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Quality Improvement in Nursing Practice
Terms in this set (31)
Why focus on improving healthcare quality?
1. Quality of healthcare varies (social, economic, geographically boundaries)
2. Only half Americans recieve recommended care
3. Disparities exist (racial and ethnic minorities)
4. A lot of spending in health care is wasteful and doesn't really help the patient
5. Med errors (third leading cause of death in USA)
Joint Commission are what?
Independent Not-for-profit organization that provides Accreditation for Hospitals
part of medicare funcding
third party, they are tasked with seeing if hospitals are eligible for medicare? - they have national safety goals, and if the hospitals don't meet the goal and they wont certify them and medicare wont reimburse them for care and stuff (b/c medicare needs the hospital to have certification in order to reimburse them)
LeapFrog Hospital Safety Grade, Hospital Survey is what?
1. They pull data from hospital, make it public, and give the hospital a grade (using hospital compare data, and breaking it down to an ABCDE level)
2. The hospital benefits from the participation in leapfrog
QSEN is what?
Quality and safety education for nurses
1. gives us a guidance
2. Focus on patient centered care, EBP, teamwork and collaborating, quality improvement, safety and informatics
Nursing Profession places a very big emphasis on ________
American Nurses Association gives us what?
1. Our code of ethics
2. The nurse participates in establishing, maintaining and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action.
Define: quality management (QM)
Hospitals idea of quality
Defining healthcare culture
Define: quality improvement (QI)
Engaging in this ongoing process of
Prevention of error
Used by institutions for quality management?
involved in this process that is there to help prevent errors
Define: performance improvement (PI)
Ensuring conformity of a standard (e.g. washing hands)
What does quality management encompass?
- the resources and organizational arrangements are in place to deliver care
-Facilities, equipment, staff, finances
-Example: number of nurses per patient
- appropriate health care provider activities are carried out to deliver care
-Example: percentage of patients with asthma for whom appropriate medications
- the results of health care delivery
What does managing quality and risk entail?
Comprehensive systematic approach
1. Prevents errors before they occur (e.g. Enterprise Risk Management)
2. Identifies and corrects errors
-Adverse events are decreased
- Safety and quality outcomes are maximized
3. Optimizes patient outcomes
4. Prevents patient care problems
5. Mitigates adverse events
Standards of Quality Care
Nurse Practice Acts
Accreditation Standards (e.g., TJC National Patient Safety Goals)
Governmental bodies (e.g., Agency for Healthcare Research and Quality [AHRQ], National Quality Forum [NQF]; the National Institute for Occupational Safety and Health [NIOSH])
Healthcare advisory groups (e.g., Institute of Medicine [IOM])
Internal or external performance measurements (e.g., patient satisfaction surveys, employee opinion surveys, safety assessment surveys, patient rounds)
Institutional Guidelines (e.g., Policies and Procedures, Structure/Process Standards)
Research/Evidence-based practice guidelines
Before we can measure these things, we need what?
standards of quality of care
ANA Scope & Standards
Standards of Practice
1. Assessment, Diagnosis, outcomes, identification, planning, implementation & evaluation.
How do we measure quality?
1. Criterion or
Standard is determined
Standard predetermined level of excellence guide for practice, should be objective, measurable and achievable
2. Information is collected to determine if the Standard has or is being met. (audits)
3. Educational or corrective action is taken if the criterion has not been met.
- end result of patient care
- how nursing care is provided
- includes resources inputs, environments, staffing ratios, staffing mix availability of supplies, technology
What is Benchmarking?
- Way of Comparing and measuring products, practices, services against best performing organizations.
Quality Gap- ??
Comparison of QA and QI:
: Improve quality
: discover/correct errors
: Inspect nurse activities; chart audits
: QA department
: set by QA team with input from staff
Comparison of QA and QI:
: Improve quality
: prevent errors
: Review nurse activities; innovation; staff dev.
: intraprofessional team
: set by QI team with input from stand AND patients
Principles of Quality Management
1. Works best with Flat, democratic Organization structures
2. Managers and workers must be committed to quality improvement
3. The goal of quality management is to improve systems and process not to assign blame.
4. Customers Define Quality
5. Quality improvement focuses on outcomes
6. Decision must be based on data.
Public reporting and transparency
: A healthcare institution (e.g., a hospital) reports the results of a standard to an external body, such as a state or federal agency. The state or federal agency then shares the data with the public so that consumers can compare results across institutions and over time.
Example: Centers for Medicare & Medicaid Services (CMS) Hospital Compare website
Examples of Accountability Measures
-Accountability Measures on Consumer Assessment of Healthcare Providers and Systems (HCAHPS):
Heart Attack Care
Heart Failure Care
Children with Asthma Care
Inpatient Psychiatric Services
VTE (Venous Thromboembolism) care
Pay for performance
: Healthcare institutions are judged by their performance on certain standards and are rewarded financially based on the quality of care that they provide. ( e.g. CMS stops reimbursing hospitals for certain preventable conditions)
Steps in Quality Improvement Process (Cycle)
Identify needs of consumer
Assemble interprofessional team
Establish outcomes and quality indicators
Develop and implement plan
*Similar to a PDSA
Steps in Quality Control Process
-The Criterion or Standard is Determined
-Information is collected to determine if the standard has been met.
Audits : Outcome, Structure, Process
-Educational or corrective action is taken if the criterion has not been met.
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