Quality Improvement – Flashcards
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What is quality?
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Degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge
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Nurses can provide high-quality care by participating in _____ and _____.
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quality improvement and quality management
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What is quality improvement?
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systematic and continuous actions that lead to measurable improvement in healthcare services and the health status of targeted patient groups
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What are some examples of quality improvement?
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using advance directives following privacy laws striving to reduce errors
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What is quality management?
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evaluates medical and nursing processes for quality and effectiveness compared to accepted standards in order to correct problems before they are clients and to prevent errors in treatment aims to provide cost-effective care by preventing overuse, misuse, and underuse of medical resources
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Quality improvement affects what?
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physiological outcomes legal and ethical issues - clinical trials require legal consent and researchers must confirm that new treatment is ethical informatics system - to accurately record a client's medical history and results of diagnostic tests
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How can healthcare quality be improved?
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properly using advance directives following privacy laws striving to reduce errors
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What are the six aims for improving the healthcare system?
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safe effective patient-centered timely efficient equitable
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What are federal initiatives aimed at quality improvement in healthcare?
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US department of health and human services (USDHHS) American Medical Association American Nurses Association
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What are some programs and documents that aim to collect and provide data that identify areas for improvement?
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national database of nursing quality indicators Patient safety and quality (an evidence-based handbook for nurses) National patient safety goals (by the joint commission)
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What is the patient protection and affordable care act (PPACA or ACA)?
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changes implemented between 2010 and 2020 to make healthcare affordable for all Americans
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What is the national strategy for quality improvement in health care?
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- better care: improve the overall quality by making healthcare more client-centered, reliable, accessible, and safe - Healthy people/healthy communities: improve the health of the US population by supporting proven interventions to address behavioral, social, and environmental determinants of health in addition to delivering higher-quality care - Affordable Care: reduce the cost of quality health care
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What are the six priorities the National Quality Strategy focuses on?
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1) make care safer by reducing harm caused in the delivery of care 2) ensure that each individual and family is engaged in their care 3) promote effective communication and coordination of care 4) promote the most effective prevention and treatment practices for the leading causes of mortality 5) work with communities to promote wide use of best practices to enable healthy living 6) make high-quality care more affordable for individuals, families, employers, and governments by developing and spreading new healthcare delivery models
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What does the ACA offer to states to help with affordable care?
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States can implement basic health programs, such as community health centers, for low-income adults and legal immigrants to provide at least the minimum essential benefits under the ACA
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Where does funding for state and local health programs come from?
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federal and state taxes
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What are the four regulations of community health centers (CHCs)?
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1) serve a medically underserved area or population 2) provide comprehensive primary care (medical, dental, eye care, preventative and diagnostic services, education, translation services) 3) adjust fees and changes based on the client's ability to pay 4) governed by a board on which over half of the members are clients at the CHC
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Why must the CHC board consist of clients at the CHC?
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to keep the health center accountable to the population
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What do community health centers provide?
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high-quality care to uninsured and underinsured services (regular checkups, preventive services, as needed care) at a reduced cost
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Quality improvement is a _____, ____, ______ process.
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continuous, multistep, multilevel
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Quality improvement analyzes current ______ and their associated _______.
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protocols; outcomes
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How does benchmarking work?
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Compares outcomes to leaders in high-quality care by: - identifying areas for improvement - researching factors that contribute to better outcomes - implementing changes to improve outcomes - analyzing client outcomes to determine effectiveness of change
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What is performance improvement?
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when quality improvement is directly linked to the performance of an individual, team, unit, or organization
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What is an intradisciplinary assessment?
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an assessment within a group of individuals who have similar positions within a healthcare system
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What is an intradisciplinary assessment important for?
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identifying areas of improvement at each level of care
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What are some things used for intradisciplinary and interdisciplinary assessments?
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peer reviews audit outcomes management
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What are peer reviews?
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professional critique a colleague's work based on predetermined standards
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How do peer reviews relate to nursing?
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nurses assess other nurses in a safe environment and can analyze complicated cases
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What is an audit?
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an examination of financial or medical records to verify accuracy and proper use by focusing on one (interdisciplinary) or multiple (interdisciplinary) disciplines
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What is a retrospective audit?
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performed after a client's discharge and evaluates the care provided to the one client with care provided to clients with similar conditions, and recommendations made to change procedures
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What is a concurrent audit?
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Performed while the client is still undergoing care and is used to evaluate adequacy of the nursing care and to determine if desired outcomes are being met
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What is outcomes management?
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it uses client experiences to guide improvement in all areas of healthcare by providing a link between medical interventions and health outcomes and between health outcomes and cost of care
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How does outcomes management work?
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implements evidence-based practices guides case decision making incorporates better and more efficient clinical management provides information to improve services evaluates area for improvement and analyzes areas of excellence (factors that contribute to success or failure) PROMIS
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What is patient reported outcomes measurement information system (PROMIS)?
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collects information from clients to measure their health status in the areas of physical, mental, social well-being
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What is an interdisciplinary assessment?
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collaborate with multiple disciplines using efficient communication, coordination, and integration of care
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What is a utilization review?
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analyzes the use of resources to identify areas of overuse, misuse, and underuse
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What is benchmarking?
