Chapter 23: Quality Control in Creating a Culture of Pt Safety (ENTIRE CHAPTER)

An example of a _____________________________ audit might include checking to see if patient call lights are in place or if patients can reach their water pitchers. It also might examine staffing patterns to ensure that adequate resources are available to meet changing patient needs.

structural

The Development of Standards: true or false: CPGs reflect evidence-based practice; that is, they should be based on cutting-edge research and best practices.

true

The Development of Standards: true or false: The ANA has played a key role in developing standards for the profession.

true

The Joint Commission: Sentinel Event Reporting: true or false: Each accredited organization is strongly encouraged, but not required, to report sentinel events to JC. Information

true

The Prospective Payment System: true or false: 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 likely resulted in declines in quality of care.

true

Who Should Be Involved in Quality Control?: true or false: Patient satisfaction often has little to do with whether a patient's health improved during a hospital stay.

true

Who Should Be Involved in Quality Control?: true or false: quality care does not always equate with patient satisfaction.

true

true or false: Employees who feel that they can influence the quality of outcomes in their work environment experience higher levels of motivation and job satisfaction. Organizations also need some control over productivity, innovation, and quality outcomes. Controlling, then, should not be viewed as a means of determining success or failure but as a way to learn and grow, both personally and professionally.

true

true or false: In health-care organizations, the goal of quality control at minimum is to create a culture of patient safety. Optimally, it allows patient health-care goals to be met.

true

Who Should Be Involved in Quality Control?: Engagement of _______________________________________ appears to be especially critical when implementing or sustaining QI efforts such as Transforming Care at the Bedside (TCAB)

frontline staff

The Joint Commission: Oryx: - a multiphase, multidimensional set of initiatives directed at modernizing the accreditation process by shifting the focus of accreditation from organizational structure to organizational performance or outcomes. - This required the development of clinical indicators to measure the quality of care provided. - To further this goal, JC approved a milestone initiative, known as ORYX

Agenda for Change

The Development of Standards: AMERICAN NURSES ASSOCIATION SCOPE AND STANDARDS OF PRACTICE The registered nurse (RN) collects comprehensive data pertinent to the health-care consumer's health or the situation.

Assessment

The Leapfrog Group: EVIDENCE-BASED LEAPFROG INITIATIVES - Outcomes of high-risk surgeries can vary greatly based on the hospital's skill at performing the procedure. - suggests that patients with high-risk conditions should be treated at hospitals with characteristics shown to be associated with better outcomes. - Consumers and health-care purchasers should choose hospitals with the best track records.

Evidence-based hospital referral

The Development of Standards: - One contemporary effort to establish standards for individual nursing practice has been the development of________________. - ___________(answer above) or standardized clinical guidelines provide diagnosis-based, step-by-step interventions for providers to follow to promote high-quality care while controlling resource utilization and costs - these should reflect current research findings and best practices. - some providers avoid these, arguing that they are "cookbook medicine."

CPGs

The Leapfrog Group: EVIDENCE-BASED LEAPFROG INITIATIVES - requires primary care providers to enter orders into a computer instead of handwriting them. - integrates medication orders with patient information, such as allergies, laboratory results, and other prescription data. The order is then automatically checked for potential errors or problems such as drug and allergy interactions or drug-to-drug interactions. It also gives providers vital clinical decision support via access to information tools that support a health-care provider in decisions related to diagnosis, therapy, and care planning of individual patients.

Computerized physician-provider order entry (CPOE)

The Prospective Payment System: As a result of _____________, 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.

DRGs

The Development of Standards: AMERICAN NURSES ASSOCIATION SCOPE AND STANDARDS OF PRACTICE The RN analyzes the assessment data to determine the diagnoses or issues.

Diagnosis

the IOM further defined quality as having the following properties or domains (AHRQ, 2018b): ___________________. Relates to providing care processes and achieving outcomes as supported by scientific evidence. __________________. Relates to maximizing the quality of a comparable unit of health care delivered or unit of health benefit achieved for a given unit of health care resources used. _______________. 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. ______________________ Relates to meeting patients' needs and preferences and providing education and support. _____________. Relates to actual or potential bodily harm. ______________. Relates to obtaining needed care while minimizing delays.

