All T2 Sets combined
The Two Challenge Rule includes which of the following?
1.Ask with curiosity and respect 2. Escalate your concern If unsuccessful, call for help
According to Chapter 20, what percentage of Anesthesia personnel suffer from addiction issues?
10%
A group of 48 nurses were randomized to a virtual or human surgeon who suggested that they do something dangerous. How many of the nurses were able to stop the line?
20%
According to SCIP, patient undergoing surgery are ___ times more likely to experience a medication error than any other patient
3
The United States consumes what percentage of the world's opioids?
80%
How often do physicians and nurses who were surveyed say it is hard or nearly impossible to speak up?
84-99%
Which of the following descriptions best describes "leadership"?
A positive, "let's do something about it" attitude toward problems
The ______ is the lead federal agency charged with improving the quality, safety, efficiency, and effectiveness of healthcare for all Americans.
Agency for Healthcare Research and Quality (AHRQ)
Article: Evidence based Medicine - what are some actions to deliver real evidence based medicine?
All of the above
Article: Evidence based Medicine - what is "Real evidence based medicine?"
All of the above
In the lesson, IHI fellow Jana Deen explained that she went back to her roots and focused on patients to start making changes in health care. What other resources might be helpful as you seek to improve health care?
All of the above
Which of the following is an example of a personality or work style profile assessment?
All of the above
Which of the following statements would you expect to hear from an effective leader in response to a problem?
All of the above
TRUE/FALSE: Wellness is a positive state of the mind, body, and spirit reflecting a balance of effective adaptation, resilience, and coping mechanisms in personal and professional environments that enhance quality of life.
True
True or False: AANA Code of Ethics contains a provision regarding "competencies including engaging in lifelong professional educational activities, participating in continual quality improvement activities and maintaining licensure"
True
True or False: CRNAs identify a colleague or supervisor as their primary source for information instead of any independent literature source
True
True or False: Optimal integration of informatics with clinical decision making has been studied to be easily available but widespread adoption by CRNAs is slowly evolving
True
True or False: Stress is a contributing factor to 60%-90% of all medical visits?
True
When effective leaders hear others complaining about a problem, which action would they most likely take?
Try to learn how big the problem really is.
Which of the following is a possible solution to inadequate substance use disorder intervention?
Unify all system elements for comprehensive education, identification, intervention, treatment, and recovery program
Which of these is a question particularly associated with the "theory of knowledge" component in Deming's System of Profound Knowledge?
What are your predictions about the system's performance?
Which of these questions is most strongly related to the "appreciation of a system" component of Deming's System of Profound Knowledge?
What is the whole system that you're trying to manage?
Which of the following best describes a workable level of unity?
When a group is willing to try an action together, even if there isn't complete agreement on what to do
In regard to health disparities around the world, which of the following statements is most true?
Where a child is born significantly affects his or her life expectancy AND The root causes of health disparities are complex
When you are applying Deming's System of Profound Knowledge, which of the following statements is true?
You can't think about any one component of the System of Profound Knowledge completely in isolation.
Article: Quality Improvement - what is a risk of encouraging the 'projectness' of QI?
a sense that QI is a series of bounded, time-limited events rather than a continuous commitment, and overly focused on 'innovation' rather than replication
compassion fatigue
a state of tension and preoccupation with the cumulative impact of caring, an evolving syndrome encompassing multiple behaviors and symptoms that extends from frazzled tiredness and anxiety to psychological and physical illness.
Improving quality in healthcare must be a _______ process comprising components that can be measured, evaluated, and improved
continuous
American Medical Association revealed that the biggest cost of litigation is the
emotional injury experienced when one is sued
Article: Quality Improvement - What does stop looking for magic bullets - focus on organizational strengthening and learn from positive deviance mean?
healthcare has tended to adopt specific interventions (eg checklists) and tried to treat them as magic bullets that are then implemented with little fidelity What is clear already is that organizations need to develop clear goals, manage people and resources effectively, foster a sense of moral community, develop their information and intelligence systems, and ensure that they have the capacity to engage in problem solving
The first step in assessing quality requires _____
identification of strategies by which any actual change can be identified and measured
Secondary stress is ____
is an empathic response associated with professional and volunteers helping participants in catastrophic or major crisis events
Why is meeting established standards important?