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A method used to compare the performance of an individual or organization to industry standards
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What is the Donabedian Model?
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standards usually relate to structure, process, and outcome
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What are structure standards?
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relate to material resources, human resources, and general organizational structure focus on the organization's capacity and systems for providing care
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What is process standards?
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focus on steps used to lead to particular outcomes used to determine if a set of steps exists and if those steps are being followed
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What is outcome standards?
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focuses on performance of a process
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Benchmarking uses indicators, or _______, that reflect the organization's ________ in a specific area, to compare to the quality of care within the organization to industry _______.
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statistics; performance; standards
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Indicators, or statistics:
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must be measurable objective sensitive to changes in performance generic or specific standards of care as state by ANA, specialty organizations, or the unit implementing quality improvement strategies
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What are sentinel events?
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An unexpected occurrence involving death or serious physical or psychological injury (loss of limb or function), or the risk thereof (any process variation for which a recurrence would carry a significant chance of a serious adverse outcome)
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What are the goals of responding to sentinel events?
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positive impact on client care prevent sentinel events understand factors that contributed to the event increase knowledge about sentinel events maintain confidence of the public
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What is the response to sentinel events?
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Root cause analysis developing a plan to reduce future risk implementing improvements monitoring effectiveness of improvements
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What is a breach of care?
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when a nurse deviates from the standard of care
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How do we reduce risks of breach of care?
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reporting problems to supervisors remaining current on skills and education basing all care on nursing process model documenting every step of the nursing care plan and client's responses
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What is risk management?
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vulnerabilities that are identified and changes made to minimize the consequences of adverse patient outcomes and liability proactive and reactive components
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What are some methods used to improve the quality of care?
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Root cause analysis reduce medication errors staffing practices in nursing resource utilization blame-free environment personal responsibility implementation of new protocols evaluation and efficacy of new protocols
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What is root cause analysis?
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problem solving to identify the root cause of faults focuses on systems and processes and analyzes both special causes and common causes
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What are some methods to reduce medication errors?
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double check the six rights have a second nurse check the medication order check known allergies avoid disruptions and distractions verify tubing placement document and understand interactions among all medications do not combine medications with the same active ingredient check a child's weight to ensure correct dosing consult with the client's physician if unsure about an order maintain a current resource to reference for drugs provide thorough education to clients about medications
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How do staffing practices in nursing improve quality of care?
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the quantity and quality of nursing staff are reflective by nursing-sensitive indicators
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How does resource utilization improve quality of care?
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reduce waste, including unnecessary or inefficient services, prices that are too high, excess administrative costs, missed prevention opportunities, and medical fraud
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How does a blame-free environment improve quality of care?
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healthcare providers can report errors or near misses without fear of punishment just culture
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What is just culture?
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attempts to balance the blame-free environment with appropriate accountability by focusing on correcting problems that lead individuals to engage in unsafe behavior while maintaining individual accountability by establishing zero tolerance for reckless behavior
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How does personal responsibility improve quality of care?
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each nurse or student must know the procedures in the facility
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How does implementation of new protocols improve quality of care?
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education about the importance of the new process, the steps involved, and associated reporting procedures
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How does evaluation of efficacy of new protocols improve quality of care?
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by quality assurance - the process of collecting data related to a problem and then analyzing the data based on benchmark standards to determine if standards are being met
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What do quality management programs include?
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information about current practices and outcomes, and accountability for those overseeing and performing client care comprehensive quality management plan
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What is the comprehensive management plan?
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used to help healthcare facilities integrate new programs, models, and technologies
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What does the comprehensive management plan address?
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needs of engagement population health value
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What does comprehensive look at?
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clinical-, managerial-, administrative, and facility-related aspects of the organization
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What are the four quality management programs?
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Total quality management continuous quality improvement six sigma lean six sigma
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How does total quality management (TQM) improve quality?
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improves quality and productivity by utilizing data and statistics to improve systems processes
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What is involved in TQM?
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communication feedback fact-based decision making a focus on continual improvement Plan-Do-Study-Act
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What is the plan do study act (PDSA) of TQM?
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planning: define goal, collect data, outline strategy do: implement plan study: outcomes of do phase are analyzed and compared to expected outcomes act: team must decide if the goal was met, plan further changes, and decide if goal is attainable
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What is the continuous quality improvement (CQI)?
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structured organizational process for involving personnel in planning and executing a continuous flow of improvements to provide quality care that meets or exceeds expectations - emphasizes system errors
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How does CQI work?
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apply to a specific problem development and implementation of policies and procedures resource utilization or implementation of evidence-based practices
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What is Six sigma?
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reduce variation within a process to produce a near-perfect product DMAIC or DMADV
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What is DMAIC or DMADV?
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define, measure, analyze, design, verify Define the problem, determine a goal, and form a team to address the problem measure: obtain data related to the current process, the problem, and the desired goal analyze: look at the data to determine cause-and-effect relationships related to the problem improve: develop solutions to problems and implement those solutions control: implement measures to sustain positive changes and continuously monitor the process to ensure goals are being met
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What is the lean six sigma?
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combines strategies of six sigma with the lean system lean system: eliminates waste to maximize value used to produce waste and provide consistency in the quality of care
