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Quality and safety

Issues of Quality and safety ch 10

QuestionAnswer
Nurses need to be prepared to support consumers with a thorough knowledge of quality, accountability, and cost-effectiveness. They must have knowledge to educate patients regarding the technology used in their TX And explained the rationale behind the Economics
Both elderly and ethnic minorities are at risk populations who suffered disadvantages in excess to care, payment for care, and quality of care. Which passage will help minimize these disparities? Affordable care act. (ACT). Societal demographics and diversity
Nursing practice must adjust to healthcare delivery trans with the inclusion of concepts in interprofessional collaboration, patient focused systems, and information literacy Technology
___ produces advancements in disease TX, ESP in areas of genetics and genomics. Which allow the redesign of TX for a variety of genetic disorders, quality improvement, and outcomes in clinical practice often related to___ Technology. Pharmacotherapeutics
All healthcare professionals need knowledge, skills, attitudes and competencies to function in a variety of settings and the ability to support the needs of the increasingly diverse population. (Collaboratively and interprofessionally) Healthcare delivery and practice
Increased ease of travel allows for migration of affected populations. Safe, quality healthcare will need to confront the challenges of increasing multiculturalism, potential for pandemic, and the effect of climate change on population on help. Environment and globalization
Private, non-prophet organization that gives unbiased expert help and scientific advice for the purpose of improving health Institute of medicine (IOM)
Quality can be defined in measured;; Quality problems are serious and extensive; current approach is to quality improvement are in adequate; there is urgent need for rapid change. IOM 1998 finding Statement on Quality Care
Enhanced knowledge and leadership regarding safety. Identify and learn from errors. Set performance standards and expectations for safety. Implement safety systems within healthcare organizations. Focus areas of to air is human recommendations (IOM, 2000)
1. Care is based on a continuous easily relationship. 2. Care is provided based on PT needs and values. 3. PT is source control of care. 4. Knowledge is shared and free-flowing. 5. Decisions are evidenced-based. 10 rules to govern healthcare reform for the 21st-century (IOM, 2001, page 61)
6. Safety is a system priority. 7. Transparency is necessary; secrecy is harmful. 8. Anticipate patient needs. 9. Waste is continually decreased. 10. Cooperation is needed between healthcare providers 10 rules to govern healthcare reform for the 21st-century (IOM, 2001, page 61)
1. The growing complexity of science and technology, and 2. increase in chronic conditions, 3. a poorly organized delivery system of care, and 4. constraints exploiting the revolution in information technology. Chasm of Quality Care. Report is dated gaps between actual care in high-quality care attributed to these into related areas in the healthcare system. (Recommendations to improve are the 10 rules to govern)
___Identifies recommendations for action oriented blueprint for the future of nursing. In managing PT care, must continually consider the impact of the system on the care provided and participate in quality and safety initiatives at the bedside, in your Future of nursing: leading change, advancing health
The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current and professional knowledge. (Basis for nursing management of PT care) Quality (defined by IOM)
1. Safe: avoiding injuries to pt from the care that is intended to help them. Effective goal of providing services based on scientific knowledge to all who could benefit & refraining from providing services to those not likely to benefit (avoid underus Six Ames for improving quality in healthcare (IOM, 2001, page 39)
3. Patient centered: providing care that is respectful of Ian responsive to individual PT preferences, needs, and values and ensuring that PT values guide clinical decisions. Timely: reducing weights and sometimes harmful delays for those who receive an Six Ames for improving quality in healthcare (IOM, 2001, page 39)
