EXAM 2- PRIORITIZATION OF CARE, DELEGATION OF CARE, EVIDENCE BASED PRACTICE, HEALTH CARE Q, Exams of Advanced Education

Download EXAM 2- PRIORITIZATION OF CARE, DELEGATION OF CARE, EVIDENCE BASED PRACTICE, HEALTH CARE Q and more Exams Advanced Education in PDF only on Docsity! EXAM 2- PRIORITIZATION OF CARE, DELEGATION OF CARE, EVIDENCE BASED PRACTICE, HEALTH CARE QUALITY evidence-based practice problem solving approach to making clinical practice that combines the best evidence with a clinicians expertise, patient preferences and values, and health care resources in making decisions about patient care the best scientific evidence comes from well-designed, systematically conducted research studies found in scientific, peer reviewed journals. Steps of Evidence Based Practice 0. Cultivate a spirit of inquiry. 1. Ask a clinical question in PICOT format. 2. Search for the most relevant evidence. 3. Critically appraise the evidence you gather. 4. Integrate all evidence with your clinical expertise and patient preferences and values. 5. Evaluate the outcomes of practice decisions or changes using evidence. 6. Share the outcomes with others. Cultivating a spirit of inquiry -constantly questioning current practices leads to consistent use of EBP -EBP institutions demonstrate a culture in which nurses are encouraged to question practices Clinical questions should be asked in a....... format PICOT PICOT format P - Identify the population or problem (age, gender, ethnicity, disease/disorder) I - Intervention, or range of interventions of interest (exposure to disease, risk behavior, education) C - What will you compare the intervention against? (no disease, absence of risk factors, placebo or no intervention) O - Outcome of interest (risk of disease, rates of occurrence of adverse outcomes, accuracy of diagnosis) T - Time it takes for intervention to achieve the outcome (selected to observe the population or problem/condition) Best evidence sources -agency policy -procedure manuals -quality improvement data -existing clinical practice guidelines -journal articles Experts to ask for help -nurses -educators -librarians Level 1 source -systematic review of meta analysis of randomized conducted trials -Evidence based clinical practice guidelines based on systematic reviews - level 2 source -a well designed RCT level 3 source controlled trial without randomization level 4 source -single non-experiment study (class control, correlational, cohort studied) Level 5 source Systematic reviews of descriptive and qualitative studies Level 6 Single descriptive or qualitative study Quantitative Research research that collects and reports data primarily in numerical form Qualitative Research research that relies on what is seen in field or naturalistic settings more than on statistical data translation research phases • Preclinical and animal studies—basic science research • Phase 1 clinical trials—testing safety and efficacy in a small group of human subjects • Phase 2 and 3 clinical trials—testing safety and efficacy in a larger group of human subjects and testing for comparison to standard treatment • Phase 4 clinical trials and outcomes research—translation to practice • Phase 5 population-level outcomes research—translation to community outcomes research studies about the effects of care and treatments on individuals and populations -helps patients, healthcare providers, and those in healthcare policy make informed decisions on the basis of current evidence -typically focuses on the benefits, risks, costs and holistic effects of a treatment on patients -outcomes must be observable or measurable -researchers need ti select appropriate outcomes when designing their studies. performance improvement a formal approach for the analysis of health care-related processes -reviews how existing interventions within a process function -PI combined with EBP is the foundation for excellent patient care and outcomes Decision making in nursing -shared governance -responsibility -autonomy -authority -accountability -staff involvement the nursing manager supports staff involvement through a variety of approaches -Establishing nursing practice through problem-solving committees or professional shared governance councils -interprofessional collaboration among nurses and health care providers -Interprofessional rounding -Staff communication -Staff education Clinical care coordination should have -Good clinical judgment -Strong priority setting -Organization skills -Appropriate use of resources -Good time management -Continual evaluation -Effective team communication -Appropriate delegation knowledge building -lifelong learning -maintaining competency health care quality the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge Quality as a perception impression of excellence quality as a feeling how satisfied someone is quality that is measurable Score on a patient satisfaction survey Number of adverse events per 100 patients per year Components of Quality Patient care outcomes Patient satisfaction Evidence-based care delivery Delivery of safe care Patient-centered care Resource efficient culture of quality involvement and commitment to quality at all levels within an organization. Major attributes of health care quality Safe Effective Timely Patient-centered Efficient Equitable SETPEE Donabedian model of structure and outcomes Organizational characteristics --> process --> outcomes organizational characteristics People, equipment and technology process -interactions b/w health care provider and patient: The actual steps taken in delivering care -results must be patient focused -must deliver results reliably (same results every time) outcomes -clinical outcomes Change (desirable or undesirable) in individuals and populations -patient perception of care or level of satisfaction -financial defined outcomes are the validators of the quality and effectiveness of medical care Errors in health plan Wrong diagnosis; wrong treatment plan Errors of execution - Failure of a planned intervention - Failure to complete an action as intended - Variations from the standards of care Errors can represent a system failure or failure by one or more members of the health care team regulatory agencies Oversight bodies in place to ensure health care quality: Centers for Medicare and Medicaid Services The Joint Commission Advisory Bodies The Institute of Medicine The National Quality Forum The National Database for Nursing Quality Indicators The National Center for Nursing Quality Nursing-specific advisory bodies Formal Process -define errors -identify risks -develop and test prevention strategies -implement and adopt strategies Failure Mode and Effects Analysis (FMEA) a systematic process for identifying potential design and process failures before they occur, with the intent to eliminate them or minimize the risk associated with them -define the problem -analyze causes -identify solutions -evaluate the results Quality plans and philosophies Plan-do-study-act leapfrog group Health Information Technology Enables the use of data to track performance against benchmarks. Coordinates the care and multidisciplinary teams. Translates new evidence into practice. interrelated concepts of health care quality Health policy Health care economics Health care organizations Safety Technology and informatics Swanson's Theory of Caring knowing, being with, doing for, enabling, maintaining belief Knock Before Entering Dangerous Mansions shared governance model of organizational decision making premised on a decentralized organizational structure in which staff nurses are empowered through autonomy and accountability This structure creates an environment in which managers and staff become more actively involved in making decisions to shape the identity and determine the success of a health care agency. Working in a decentralized structure has the potential for greater collaborative effort, increased competency of staff, increased staff motivation, and ultimately a greater sense of professional accomplishment and satisfaction Time-sensitive indicators that are relevant in the acute care setting healthcare provider's orders medication administration treatments patient data interpretation knowledge recall about patient conditions ,triaging or ranking of patient risks Prioritization begins with determining immediate threats to life as part of the initial assessment and is based on the ABC pneumonic focusing on the airway as priority, moving to breathing, and circulation