Effectiveness Efficiency Equity Patient centeredness. Safety Timeliness

The Development of Standards: AMERICAN NURSES ASSOCIATION SCOPE AND STANDARDS OF PRACTICE The RN evaluates progress toward the attainment of outcomes.

Evaluation

Quality Control as a Systematic Process/FOCUS PDCA: FOCUS PDCA: A METHOD FOR HEALTH-CARE QUALITY IMPROVEMENT F: ______________ a process to improve. O: Organize a team that knows the process. C: _________________________________ of the process. U: _____________________________________ and capability of the process. S: Select a plan for continuous improvement. P: Plan. D: Do. C: _______________ A: Act.

Find Clarify current knowledge Understand the variability Check

Centers for Medicare & Medicaid Services: Hospital Consumer Assessment of Healthcare Providers and Systems Survey - the first national, standardized, publicly reported survey of patients' perspectives of hospital care. - the 32-item __________________(same term) survey instrument measures patients' perceptions of their hospital experience and can be conducted by mail, telephone, mail with telephone follow-up, or active interactive voice recognition - The survey asks medical, surgical, and maternity care patients who have been recently discharged (between 48 hours and 6 weeks) about aspects of their hospital experience including "how often" or whether patients experienced a critical aspect of hospital care rather than whether they were "satisfied" with the care. - Data collected include how well nurses and doctors communicate with patients, how responsive hospital staff are to patients' needs, how well hospital staff help patients manage pain, how well the staff communicates with patients about medicines, and whether key information is provided at discharge.

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)

The Development of Standards: AMERICAN NURSES ASSOCIATION SCOPE AND STANDARDS OF PRACTICE The RN implements the identified plan. 1. Standard 5A. Coordination of Care—The RN coordinates care delivery. 2. Standard 5B. Health Teaching and Health Promotion—The RN employs strategies to promote health and a safe environment.

Implementation

The Leapfrog Group: EVIDENCE-BASED LEAPFROG INITIATIVES - Given the high stakes involved, the quality of care delivered in ICUs is particularly important. - This initiative examines the level of training of ICU medical personnel and suggests that quality of care in hospital ICUs is strongly influenced by (a) whether intensivists (doctors with special training in critical care medicine) are providing care and (b) the staff organization in the ICU.

Intensive care unit (ICU) physician staffing (IPS)

The Joint Commission: - first to mandate that all hospitals have a QA program in place by 1981. - These QA programs were to include a review of the care provided by all clinical departments, disciplines, and practitioners; the coordination and integration of the findings of quality control activities; and the development of specific plans for known or suspected patient problems. - this organization began to require quarterly evaluations of standards for nursing care as measured against written criteria.

Joint Commission

Medical Errors: An Ongoing Threat to Quality of Care: - adverse events that could be prevented given the current state of medical knowledge. - the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim.

Medical errors

Centers for Medicare & Medicaid Services: - a new era of public reporting on quality began. - These diverse initiatives encouraged the public reporting of quality measures for nursing homes, home health agencies, hospitals, and kidney dialysis facilities. - These data are then made available to consumers on the Medicare website to assist them in making health-care choices or decisions.

Medicare Quality Initiatives

Medical Errors: An Ongoing Threat to Quality of Care: _____________________________ errors are the most common type of medical error and are a significant cause of preventable adverse events

Medication

Centers for Medicare & Medicaid Services: Multistate Nursing Home Case Mix and Quality Demonstration seeks to develop and implement both a case mix classification system to serve as the basis for Medicare and Medicaid payment and a quality-monitoring system to assess the impact of case mix payment on quality and to provide better information to the nursing home survey process.

