Quality improvement assumes that? - ANSWER-Most problems with service delivery resilt from process difficulties, not individuals.
*QI starts with the
... [Show More] assumption that erros occur as a result of system failures, not individual errors.
The term "quality" as used in quality improvement usually refers to? - ANSWER-Characteristics of a product or service that bear on its ability to satisfy stated or implied needs
*Quality rests on the ability to satisfy customer needs
Three major differences between traditional "quality assurance" (activities like keeping track of total number of different procedures conducted in your practice, rates of adverse outcomes) and "quality improvement" activities is that quality improvement also focuses on? - ANSWER-Systems and processes
*rather than individuals and products
Effective quality improvement does not require? - ANSWER-An increased emphasis on inspection of individuals' work
A leadership style that is sad to motivate employees and that optimizes the introduction of change is? - ANSWER-Participatory- An approach where leaders interact with other participants as peers, engaging them in the decision- making process and playing an equal role in the process as others and jointly carrying out the problem solving activities
What representatives of a CV practice should be included on a quality improvement team to implement a new practice? - ANSWER-All staff directly affected by the quality improvement practice to be implemented
When is it appropriate to collect and use data? - ANSWER-Before the QI project, to prove problem exists
During the QI project, to answer questions about the cause and help prioritize the implementation of improvements
After the implementation of the improvement to maintain the gain
A concern that would be best solved by a QI team? - ANSWER-A financial variance in cost per left heart cath procedure over the past 6 months
*Substantial variation in cost for a procedure is a problem that directly affects customers and could have implications for organizational processes. It is an ideal concern for a QI team to handle
The first step in problem solving is to? - ANSWER-Define the problem issue
After assessing current work flow and processes, a clinical team presumes that a delay can occur anywhere along the process of their tasks. Data is inadequate at this point to identify a particular time of day, day of week, type of patient, or step in the process that is largely responsible for the delays. Further data collection is necessary. What should the team "product" be for the next meeting? - ANSWER-A list of questions to be answered and a draft data collection tool
As a building block for determining whether or not quality has been improved, the use of basic descriptive statistics in applying QI is critical. What is not strictly quantitative description of the basic features of a study? - ANSWER-Hospital ratings
Two statistics essential for identifying opportunities for performance improvement? - ANSWER-Variance and distributions
Comparisons of your data against the top performers in your region describe the process of? - ANSWER-External benchmarking
Benchmarking creates objective measures of performance that are based on? - ANSWER-Past performance targets within an organization
Performance of a competing external organization
Some external universal performance target established by the industry
What quality tools would be most useful for identifying a problem in a process that could benefit from a quality improvement strategy? - ANSWER-Flow Chart
A patient has terminal illness. Against the family's wishes, the patient requests a DNR order. What ethical principle supports the patient's decision? - ANSWER-Autonomy
What ethical conflict places the equitable access to health care against actions that produce the greatest good? - ANSWER-Justice versus utilitarianism
4 strategies that promote staff empowerment are adopting a shared vision, team building, relinquishing administrative control and? - ANSWER-Rewarding performance that adheres to high standards
The nurse executive is the chair of a new performance improvement team whose purpose is to address patient flow through the ER. A laboratory team member openly blames ER nurses for a long turnaround time in obtaining patient test results. To which phase of group development does the nurse executive attribute the blaming behavior? - ANSWER-Storming- refers to the conflict-ridden stage of team development
*forming- the team is brought together
*norming- team members begin to resolve differences
*performing- team members begin to obtain results
The nurse executive develops a balanced scorecard for nursing practice by emphasizing? - ANSWER-Internal and external benchmarks
A nurse executive sponsors a multidisciplinary team that is charged with educating patients scheduled for total joint replacement surgery about topics including what to expect after discharge. What is the nurse executive's response when encountering resistance from team members? - ANSWER-Gather together the various disciplines and listen to their concerns about the project
