Exam 3 - Ch 22 & 8
Standardized Processes
"best-known methods" or "best practices" Care carried out in uniform, systematic method Employees are trained to perform procedures according to standards rather than learning by watching others Avoids haphazard changes to procedures Standardized practices should be based on scientific evidence and research
Run Chart
- Graph of data points as they occur over time - Sometimes referred to as time plots - A control chart is a more sophisticated run chart that helps to distinguish between "common" cause and "special" cause
Six QSEN competencies
1) Patient-centered care 2) Quality improvement 3) Teamwork and collaboration 4) Evidence-based practice 5) Safety 6) Informatics
Ten Simple Rules to Guide Improvements
1. Care based on continuous healing relationships 2. Care customized to patient needs and values 3. The patient is the source of control 4. Knowledge is shared, and information flows freely 5. Decision-making is evidence-based 6. Safety is a system property 7. Transparency is necessary 8. Needs are anticipated 9. Waste is continually decreased 10. Cooperation among clinicians is a priority
Federal Statutory Law
1. Code of Federal Regulations (CFR), Title 42 2. Emergency Medical Treatment & Active Labor Law (COBRA, 42) 3. American with Disabilities Act of 1990 4. Patient Self-Determination Act of 1990; Omnibus Budget Reconciliation Act of 1990 5. Health Insurance Portability & Accountability Act (HIPAA)
Federal Statutory Law - Emergency Medical Treatment & Active Labor Law (COBRA, 42)
> "Antidumping" law prohibits the refusal of care for indigent and uninsured patients seeking medical assistance in the ED. > Also prohibits the transfer of unstable patients, including women in labor, from once facility to another. > Applicable to people coming to non-ED settings, such as urgent care clinics > Also governs the transfer of patient from an inpatient setting to a lower level of care in some parts of the US. > Penalties of $25,000-$50,000 & revoking facility's Medicare contract
Teamwork and Collaboration: Attitude
> Acknowledge one's own potential to contribute to effective team functioning > Appreciate the risks associated with hand-offs among providers and across transitions in care
Evidence-Based Practice: Attitude
> Appreciate strengths and weaknesses of scientific bases for practice > Acknowledge own limitations in knowledge and clinical expertise before determining when to deviate from evidence-based best practices
Quality Improvement: Attitude
> Appreciate that continuous quality improvement is an essential part of the daily work of all health professionals > Appreciate the value of what individuals and teams can do to improve care
Federal Statutory Law - Code of Federal Regulations (CFR), Title 42
> Conditions of Participation for Hospitals (CoPs) in Medicare Title 42 Part 482 mandates a minimal standard for all health care settings that receive reimbursement for treatment of Medicare benefits. a. Requires nurses to develop individualized nursing care plan for each pt. & revise the plans as necessary. b. Mandates that hospitals properly train nurses for their roles c. Mandates that hospitals provide adequate staffing d. Mandates that nurses begin DC planning ASAP after admission e. In 2008 new rule that halts payment to hospitals for tx of preventable pt complications and injuries (HAC list p. 123) f. Nurses are also required to develop greater expertise of evidence-based pt care, case management, & DC planning FEDERAL AND STATE LAW
Teamwork and Collaboration: Skills
> Demonstrate awareness of one's own strengths and limitations as a team member > Follow communication practices that minimize risks associated with handoffs among providers and across transitions in care
Safety: Skills
> Demonstrate effective use of technology and standardization practices that support safety and quality > Use national patient safety resources for own professional development and to focus attention on safety in care settings
Evidence-Based Practice: Knowledge
> Demonstrate knowledge of basic scientific methods and processes > Discriminate between valid and invalid reasons for modifying evidence-based clinical practice based on clinical expertise or patient/family preference
Teamwork and Collaboration: Knowledge
> Describe one's own strengths, limitations, and values in functioning as a team member > Describe examples of the effect of team functioning on safety and quality of care.