5. Efficient: avoiding Waze, in particular that of equipment, supplies, ideas, and energy. Equitable providing care that does not vary in quality because of characteristics such as gender time ethnicity, geographic location in Socio economic status Six Ames for improving quality in healthcare (IOM, 2001, page 39)
___Used retrospective audit charts and fixed errors after problems were found. Placed very little emphasis on change or assuming a proactive approach.__Uses systemwide approach to maintaining quality Quality assurance (QA.). Quality improvement (QI)
1. Link to key elements of organization strategic plan. 2. Quality council consisting of institutions top leadership. 3. Training program for all levels of personnel. Common characteristics of QI
4. Mechanism for selecting improvement opportunities. Formation process improvement teams. Staff support for process analysis and redesign. Personnel policies that motivate and support so DEF participation and process improvement. Common characteristics of QI
1. Identifies areas of concern (indicators). Continuously collecting data on indicators. Analyzing and evaluating the data. Implementing needed changes. (Analyzes past, present and future data--it is everyone's job to collect data) Continuous quality improvement (CQI). Monitors and evaluate quality of care
Indicators can be identified by either and a credit dating agency or the facility itself. The aim of CQI is to act___and avoid blaming___. (It is everyone's job to collect data) Proactively. Environment
Short, visionary, conceptual a document that: serves as a framework for decisions or for securing support/approval. Provides a basis for more detailed planning. Explains the business to others in order to inform, motivate, involved. Assist benchmarking a Strategic plan (to stay on track, organize needs)
1. Who are our customers, stakeholders, markets? What do they expect from us? What are we trying to accomplish? What changes do we think will make an improvement? How/when will we pilot test our predicted improvement? question the team needs to ask (QI page 153)
What do we expect to learn from the pilot test? What will we do with the negative results? Positive results? How will we implement the change? How will we measure success? What did we learn as a team from this experience? What changes would we make for th question the team needs to ask (QI page 153)
Tools for tracking outcomes. They are interprofessional tools to identify best practices, facilitate standardization of care, and provide a mechanism for variance tracking, quality enhancement, outcomes measurement and outcomes research. Structured care mythologies is in methodologies
Identify core aspects of nursing performance. Incorporates many of SCM. Tools, offers decision makers a conceptual estimate the asked to define performance, create a shared and stable set up performance indicators for a given segment of nursing care, an Nursing care performance framework (NCPF)
Guidelines. Protocols. Algorithms. Standards of care. Critical (or clinical pathways c guidelines. Protocols. Algorithms. Standards of care. Critical (or clinical) pathways Nursing care performance framework (NCPF)
Help HCP's and PT to make appropriate healthcare decisions. These are based on current research strategies. Often develop by experts in the field. Seen as a way to decrease variations in practice. Guidelines
Specific, formula document that outlines how a procedure/intervention should be conducted. A standardized approach to achieve desired outcomes. (Example hospitals use these for chest pain) Protocol
Systematic procedure that follow a logical progression based on additional information or patient response to TX. Advanced cardiac life support of these are widely used. Algorithms
Often discipline related and help to operationalize patient care processes and provide a baseline for quality of care. Layers often referred to a disciplines standards of care in evaluating rather a patient has received appropriate services Standard of care
Outlines the expected course of treatment for patients who have similar diagnosis is. The shit orient the nurse easily to a patient outcomes for the day. Critical (or clinical) pathways. (Page 154)
Fundamental purpose of__is to assist HCP's in implementing practices identified with good clinical judgment, research-based interventions, and improve patient outcomes. Structured care methodologies (SCM).
