Quality Control and Case Management

  1. Nursing roles in quality  (5)
    • Pivotal (leadership)
    • Active engagement and understanding
    • Collaboration and integration of care
    • Error prevention / patient safety advocates
    • Professional practice models / shared governance
  2. List the five things that trust, empowerment, and accountability all share together
    • shared goals
    • clear expectations
    • open feedback
    • future orientation
    • Learning focus
  3. List the three reasons why we measure quality
    • It drives improvement
    • Inform consumers
    • Influence payment: pay for performance
  4. What are the three kinds of audits?
    • Outcome: pain management - tolerance met?
    • Process: looks at how the procedure was done (related to quality of care) 
    • Structure audit: how environment influences on care (structures within)
  5. List deming principles of management principles (bolded)
    • 1. Adopt philosophy of continual improvement
    • 2. Improve processes: cease dependence on inspection only
    • 3. Minimize total cost by working with a single supplier
    • 4. Drive out fear = just culture
    • 5. Foster inter-department cooperation
    • 6. Promote team work: eliminate annual rating or merit system
  6. List cyclical processes of CQI model (3)
    After the 3 processes are over, what do you do last?
    • 1. Identify area for improvement
    • 2. Outline sequence of activities to solve problem
    • 3. Implement them

    • After: Evaluate by determining if problem is solved.
    •  - If not, repeat cycle
  7. What TCAB?
    What is its goal?
    • Transforming Care at the Bedside (TCAB): 
    •  - engages leaders, empowers staff and enlists patient/family in decisions to improve care
  8. What is DMAIC?
    • Define: problem
    • Measure: current state
    • Analyze: root causes
    • Improve: Implement the solution
    • Control: measure the impact and establish control plan
  9. What is TPS model?
    Toyota Production system: complete elimination of waste = LEAN

    • - uses most efficient production model
    •  - root cause analysis at event
    • - requires commitment of leadership time/resources and extensive prep with training staff
  10. What is six sigma model?
    • Another Lean approach for safety
    •  - grounded in measurement and statistical rigor to develop plans of action backed by data to improve a process
  11. List collaborative process of case management
    • assessment
    • planning
    • facilitation
    • advocacy
  12. What cost effective things do case managers look for in patients?
    cost effective tx, providers, and care setting
  13. What is required of a case manager in their roles?
    • Depends on organization and defined population served (dz management)
    • Requires ability to work across disciplines
    • Manage LOS, reimbursement
  14. What does it mean when a patient is a variance?
    Anything that takes the patient away from the critical path MAP (multidisciplinary action plan).
  15. Which cyclic model is this:
     - Identify area for improvement
     - Outline sequence of activities to solve problem
     - Impliment them
     - Evaluate, and repeat if problem continues

  16. List case manager qualitications
    How do you become nationally certified?
    • Usually a RN or social worker
    • Historically hospital trained
    • ANCC: RN license w/ 2 years CM exp. and 2000 hours in CM work and 30 hours/units of CM CE in the past 3 years
  17. Which cyclic model is this?
     - Plan the change or test
     - Do carry out the plan
     - Study summarize what was learned
     - Act on the recommendations

  18. What is this term: 
    Identifies organization's constituency and position regarding ethics, principles and standards of practice.
    Mission statement
  19. Match the standard to the example

    1. ANA - scope and standards  of nursing practice ___
    2. Benchmarking ____
    3. Patient safety and harm reduction ____
    4. Contemporary research leading to best practice (EBP and best equal care) ____

    a. Industry standards
    b. Clinical practice guidelines
    c. Professional practice standards
    d. Regulatory Standards
    • 1. ANA - scope and standards  of nursing practice __c. Professional practice standards__
    • 2. Benchmarking __a. Industry standards
    • __
    • 3. Patient safety and harm reduction __d. Regulatory Standards__
    • 4. Contemporary research leading to best practice (EBP and best equal care) __b. Clinical practice guidelines
    • __
  20. What does this 2002 initiate from the Joint Commission stand for: "SPEAKUP"
    • Speak up if you have questions or concerns
    • Pay attention to the care you get
    • Educate yourself about your illness
    • Ask a trusted family member or friend to be your advocate
    • Know what meds you take and why you take them
    • Use a health care organization that has been carefully checked out
    • Participate in all decisions about your tx
  21. What are the 5 quality drivers that all lead to quality initiatives?
    • 1. reimbursement
    • 2. Mission/vision
    • 3. regulatory
    • 4. outcomes
    • 5. Professional Organizations
  22. List the 6 TJC core measures (bolded)
    • 1. Tobacco tx
    • 2. PNA prevention
    • 3. Immunization
    • 4. HF
    • 5. CVA
    • 6. Hospital-based inpatient psych services
  23. What are the 2017 TJC patient safety goals (bolded) (7)
    • 1. 2 patient identifiers
    • 2. Med safety (labeling, med reconciliation, etc.)
    • 3. Infection prevention (hand washing)
    • 4. Identify patient safety risks; suicide prevention
    • 5. Team communication (test results going to the right staff)
    • 6. Responding to alarms in a timely manner
    • 7. Using a "time-out" during surgery
Card Set
Quality Control and Case Management