The nurse executive receives notice that critical supplies have not arrived before a three day holiday weekend. Due to a computer system error, "just in time" supplies were not queued for delivery. The nurse executive's next action is to? - ANSWER-Contact the materials manager to expedite the delivery of supplies before the end of the work day
What is the primary purpose of a policy, as opposed to a procedure? - ANSWER-A policy is broad and durable, designating actions for matters that frequently recur
A 14-year old female patient who is a Jehovah's Witness is admitted for anemia. The DR determines that blood transfusions are necessary, but the patient's parents refuse consent. The patient states she wishes to be treated, the advanced practice nurse action is to? - ANSWER-Contact local clergy for assistance in crisis intervention
What statement is an outcome indicator for an educational strategy? - ANSWER-The patient named all medications to be taken after discharge
The data obtained for quantitative research would best be used for what purpose? - ANSWER-To predict future clinical outcomes
Research suggests that a nurse executive most effectively improves employee job satisfaction by? - ANSWER-Increasing staff autonomy
The first step in remedial action program for an employee whose clinical performance does not meet standards is to? - ANSWER-Determine whether the problem is related to a lack of competency or a lack of productivity
A committee in a large urban hospital is appointed to plan improvement in patient care. The committee members include the? - ANSWER-Medical, nursing, and ancillary staff personnel
Describes examples of patient safety barriers? - ANSWER-Persistent fear and hierarchical authority
Complexity and deficient measures
Diffuse accountability and lack of leadership
If data plotted over time, the resulting chart will be? - ANSWER-Run Chart
Before selecting a vendor of a particular healthcare equipment or supply, the masters prepared nurse should? - ANSWER-Define departmental needs
What is a priority for the MSN in planning quality improvement training? - ANSWER-Connecting training to organizational needs
To be effective, quality initiatives must be? - ANSWER-Developed by stakeholders
An integral part of the overall organizational strategic plan
What is NOT an appropriate goal for quality improvement education of MSN's? - ANSWER-Define the chain of command for approving quality procedures
In what order are the training design steps? - ANSWER-Establish consensus on needs
Define training objectives
Determine course structure and sequence
Prepare training materials
An MSN wants to implement Leadership Rounds in the hospital to include participation of the CEO. This initiative would provide an informal way for senior leaders to talk with front line staff about safety issues in the organization and to encourage reporting of errors. What is not a benefit of having the CEO involved in these rounds? - ANSWER-Improved dissemination if information throughout the organization
In order to be successful in the role of change agent, an MSN should do all but what? - ANSWER-Communicate change initiatives only to senior management
What is first priority when starting a quality improvement initiative ? - ANSWER-Identify an aim
An advantage of team decision-making? - ANSWER-Increased acceptance of decisions
The wide scale collection of patient weight into a large dataset is primarily used to measure and improve healthcare for what type of group? - ANSWER-Population health
A PCP refers a patient to a specialist. The specialist treats the patient then sends the patient with a report back to the PCP. A manual system was used in this referral process. What statement about manual process is true? - ANSWER-Often involve no agreement on who is responsible for closing the loop (ensuring information is exchanged provider to provider)
A patient's right to make informed decisions does NOT include? - ANSWER-Right to receive care that is not medically necessary
An MSN manager is trying to meet the Meaningful Use Requirements for a newly implemented EHR system for the practice. She is behind on her work. What approach is best for solving this problem? - ANSWER-Meet with the medical director of the practice, explain the situation and request additional short-term help since the deadlines for attestation and reporting periods in this incentive program are fixed
Based on patient survey data that indicate patient's were dissatisfied with the level of noise on the patient care unit, the QI team had recommended the use of a sound machine in each patient room to muffle the ambient noise on the unit. How should the MSN respond to this recommendation? - ANSWER-The MSN should search the literature to confirm that the recommendation is evidenced-based
Historically, what group is closely aligned with the financial success of healthcare organizations and therefore is designated the leader for most clinically-based innovations? - ANSWER-Physicians