Multistate Nursing Home Case Mix and Quality Demonstration

Standardized Nursing Languages: what is an example of a standardized nursing language

NANDA (nursing dx)

National Committee for Quality Assurance: Another external force assessing quality control in health-care organizations is the _____________________________________________(NCQA). The NCQA, a private nonprofit organization that accredits managed care organizations, has developed the Health Plan Employer Data and Information Set (HEDIS) to compare the quality of care in managed care organizations. HEDIS is used by more than 90% of America's health plans to measure performance on important dimensions of care and service

National Committee for Quality Assurance

National Database of Nursing Quality Indicators: - founded by the ANA in 2001 to examine the relationships between nursing and patient outcomes by tracking nursing-sensitive quality measures - the richest database of nursing performance in the country (NDQI, n.d.-a). - Hospitals can compare performance and job satisfaction levels of individual nursing units to similar units locally, regionally, and nationally, allowing them to develop more effective, finely targeted improvements and also helping them to understand the relationship between the nursing-sensitive quality indicators, staffing data, and RN survey data

National Database of Nursing Quality Indicators (NDNQI)

The Joint Commission: National Patient Safety Goals: - To augment the core measures and promote specific improvements in patient safety, JC also issues _________________________________(NPSGs) annually. - Sample hospital goals included using at least two patient identifiers when providing care, treatment, and services; eliminating transfusion errors related to patient misidentification; reporting critical results of tests and diagnostic procedures on a timely basis; and labeling all medications, medication containers, and other solutions on and off the sterile field in perioperative and other procedural settings

National Patient Safety Goals

The Leapfrog Group: EVIDENCE-BASED LEAPFROG INITIATIVES - endorsed safe practices cover a range of practices that, if utilized, would reduce the risk of harm in certain processes, systems, or environments of care. report on the following five Safe Practices: 1. Safe Practice 1: Culture of Safety Leadership Structures and Systems 2. Safe Practice 2: Culture Measurement, Feedback, and Intervention 3. Safe Practice 4: Risks and Hazards 4. Safe Practice 9: Nursing Workforce 5. Safe Practice 19: Hand Hygiene

National Quality Forum (NQF)-endorsed Safe Practices

The Joint Commission: Oryx: - This initiative integrated outcomes and other performance measures into the accreditation process with data being publicly reported at a website known as Quality Check - Under this, all organizations accredited by JC were required to select at least 1 of 60 acceptable performance measurement systems and to begin data collection on specific clinical measures

ORYX

Medical Errors: An Ongoing Threat to Quality of Care: adverse changes in health that occur as a result of treatment. When medications are involved, these are known as adverse drug events (ADEs)

adverse event

The Development of Standards: AMERICAN NURSES ASSOCIATION SCOPE AND STANDARDS OF PRACTICE The RN identifies expected outcomes for a plan individualized to the health-care consumer or the situation.

Outcomes identification

Medical Errors: An Ongoing Threat to Quality of Care: Reporting and Analyzing Errors in a Just Culture: This bill protects medical error information voluntarily submitted to private organizations (patient safety organizations) from being subpoenaed or used in legal discovery and generally requires that the information is treated as confidential.

Patient Safety and Quality Improvement Act

The Development of Standards: AMERICAN NURSES ASSOCIATION SCOPE AND STANDARDS OF PRACTICE The RN develops a plan that prescribes strategies and alternatives to attain expected outcomes.

Planning

Audits as a Quality Control Tool: - measure how nursing care is provided. - The audit assumes a connection between the process and the quality of care. - Critical pathways and standardized clinical guidelines are examples of efforts to standardize the process of care. - They also provide a tool to measure deviations from accepted best practice process standards.

Process Audit

Professional Standards Review Organizations: - mandated certification of need for the patient's admission and continued review of care; evaluation of medical care; and analysis of the patient profile, the hospital, and the practitioners. - As a result of these, health-care organizations began to question basic values and were forced to establish new methods for collecting data, keeping records, providing services, and accounting in general - organizations that were unwilling or unable to meet these changing needs did not survive financially.

Professional Standards Review Organizations

Audits as a Quality Control Tool: attempt to identify how future performance will be affected by current interventions

Prospective audits

Quality Improvement Models: what is the difference between QI & QA

QA models target currently existing quality; QI models target ongoing and continually improving quality. One model that emphasizes the ongoing nature of QI includes total quality management (TQM).

Quality Improvement Models: Over the past several decades, the American health-care system has moved from a quality assurance (QA) model to one focused on ________________

QI

The Joint Commission: Sentinel Event Reporting: - Another JC priority is the development of RCA with a plan of correction for the errors that do occur. - JC's Sentinel Event Policy provides that organizations that are either voluntarily reporting a sentinel event or responding to JC's inquiry about a sentinel event submit their related ________________________ & ____________________________ electronically to JC whenever such events occur. - The sentinel event data are then reviewed, and recommendations are made. JC defends the confidentiality of the information, if necessary, in court.