Quality Improvement: Knowledge
> Describe strategies for learning about the outcomes of care in the setting in which one is engaged in clinical practice > Describe approaches for changing processes of care
Patient-Centered Care: Skills
> Elicit patient values, preferences, and expressed needs as part of clinical interview > Communicate patient values, preferences, and expressed needs to other members of the health care team
Nurses' Role in Quality Improvement
> Enter practice with knowledge and skills to make quality improvement part of their regular work > Quality improvement should not be considered a separate function within the nursing role but rather an ongoing part of the professional role
Safety: Knowledge
> Examine human factors and other basic safety design principles as well as commonly used unsafe practices > Discuss potential and actual effect of national patient resources, initiatives, and regulations
Informatics: Knowledge
> Identify information that must be available in a common database to support patient care > Describe how technology and information management are related to the quality and safety of patient care
Patient-Centered Care: Knowledge
> Integrate understanding of multiple dimensions of patient-centered care > Describe how diverse cultural, ethnic, and social backgrounds function as sources of patient, family, and community values
Federal Statutory Law - Americans with Disabilities Act of 1990
> Intent is to end discrimination against qualified persons with disabilities by removing barriers that prevent them from enjoying the same opportunities available to persons without disabilities > Health care facilities must provide reasonable accommodations to patients with sensory disabilities, such as vision & hearing impairments > Health care facilities must have a policy that defines how it will meet the client's needs for education and information when there are vision or hearing disabilities
Statutory Law
> Law written and enacted by a legislative body. > Violation of law is a criminal offense against the general public and prosecuted by government authorities. > Crimes are punishable by fines or imprisonment > Includes federal and state statutes (laws)
Common Law
> Laws created through cases heard and decided in federal & state appellate courts > Also known as decisional or judge-made laws.
Informatics: Skills
> Navigate the electronic health record > Respond appropriately to clinical decision-making supports and alerts
Contributing factors to medical errors annually
> Overuse of expensive invasive technology > Underuse of inexpensive care services > Error-prone implementation of care that could harm patients & waste money
Evidence-Based Practice: Skills
> Participate effectively in appropriate data collection and other research activities > Consult with clinical experts before deciding to deviate from evidence-based protocols
Quality and Safety Education in Nursing (QSEN)
> Project created through support from the Robert Wood Johnson Foundation to support development of six competencies for nursing students and nurses > Six QSEN competencies > Continual improvement in the six competencies allows nurses to shape the quality and safety of health care systems
2002 IOM Health Professional Education Summit
> Purpose to discuss potential health care reforms with the goal of improving quality and patient safety > Included participants from throughout the healthcare disciplines > Nursing led the charge with the development of the Quality & Safety Education for Nurses (QSEN) Institute
Quality Improvement: Skills
> Seek information about outcomes of care for populations served in a care setting > Design a small test of change in daily work
Patient-Centered Care: Attitudes
> Value seeing health care situations "through patients' eyes" > Respect and encourage individual expression of patient values, preferences, and expressed needs
Informatics: Attitude
> Value technologies that support clinical decision making, error prevention and care coordination > Value nurses' involvement in design, selection, implementation, and evaluation of information technologies to support patient care
Safety: Attitude
> Value the contributions of standardization/reliability to safety > Value relationship between national safety campaigns and implementation in local practices and practice settings
Quality
A customer's perspective on quality, including personal interactions he or she experiences with an organization's personnel in addition to the products or services he or she receives. - Customer defines quality
The staff on a nursing unit notes that patient satisfaction varies from month to month. They plot the degree of patient satisfaction each month for 1 year to determine when the periods of greatest dissatisfaction are occurring. The staff uses which type of graph to present this information? a. Time plot b. Fish bone diagram c. Flowchart d. Cause-and-effect diagram
ANS: A A run plot, or time plot, graphs data in time order to identify any changes that occur over time. A cause-and-effect diagram is used for identifying and organizing possible causes of a problem in a structured format. It is sometimes called a fishbone diagram because it looks like the skeleton of a fish. Flowcharts?4 are pictures of the sequence of steps in a process. Different steps or actions are represented by boxes or other symbols.
The surgical team arrives in the operating room and one-member states, "Everyone stop. Let's identify the patient and operative site. Now does anyone have any questions or concerns?" This process is referred to by what term? a. Time-out b. A critical pathway c. Special cause variation d. Lean methodology
ANS: A A time-out occurs in the operating room to ensure the entire surgical team identifies the patient, operative site, and possible concerns or questions about the procedure.