it's important from a quality perspective and for reimbursement purposes
Article: Quality Improvement - what does "think programs and resources, not projects" mean?
not being able to publish and share diminishes the attractiveness of improvement work in terms of career rewards and satisfaction. Healthcare needs to do for QI what it has done for research: build an infrastructure that enables learning about successful and less successful efforts to be curated and searched by others. An open-access, peer-reviewed curation model that provides a searchable database of improvement resources that people have developed or used in their organizations is one possibility worth exploring.
Which of the following is an effect of clinician burnout?
physical, cognitive and emotional deterioration of health; negative attitude, reduced professional efficiency. caused by emotional exhaustion, depersonalization and reduced personal accomplishment
AHRQ, NQF, and SCIP initiatives all highlight ____
preventable medical errors
Article: Quality Improvement - What does act like a sector mean?
quality challenges that confront healthcare need to be solved at the level of entire systems, not hospital by hospital, practice by practice. Healthcare as a collective whole or sector-like entity capable of agreeing standard operating procedures and systems that are designed with the right expertise, tested properly, implemented with professional leadership at the core, and remain open to innovation.
Article: Evidence based Medicine - how can overpowering a trial effect the outcome?
small differences will be statistically significant, setting inclusion criteria to select those most likely to respond to treatment, manipulating the dose of both intervention and control drugs, using surrogate endpoints, and selectively publishing positive studies, industry may manage to publish its outputs as "unbiased" studies in leading peer reviewed journals
Article: Evidence based Medicine - The evidence based quality mark has been misappropriated and distorted by vested interests. What does this mean?
the drug and medical devices industries increasingly set the research agenda. They define what counts as disease and pre-disease "risk states" . They also decide which tests and treatments will be compared in empirical studies and choose (often surrogate) outcome measures for establishing "efficacy
Which of the following improvement efforts is the best example of making care more patient centered?
Better identifying patient concerns and values by instituting quarterly patient focus groups
Substance use disorder stigma commonly includes all the following perceptions of the individual except which of the following?
Brilliant
A young doctor is practicing in an urban clinic. A patient whom the doctor has seen four times in the past month comes to the office complaining of shoulder pain. The patient is known to be confrontational when he finds the doctor's recommendations unsatisfactory. On examination, the patient's shoulder seems fine. The doctor decides to order a new nerve conduction study even though he is almost certain there is nothing wrong with the patient's shoulder. Which of the following incentives for overuse is highlighted in the scenario?
Defensive medicine
Which of the following statements is true:
During the past 15 years, the cost of care has been a growing problem for many developed nations.
A comprehensive opioid diversion prevention program includes all of the following except which of the following items?
Encouraging staff to carry scheduled drugs on their person
You are working to improve the care of diabetics in your community health clinic, and today you're giving a presentation to the clinic's leadership. You begin by telling the story of Kevin, a diabetic in the clinic who underwent a below-the-knee amputation after years of poorly controlled diabetes. What is the reason for telling this story?
Engage the largest possible number of people in the room.
what is the purpose of Joint Commission?
Establishes standards or measures for ensuring quality in hospitals voluntarily accredited by them
Which of the following is a basic principle of improvement?
Every system is perfectly designed to get the results it gets.
the integration of individual clinical expertise with the best available external clinical evidence from systematic research is characterized by ____
Evidence-Based Practice
Article: Quality Improvement - what are some issues with Quality improvement in healthcare when it comes to expanding upon larger projects?
One risk is that QI becomes an activity largely assigned to professionals in training, who rarely have the skills, resources or power to affect the kinds of changes that may be required.
AHRQ develops PSIs which are what ?
Patient Safety Indicators
Michael S., a 49-year-old factory worker, goes to the hospital after developing chest pain at work. Physicians quickly diagnose him with an acute myocardial infarction (heart attack), and he has successful surgery to open his blocked coronary artery. While he is recovering in the hospital, he contracts an infection that could have been prevented through better infection control practices in the hospital. Which of the IOM aims has this hospital failed to meet?
