N234 Health Care Quality

Describe the process of reporting sentinel events.

Identify sentinel event and initiate report. Notify involved person(s) and manager/supervisor. Complete occurrence/incident/variance report. Immediate containment action. Take to a task force for completion of root cause analysis, action plan, and monitoring.

Regulatory Agencies

Oversight bodies in place to ensure health care quality: Centers for Medicare and Medicaid Services (CMS) The Joint Commission (TJC) Occupational Safety and Health Administration (OSHA) Department of Health and Safety of the U.S. Food and Drug Administration (FDA) Department of Justice (DOJ) Office of the Inspector General (OIG) Drug Enforcement Administration (DEA)

Components of Quality

Patient care outcomes Patient satisfaction Delivery of safe care Evidence-based care delivery Resource efficient Patient-centered care

Define health care quality

"degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge"

8 dimensions of patient centered care

-Respect Values, Preferences, and Expressed Needs -Coordination and Integration of Care -Information, Communication, and Education -Physical Comfort -Emotional Support and Relief of Fear and Anxiety -Involvement of Family and Friends -Transition and Continuity -Access to Care

Coordination and integration of care

A competent and caring staff reduces feelings of powerlessness. • Patients look for someone to be in charge of care and communicate clearly with other health care team members. • Patients expect to have services and care well coordinated. This includes areas of clinical care, front-line patient care, and ancillary and support services. • Patients need to know at all times whom to call for help.

Define sentinel events

A serious adverse event is called a sentinel event when a patient dies or has a serious, undesirable, and largely avoidable outcome as a result of the error.

Discuss the underlying theory of quality.

Avedis Donabedian defined quality as values and goals present in the medical system and defined outcomes as a validator of the quality and effectiveness of medical care. He stated that examining care processes instead of focusing on outcomes provided a more reliable indicator of the quality of medical care. Donabedian believed there was a framework that included all the various definitions and specifications, including how variations in care occur, or relate to one another, and the consequences they have on measuring, monitoring, and developing quality measurements in health care.

What happens with a variance/occurence/incident report?

Confidential Documentation of event with follow-up of investigation and corrective actions

Identify the context of health care quality in nursing and health care practice.

Delivering quality health care and monitoring its outcomes are inherent in all nursing practice environments, and all nurses are responsible for delivering safe, effective, and efficient care. Nurses are the front-line defense against actual and potential risks to patients; this requires an understanding of, and willingness to participate in, measures that promote and ensure the health and safety of patients. This includes being able to identify unsafe practices and respond appropriately to ensure a safe outcome for patients, clients, oneself, and others.

Root Cause Analysis

Formal process: Define errors/problems. Identify risks and protective factors. Develop and test prevention strategies. Implement and adopt strategies.

Physical comfort

Physical care needs to provide comfort for pain management. • Nurses need to respond in a timely and effective way to any request for pain medication, explain the extent of pain patients can expect, and offer alternatives for pain management. • Patients expect privacy and to have their cultural values respected. • Patients often need help to complete activities of daily living. • The health care setting environment needs to be clean and comfortable, with accessibility for visits by family.

Failure Mode Effective Analysis

Process to prevent the occurrence of errors of system failures includes: Define the problem Analyze causes Identify solutions Evaluate the results

What is the purpose of reporting sentinel events?

Quality improvement tool Early detection and prevention of actual/potential problems Identify areas for improvement

Other Quality Initiatives

Quality plans and philosophies Plan-Do-Study-Act (PDSA) Leapfrog Group Health information technology (HIT) Enables the use of data to track performance against benchmarks. Coordinates the care and multidisciplinary teams. Translates new evidence into practice.

Discuss the importance of reporting sentinel events.

Reporting of sentinel events allows the health care facility to evaluate effectiveness of procedure, investigate what caused the problem and to initiate corrective procedural changes

Major Attributes of Quality Health Care

Safe Avoidance of injuries Practice within standards of care Effective Offers services most important addresses needs of populations served Efficient Transitions are coordinated monitors costs minimizes length of stay work done well and with fewer resources

Advisory Bodies

The Institute of Medicine (IOM) The National Quality Forum (NQF) The National Database for Nursing Quality Indicators (NDNQI) The National Center for Nursing Quality Nursing-specific advisory bodies

Revised Magnet model's 5 components

The five components are Transformational Leadership; Structural Empowerment; Exemplary Professional Practice; New Knowledge, Innovation, and Improvements; and Empirical Quality Results.

Reasoning for following agency policy when making incident reports

These reports are an important part of quality improvement. The overall goal is to identify changes needed to prevent future recurrence. File the report with the appropriate risk-management department of the agency. Analysis of incident or occurrence reports helps identify trends in an organization that provide justification for changes in policies and procedures or for in-service programs.

