-quality care and yet control resource utilization and costs. They go beyond just describing the etiology and diagnosis of a problem; the focus is on treatment. Recommendations are based on evidence and not common practices at high-performing organizations. CPGs do not directly address issues related to reimbursement.
When creating a clinical practice guideline for the management of aggressive behavior on a mental health unit, the nursing committee should perform what action first? a. Interviewing senior staff for practice suggestions b. Conducting a search of the literature for research results c. Reviewing client satisfaction data to identify the unit's strengths and weaknesses d. Educating all unit nursing staff on the need to adhere to established guidelines
ANS: B Feedback: Clinical practice guidelines reflect evidence-based practice; that is, they should be based on cutting-edge research and best practices. The other options may be helpful but should occur after the review of the research literature.
A nurse-manager and several colleagues are reviewing the results of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. These results will allow the team to make what assessment? a. The root causes of adverse incidents b. Clients' perspectives on the care they received c. Consumers' health outcomes at 3 and 6 months after discharge d. Clients' health status at admission versus at discharge
ANS: B Feedback: HCAHPS is a publicly reported survey of clients' perspectives of hospital care. These surveys do not address adverse incidents or clients' objective health outcomes.
What is the greatest limitation of the Health Plan Employer Data Information Set (HEDIS)? a. The Joint Commission has not updated the HEDIS since 2009. b. Managed care organizations are not required to collect HEDIS data. c. Performance indicators are exclusively process focused rather than outcome focused. d. HEDIS performance measures focus on medical interventions and do not address nursing actions.
ANS: B Feedback: The NCQA, not The Joint Commission, has developed HEDIS. One of the most significant weaknesses of NCQA accreditation is that such accreditation is voluntary, so some managed care organizations do not currently undergo such review. The varied measures are not limited to processes and medical interventions.
During a quality improvement initiative, the leadership of a health-care organization has worked with senior managers to implement the principles of Lean Manufacturing. This initiative will focus on what factor? a. Identifying sentinel events b. Identifying and preventing waste c. Engaging all staff members d. Performing root cause analysis of errors
ANS: B Feedback: The main focus in Lean Manufacturing is the removal of waste from a value stream. It does not focus on sentinel events, staff engagement, or root cause analysis of errors.
Which of the following would be considered sentinel events that should be reported to The Joint Commission? Select all that apply. a. A client with ischemic heart disease dies of a myocardial infarction. b. A client with dementia falls and suffers a hip fracture while trying to walk to the bathroom. c. A client files a formal complaint about the inattention of staff while he was in the hospital. d. A client experiences nephrotoxicity and requires dialysis because of a medication error. e. A client experiences a transfusion reaction after receiving the wrong type of packed red blood cells.
ANS: B, D, E Feedback: Drug errors causing harm, falls causing injury, and blood transfusion reactions are considered sentinel events. Deaths related to an underlying diagnosis and client dissatisfaction are not considered sentinel events.
Thirty-eight percent of the people who attended a smoking cessation clinic were not smoking 1 year after completing treatment. What type of audit provided this type of data? a. Structure b. Process c. Outcome d. Concurrent
ANS: C Feedback: An outcome audit determines what outcomes resulted from specific nursing interventions for clients. In a smoking cessation program, abstinence from tobacco would be desired outcome. This does not meet the criteria for a structure, process, or concurrent outcome.
What action should the nurse-manager and other leaders in the health-care organization perform in order to ensure that a quality control program will be effective? a. Set a goal of meeting federal and state standards. b. Set quality control standards at minimum acceptable levels so the organization will score well on self-assessment audits. c. Integrate quality control through all levels of the organizational hierarchy. d. Focus quality improvement efforts on reacting to problems that have been identified.
ANS: C Feedback: For any quality control program to be effective, a belief in the importance of quality control must be integrated through all levels of the organizational hierarchy. A proactive approach should be sought rather than just a reactive approach. Meeting minimum standards (whether imposed or self-identified) will not guarantee high levels of quality.
What task will best allow a health-care organization to benchmark its performance? a. Comparing its performance on key indicators to its performance the previous year b. Setting ambitious but realistic goals for the coming year c. Comparing the organization's performance with that of best performing institutions d. Seeking input from clients and families about the organization's performance
ANS: C Feedback: In benchmarking, an organization compares its performance with that of best performing institutions. Benchmarking is not achieved by comparing with the previous year's performance. Seeking input from clients and setting useful goals are valid components of quality improvement and quality control, but these actions are not part of benchmarking.