RCA and action plan

Who Should Be Involved in Quality Control?: Transforming Care at the Bedside (TCAB) - directed at medical/surgical units - TCAB engaged leaders at all levels of the organization, empowered frontline staff to improve care processes, and engaged family members and patients in decision making about their care. - Ideas that came out of TCAB were the use of ________________________________, specific communication models that supported consistent and clear communication among caregivers, liberalized diet plans and meal schedules for patients, and redesigned workspaces that enhanced efficiency and reduced waste - The result was an improvement in patient safety indicators.

Rapid Response Teams

Audits as a Quality Control Tool: are performed after the patient receives the service.

Retrospective audits

Six Sigma Approach and Lean Manufacturing: - a statistical measurement that reflects how well a product or process is performing. Higher sigma values indicate better performance. - Organizations should aim for this target by carefully applying the Six Sigma methodology to every aspect of QI. In doing so, patient satisfaction can be increased, and errors can be reduced by process improvement strategies

Six Sigma approach

The Leapfrog Group: - help minimize risks to patients, the standards and expectations of oversight groups, insurers, and professional groups have been raised. - committed to modernizing the current health-care system - has identified four evidence-based standards that they believe will provide the greatest impact on reducing medical errors: computerized physician-provider order entry (CPOE), evidence-based hospital referral, intensive care unit physician staffing (IPS), and the use of National Quality Forum-endorsed Safe Practices.

The Leapfrog Group

Medical Errors: An Ongoing Threat to Quality of Care: - IOM report - conclusion that most of these 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. The current focus in medical error research is on fixing these flaws and creating and/or fostering environments that minimize the likelihood of errors occurring. Strategies to create such environments include better reporting of the errors that do occur, The Leapfrog Group initiatives, reform of the medical liability system, and other point-of-care strategies such as bar coding, smart intravenous pumps, and medication reconciliation.

To Err Is Human

Quality Control as a Systematic Process/FOCUS PDCA: - The fourth step in auditing quality control is ___________________________________________________ - For example, if the standards specify that postoperative vital signs are to be checked every 30 minutes for 2 hours and every hour thereafter for 8 hours, it is necessary to look at how often vital signs were taken during the first 10 hours after surgery. - The frequency with which vital signs are assessed is listed on the postoperative flow sheet and then is compared with the standard set by the unit. - The resulting discrepancy or congruency gives managers information with which they can make a judgment about the quality or appropriateness of the nursing care.

analyzing information

Audits as a Quality Control Tool: - a systematic and official examination of a record, process, structure, environment, or account to evaluate performance. - ___________________ in health-care organizations provides managers with a means of applying the control process to determine the quality of services rendered.

audit

what is a tool used for assessing quality

audits

The Leapfrog Group: The Leapfrog Group has also endorsed the use of ________________________ to reduce point-of-care medication errors. As set forth by the U.S. Food and Drug Administration (FDA), all prescription and over-the-counter medications used in hospitals must contain a national drug code number, which indicates its dosage forms and strength.

bar coding

Quality Control as a Systematic Process/FOCUS PDCA: - Many organizations have begun using ___________________________—the process of measuring products, practices, and services against best performing organizations—as a tool for identifying desired standards of organizational performance. - In doing so, organizations can determine how and why their performance differs from exemplar organizations and use the exemplar organizations as role models for standard development and performance improvement.

benchmarking

Quality Control as a Systematic Process/FOCUS PDCA: Experts review the submissions, examine outcomes, and then designate a ________________________.

best practice

Quality Control as a Systematic Process/FOCUS PDCA: - The third step is determining ways to ___________________________. - As in all data gathering, the manager must be sure to use all appropriate sources. - When assessing quality control of the postoperative patient, the manager could find much of the information in the patient chart. - Postoperative flow sheets, the physician orders, and the nursing notes would probably be most helpful. Talking to the patient or nurse could also yield information.

collect information

Defining Quality Health Care: HROs are organizations that perform well (minimal catastrophic error) despite high levels of ______________________ and the existence of multiple risk factors that encourage error. Achieving this quality designation, however, is both difficult and complex because quality care itself is both difficult to define and even more difficult to achieve.

