47 terms

Quality Improvement Chapter 7, 8 and 9 Combo

Four core processes
TEST (Name the four core process involved in care, treatment, and service to patients)
1 - Assessing the patient's needs
2 - Planning care, treatment, and services
3 - Providing care, treatment, and services
4 - Coordinating care, treatment, and services
1 - Assessing the patient's needs
Initial assessment determines the patient's appropriateness for admission to the facility and the level of care to be rendered
Assessing the patient's needs
- Physical, psychological, and social assessment
-- addictions, abuse, pain
-- H&P within 24 hours of admission (or 30 days prior)
-- Nursing assessment within 24 hours
- Nutrition and hydration status
- Functional status (activities of daily living)
- Social, spiritual, and cultural variables
2 - Planning care, treatment, and services
Establishment of an interactive, written care plan based on previous assessments
3 - Providing care, treatment, and services
The care pathway defines the specific treatment and its timing and frequency
- core measures monitoring program
- Patient's status is continuously monitored for signs of stabilization, improvement, or destabilization
- Labs, radiology, pharmacy, dietary, nursing, and therapy
- Patients and families should be involved
4 - Coordinating care, treatment, and services
There is a defined process in the healthcare facility to receive and share patient info when the patient if referred
-- Primary care provider
-- Community resources, i.e. home health
-- Family or friends
-- Rehab and long-term care settings
Prevent duplication of services
Inform patient of what to do when discharged, i.e. activity, medications, weight, sex, diet
Optimizing patient care
Step 1 - Conduct patient care outcome reviews
Step 2 - Conduct eval of seclusion, restraints, and protective devices
Step 3 - Conduct eval of lab services and use of lood products
Step 4 - Conduct eval of medication system & process
Step 5 - Conduct policy, procedure, and docuemntation review
Step 6 - Eval standards of care and caer pathways
Step 1 - Conduct patient care outcome reviews
Improve safety and outcomes by collecting data
Step 2 - Conduct eval of seclusion, restraints, and protective devices
Behavioral management procedures
- Denial of food, shelter, clothing, restraints, etc
-- The use of restraints involves an increased risk of client deaths
Non-behavioral use of restraints
- Use of restraints based on patient's needs
- Use least-restrictive
- Safe application
Ordered by licensed independent practitioner
- written or verbal order within 12 hours
- examined with 24 hours
- monitored at least every 2 hours
Limit orders to 4 hrs > 17, 2 hours 9-17, 1 hours <9
Step 3 - Conduct eval of lab services and use of lood products
Two patient identifiers are used when administering blood products
- patient to blood product; blood product matched to order
- One person must be qualified transfusionist
Step 4 - Conduct eval of medication system & process
One of the most complex healthcare processes
Step 5 - Conduct policy, procedure, and documentation review
Policies are updated and revised as national standards of care and NPSGs change.
Poor documentation leads to the largest number of risk management and legal situations in the industry
Step 6 - Eval standards of care and caer pathways
Standards of care and clinical practice standards
- model defines practice based on diagnosis
- variation, sentinel events, and high-risk activities must be examined
National Patient safety Goals (NPSGs)
Identify patient correctly
Improve staff communication
Use medications safely
Prevent infection
Give med list to next provider/next of kin
Prevent bed sores
National standardization of health care
Clinical guidelines
Critical pathways
Evidence-based medicine
P4P initiatives
Hospital Quality Initiative
Physician Quality Reporting
OASIS in home health care
MDS for Long-Term Care
HEDIS (Health Plan Employer Data and Information Set)
Measures quality, access, membership, utilization, and financial performance
Continuum of Care
- Perform preadmission planning
- Perform care planning at the time of admission
- Review the progress of care
- Conduct discharge planning
- Conclude postdischarge planning
Step 1 - Preadmission care planning
- PCP contacts a healthcare organization to schedule an episode of care service
- Case manager reviews the patient's projected needs
- Admission criteria are established on the basis of a suggested diagnosis
- Case manager may contact the patient or the patient's payer for preauthorization
Step 2 -Perform care planning at the time of admission
- Case manager confirms that the patient meets the admission criteria
- Case manage confirms that the patient requires services that can be performed at the facility
- Case is assigned ot the appropriate critical pathway
Step 3 -Review the progress of care
- Case manager compares the patient's progress with the pathway
- Case manager plans with the patient, the patient's family, and the clinical team, the services the patient will need after discharge
Step 4 - Conduct dicharge planning
- The patients continued care after discharge is planned
- A detailed list of current medications is forwarded to the next provider
Step 5 - Conclude postdischarge planning
Case manager conveys information about the patient's course of treatment to the clinicians who will continue to care for the patient
Case management (112)
Optimizes the patients continuum of care
Community of needs assessment (112)
Identify the community's characteristics as a healthcare client, and assess that set of clients by collecting and analyzing information about the community needs.
Continuum of care (106)
The emphasis is treating individual patients at the level of care required by theur course of treatment.
- The overall goal of the U.S. healthcare system is to achieve equilibrium between healthcare and spendiing
- At some point for every patient within the healthcare system, no additional benefit would be achieved by further spending
- Regulatory approaches seek to control expenditures on individuals who cannot benefit from them and spend the monies on patients who can benefit.
Critical pathway (112)
An outline of anticipated care within an appropriate tiemframe to aid the patient inmoving progressively through a clinical experience that ends in a positive outcome.
Gantt chart (119)
Divide a horizontal scale into days, weeks, or months and a vertical scale into project activities or tasks
Indicator (118)
A performance measure that enables healthcare organizations to moitor a process to determine whether it is meeting requirements
Case managers
Work with physicians and hospital employees to ensure that the care ordered was appropriate to the diagnosis and that it was payable under the insurance policy
Real life Example
- Patients were admitted for care when they could have recieved appropriate care in a less intensive setting
- hospital stays were continued when the patient could have receive appropriate care in a less intensive setting
- Families were not involved
- Insurance carriers were denying claims that had not been preauthorized
- Health records contained inadequate documentation
Criteria that has been developed by many of the same agencies for use across the continuum of care and in various regions of the country
Core measure criteria
All except diabetes mellitus
Standards of care
Clinical guidelines
Clinical pathways
Clinical standards
Standard precautions
Proper handwashing
Most important means of preventing infection
Healthcare associated infection
Community-acquired infection
JC manages NNIS
False, CDC Divison of Healthcare Quality Promotion does
Performed by humans
Evaluate the process
Double walled rectangle
Carried out the same way each time
Obtuse Rectangle
Record in computer or paper-based
Process icon
Skips to another common point of the process