According to the Quality Chasm report what statement is true? a. Health care providers should be proactive rather than reactive to patient needs. b. Common needs rather than individual preferences should be the priority. c. Medical information should be confined to the primary care provider. d. Specialized providers or case managers should control health care decisions.
ANS: A Quality is based on predicting patient needs rather than reacting to needs.
A team of experienced nurses work together to develop algorithms that are converted into checklists to ensure standardization of commonly performed procedures. The focus of this team is primarily on which Institute of Medicine (IOM) competency? a. Safety b. Timely c. Equitable d. Patient-centered care
ANS: A Standardization contributes to safety and improves individual performance of care providers.
Regardless of the term used to describe high-quality health care, what is the primary focus of quality? a. Meeting consumer needs and wants b. Providing economical care c. Utilizing technologic advancements d. Equally distributed care
ANS: A The customer determines quality based on his or her unique perception of high-quality care.
The National Database of Nursing Quality Indicators (NDNQI) identifies what client focused events as outcome indicator? (Select all that apply.) a. A patient falls and fractures a hip. b. A patient develops bilateral pressure ulcers on their heels. c. A patient develops a catheter-associated urinary tract infection. d. A patient develops post-surgical delirium. e. A patient develops pneumonia related to ventilator use.
ANS: A, B, C, E Outcome indicators include patient falls, pressure injuries, catheter-associated urinary tract infections, and ventilator-associated pneumonia. Post-surgical delirium is not identified by this organization.
A patient with complicated diabetes is scheduled for a below the knee amputation at 7 AM. The surgical team adheres to the 2018 National Patient Safety Goals by implementing which protocols? (Select all that apply.) a. The surgical team asks the patient to verify his or her name, type of surgery, and limb to be removed. b. Ask each member of the surgical team to provide a copy of licensure and, if applicable, certification to patient and family. c. The surgical team uses the chart number and name/hospital number to ensure they have the correct patient. d. Mark the procedure site with "X" and again ask the patient to verify correct site. e. After arrival in the operating room, perform a "time-out" for final identification of patient and operative site along with agreement of what procedure is scheduled.
ANS: A, C, D, E The 2018 National Patient Safety Goal includes universal precautions to ensure patient safety and prevent sentinel events. Methods to identify patient and surgical procedure are required.
Patients with heart failure have extended lengths of stay and are often readmitted shortly after they have been discharged. To improve quality of care, a type of "road map" that included all elements of care for this disease and that standardized treatment by guiding daily care was implemented. This road map is referred to using what term? a. Clinical protocol b. Critical pathway c. Algorithm d. Case management
ANS: B A critical pathway determines the best order and timing of interventions provided by health care team members for a particular diagnosis. Clinical protocols or algorithms are different from clinical pathways because they represent more of a decision path that a practitioner might take during a particular episode or need. Case management is a nursing care delivery system.
A nurse is assisting with the delivery of twins. The first infant is placed on the scale to be weighed. The physician requests an instrument stat. The nurse turns to hand the instrument to the physician, and the infant falls off the scale. When evaluating the incident, the nurse and her manager list contributory factors such as the need for two nurses when multiple births are known, and the location of the scale so far from the delivery field. These nurses are engaged in what process? a. Standardization of care b. Root cause analysis c. Process variation d. Analysis of a deployment flowchart
ANS: B A root cause analysis is a process by which factors that underlie variation in performance, including the occurrence or possible occurrence of a sentinel event, are identified. The purpose of root cause analysis is to identify improvements that can be implemented to prevent future occurrences. Standardization of care is process improvement that involves developing and adhering to best-known methods and repeating key tasks in the same way, time and time again, until a better way is found, thereby creating exceptional service with maximal efficiency. Process variation is a difference in how the steps in a work process might be accomplished and/or the variables that may affect each step in the process. Variation results from the lack of perfect uniformity in the performance of any process. A deployment flowchart maps out the steps of a process under headings that designate the people or departments who carry out each step. This type is especially helpful when dealing with processes that cross multiple areas or caregivers and when there is a need for common under-standing of what the process is doing as a whole.