A nurse-manager is participating in a hospital's quality control efforts and is collating data sources. What data source should the manager identify as a qualitative source? a. The hospital's rate of nosocomial infections b. The hospital's readmission rate c. Results of interviews with discharged clients d. The previous year's budget for continuing education initiatives
ANS: C Feedback: Infection rates, spending, and readmission rates are all quantifiable. Interview data, however, is qualitative in nature.
What is the best course of action to stimulate broad participation of employees in quality control efforts? a. Encourage regular meetings between middle management and upper management. b. Educate staff about the relationship between the organization's accreditation and their own licensure. c. Engage closely with the frontline staff who provide client care. d. Educate staff about the correct way to document and report sentinel events.
ANS: C Feedback: Staff should be involved in determining criteria or standards, reviewing standards, and collecting data. To encourage broad participation, it is vital for managers and leaders to engage closely with the frontline staff. This affects more employees than meetings between upper and middle management. In general, an organization's accreditation (or lack thereof) does not affect a nurse's ability to maintain licensure. Responses to sentinel events are important but do not promote the wider practice of participating in quality control and improvement.
Which is a true statement regarding TQM? a. It is based on the premise that the organization knows what is best for the consumer. b. Its guiding purpose is to save the organization money. c. It recognizes that the customer is the focal element on which production and service depend. d. It assumes that inspection and removal of errors lead to the delivery of quality services.
ANS: C Feedback: TQM is based on the premise that the customer is the focal element on which production and service depend and that the customer knows best. The primary focus is on quality and not cost. The avoidance of errors does not necessarily guarantee high quality.
A nurse-manager is overseeing an organization that uses the Nursing Minimum Data Set (NMDS). What will the use of the NMDS achieve? a. Comparing the quality of nursing care and medical care with reference to standardized data b. Identifying minimal levels of quality necessary for nurses to maintain licensure c. Standardizing the collection of nursing data for use by multiple users d. Identify only "nursing-sensitive" client outcome measures
ANS: C Feedback: The NMDS standardizes the collection of nursing data for use by multiple data users. The NMDS is not designed for comparing nursing interventions with medical interventions, and it does not lay out criteria for licensure. It is not limited to nursing-sensitive outcome measures.
A novice nurse-manager is a member of a team that will oversee quality control in a health-care organization. What action should the nurse and the other members off the team perform first? a. Take corrective action to address standards that are known to be challenging. b. Collect the essential data that will give a general overview of performance data. c. Determine the specific criteria and standards by which quality will be measured. d. Assign tasks between the team members to address identified standards.
ANS: C Feedback: The first step in quality control is to determine criteria and standards. Measuring performance, assigning tasks, or making corrections is impossible if standards have not been clearly established.
A hospital is using the guidelines of the Leapfrog Group to inform safety improvements in the organization. What action will best incorporate these guidelines? a. Replacing practical nurses with registered nurses whenever possible b. Eliminating the use of high-risk medications and increasing the role of pharmacists c. Purchasing a computerized physician-provider order entry system d. Converting shared rooms to single-occupant rooms
ANS: C Feedback: The use of computerized order entry is one of the Leapfrog Group's four key recommendations. These guidelines do not address the nursing skills mix, single-occupant rooms, or the use of high-risk medications.
As part of a quality improvement initiative, administrators are conducting outcomes analysis and have included nursing-sensitive outcome measures. These outcome measures will: a. highlight the aspects of nursing that are contentious or controversial. b. cause the quality improvement process to prioritize nurses over other providers. c. separate out the unique contributions that nurses make to client outcomes. d. require other members of the health-care team to rate nurses' contributions.
ANS: C Feedback: There is growing recognition that it is possible to separate the contribution of nursing to the patient's outcome; this recognition of outcomes that are nursing-sensitive creates accountability for nurses as professionals and is important in developing nursing as a profession. This does not focus on controversial issues or prioritize nursing interests over others in the overall quality improvement process. This does not require other providers to "rate" nurses.
What role has The Joint Commission assumed in ensuring quality at the organizational level? a. Establishing clinical practice guidelines b. Reducing diagnosis-related group reimbursement levels c. Standardizing clinical outcome data collection d. Assessing monetary fines for organizations that fail to meet standards
ANS: C Feedback: Under ORYX, The Joint Commission ensures quality at the organizational level by requiring participating organizations to choose from among 60 acceptable performance measurement systems. The Joint Commission is not actively involved in any of the other options.
In order to improve the likelihood that errors in the health-care system will be reported, nurse-managers should: a. give professionals the choice of whether or not to report errors. b. establish firm and meaningful punishments for staff who commit an error. c. assign "safety officers" whose exclusive role is to monitor for, identify, and follow up errors. d. foster a climate where analysis of errors is not solely focused on blame.