Safe
The performance of a process is used to measure improvement by comparing the baseline process capability (before improvement) with the process capability after piloting potential solutions for quality improvement
Six Sigma System
Why was it important for the Institute of Medicine (IOM) to develop its six aims for health care?
So that health care organizations would have a better idea of what they needed to improve
Hospitals and other healthcare institutions that seek Medicare reimbursement must meet certain predetermined conditions of participation established by the ________
Social Security Amendments of 1965
A ______ is an expectation of practice, a mandated rule of sorts, used as a basis of comparison for measuring or judging value or quality
Standard
______ is a medicare-sponsored partnership of organizations seeking to improve patient care by reducing surgical complications
Surgical Care Improvement Project
Areas of focus include surgical infections, adverse cardiac events, deep vein thrombosis, and postoperative pneumonia. what agency looks at these?
Surgical Care improvement project
What are some examples of PSIs?
Complications of anesthesia, decubitus ulcer, failure to rescue
Which of the following improvement efforts is the best example of increasing the efficiency of care?
Decreasing unnecessary surgical procedures by helping patients reduce their pain through physical activity
This method is often used by hospitals to evaluate alternative processes or procedures as well as to monitor change over time
Failure Modes and Effects Analysis
T/F: EBP regarding BIS monitoring stated that there was no improvement in the recovery time with the group that used BIS monitoring
False
TRUE/FALSE: Addiction is a choice and not related to physical changes in the brain.
False
TRUE/FALSE: Substance use disorder only impacts the individual and not their family, friends and colleagues.
False
True or False: EBP taught in the classroom is better than clinically integrated EBP
False
As a strong leader, when you aim to achieve something and initially fail, what would you most likely do?
Find a new way to work with people to get it done.
The history of nurse innovation began with:
Florence Nightengale
Reggie is a new pharmacist in a surgical intensive care unit. He notices that it is taking an average of three hours from the time an order is placed until a patient receives an antibiotic, whereas the goal is one hour.Reggie takes a look at the time between antibiotic order and administration in the other ICUs in his hospital. He discovers that most of the ICUs have the same problem. This is an example of which of the following actions of leaders discussed in this lesson?
Forming a clearer picture of the problem
The incidence and prevalence of substance use disorder in the healthcare industry is best described as which of the following?
Greater than other industries.
If a healthcare provider engages in personal professional psychotherapy for shame, they are more likely to:
Have better health care options
A young doctor is practicing in an urban clinic. A patient whom the doctor has seen four times in the past month comes to the office complaining of shoulder pain. The patient is known to be confrontational when he finds the doctor's recommendations unsatisfactory. On examination, the patient's shoulder seems fine. The doctor decides to order a new nerve conduction study even though he is almost certain there is nothing wrong with the patient's shoulder. Which of the following is the most appropriate motivation for ordering a test?
High pre-test probability
Patient safety Indicators ___
Identify problems that patients experience within the healthcare system that could be prevented by implementing system level changes
Put the Pyramid of Evidence in order from Least to Most trustworthy EBP
In vitro research, Animal Research, Case reports, Cohort studies, RCT Double blind studies, Systematic Reviews and Meta-analysis
Historically, which of the following receives the most federal funding in the war on drugs?
Incarceration/Prosecution
Michael Pugh talks about the distinction between management and leadership. Which of the following is most indicative of leadership?
Influencing people
Which of the following countries has had a relatively inexpensive universal health insurance system for more than 50 years?
Japan
Article: Quality Improvement - what are some issues with Quality improvement in healthcare, particularly porting QI methods from other industries?
Lean interventions, for example, do not have a significant association with patient satisfaction or health outcomes, but do have a negative association with financial costs and worker satisfaction, and inconsistent effects on process outcomes.
Reggie is a new pharmacist in a surgical intensive care unit. He notices that it is taking an average of three hours from the time an order is placed until a patient receives an antibiotic, whereas the goal is one hour. What might Reggie do if he were to act like a leader?
Look into the cause of the problem and research how other ICUs have solved it.
