leadership modules (471)

TQM aka CQI

- Based on premise that the individual performing the service is the most informed and most empowered to make improvements - Focus is on problem prevention planning not inspection and reactive problem solving

there are hallmarks that are associated with effective quality control programs, they are:

Administration support, organizational support, process is ongoing

Nurse leaders make use of quality control tools to identify various types of errors as outlined by the IOM report. What are some of the most common types of errors reported in today's healthcare system?

Diagnostic errors Communication errors Equipment errors Medication errors

audit process diagram

Establish control criteria Identify the info relevant to the criteria Determine ways to collect the info Collect and analyze the info Compare collected info w the established criteria Make a judgement about quality Provide info and if necessary take corrective action regarding findings Reevaluate

Quality control tools used by the nurse leader include which of the following?

process audits and structure audits

A nurse leader is performing a process audit. Which would be considerations?

Comparing the pts med order to the med that he has been taking Checking completion of pts med record Ensuring that machines are re-calibrated according to dept policy

outcome audits

Determine what results occurred as a result of specific nursing interventions for patients Outcomes are the most valid indicators of quality care but many factors contribute to patient outcomes, so it can be difficult to separate out those that are directly related to nursing intervention

A patient is planning to have a surgical procedure but is concerned about poor patient care quality at the local hospital and performed a quality check and comparison of several hospitals. What conglomeration of non health care Fortune 500 companies defined quality measurements to allow consumers to compare hospitals?

Leapfrog

process audits

Measure how nursing care is provided against standard guidelines Task oriented Documented in pt care plans Medication reconciliation: the process of comparing the pts medication orders to all the meds that the patient has been taking

An older adult patient recently had a hip replacement with an indwelling catheter inserted. The patient developed symptoms of a UTI postoperatively and the nurse placing the catheter was re educated by the nurse leader regarding avoidance of UTIs when inserting catheters. Which quality approach did the nurse leader use?

Quality assurance techniques

A nurse manager discusses with the health care team the importance of performing core measures for the designated areas of implementation. What should the manager be sure to inform the team may be the consequence of noncompliance?

a 2% reduction in the Medicare anual payment

A nurse is tasked with performing an audit on the pts in the long term care facility who are developing pressure ulcers. After identifying the info relevant to the criteria, what is the next action?

determine ways to collect data

What is the final step of the quality improvement process that a nurse leader must complete in order to improve patient care?

evaluation

The National Quality Forum

is the root influence for the quality management responsibility of using standard quality measurement tools

Which statement about total quality management is correct?

it considers the individual as the focal element on which production and service depend

Nurse leaders need to understand that in order to be effective, the quality control process must be

ongoing

The NM of an acute care unit determines the inc in incidence of med errors over the last 6 months and identifies this as a focus area for improvement. What is the next action by the NM?

organize a total quality management meeting

benchmarking

process of looking at the practices of high performing organizations (or departments w/in organizations) to determine what they are doing that contributes to their success. Once these elements are identified, the current practices are evaluated in comparison and action plans can be created to bring the current practices up to those of the benchmarked entity

best practices are the

results of gathering from multiple benchmarked entities

A new graduate asks the nurse manager what organization develops the standards of the nursing profession so that the quality of practice can be measured. What is the best response by the manager?

the American Nurses Association

nurse leaders should understand

the criteria or standards that are needed to establish effective quality control process

After a patient had a negative outcome related to a medical error the nurse follows the policy for sentinel events. What organization does the nurse recognize monitors the adherence to this type of policy for accreditation?

the joint commission

A nurse leader wants to ensure that the team is always practicing proper hygiene after caring for a patient. What is the nurse leader's control criteria?

whether the team is practicing proper hygiene

A healthcare team is implementing the Toyota Production System (TPS) bc the facility is having financial difficulty and may have to consider minimizing its workforce. Prior to implementing TPS, what should the team consider?

- How it will change the org culture, values and roles - The commitment of time and resources from the facility's leadership - The level of staff prep and involvement that will be required

structure audits

Assumes that a relationship exists between quality care and appropriate structure Does not address actual care provided; focus is on the resources and the environment Goal is to ensure adequate resources are available to meet changing patient needs

A nurse manager would like to determine how well the team is doing in terms of meeting the hospital's goal of increased patient satisfaction. What action should the manager take after determining best practices?

Capture when the team is and is not using best practices and the outcomes

An older patient fell out of bed 2 days after hip replacement and had to return to surgery. What process should be done in order to prevent future negative outcomes such as this?

Critical event analysis

Which of the following is considered nursing leadership roles in regards to quality control?

Embraces, supports and champions the quality improvement process

A nurse manager is implementing the National Patient Safety Goals for the acute care unit. What will the manager have the staff implement to meet these goals?

Have patient identify surgical site prior to going to the perioperative suite When handing off report to the other staff use the SBAR format Check ID bracelet and ask pt name and DOB prior to admin of meds Use the Braden Scale to determine the pt's risk for impaired skin integrity

What are the focus areas of the To Err is Human recommendations?

Identify errors and provide solutions for prevention Enhance leadership Implement safety systems Set performance standards for safety Enhance knowledge

A nurse leader at a long term care facility wants to determine if vital signs are being checked according to policy. What can the leader do to measure this process of care?

a process audit

A nurse manager is attempting to ensure adequate resources are available in order to meet changing patient needs. What would be the best type of audit for the manager to perform?

a structure audit

A nurse manager is implementing a quality control tool that is systematic and will allow the official examination of a record for the pts w postop infections. What type of tool is the nurse manager using to collect and evaluate data?

an audit

total quality management is referred to

as continuous quality improvement and is used to meet the Healthy People Living 2020 goals

A health care team has been challenged to determine what other facilities are doing to decrease the number of hospital acquired infections so that an action plan can be created to decrease the rate in their facility. What will the health care team do to achieve this challenge?

benchmarking

Lean

customer focused quality improvement model - system built on the complete elimination of waste or what is not of value to the customer - adopting lean in an org can require substantial commitment of leadership time and resource

audit

determine a point of focus, define what data to collect and how to collect it and decide how deviation will be measured

Critical event analysis and root cause analysis help to

identify not only what event happened and how it happened, but also why it happened, with the end goal being to ensure that a preventable negative outcome does not recur

A nurse leader is trying to bring about change on the unit. Which intervention is associated with the nurse leader role?

inspiring staff to maintain high standards regarding patient care

the most deaths in 1999 were caused by

medical errors according to the IOM

A nurse leader works at a facility that has total quality management TQM as the backbone of its org goals and objectives for quality control. Which activity reflects how the leader can practice TQM on their unit?

promote teamwork rather than individual accomplishments

The six aims for improving quality health care as directed by the institute of medicine include

safe effective patient centered timely efficient equitable

The Joint Commission's creation of National Patient Safety Guidelines is

the root influence for the quality management responsibility of proactively creating an environment that minimizes risk from error

The Centers for Medicare and Medicaid are

the root influence for the quality management responsibility of providing easy-to-understand data on health care quality to all consumers

Health care shifted focus from patient care

to issues of cost and quality

The Institute of Medicine's 1999 Report To Err is Human is

the root influence for the quality management responsibility of reporting on "near misses" of medical errors