A nurse is removing a saturated dressing from an abdominal incision and must cut the tape to remove the dressing. The nurse accidentally cuts the sutures holding the incision, and evisceration occurs. In quality improvement, this incident is best identified using what term? a. Root cause b. Sentinel event c. Variation in performance d. Causal factor
ANS: B A sentinel event is an unexpected occurrence that could result in serious physical or psychological injury to the patient, including the possibility of returning to surgery and a prolonged length of stay. A root cause or causal factor is the factor that resulted in a sentinel event. A variation in performance is the action that includes the occurrence or possible occurrence of a sentinel event.
A nurse is preparing to administer a medication by using the vastus lateralis site and is unfamiliar with the process. A step-by-step reference that shows how to complete the process is referred to by what term? a. Deployment flowchart b. Top-down flowchart c. Pareto chart d. Control chart
ANS: B A top-down flowchart shows the sequence of steps in a job or process such as medication administration. A deployment flowchart maps out the steps of a process under headings that designate the people or departments who carry out each step. A Pareto chart is a type of bar graph, with the height of bars reflecting the frequency with which events occur or the effect events have on a process problem. A control chart is basically a run chart with statistical control limits added.
A hospital is concerned that the number of medication errors has increased significantly in the past year. A project revealed four causes of medication errors. The above chart was used to help staff and administration know where to focus efforts to reduce errors. Which process improvement tool is used in this situation? a. Run chart b. Pareto chart c. Flowcharts d. Cause-and-effect diagrams
ANS: B Pareto charts are used to prioritize areas to reduce medication errors. Eighty percent of all errors were caused by interruptions, so this should be the area of priority.
Nurses working on an orthopedic unit use personal digital assistants (PDAs) to review medications prior to administration to reduce potential drug interactions. Software is also installed that provides video clips of common procedures performed by nurses. Nurses on this unit are best demonstrating which QSEN competencies? a. Patient-centered care b. Informatics c. Teamwork d. Quality improvement
ANS: B Technology (PDA) is used to aid decision making and reduce errors.
What nonprofit organization distributes knowledge related to health care for the purpose of improving health to governmental agencies, the public, business, and health care professionals? a. Institute for Safe Medication Practices b. Institute of Medicine (IOM) c. National Committee for Quality Assurance d. The Joint Commission. (TJC)
ANS: B The Institute of Medicine is a nonprofit organization whose mission is to advance and disseminate to the government, the corporate sector, the professions, and the public scientific information that will improve human health.
Each month data on admission assessments that are based on the following standard are entered: "All patients will be assessed by an RN within 2 hours of admission." The target goal for this standard is 97% compliance. Data are displayed on a graph that shows number and time of admission assessments and compliance variation limits. This pictorial representation is documented using what tool? a. Pareto chart b. Control chart c. Deployment chart d. Top-down flowchart
ANS: B The control chart is a run chart that has a centerline and added statistical control limits that help to detect specific types of change needed to improve a process. A Pareto chart is a type of bar graph, with the height of bars reflecting the frequency with which events occur or the effect events have on a process problem. A control chart is basically a run chart with statistical control limits added. A top-down flowchart shows the sequence of steps in a job or process such as medication administration.
A nurse educator is explaining to licensed staff that health care is no longer safe and describes The Quality and Safety for Nursing (QSEN) recommended competencies for educating nursing professionals. What competency is included? (Select all that apply.) a. Advanced health assessment techniques b. Patient-centered care c. Prescriptive pharmacology content d. Quality improvement e. Safety
ANS: B, D, E Patient-centered care is a recommended competency, along with teamwork and collaboration, evidence-based practice, and informatics. Quality improvement is a recommended competency, along with patient-centered care, teamwork and collaboration, evidence-based practice, and informatics. Safety is a recommended competency, along with patient-centered care, teamwork and collaboration, evidence-based practice, and informatics.
Nurses, physicians, and social workers finalize the plan of care and coordinate discharge for a homeless person who will need wound care and follow up over the next 4 weeks. Each member contributes based on his or her area of expertise but also recognize other members' strengths. Which of the QSEN competencies are being demonstrated? a. Quality improvement b. Evidence-based practice c. Teamwork and collaboration d. Patient-centered care
ANS: C An interdisciplinary team is working to prevent hand-off errors on discharge.