complexity

Quality Control as a Systematic Process/FOCUS PDCA: If vital signs were not taken frequently enough to satisfy the standard, the manager would need to obtain further information regarding why the standard was not met and counsel employees as needed. This is often done using ________________________________________________ (CEA) or through root cause analysis (RCA).

computer-aided error analysis

Quality Control as a Systematic Process/FOCUS PDCA: - The first step, is the establishment of _________________________________________. - Measuring performance is impossible if standards have not been clearly established. - Not only must standards exist, leader-managers must also see that subordinates know and understand the standards. - Because standards vary among institutions, employees must know the standard expected of them at their organization and be aware that their performance will be measured in terms of their ability to meet the established standard. - For example, hospital nurses should provide postoperative patient care that meets standards specific to their institution.

control criteria or standards

- Because the management process—like the nursing process—is cyclic, _____________________ is not an end in itself; it is implemented throughout all phases of management. - 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.

controlling

what is the 5th and final step in the management process

controlling

Phases of Management Process: performance is measured against predetermined standards, and action is taken to correct discrepancies between these standards and actual performance.

controlling phase

The Joint Commission: Core Measures: - this was developed to better standardize its valid, reliable, and evidence-based data sets. - Hospitals that choose not to participate in the this initiative receive a reduction in their Medicare Annual Payment. - The four areas initially targeted for ________________________ implementation were acute myocardial infarction, pneumonia, heart failure, and the surgical care improvement project.

core measures

The Prospective Payment System: The advent of diagnosis-related groups (DRGs) added to the ever-increasing need for organizations to monitor ___________________________ yet guarantee a minimum level of quality

cost containment

The Joint Commission: THE FIVE STEPS OF MEDICATION RECONCILIATION 1. Develop a list of ____________________ medications. 2. Develop a list of medications to be prescribed. 3. _______________________ the medications on the two lists. 4. Make clinical decisions based on the comparison. 5. Communicate the new list to appropriate caregivers and to the patient.

current Compare

The Joint Commission: Sentinel Event Reporting: - The JC also maintains one of the nation's most comprehensive databases of sentinel events - A sentinel event is defined by JC as a patient safety event (an event, incident, or condition that could have resulted or did result in harm to a patient) that reaches a patient and results in ________________________,________________________, & ____________________________ and intervention required to sustain life (JC, 2017). - Such events are called "sentinel" because they signal the need for immediate investigation and response.

death, permanent harm, or severe temporary harm

Who Should Be Involved in Quality Control?: _______________________ in the organization should participate in quality control because everyone is a recipient of the benefits. Quality control gives employees feedback about their current quality of care and how the care they provide can be improved.

everyone

Defining Quality Health Care: the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge

health-care quality

Defining Quality Health Care: The second implication in the IOM definition is that for care to be considered ___________________________, it must be consistent with current professional knowledge. Staying current in terms of professional knowledge is difficult for even the most dedicated providers.

high quality

Defining Quality Health Care: Quality measurement and outcomes accountability have been buzzwords in health care since the 1980s and continue to be at the forefront of almost every health-care agenda today. Indeed, most health-care organizations today are striving to become __________________________ _________________________ (HROs).

high-reliability organizations

Quality Control as a Systematic Process/FOCUS PDCA: - The second step in the quality control process includes ________________________________ relevant to the criteria. - What information is needed to measure the criteria? In the example of postoperative patient care, this information might include the frequency of vital signs, dressing checks, and neurologic or sensory checks. - Often, such information is determined by reviewing current research or existing evidence.

identifying information

Quality Improvement Models: Total Quality Management: - Because TQM is a never-ending process, everything and everyone in the organization are subject to continuous improvement efforts. No matter how good the product or service is, the TQM philosophy says that there is always room for ________________________________________

improvement

Medical Errors: An Ongoing Threat to Quality of Care: Reporting and Analyzing Errors in a Just Culture: where individuals are blamed for all mistakes

just culture

The Joint Commission: Medication Reconciliation: - process to prevent medication errors at patient transition points - the process of comparing the medications a patient is taking (or should be taking) with newly ordered medications. - This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. It should be done at every transition of care in which new medications are ordered or existing orders are rewritten.