By focusing on the patient, we can achieve the IHI Triple AIM. The Triple Aim is simply stated to create? - ANSWER-Better outcomes, great patient experiences and reduced costs
An MSN needs to assign a staff member to assist a medical director in the development of a quality program for a newly established service. What staff member is most appropriate for this project? - ANSWER-A competent staff member who has good interpersonal skills
A surgeons wound infection rate is 32%. Further examination of what data will provide the most useful information in determining the cause of the surgeons infection rate? - ANSWER-Use of prophylactic antibiotics
Pharmacy and nursing are having difficulty developing an action plan for medication errors. Pharmacy services states that nursing services cause the majority of the problems related to errors while Nursing Services states the opposite. The QI department's role in resolving this problem is to? - ANSWER-Facilitate discussion between the groups to enable them to assume ownership of their portions of the problem
Most likely to be a benefit of concurrent ambulatory surgical case review? - ANSWER-Decreased medical record review at discharge
A well-designed patient safety program should NOT include? - ANSWER-An annual patient safety committee meeting
Discharge planners regularly monitor the number of inappropriate referrals, the timeliness of discharge planning and the number of days of discharge delays. What additional monitor should be added to evaluate the appropriateness of discharge planning interventions? - ANSWER-Attainment of discharge planning goals
A primary purpose of an information management system is to allow an organization to? - ANSWER-Evaluate data
What monitors provide patient outcome information? - ANSWER-Health-acquired infection rate
Flowcharts are primarily used in quality improvement to? - ANSWER-Understand the overall process or system being audited
What QI goal is most effective for the QI team to use? - ANSWER-The pt satisfaction score will be 95% by December 1st
* this provides additional piece of information that is important in setting SMART goal (specific, measurable, achievable, relevant, time bound)
Aka a goal without a deadline is just a dream
Based on observation, an NP believes that the rates of smoking and obesity are increasing in their patient population and wants to implement a program to address this issue in the ambulatory clinic. What is the first step the NP should take to determine if this belief Is in fact a trend? - ANSWER-Work with the practice manager to determine rates of smoking and obesity in the practice
The wide scale collection of patient weight into a large dataset is primarily used to measure and improve healthcare for what type of group? - ANSWER-Population health
The nurse administrator reviews longitudinal hospital-based data regarding nurse staffing and nurse-sensitive patient outcomes. The data reveal that patient outcomes related to the development of pressure ulcers are better when the nurse to patient ratio is one nurse to four patients compare to one to six. What should the nurse administrator do with these data? - ANSWER-Develop a recommendation for changing the nurse to patient staffing ratio
A nurse has been asked to help design an individualized teaching plan for a patient who has been recently diagnosed with multiple sclerosis, what information must the nurse obtain in order to accomplish this? - ANSWER-The patient's current level of knowledge about the disease
Clinical leadership in a large healthcare system is committed to assisting patients to engage in healthy lifestyle behaviors. The team is determining the need for a weight loss support program at one of the clinics. What information is required in order to determine the need for such a program? - ANSWER-The % of patient's who are overweight and have expressed interest in losing weight
What role should an infection control nurse have in a WI program of decreasing CLABSI rates? - ANSWER-Determine if this is a worthy QI program for the patient population along with the QI personnel
A nurse serving as a member of an EBP team has noticed that another EBP team member rarely speaks during the teams meetings. What is the responsibility of the nurse to this EBP team member? - ANSWER-Encourage the team member's participation in meetings
An APN wants to manage long term ventilation patients according to EBP guidelines, what two variables should the nurse evaluate in order to determine if a change has been beneficial to patient's ? - ANSWER-Length of ICU stay and duration of ventilation
An advanced practice nurse discovers that the peds clinic she works in has started using super glue instead of dermabond for lacerations on children who have no insurance and for those whose insurance yields poor reimbursement of dermabond. How could the nurse advocate for the patient? - ANSWER-Identify medically sound but less costl [Show Less]