Which of the following occurrences would be classified as a sentinel event? a. A postpartum patient who elects to breastfeed only twice daily develops mastitis. b. A newly diagnosed diabetic patient self-injects insulin in the abdominal area rather than the upper thigh as instructed by the patient educator. c. A nurse assisting with the delivery of twins places the "Twin 1" name tag on the second-born twin, causing the first-born twin to undergo surgery that was scheduled for the other twin. d. A nurse administers 3 units of regular insulin rather than 3 units of NPH insulin subcutaneously, resulting in a drop in the patient's serum glucose from 160 to 100 mg.
ANS: C Any procedure performed on a wrong person or organ constitutes a sentinel event.
Institute for Healthcare Improvement (IHI) proposed a process for quality improvement with steps known as "PDCA." What statement should be made when explaining the steps to a group of nurses interested in improving the process of medication reconciliation for heart failure patients with high rates of recidivism? a. P stands for process. Following a top-down flowchart provides the steps for reviewing patient medications taken at home compared to those prescribed during hospitalization. b. D stand for deviation, which is an alteration in the expected drugs ordered. c. C is for check if the process for change worked. Was there an improvement in accurate reconciliation? And what was learned? A stands for algorithm, which includes all steps of the process. d. A stands for algorithm, which includes all steps of the process.
ANS: C C stands for check if the change improved the process and what was learned.
The number of IV site infections has more than doubled on a nursing unit. The staff determine common causes include the site is cleaned using inconsistent methods, dressing frequently becomes wet when patient showers, IV tubing is not changed every 48 hours per protocol, and inadequate hand washing of RN prior to insertion. A bar graph demonstrates the frequency in descending order, with 80% of infections being attributed to inadequate hand washing. The quality tool used is referred to as what? a. Cause-and-effect diagram b. Run chart c. Pareto chart d. Flowchart
ANS: C Pareto charts are bar graphs that show causes contributing to a problem in descending order so the leading cause is easily recognized. A cause-and-effect diagram is used for identifying and organizing possible causes of a problem in a structured format. It is sometimes called a fishbone diagram because it looks like the skeleton of a fish. Flowcharts?4 are pictures of the sequence of steps in a process. Different steps or actions are represented by boxes or other symbols. Run charts, also known as time plots, are graphs of data points as they occur over time.
A nurse is asked to "float" to a telemetry floor and is to place a patient on telemetry monitor. The nurse is unfamiliar with placement of EKG leads and would consult which type of chart to learn the correct placement?
ANS: C The Pareto chart is used to prioritize interventions that caused the majority of the problems.
A patient is ordered a low-protein, low-calorie diet but the patient's family brings fish, lentils, and unleavened bread for a meal to observe a cultural practice. The nurse works with the dietitian to adjust the next few meals to accommodate for this variance. What term should be used to identify this situation? a. A sentinel event b. An adverse event c. Patient-centered care d. The communication technique of "call-out"
ANS: C The nurse and dietitian are respecting patient values, preferences, and expressed needs.
An organization's emergency preparedness task force meets to discuss how it should react in case of a terrorist attack and develops a disaster evacuation plan that details how each department will assist individuals in reaching safety. This type of diagram is referred to using what term? a. Pareto chart b. Control chart c. Top-down flowchart d. Deployment chart
ANS: D A deployment flowchart would show the detailed steps involved in the process and the people or departments that are to be involved at each step to assist individuals in reaching safety. A top-down flowchart shows the sequence of steps in a job or process such as medication administration. A Pareto chart is a type of bar graph, with the height of bars reflecting the frequency with which events occur or the effect events have on a process problem. A control chart is basically a run chart with statistical control limits added. A top-down flowchart shows the sequence of steps in a job or process such as medication administration.