ANS: D Feedback: A just culture avoids focusing solely on blame and punishment while still promoting accountability. Errors should always be reported in some manner, and the use of "safety officers" has not been broadly advocated.
What piece of data should the nurse-manager include in an outcome audit? a. Nursing handoffs occur at the client's bedside and include family input. b. Client-nurse ratios are capped at 3:1 in the day and 4:1 at night. c. Technology is acquired so documentation can be completed at the bedside. d. At discharge, a client was able to ambulate 40 feet unassisted.
ANS: D Feedback: A particular client's change in health status is an outcome. The other responses address the structure and process of care.
As part of the quality control, managers have set standards for performance and assessed whether these standards are being met. It has been determined that several standards are not being met. What is the priority response to this finding? a. Release the findings to the public to ensure transparency. b. Compare the organization's results to benchmarks. c. Determine whether similar organizations in the region are experiencing similar results. d. Perform interventions that will correct the deficiencies.
ANS: D Feedback: Applying corrective actions is the essential response to deficiencies revealed in the quality control process. It is not always necessary or appropriate to disseminate these findings publicly. Comparison to benchmarks would take place earlier in the quality control process. Comparison to other similar organizations is not a priority over resolving deficiencies.
A nurse-manager is opposing the expansion of the prospective payment system (PPS). What argument against the PPS should the manager cite? a. Diagnosis-related groups have caused an increase in health-care costs. b. The PPS has unnecessarily increased the length of hospital stays. c. The PPS is linked to increased prices for pharmaceuticals. d. The PPS has been linked to a decline in the quality of care.
ANS: D Feedback: 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 resulted in declines in the quality of care.
An RN is a supervisor in an organization that has total quality management (TQM) as the basis for its organizational goals and objectives for quality control. How should the RN practice TQM on the unit? a. Encourage colleagues to create vision and mission statements. b. Develop a quota system for number of clients cared for. c. Explain to the staff that "if it's not broke, don't fix it." d. Promote teamwork rather than individual accomplishments.
ANS: D Feedback: In TQM, team efforts are favored over individual accomplishments. Quota systems and maintaining the status quo work against quality in this philosophy. It is beneficial for a unit to have a mission and vision statement, but these are not core components of the TQM philosophy.
What is the definition of a standard? A) A predetermined baseline condition or level of excellence that constitutes a model to be followed and practiced B) Diagnosis-based, step-by-step interventions for nurses to follow in an effort to promote evidence-based, high-quality care C) Process of measuring products, practices, and services against those of best-performing organizations D) Identify not only what and how an event happens but why it happens, with the end goal being to ensure that a preventable negative outcome does not recur
Ans: A Feedback: A standard is a predetermined baseline condition or level of excellence that constitutes a model to be followed and practiced. The remaining options all fail to accurately define a standard.
Which intervention is associated with the nursing leadership role? A) Inspiring staff to establish and maintain high standards regarding patient care B) Being aware of the changes in quality control regulations C) Reviewing research results upon which to base changes D) Identifying outcomes that support quality nursing care
Ans: A Feedback: Inspiring subordinates to establish and achieve high standards of care is a leadership skill. The remaining options are management roles.
What are the four evidence-based standards identified by the Leapfrog Group to reduce medical errors? A) Computerized physician-provider order entry, evidence-based hospital referral, ICU physician staffing, and the use of Leapfrog Safe Practices scores B) Computerized physician-provider order entry, evidence-based visiting nurse referral, ED physician staffing, and the use of Leapfrog Safe Practices scores C) Computerized primary care provider order entry, evidence-based hospital referral, ICU physician staffing, and the use of Leapfrog Safe Medication scores D) Computerized nurse practitioner-provider order entry, evidence-based outpatient referral, ED physician staffing, and the use of Leapfrog Safe Medication scores
Ans: A Feedback: The Leapfrog Group identified four evidence-based standards that they believe will provide the greatest impact on reducing medical errors: computerized physician- provider order entry, evidence-based hospital referral, ICU physician staffing, and the use of Leapfrog Safe Practices scores.
Which practice has the U.S. Food and Drug Administration suggested in order to decrease the risk of medication errors? A) Computerized order entry with a drug bar code system B) Medications automatically dispensed to patients at predetermined times C) Use of medication nurses to administer all ordered medications D) Have patients' medicatiNons kept at the bedside for self-administration
Ans: A Feedback: The U.S. Food and Drug Administration has suggested that a drug bar code system coupled with a computerized order entry system would greatly decrease the risk of medication errors.
