Quality Control in Creating a Culture of Patient Safety, Exams of Medicine

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Quality Control in Creating a Culture of

Patient Safety

Controlling Phase - ✔ANS: -performance is measured against predetermined standards, and action is taken to correct discrepancies between these standards and actual performance -way to learn and grow, both personally and professionally -fifth and final step of the management process Quality Control - ✔ANS: -refers to activities that are used to evaluate, monitor, or regulate services rendered to clients -performance is measured against predetermined standards -action is taken to correct discrepancies between these standards and actual performance High-Reliability Organizations (HROs) - ✔ANS: organizations that perform well (minimal catastrophic error) despite high levels of complexity and the existence of multiple risk factors that encourage error Healthcare Quality - ✔ANS: -the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge (defined by IOM in 1994) -involves effectiveness, efficiency, equity, patient centeredness, safety, and timeliness Effectiveness -

✔ANS: relates to providing care processes and achieving outcomes as supported by scientific evidence Efficiency - ✔ANS: related to maximizing the quality of a comparable unit of health care delivered or unit health benefit achieved for a given unit of health care resources used Equity - ✔ANS: related to providing health care of quality to those who may differ in personal characteristics other than their clinical condition or preferences for care Patient Centeredness - ✔ANS: relates to meeting patients' needs and preferences and providing education and support Safety - ✔ANS: relates to actual or potential bodily harm Timeliness - ✔ANS: relates to obtaining needed care while minimizing delays Management Controlling Functions - ✔ANS: -periodic evaluation of unit philosophy, mission, goals, and objectives -measurement of individual and group performance against preestablished standards -auditing of patient goals and outcomes Hallmarks of Effective Quality Control Programs - ✔ANS: -support from a top level administration -commitment by the organization in terms of fiscal and human resources -quality goals reflect search for excellence rather than minimums -process is ongoing (continuous)

Three Steps of Quality Control - ✔ANS: -criterion or standard is determined -information is collected to determine whether the standard has been met -educational or corrective action is taken if the criterion has not been met Steps in Auditing Quality Control - ✔ANS: 1. Establish control criteria

2. Identify the information relevant to the criteria
3. Determine the ways to collect the information.
4. Collect and analyze information
5. Compare collected information with the established criteria.
6. Make a judgement about quality.
7. Provide information and, if necessary, take corrective action regarding findings.
8. Reevaluation Standards - ✔ANS: -predetermined baseline condition or level of excellence that constitutes a model to be followed and practiced -each organization and profession must set standards and objectives to guide individual practitioners in performing safe and effective care -ANA played a key role in developing these for the nursing profession -must be objective, measurable, and achievable Standards of Practice - ✔ANS: define the scope and dimensions of professional nursing Scope and Standards of Practice - ✔ANS: -originally posted by the ANA in 1991 -provides a foundation for all RNs in practice

Organizational Standards - ✔ANS: outline levels of acceptable practice within the institution Clinical Practice Guidelines - ✔ANS: -aka standardized clinical guidelines -provide diagnosis based, step by step interventions for providers to follow to promote high quality care while controlling resource utilization and costs -should reflect EBP; that is, they should be based on cutting edge research and best practices Quality Gap - ✔ANS: -the difference in performance between top performing healthcare organizations and the national average -typically small in industries such as manufacturing, aviation, and baking -variation is more common in healthcare Benchmarking - ✔ANS: -process of measuring products, practices, or services against best- performing organizations -organizations can determine how and why their organization differs from these exemplars and then use the exemplars as role models for standard development and performance improvement -critical event analysis and root cause analysis help to identify not only what and how an event happened but also why it happened, with the end goal being to ensure that a preventable negative outcome does not recur FOCUS-PDCA - ✔ANS: -Find a process to improve -Organize a team Clarify the current process -Understand variations in current process

-Select the process to improve -Plan the improvement -Do the improvement -Check for results -Act to hold the gain -created by Edward Deming to show that people have a greater impact on waste when the entire process is understood rather than just looking at the outcome -PDCA allows for a continuous quality improvement cycle to test improvement strategies one by one, in a controlled manner, to measure results and drive further improvements Audit - ✔ANS: -systematic and official examination of a record, process, or structure, environment, or account to evaluate performance -provides managers with a means of applying the control process to determine the quality of services rendered in a healthcare setting -can occur retrospectively, concurrently, or prospectively -ones frequently used in quality care are structure, process, and outcome Retrospective Audits - ✔ANS: performed after the patient receives the service Concurrent Audits - ✔ANS: performed while the patient is receiving the service Prospective Audits - ✔ANS: attempt to identify how future performance will be affected by current interventions Patient-Reported Outcome Measures (PROMs) -