medication reconciliation

Audits as a Quality Control Tool: Outcome Audit: - it is possible to separate the contribution of nursing to the patient's outcome; this recognition of outcomes that are _______________________________________creates accountability for nurses as professionals and is important in developing nursing as a profession. - Although outcomes traditionally used to measure quality of hospital care include mortality, morbidity, and length of hospital stay, these outcomes are not highly nursing sensitive. - More ________________________________ outcome measures for the acute care setting include patient fall rates, nosocomial infection rates, the prevalence of pressure sores, physical restraint use, and patient satisfaction rates.

nursing-sensitive

The Development of Standards: - Because standards are used as measurement tools, they must be ________________,_________________, and ____________________ - There is no one set of standards. - Each organization and profession must set standards and objectives to guide individual practitioners in performing safe and effective care.

objective, measurable, and achievable.

Quality Improvement Models: TOTAL QUALITY MANAGEMENT PRINCIPLES DISPLAY 23.6 TOTAL QUALITY MANAGEMENT PRINCIPLES 1. Create a constancy of purpose for the improvement of products and service. 2. Adopt a philosophy of continual improvement. 3. Focus on improving processes not on inspection of product. 4. End the practice of awarding business on price alone; instead, minimize total cost by working with a single supplier. 5. Improve constantly every process for planning, production, and service. 6. Institute job training and retraining. 7. Develop the leadership in the organization. 8. Drive out fear by encouraging employees to participate actively in the process. 9. Foster interdepartmental cooperation and break down barriers between departments. 10. Eliminate slogans, exhortations, and targets for the workforce. 11. Focus on quality and not just quantity; eliminate quota systems if they are in place. 12. Promote teamwork rather than individual accomplishments. Eliminate the annual rating or merit system. 13. Educate/train employees to maximize personal development. 14. Charge all employees with carrying out the total quality management package.

ok

The Joint Commission: Sentinel Event Reporting: - Suicide of any patient receiving care, treatment, and services in a staffed around-the-clock care setting or within 72 hours of discharge, including from the hospital's emergency department (ED) - Unanticipated death of a full-term infant - Discharge of an infant to the wrong family - Abduction of any patient receiving care, treatment, and services - Any elopement (that is, unauthorized departure) of a patient from a staffed around-the-clock care setting (including the ED), leading to death, permanent harm, or severe temporary harm to the patient - Hemolytic transfusion reaction involving administration of blood or blood products having major blood group incompatibilities (ABO, Rh, other blood groups) - Rape, assault (leading to death, permanent harm, or severe temporary harm), or homicide of anyone - Invasive procedure, including surgery, on the wrong patient, at the wrong site, or that is the wrong (unintended) procedure - Unintended retention of a foreign object in a patient after an invasive procedure, including surgery - Severe neonatal hyperbilirubinemia (bilirubin >30 milligrams/deciliter) - Prolonged fluoroscopy with cumulative dose >1,500 rads to a single field or any delivery of radiotherapy to the wrong body region or >25% above the planned radiotherapy dose - Fire, flame, or unanticipated smoke, heat, or flashes occurring during an episode of patient care - Any intrapartum (related to the birth process) maternal death - Severe maternal morbidity (not primarily related to the natural course of the patient's illness or underlying condition) when it reaches a patient and results in any of the following: Permanent harm or severe temporary harm

ok

The Joint Commission: THE JOINT COMMISSION CORE MEASURES FOR 2019 1. Acute myocardial infarction 2. Children's asthma care 3. Emergency department 4. Hospital outpatient department 5. Hospital-based inpatient psychiatric services 6. Immunization 7. Perinatal care 8. Stroke 9. Venous thromboembolism

ok

Medical Errors: An Ongoing Threat to Quality of Care: Reporting and Analyzing Errors in a Just Culture: One critical strategy for addressing errors in the health-care system is the need to increase both the mandatory and voluntary reporting of medical errors. At the unit level, organizational cultures must be created that remove blame from the individual and, instead, focus on how the _________________________________ can be modified to reduce the likelihood of such errors occurring in the future.