During the night, a patient fell in the bathroom and sustained a hip injury. The patient was very upset because of being unable to attend a granddaughter's wedding in 2 days. The team looked at the process and determined that the patient had been medicated with a narcotic, had urinary urgency so had not taken the time to put on shoes, failed to turn on the light because the door to the hall let in some light, and stumbled over a towel that had been placed to collect water leaks caused by construction that was in progress to replace damaged sinks. Which factor was a special cause variation? a. Failure to take time to put on shoes due to urgency b. Unsteady gait due to narcotic administration c. Poor lighting that led to decreased vision d. Improper construction that caused the leak and towel placement
ANS: D A special cause variation is an uncommon variation that is unstable and unpredictable, is not under statistical control, and is related to a clearly identified single source, which in this scenario is the construction project.
Which of the following statements concerning the Institute of Medicine (IOM) competencies is correct? a. Each competency is mutually exclusive. b. The competencies focus on individual efforts to reduce errors. c. Physicians lead the team to achieve each competency. d. The competencies address both individual and system approaches to transform care.
ANS: D Errors and increased health care costs result from both the actions of health care workers and the nature of the system in which they deliver care.
A group of nurses are presenting the importance of high-quality care during a system-wide meeting of medical-surgical nurses. They point out a finding of the Quality Chasm that supports what? a. Being insured has little effect on a person's longevity and the quality of care received. b. Lobbyists for the drug companies can gain permission for the use of new drugs within 1 year of their discovery. c. Although a greater number of lawsuits stem from medication errors, more people actually die from human immunodeficiency virus (HIV) and acquired immunodeficiency disease syndrome (AIDS). d. Medication-related errors place a tremendous financial burden on the U.S. health care system.
ANS: D Medication-related errors for hospitalized patients cost roughly $2 billion annually.
Quality is defined by the ____________.
ANS: patient Quality is based on the perspective of the consumer or, in this instance, the patient.
While taking a shower, a patient pushes the emergency light. When the nurse arrives, the patient complains of feeling dizzy and unsteady. The nurse turns to reach for the patient's walker and the patient falls, hitting the right side of the face resulting in loss of vision in the right eye. This scenario represents a _______ event.
ANS: sentinel A sentinel event is an occurrence that results in death or serious illness and requires immediate investigation.
The Joint Commission (TJC) not only focuses on an organization's ability to provide safe high-quality care but also requires evidence of?
Actual performance and continued improvement
Centers for Medicare and Medicaid Services (CMS)
Administers the Medicare program Requires quality management in "Conditions of Participation"
STEEEP : Safe
Avoiding injuries to patients caused by the care that is intended to help them
STEEEP: Efficient
Avoiding waste of equipment, supplies, ideas, and energy
Root Cause Analysis
Conducted to understand the systems at fault within the organization so that improvements can be determined and implemented to prevent future occurences
Regulatory and Accreditation Agencies
Drive quality improvement efforts in health-care facilities Almost all regulatory and voluntary accrediting agencies require quality management in some form Most state licensing authorities require quality improvement standards
"All one team"
Effective team functioning, which embodies the principles of believing in people; treating everyone in the workplace with dignity, trust, and respect; and working toward win-win situations for all customers, employees, shareholders, suppliers and perhaps even the broader community as a whole.
Process Improvement Tools Include:
Flowchart Pareto-Chart (bar chart) Cause-and-effect Diagram (fishbone) Run Chart
Quality Improvement (QI)
Framework for taking action to systematically make changes that lead to measurable improvements in health care services for patients, staff, and organizations; quality is determined by the needs, expectations, and desired health outcomes of individuals and populations. - The term itself is not as important as the principles it embodies: assessing and improving work processes while focusing on what customers want and need.