Which task is a management function associated with quality control? A) Periodic evaluation of unit mission and philosophy B) Making out the daily patient care assignments C) Creating a yearly budget D) Distributing holiday staffing policies
Ans: A Feedback: Unit mission, philosophy, goals, and objectives are the blocks on which policies and standards rest. All these must be in place to measure whether quality is being achieved on the unit. The other options are not related to quality control.
Who is involved in quality control measurement functions? Select all that apply. A) Facility staff B) Consumers C) All levels management D) Health-care professionals
Ans: A, B, C, D Feedback: Consumers, health professionals, staff, and all levels of management should be involved in quality control measurement. Community members become involved when they become health-care consumers.
Nursing students who scored in the top 5% on the examination studied in small groups, attended class 100% of the time, took frequent rest breaks during study sessions, and ate a balanced diet for 1 week before the examination. What type of audit provided this type of data? A) Structure B) Process C) Outcome D) Concurrent
Ans: B Feedback: A process audit assumes that a relationship exists between the process used and the quality of the result. This is the only option that fulfills that function.
Which statement is true regarding adverse drug events (ADEs)? A) They occur infrequently in accredited hospitals B) They are responsible for about 20% of hospitalized disabilities C) They usually involve either prescribing or pharmacy errors D) They occur because of individual recklessness
Ans: B Feedback: ADEs occur in all hospitals, are to blame for 20% of injury disabilities, and involve more than prescribing or pharmacy errors, but are rarely due to individual recklessness. They occur in both accredited and unaccredited facilities.
What results from the development of plan of correction associated with health-care delivery errors? A) Sentinel event B) Root cause analysis C) Quality assessment (QA) program D) Failure mode and effects analysis (FMEA)
Ans: B Feedback: Another Joint Commission priority is the development of root cause analysis with a plan of correction for the errors that do occur. A sentinel event is likely the trigger of the root cause analysis. FMEA examines all possible failures in a design—including sequencing of events, actual and potential risk, points of vulnerability, and areas for improvement. QA is an ongoing process that focuses on continued delivery improvement.
What do clinical practice guidelines provide? A) A predetermined baseline condition or level of excellence that constitutes a model to be followed and practiced B) Diagnosis-based, step-by-step interventions for nurses to follow in an effort to promote evidence-based, high-quality care C) Process of measuring products, practices, and services against those of best-performing organizations D) Identify not only what and how an event happens but why it happens, with the end goal being to ensure that a preventable negative outcome does not recur
Ans: B Feedback: Clinical practice guidelines provide diagnosis-based, step-by-step interventions for nurses to follow in an effort to promote evidence-based, high-quality care and yet control resource utilization and costs. The remaining options all fail to accurately identify what a clinical practice guideline provides.
When working on clinical practice guidelines for a mental health unit, the nursing committee will implement which intervention initially? A) Assessing the medical psychiatric staff for practice suggestions B) Implementing a search of the literature for current related research results C) Reviewing patient satisfaction data to identify the unit's strengths and weaknesses D) In-servicing all unit nursing staff on the need to adhere to established guidelines
Ans: B Feedback: Clinical practice guidelines reflect evidence-based practice; that is, they should be based on cutting edge research and best practices. The other options may be helpful but should occur after the review of the research literature.
What is the greatest limitation of the Health Plan Employer Data Information Set (HEDIS)? A) Findings are not released to the public B) Only about half of managed care organizations have chosen to participate C) Performance indicators are process focused rather than outcome focused D) There are only 15 performance measures
Ans: B Feedback: The NCQA, a private nonprofit organization that accredits managed care organizations, has developed HEDIS. One of the most significant weaknesses of NCQA accreditation is that such accreditation is voluntary and only about half of managed care organizations currently undergo such review. The remaining options do not relate to the HEDIS
Thirty-eight percent of the people who attended a smoking cessation clinic were not smoking 1 year after the clinic closed. What type of audit provided this type of data? A) Structure B) Process C) Outcome D) Concurrent
Ans: C Feedback: An outcome audit determines what outcomes resulted from specific nursing interventions for clients. That is the function of the remaining options.
Which statement is true regarding criteria for assuring that a quality control program will be effective? A) The primary purpose of the program is to satisfy various federal and state standards B) Developed standards should reflect minimally acceptable levels so the organization will score well on self-assessment audits C) A belief in the importance of quality control must be integrated through all levels of the organizational hierarchy D) The process should be reactive; in other words, quality improvement efforts should be initiated after problems are identified
Ans: C Feedback: For any quality control program to be effective, a belief in the importance of quality control must be integrated through all levels of the organizational hierarchy. The remaining statements are false.