organization itself

The Development of Standards: - outline levels of acceptable practice within the institution. - For example, each organization develops a policy and procedures manual that outlines its specific standards. - These standards may minimize or maximize in terms of the quality of service expected. - Such standards of practice allow the organization to measure unit and individual performance more objectively.

organizational standards

Audits as a Quality Control Tool: The audits most frequently used in quality control include the __________________, process, and structure audits.

outcome

Audits as a Quality Control Tool: _______________________ audits reflect the result of care or how the patient's health status changed as a result of an intervention.

outcome

Audits as a Quality Control Tool: Outcome Audit: - attempt to capture whether the services provided actually improved patients' health and sense of well-being - argue that the ultimate measure of health system performance is whether it helps people recover from an acute illness, live well with a chronic condition, and face the end of life with dignity—and people's reports are the only way to gauge success. - Thus, this audit a critical component of assessing whether clinicians are improving the health of patients.

outcome audit

The Development of Standards: 1. Assessment 2. diagnose 3. ________________________________________ 4. planning 5. implementation 6. evaluation

outcome identification

Who Should Be Involved in Quality Control?: - Many contemporary organizations designate an individual (frequently a nurse) to be their _______________________________ - This strategy is risky, as it may create the impression that the responsibility for quality care is not shared. - Therefore, although it is impractical to expect full staff involvement throughout the quality control process, as many staff as possible should be involved in determining criteria or standards, reviewing standards, collecting data, or reporting.

patient safety officer.

Who Should Be Involved in Quality Control?: Quality control also requires evaluating the _____________________________ of all members of the multidisciplinary team.

performance

The Leapfrog Group: what does scientific evidence suggest the leapfrog group initiatives will reduce

preventable medical errors

Quality Improvement Models: Total Quality Management: - Any problems encountered are approached in a preventive or _______________________________ mode so that crisis management becomes unnecessary. - Another critical component of TQM is the empowerment of employees by providing positive feedback and reinforcing attitudes and behaviors that support quality and productivity.

proactive

Quality Measurement as an Organizational Mandate: Managers must be cognizant of changing government and licensing regulations that affect their unit's quality control and standard setting. This awareness allows the manager to implement ________________________ rather than reactive quality control.

proactive

Audits as a Quality Control Tool: Process Audit: - tend to be task oriented and focus on whether practice standards are being fulfilled. - Process standards may be documented in patient care plans, procedure manuals, or nursing protocol statements. - A ___________________ audit might be used to establish whether fetal heart tones or blood pressures were checked according to an established policy. - In a community health agency, a ___________________ audit could be used to determine if a parent received instruction about a newborn during the first postpartum visit.

process audit

- a specific type of controlling—refers to activities that are used to evaluate, monitor, or regulate services rendered to clients. - For this type of control program to be effective, certain components need to be in place - First, the program needs to be supported by top-level administration; a ____________ control program cannot merely be an exercise to satisfy various federal and state regulations. A sincere commitment by the institution, as evidenced by fiscal and human resource support, will be a deciding factor in determining and improving quality of services.

quality control

Integrating Leadership Roles and Management Functions With Quality Control: Quality control provides managers with the opportunity to evaluate organizational performance from a systematic, scientific, and objective viewpoint. To do so, managers must determine what standards will be used to measure quality care in their units and then develop and implement_______________________________ programs that measure results against those standards.

quality control

Quality Control as a Systematic Process/FOCUS PDCA: The difference in performance between top-performing health-care organizations and the national average is called the _______________________.

quality gap

To understand quality control, the manager must become familiar with the process and terminology used in __________________________ and __________________________ activities.

quality measurement; improvement

Centers for Medicare & Medicaid Services: Medicare also established pay for performance (P4P), also known as ___________________________________________. Because research conducted in the past decade has suggested little relationship between quality of care provided and the cost of that care, P4P initiatives were created to align payment and quality incentives and to reduce costs through improved quality and efficiency. Multiple P4P programs have been developed and implemented since that time. All provided incentive payments to eligible professionals who satisfactorily reported quality information to Medicare.

quality-based purchasing

Quality Control as a Systematic Process/FOCUS PDCA: To make the process more effective and efficient, the collection of both _____________________ and ________________ data is used as well as a specific and systematic process.