Teamwork and Collaboration
Function effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision making to achieve quality patient care
ANA National Database of Nursing Quality Indicators (NDNQI)
Indicators that strongly affect clinical outcomes Samples of NDNQI indicators > Nursing hours per patient-day > Staff mix (RNs, LPNs/LVNs, UAP) > Hospital-acquired pressure ulcers > Patient falls/injury resulting from falls > Nurse staff satisfaction/RN survey > RN education and certifaction > Nurse turnover > Nosocomial Infections
Evidence-Based Practice
Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care
Flowchart
Maps out what actually occurs in a work process
Clinical Indicators
Measurable items that reflect the quality of care Used as an assessment of clinical care to identify areas in which quality improvement issues may be present Help to identify the goals of quality improvement
National Hospital Quality Measures
Measures are being used along with patient satisfaction scores and other select clinical measures "pa for performance" Goal is to move health care payments away from simply paying for the provision of services to paying based on the quality process and outcomes associated with those services
Safety
Minimize risk of harm to patients and providers through system effectiveness and individual performance
Institute for Safe Medication Practices (ISMP)
Nonprofit organization known as an education resource for the prevention of medication errors Provides independent, multidisciplinary, expert review of reported errors Healthcare professionals across the nation voluntarily and confidentially report medication errors and hazardous conditions that could lead to errors Offer Medication Safety Self Assessments to allow nurses and other health care professionals to assess the medication safety practices in their work setting
The Joint Commission (TJC)
Organization that offers voluntary accreditation for health care settings, has a strong focus on quality standards. Health care organizations voluntarily seek TJC accreditation to demonstrate that they have achieved a "gold seal of approval" by following the quality and safety standards established by TJC.
Methods Of Standardization: Clinical Guidelines or pathways
Outline the optimal sequencing and timing of clinical interventions for a particular diagnosis or procedure
The Joint Commission (TJC) address the organizations level of performance in key functional areas such as?
Patient Safety Patient Rights Patient Treatment Infection Control
Two-Part Model for Improving Health Care (IHI): Plan-Do-Check-Act (PDCA) cycle
Plan - Develop action plan based on the three questions Do - Take action to test the action plan Check - Assess results and make refinements as needed Act - Implement resultant changes in real work settings
Purpose of the TJC National Patient Safety Goal
Promote specific improvements in patient safety with the goals highlighting problematic areas and evidence-based solutions to the problems with system-wide solutions whenever possible.
Two major purposes for the ANA National Database of Nursing Quality Indicators (NDNQI)
Provide comparative data to health care organizations to support quality improvement activities Acquire national data for better understanding of link between nurse staffing and patient outcomes
STEEEP: Equitable
Providing care that does not vary in quality because of personal characteristics
STEEEP: Patient-Centered
Providing care that is respectful of an responsive to individual patient preferences, needs, and values
STEEEP: Effective
Providing services based on scientific knowledge to all who could benefit
Cornerstones of Quality Management**
Quality Scientific Approach "All one team"
Patient-Centered Care
Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient's preferences, values, and needs
STEEEP: Timely
Reducing waits and sometimes harmful delays for those who receive and those who give care
Benefits of Standardization
Reduction in variation of care provided Facilitation and achievement of expected outcomes Reduction in care delays and lengths of stay Improvements in cost-effectiveness Increase in patient and family satisfaction with care
Pareto-Chart (bar chart)
Reflects frequency at which events occur, or the effect events have on a process
Six Aims to Guide Improvement: STEEEP
Safe Timely Effective Efficient Equitable Patient-Centered
Centers for Medicare & Medicaid Services - NEVER Events
Serious, costly errors that should never happen Example: Wrong site surgery, mismatched blood transfusions, patient falls, hospital-acquired infections CMS will no longer pay the additional cost of hospitalization of such conditions as an incentive to hospitals to prevent the events
Programs Initiated in Response to Imperative to Improve Patient Safety
TJC Sentinel Event Standard > Requires organizations to carry out designated steps to fully understand the factors and systems associated with adverse patient events > Root Cause Analysis
Scientific Approach
To make significant improvements in an organization's processes, decisions must be based on sound, valid data, and the people managing the processes must have a clear understanding of the nature of variation in processes. - Improvement decisions based on sound, valid data
Quality Improvement
Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continually improve the quality and safety of health care systems
Informatics
Use information and technology to communicate, manage knowledge, mitigate error, and support decision making
Institute for Healthcare Improvement (IHI)
Voluntary organization formed to assist health care leaders to improve quality Led development of change concepts for specific areas > Reducing patient delays > Reducing cesarean deliveries > Reducing adverse drug events
Cause-and-Effect Diagram (Fishbone)
•Lists potential causes arranged by category to show their effect on a problem •Helps determine potential causes of a problem (Ask why 5xs)