Clinical protocols is loving all disciplines. Designed for tracking a plan clinical course for patients based on Everett and expected lengths of stay. Financial outcome can be evaluated from this by assessing variances from the proposed link of stay. Critical pathways
Provide a framework for communication, documentation of care, teaching tool, evaluate cost of care for different populations. Canby use chronologically, diagrammatic . Time frames from daily to hr. This it will include discharge planning, patient EDU. C Critical pathway critical pathway
Evaluates aspects of healthcare: structure within which the care is giving Tamil the process of giving care, and outcome of that care. Comprehensive evaluation should include all three aspects. A CQI (continuous quality improvement) Aspects of healthcare to evaluate
The setting in which the care is given and to the resources (human, financial, and material) that are available. (Facilities, equipment, staff, finances) Structure
Adequate supplies, state of the art equipment, and Staff ability to use equipment. Equipment (Structure)
Comfort, tubing it's a layout, assessability time all of the support services, and safety Facilities (structure)
Credentials, experience, absenteeism, turnover rate, staff-patient ratios Staff (structure)
Salaries, adequacy, sources Finances (structure)
Activities carried out by the HCP & all the decisions made while a patient is interacting with the organization (setting appointments, conducting pt assessment, ordering x-ray and MRI, blood transfusion, Plan PT for discharge, Phoning ptpost discharge Process
The ANA a standards of care are process standards the answer the question What should the nurse been doing, and what process should the nurse follow to ensure quality care.
Result of all HCP activities. Measures evaluate effectiveness of nursing activities by answering questions Did the patient recover? Is the family more independent now? Has team functioning approved?
Out come questions asked during evaluation should___observable behavior (patient. Family. Team) Measurable (pg 158)
Process of identifying, analyzing, treating and evaluating real and potential hazards. It is the nurses responsibility to report adverse incident to the risk manager time well. In many states it is a legal requirement. Risk management
Service occurrence. Serious incident. Setinel events. Risk events are categorized according to severity. Risk management
___Unexpected occurrence that does not result in clinically significant interruption of services and that is without apparent patient or employee injury. (Minor property or equipment damage, unsatisfactory provision of services at any level, inconsequent Serious occurrence (risk management)
____A clinically significant interruption of therapy or service, minor injury to a PT or employee, or significant loss or damage to equipment our property. Minor injuries are usually defined yea A clinically significant interruption of therapy or service, Serious incident (risk management. Needing medical intervention outside of hospital admission or physical or psychological damage.)
___ Unexpected occurrence involving death or serious/permit physical or psychological injury, or risk there of. This type of process requires____ Sentinel event. (Risk management). It signals need for immediate investigation in response. Appropriate individuals in the organization must be made aware of the event. They must investigate and understand the causes of the event. They must take charge
And even at that results in unanticipated death, major permanent loss of function that is not related to natural course of PT illness or underlying condition. Subject to review by the joint commission.
Even if outcome was not dad or major permanent loss of function. Suicide a patient in around the clock setting (hospital, presidential TX Center, crisis stabilize Asian center). In a bit abduction or discharge to Ron family. Rate. Hemolytic transfusion Subject to review by the joint commission
Med errors. Documentation errors/or omission. Failure to perform nursing care or treatment correctly. Errors in PT safety that results in Falls. Failure to communicate significant data to PT and other providers. Common risk areas for nursing. Adhering to standards of care and exercising the amount of care that a reasonable nurse would demonstrate under the same or similar circumstances can't protect the nurse from litigation.
After an incident, it's that reports are made___. They are used to collect and analyze data for determination of for the future risk. Reports should be accurate, objective, complete, and factual. Incident report. Immediately. (Attorneys can subpoena Report)
Incident report should be prepared in___copy and (always or never) placed in the medical record. It will be kept in the___hospital correspondence Single. Never. Internal
The failure of a plant action to be completed as intended (error of execution) seas or the use of a wrong plan to achieve an aim (error of planning.) Are these intentional or unintentional? Error. Unintentional and Matt are errors lead to adverse events causing harm or death.