Error Reduction

Types of errors: Errors of execution Failure of a planned intervention Failure to complete an action as intended Variations from the standards of care Errors in health plan Wrong diagnosis; wrong treatment plan Errors can represent a system failure or failure by one or more members of the health care team.

Example of six sigma

a nursing unit sets up a project to collect data on the process of administering the first dose of an ordered chemotherapy. The audit reveals delays in getting the drug from the pharmacy to the nursing unit. Using Six Sigma, the collected data are analyzed, and unnecessary steps in the process are identified. On the basis of this analysis the process is streamlined to decrease time from ordering to administration.

Pay for performance programs and public reporting of hospital quality data

are designed to promote quality, effective, and safe patient care by physicians and health care organizations. These programs are quality improvement strategies that reward excellence through financial incentives to motivate change to achieve measurable improvements

Outcomes

are the impact of structure and process on the patient's satisfaction; perceptions of quality, knowledge, attitudes, and behavior; and health outcomes. For example, if a provider or facility is unavailable or if patients do not have accessibility, then the outcome will be a direct result of inadequate access.

lean sigma six and value stream analysis

are two other methods that focus on improvement of processes through studying each step of a process to determine if the step adds value and reduces the health care organization's time, costs, and resources

HEDIS

compares how well health plans perform on 71 measures across eight domains of care in the key areas of quality and effectiveness of care, access to care, and patient satisfaction with the health plan and doctors

National Quality Forum practices

hand hygiene, teamwork, training, influenza prevention, catheter-associated urinary tract infection prevention, fall prevention, and medication reconciliation

Research found that

hospitals that improved the nursing work environment and lowered nurse-patient ratios by one patient had higher patient satisfaction levels and patients who were more likely to recommend the hospital to others

Examples of incidents

include patient falls, needlestick injuries, a visitor having symptoms of illness, medication administration errors, accidental omission of ordered therapies, and circumstances that lead to injury or a risk for patient injury.

Process

include the services offered, the technical quality of the services (i.e., the staff and providers perform the technical aspects of the task or job), the quality of interpersonal relations, and the adequacy of patient education, access, safety, and promotion of continuity of care (i.e., appropriate referral, follow-up)

Six Sigma

is a data-driven approach to process improvement that reduces variation in process. It is a measure of quality

The Hospital Consumer of Assessment of Healthcare Providers and Systems (HCAHPS)

is a standardized survey developed to measure patient perceptions of their hospital experience

An incident of occurence

is any event that is not consistent with the routine operation of a health care unit or routine care of a patient.

Structure

is defined as the attributes of settings where care is delivered. These include the adequacy of facilities, equipment, supplies, staff training, provider knowledge and attitudes, and supervision.

The framework in the Donabedian model

is founded on quality using a three-part procedure: structure, process, and outcomes.

Health care providers define the quality of their services by

measuring health care outcomes that show how a patient's health status has changed. Examples of outcomes that are monitored are readmission rates for patients who have had surgery, functional health status of patients after discharge (e.g., ability and time frame for returning to work), and the rate of infection after surgery.

Health care organizations that apply for magnet status

must demonstrate quality patient care, nursing excellence, and innovations in professional practice. The professional work environment must allow nurses to practice with a sense of empowerment and autonomy to deliver quality nursing care.

Involvement of family and friends

• Care providers need to recognize, respect, and meet the needs of patients, family, and friends. • Patients have the right to determine if family members are to be involved in decisions about their care. • Patients expect family or friends who will provide physical support and care after discharge to be properly informed.

Respect values, preferences, and expressed needs

• Patients expect to be treated with dignity, respect, and sensitivity to cultural beliefs, values, and quality-of-life issues. • Patients want to be informed and share in decisions about their care. • Patients' perceptions of needs should not be completely different from those identified by a care provider.

Information, communication, and education

• Patients expect to receive accurate and timely information about their clinical status, progress, or prognosis. • Patients and families need to be informed of major changes in therapies or status. • Patients need tests and procedures explained clearly in language they understand. • Patients and family members want to know how to manage care on their own.

Emotional support and relief of fear and anxiety

• Patients look to care providers to share their fears and concerns. • Patients need to understand the impact that illness will have on their ability to care for themselves and their family. • Patients worry about their ability to pay for their medical care. Identify staff that will help alleviate this worry.

Transition and continuity

• Patients want information about medications to take, physical limitations, dietary or treatment plans to follow, and danger signals for which to look after hospitalization or treatment. • Patients expect to have their continuing health care needs met after discharge with well-coordinated services. • Patients and family members expect access to necessary health care resources on a continuing basis.

Access to care

• Patients want to get to hospitals, clinics, and physicians' offices easily and without hassle. • Patients need to be able to find transportation when going to different health care settings. • Patients want to schedule appointments at convenient times without difficulty. • Patients want to be able to see a specialist when a referral is made. • Patients expect to receive clear instructions on how to obtain referrals to other health care providers.