quantitative and qualitative

Quality Control as a Systematic Process/FOCUS PDCA: - The last step is ______________________________. - If quality control is measured on 20 postoperative charts and a high rate of compliance with established standards is found, the need for short-term reevaluation is low. - If standards are consistently unmet or met only partially, frequent reevaluation is indicated. - However, quality control measures need to be ongoing, not put forth simply in response to a problem.

reevaluation

Report Cards: In response to the demand for objective measures of quality, many health plans, health-care providers, employer purchasing groups, consumer information organizations, and state governments have begun to formulate health-care quality report cards.

report card

Integrating Leadership Roles and Management Functions With Quality Control: The manager, however, cannot operate in a vacuum in determining what quality is and how it should be measured. This determination should come from _______________________________________________ evidence.

research-based

Quality Control as a Systematic Process/FOCUS PDCA: This process, when viewed simplistically, can be broken down into three basic steps: 1. The criterion or _______________ is determined. 2. Information is collected to determine if the standard has been met. 3. Educational or ___________________ action is taken if the criterion has not been met.

standard corrective

Standardized Nursing Languages: provides a consistent terminology for nurses to describe and document their assessments, interventions, and the outcomes of their actions.

standardized nursing language

The Development of Standards: - a predetermined level of excellence that serves as a guide for practice. - _______________________ have distinguishing characteristics: They are predetermined, established by an authority, and communicated to and accepted by the people affected by them.

standards

The Development of Standards: define the scope and dimensions of professional nursing.

standards of practice

Audits as a Quality Control Tool: - assume that a relationship exists between quality care and appropriate structure. - A ___________________ audit includes resource inputs such as the environment in which health care is delivered. It also includes all those elements that exist prior to and separate from the interaction between the patient and the health-care worker. - For example, staffing ratios, staffing mix, emergency department wait times, and the availability of fire extinguishers in patient care areas are all structural measures of quality of care.

structure audit

Quality Control as a Systematic Process/FOCUS PDCA: what should the manager do if unit goals are consistently unmet?

the leader must reexamine those goals and determine if they are inappropriate or unrealistic.

HALLMARKS OF EFFECTIVE QUALITY CONTROL PROGRAMS: 1. There must be support from _______-level administration. 2. There must be a commitment by the organization in terms of fiscal and human resources. 3. Quality goals reflect search for ______________________ rather than minimums. 4. Process is ongoing (continuous).

top excellence

Quality Improvement Models: Total Quality Management: - aka continuous quality improvement - assumes that production and service focus on the individual and that quality can always be better. Thus, identifying and doing the right things, the right way, the first time, and problem-prevention planning—not inspection and reactive problem solving—lead to quality outcomes.

total quality improvement

Audits as a Quality Control Tool: Process Audit: true or false: Process audits are used to measure the process of care or how the care was carried out and assume that a relationship exists between the process used by the nurse and the quality of care provided.

true

Audits as a Quality Control Tool: true or false: Auditing can occur retrospectively, concurrently, or prospectively.

true

Defining Quality Health Care: true or false: Although outcomes are an important measure of quality care, it is dangerous to use them as the only criteria for quality measurement.

true

Medical Errors: An Ongoing Threat to Quality of Care: Reporting and Analyzing Errors in a Just Culture: true or false: Ignoring the problem of medical errors, denying their existence, or blaming the individuals involved in the processes does nothing to eliminate the underlying problems.

true

Quality Control as a Systematic Process/FOCUS PDCA: true or false: Benchmarking is the process of measuring products, practices, and services against best performing organizations.

true

Quality Control as a Systematic Process/FOCUS PDCA: true or false: Quality control efforts must be proactive, not solely as a reaction to a problem.

true

Quality Control as a Systematic Process/FOCUS PDCA: true or false: here is danger that the leader, who feels pressured to meet unit goals, may lower standards to the point where quality is meaningless. This reinforces the need to determine standards first and then evaluate goals accordingly.

true

Quality Improvement Models: Total Quality Management: true or false: TQM is based on the premise that the individual is the focal element on which production and service depend (i.e., it must be a customer-responsive environment) and that the quest for quality is an ongoing process.

true

Six Sigma Approach and Lean Manufacturing: true or false: The safety record in health care is a far cry from the enviable record of the similarly complex aviation industry.

true