Occur when slips or lapses in the actions taken by the provider or not what was intended. Skill-based errors
Errors that occur when a standard or rule is violated. (And experienced nurse and ministering the wrong medication by taking up the wrong syringe) Rule based errors
Error or mishap that results in no harm or very minimal patient harm. They are useful in identifying and remedying von abilities in systems before harm can occur. (Catching a medication error before the med is given) Near Miss
Injury to a patient caused by medical management rather than an underlying condition of the patient. (Classified: diagnostic, Treatment, preventative time all other) Adverse event
Error or delay in diagnosis. Failure to employ indicate a test. Use of outmoded test or therapy. Failure to act results of monitoring or testing. Diagnostic (adverse event-type of error)
Error in the performance of an operation, procedure or test. Error in administering the treatment. Error in dose or method of using a drug. Avoidable delay in treatment or in responding to an abnormal test. Inappropriate (not indicated) care Treatment (adverse event-type of error)
Failure to provide prophylactic treatment. In adequate monitoring or follow-up treatment. Preventative (adverse event-type of error)
Failure of communication. Equipment failure. Other system failure. Other (adverse event-type of error)
Event that involves damage to a defined system that disrupts that the going to future output of that system. These occur when multiple systems fail and tend to be unplanned or unforeseen. They provide information about systems Accidents
A Blame free environment in which reporting of errors is promoted in rewarded. This promotes trust, honesty, openness, and transparency. (These hospitals have fewer Reported cases of adverse safety events) Culture of safety (organizations and senior leadership need to drive the change to develop this)
___Mandates reporting of serious harm or death related to drugs and medical devices. Failure to report mandatory requirements may lead to___ FDA. (Fines, withdrawal of participation in clinical trials, or loss of licensure to operate)
Joint commission relies on___from it sentinel event. This analysis is the process for learning from consequences. (Review medication error, especially one result death or severe complications) Root cause analysis
1. Determine what influence the consequences, (determine necessary and sufficient influences that explain the nature and magnitude of the consequences) Principle of root cause analysis
Establish tightly linked chains of influence. It every level of analysis, determine the necessary and sufficient influences. Whenever feasible, drill down to root causes. Know that there are always multiple root causes Principle of root causes analysis
Sets pt safety standards. Implements & oversee sentinel event policy and adversory group. Publishes sentinel event alert news letter & quality check reports. Set yearly national patient safety goals. Develops the universal protocol related to surgical Joint Commission International center for patient safety (page 162 box 10-8 )
Evaluates organizations monitoring of quality of care issues. Conduct patient safety research. Provides patient safety resources. Supports the speaker program. Involved with patient safety coalitions and legislative efforts. Joint Commission International center for patient safety (page 162 box 10-8 )
Initiative that aims to ensure each Medicare he said be at receives the appropriate levels of care. It is a community-based QI program that provides tools and resources to Currys changes in processes, structures, and behaviors within the healthcare commu MedQIC
CM S is examining post acute transfers with the aim of reducing care fragmentation and unsafe transitions Post acute care reform plan
Page 163 has the list of organizations and agencies supporting quality and safety. Includes governmental agencies, healthcare provider professional organizations, nonprofit organizations, etc. Aaa
Major initiative aimed at improving quality of care at the provider & organizational level. Creates a uniform set of quality measurements by which consumers can compare organizations & by which organizations can benchmark progress towards achieving goals Hospital quality initiative (organizations provide data to CMS through public reporting the fed into the hospital compare website.)
Lead federal agency charged with improving the quality, safety, efficiency, effectiveness of healthcare for Americans which is under HHS. Healthcare research and quality. (AHRQ )
___Aims to fill its mission is health IT. National quality measures clearinghouse (NQMC). Medical errors and patient safety. AHRQ quality indicators. AHRQ
Provides technical assistance and research funding to a technology implementation within communities. Learning laboratories to develop and test health__applications Health IT
Website accessible database provides access to evidence-based quality measures &measure sets. It provides access for obtaining detailed information on quality measures & to further dissemination, &implementation, use in order to inform healthcare decisio National quality measures clearinghouse (NQMC)
Website providing access to evidence-based tools and resources for consumers and providers Medical errors and patient safety
Set of quality indicators used by organizations to highlight potential quality concerns, identify areas that need further study and investigations come and track changes over time. AHRQ Quality indicators
Left off at healthcare provider professionals organization page 164 Aaa
Created by: srchilds