✔ANS: -attempt to capture whether services provided actually improved patient's health and sense of well being -critical component of assessing whether clinicians are improving the health of patients Outcome Audits - ✔ANS: -determine what results, if any, followed from specific nursing interventions for patients -assume that the outcome accurately demonstrates the quality of care that was provided Process Audits - ✔ANS: -measure the process of care or how the care was carried out -assumes a connection between the process and the quality of care -tend to be task oriented and focus on whether practice standards are being fulfilled -might be used to establish whether fetal heart tones or blood pressure were checked according to established policy Structure Audits - ✔ANS: -monitor the structure or setting in which patient care occurs -assumes that a relationship exists between quality of care and appropriate structure -includes resource input such as environment in which healthcare is delivered -includes all those elements that exist prior to and separate from the interaction between the patient and the healthcare worker -ex: checking to see if patient call lights are in place or if patients can reach their water pitchers; staffing patterns to ensure that adequate resources are available to meet changing patient needs Standardized Nursing Language -

✔ANS: -provides a consistent terminology for nurses to describe and document their assessment, interventions, and the outcomes of their actions -NANDA International (NANDA-I) -nursing outcomes classification (NOC) -clinical care classification system (CCC) -the Omaha system -perioperative nursing data set (PNDS) -international classification for nursing practice (ICNP) -systemized nomenclature of medicine clinical terms (SNOMED CT) -logical observation identifiers names and codes (LOINC) -nursing minimum data sets (NMDS) -ABC codes Quality Assurance and Quality Improvement - ✔ANS: -healthcare is moving from QA to QI -QA models target currently existing quality -QI models target ongoing and continually improving quality -the 2 models that emphasize the ongoing nature of QI are total quality management (TQM) and the Toyota production system (TPS) Total Quality Management (TQM) - ✔ANS: -aka continuous quality improvement (CQI) -philosophy developed by Edward Deming -assumes that production and service focus on the individual and that quality can always be better -based on the premise that the individual is the focal element on which production and service depend

-focus is on doing the right things, the right wat, the first time, and problem prevention planning, not inspective and reactive problem solving -always room for improvement -never ending process -empowerment of employees by providing positive feedback and reinforcing attitudes and behaviors that support quality and productivity Toyota Production System (TPS) - ✔ANS: -customer focused quality improvement model -production system built on the complete elimination of waste and focused on the pursuit of the most efficient production method possible -adopting this in an organization requires a substantial commitment of leadership time and resources -quality control in healthcare organizations has evolves primarily from external focus and not as a voluntary effort to monitor the quality of services provided The Joint Commission - ✔ANS: -major accrediting body for healthcare organizations and programs in the US -it also administers the ORYX initiative and collects data on core measures to better standardize data collection across acute care hospitals ORYX - ✔ANS: -An initiative of TJC that implements 5 core measures to improve safety and quality of health care -initiative integrated outcomes and performance measures into the accreditation process with data being publicly reported at a website known as Quality Check Core Measures - ✔ANS: -hospital quality measures -implemented as a part of ORYX in 2002

-used to better standardize its valid, reliable, and evidence based data sets National Patient Safety Goals (NPSGs) - ✔ANS: -used to augment the core measures and promote specific improvements in patient safety Centers for Medicare and Medicaid Services (CMS) - ✔ANS: -plays an active role is setting standards for and measuring quality in healthcare including pay for performance -the National Committee for Quality Assurance (NCQA), a private nonprofit organization that accredits managed care organizations, also developed the health plan employer data and information set (HEDIS) to compare quality of care in managed care organizations -hospital consumer assessment of healthcare providers and systems Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) - ✔ANS: -survey -first national, standardized, publicly reported survey of patients' perspectives of hospital care -measures recently discharged patients' perceptions of their hospital experience -asks medical, surgical, and maternity care patients who have recently been discharged (48 hours to 6 weeks) about aspects of their hospital experience including "how often" or whether patients experienced a critical aspect of hospital care rather than whether they were "satisfied" with the care Medical Errors - ✔ANS: -adverse events that could be prevented given the current state of medical knowledge -the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim -plethora of studies across the past 2 decades suggest that these are rampant in the healthcare system

-ignoring the problem, denying their existence, or blaming the individuals involved in the processes does nothing to eliminate the underlying problems -medication errors are the most common type Just Culture - ✔ANS: -culture where staff are willing to come forward with information about errors so everyone can learn from mistakes; the culture recognizes the need for accountability & at times disciplinary action -deemphasizes blame for errors and focuses instead on addressing factors that lead to and cause near misses, medical errors, and adverse events Strategies to Prevent Medical Errors - ✔ANS: -better reporting of the errors that do occur -leapfrog initiatives -reform of the medical liability system -other point of care strategies (bar coding, smart IV pumps, medication reconciliation) Leapfrog Group Initiatives - ✔ANS: -growing conglomeration of nonhealthcare Fortune 500 company leaders who are committed to modernizing the current healthcare system 4 Evidence-Based Standards -computerized physician provider order entry -evidence based hospital referral -ICU physician staffing -use of Leapfrog safe practices scores Six Sigma Approach - ✔ANS: -sigma is a statistical measurement that reflects how well a product or process is performing

-higher sigma values indicate better performance -historically, the healthcare industry has been comfortable striving for three sigma processes in terms of healthcare quality, instead of 6