______ endorses measures to be scientifically sound, relevant and help standardize and raise the bar for performance across the industry
National Quality Forum (NQF)
Dhruv, a 65-year-old retiree, is brought to the hospital after developing chest pain while gardening. He is quickly diagnosed with an acute myocardial infarction (heart attack). However, he waits almost two hours to get to the catheterization lab and have his blocked coronary artery opened. Ultimately, he suffers permanent damage to his heart.The hospital where Dhruv is recovering reviews its patient satisfaction survey results in order to improve its care and patient outcomes. Leaders poring over the data note that 90 to 100 percent of patients rate staff as "excellent" in the following categories: listening, answering questions, being friendly and courteous, and giving good advice based on specific needs and preferences. Which aim is the hospital generally achieving?
Patient-Centered
Article: Evidence based Medicine - Too much evidence can lead to what problem?
Patients with many diagnoses require hundreds/thousands of pages of research to evaluate the "best possible care"
You gather some data about the use of a surgical checklist in your operating rooms and have an idea for an improvement. At the next month's meeting, you present the idea to your colleagues. The most likely outcomes will include:
People will have different reactions; some will support you, others will initially resist you.
The primary feature of this model is the cyclical nature of effecting and assessing change or outcome.
Plan-Do-Study-Act (PDSA)
The purpose of ____ quality improvement efforts is to establish a functional or causal relationship between changes in processes, specifically behaviors and capabilities, and outcomes.
Plan-Do-Study-Act (PDSA)
Which of the following is a trend in modern health care across industrialized nations?
Providers are becoming more specialized and there is a growing demand for complicated procedures.
Which of the following is an essential component of systems thinking included in Deming's System of Profound Knowledge?
Psychology
_____ is a process-driven approach to improving patient safety by means of specific steps that help define and attain outcome goals.
Quality assurance
You are a radiology resident, and you're working to decrease the time it takes to get chest x-rays read in the hospital. You've gathered some data, and you're now discussing your results with the residency director and the chief of radiology. Thus far, you have presented the data to them and reviewed a case of a patient who had a negative outcome because of a delay in the reading of his chest x-rays. During this meeting, it would be a good idea to also:
Relate your goal to national radiology standards.
_______ is a commonly used paradigm that assesses reported incidents and differentiates between active and latent errors. It also serves as a basis to suggest system changes, including reducing risk and improving communication
Root Cause analysis (RCA)
According to Chipas and McKenna, which of the following groups reported the highest average stress scores?
SRNAs
TRUE/FALSE: Nurses are natural innovators.
True
What can quality improvement teams learn from Renoir, Monet, and Cezanne?
Teamwork can lead to creative ideas.
The reward pathway does not include which areas of the brain?
Thalamus
Which of the following statements is a reason for improving the US health care system?
The US government and citizens alike are struggling to afford the cost of care.
Article: Quality Improvement - what does build capacity for designing and testing solutions, and plan for replication and scaling from the start mean?
The goal of such testing should be to identify, among other things, how the solution might work in different scenarios and conditions, and to work out what are the core, non-negotiable elements and what can be locally customised. Testing should also support intelligent replication and scaling. It is now clear that a simple description of the components of an intervention is not enough; what matters is likely to be the activation of mechanisms, even if precise activities undertaken to activate those mechanisms differ across contexts
T/F: EBP regarding BIS monitoring showed that less propofol could be used with BIS monitoring however the use of volatile anesthetics with BIS monitoring showed less consistent data so no recommendation could be made for gases+BIS monitoring
True
TRUE/FALSE: CRNA autonomy and skill variety were negatively associated with burnout.
True
TRUE/FALSE: Listening to shame can silence your health care options.
True
TRUE/FALSE: Nonverbal communication plays a huge role as 80% of communication.
True
According to Peter Drucker, which of the following statements is true?
all of the above
Article: Evidence based Medicine - how can EBM lead to a an overemphasis on following algorithmic rules?
an audit driven, technocratic exercise in which few patients are offered personalized shared decision making with a senior clinician before having the recommended tests and treatments, and in which clinical consultations are continually interrupted by pop-up point of care prompts.
