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
List the five things that trust, empowerment, and accountability all share together
- shared goals
- clear expectations
- open feedback
- future orientation
- Learning focus
List the three reasons why we measure quality
- It drives improvement
- Inform consumers
- Influence payment: pay for performance
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)
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
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
What is its goal?
- Transforming Care at the Bedside (TCAB):
- - engages leaders, empowers staff and enlists patient/family in decisions to improve care
What is DMAIC?
- Define: problem
- Measure: current state
- Analyze: root causes
- Improve: Implement the solution
- Control: measure the impact and establish control plan
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
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
List collaborative process of case management
What cost effective things do case managers look for in patients?
cost effective tx, providers, and care setting
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
What does it mean when a patient is a variance?
Anything that takes the patient away from the critical path MAP (multidisciplinary action plan).
Which cyclic model is this:
- Identify area for improvement
- Outline sequence of activities to solve problem
- Impliment them
- Evaluate, and repeat if problem continues
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
Which cyclic model is this?
- Plan the change or test
- Do carry out the plan
- Study summarize what was learned
- Act on the recommendations
What is this term:
Identifies organization's constituency and position regarding ethics, principles and standards of practice.
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
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
What are the 5 quality drivers that all lead to quality initiatives?
- 1. reimbursement
- 2. Mission/vision
- 3. regulatory
- 4. outcomes
- 5. Professional Organizations
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
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