What results from effective benchmarking? A) Two organizations become financially integrated under a capitated model B) Organizations compete for a "best practices" label from the National Committee for Quality Assurance (NCQA) C) An organization compares its performance with that of "best-performing institutions" D) Minimum practice guidelines are established for each health-care organization
Ans: C Feedback: In benchmarking, an organization compares its performance with that of "best-performing institutions." Benchmarking is not associated with the other options.
What is the best course of action to stimulate staff nurses' involvement in quality control research on a nursing unit? A) Hire a well-qualified researcher to help staff design studies B) Create a joint medical/nursing staff research committee C) Provide staff with paid release time for research activities D) Ensure that research designs are well grounded and scientific
Ans: C Feedback: Staff should be involved in determining criteria or standards, reviewing standards, and collecting data. To stimulate staff nurses' involvement in quality control research, the best course of action would be to provide staff with paid release time for research activities. The other options fail to actually stimulate the nurse's involvement in the process.
Which is a true statement regarding TQM? A) It is based on the premise that the organization knows what is best for the consumer B) Its guiding purpose is to save the organization money C) It is based on the premise that the customer is the focal element on which production and service depend D) It assumes that inspection and removal of errors lead to the delivery of quality services
Ans: C Feedback: TQM is based on the premise that the customer is the focal element on which production and service depend. The other options are false statements.
What role has the Joint Commission assumed in ensuring quality at the organizational level? A) Establishing clinical practice guidelines B) Reducing diagnosis-related group reimbursement levels C) Standardizing clinical outcome data collection D) Assessing monetary fines for hospitals that fail to meet standards
Ans: C Feedback: The Joint Commission ensures quality at the organizational level by requiring participating organizations to choose from among 60 acceptable performance measurement systems. The Joint Commission is not actively involved in any of the other options.
What is the first step in quality control? A) To take corrective action when standards have not been met B) To collect data to determine whether standards have been met C) To determine criteria and standards D) To determine who will measure the standard
Ans: C Feedback: The first step in quality control is to determine criteria and standards. Measuring performance or making corrections is impossible if standards have not been clearly established.
What is the function of a nursing minimum data set? A) Compares the quality of nursing care and medical care B) Identifies minimal levels of quality necessary for nurses to maintain licensure C) Standardizes the collection of nursing data for use by multiple data users D) Identifies only "nursing-sensitive" patient outcome measures
Ans: C Feedback: The nursing minimum data set standardizes the collection of nursing data for use by multiple data users. None of the remaining options accurately describes the function of such a data set.
What is the guiding principle when attempting to address errors made in the delivery of health care? A) Reporting of errors must be both mandatory and voluntary B) Errors are a result of faulty organizational processes C) People are the root cause of health delivery errors D) Errors are either unavoidable or result from reckless behavior
Ans: D Feedback: A just organizational culture emphasizes the finding of the middle ground between the two extremes of error cause (people or system). It seeks to separate unavoidable error from reckless behavior and unjustifiable risk. Reporting of errors can be both mandatory and voluntary but this factor has less importance than the organization attitude regarding the cause of errors.
What do the critics of prospective payment system argue? A) Diagnosis-related groups have not helped to contain rising health care costs B) The system has increased the length of hospital stay C) Services provided under this system have only slightly increased D) On the whole quality of care has declines since its implementation
Ans: D Feedback: Critics of the prospective payment system 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 resulted in declines in the quality of care.
An RN is a supervisor in an organization that has total quality management (TQM) as the backbone of its organizational goals and objectives for quality control. How does the RN practice TQM on the unit? A) Encouraging employees to think of a unit slogan B) Developing a quota system for number of patients cared for C) Explaining to the staff that "if it's not broke, don't fix it" D) Promoting teamwork rather than individual accomplishments
Ans: D Feedback: In TQM, team efforts are favored over individual accomplishments. Slogans, quota systems, and maintaining the status quo work against quality in this philosophy.
What is the best qualitative measurement in determining quality control for marketing? A) Morbidity and mortality rates B) Nursing care hours per patient day C) Average length of stay D) Patient surveys of general satisfaction
Ans: D Feedback: In determining quality control for marketing, the best qualitative measurement would be patient surveys. The other options are not necessarily qualitative measurements.
Which statement is true regarding the factors that impact patient satisfaction with a hospitalization? A) The quality of care delivered is the primary factor related to B) The patient's understanding of his/her condition influences satisfaction C) The length of the hospital stay is the deciding influence on satisfaction D) The patient's satisfaction has little to do with actual health improvement
Ans: D Feedback: Patient satisfaction often has little to do with whether a patient's health improved during a hospital stay. It is important to remember that quality care, length of stay, and patient perception do not always equate with patient satisfaction.
