Upgrade to remove ads
Only $2.99/month

N444 Final

Terms in this set (110)

Health Policy
set course action taken by governments or healthcare organizations to obtain desired health outcomes
Private Health Policy
made by healthcare organizations such as hospitals and managed care organizations
public health policy
local, state, and federal legislation; regulation; and court rulings that govern the behavior of individuals and organizations in the provision of health care services
local health policy
Cities or counties offer a variety of health care services to meet the needs of their residents
examples of local health policy
free or reduced-rate immunizations, tobacco-free public buildings, safe drinking water, enforcement of seatbelt laws
State health policy
governs nursing through the nurse practice act
Provides invisible services through regulatory activities
Invisible services
maintains a safe meat supply through livestock inspections
ensures safe food storage
State Health Insurance Exchanges
set of state regulated and standardized health care plans from which individuals may purchase health insurance eligible for federal subsidies
Federal health policy
Funds health-related research
Funds education for health professionals, including nurses and physicians
Pays for health care through Medicare, Medicaid, SCHIP, and the Veterans Administration Health Care system
Plays a monumental role in shaping nursing practice
Federal policy that shaped nursing practice
nurse practice acts
sheppard-towner Act
Hill-Burton Act
medicare program
renal disease program
diagnosis related groups
Health Policy Development
Complex, dynamic process; occurs in various ways
Enactment of legislation and accompanying rules and regulations that carry the weight of law
Administrative decisions made by various governmental agencies
Judicial decisions that interpret the law
those involved in health policy development
elected officials
officials from government agencies
experts in the related area
stakeholders like corporate representatives
affected citizens
steps in the legislative process
introduction, committee action, house/senate action, presidential action
regulation
written set of rules issues by the government agency that has responsibility for administrating
the new law
regulation and health policy connection
interval between interim rules and final rules critical for assessing effect of the policy; concerted nursing action is required
Grassroots Political Strategies
-Registering to vote and voting in all elections
-Joining a professional nursing organization
-Working in candidates campaigns
-Attending a "meet the candidates" town hall meeting
-Visiting with policy makers or their staff
-Communicating with policymakers by email, fax, & phone
ANA organizational affiliates
American Nurses Credentialing Center
American Nurses Foundation
American Academy of Nursing
Specialty organizations such as the American Association of Critical Care Nurses
Nurses Strategic Action Team (N-STAT)
-Unifies nurses' political voices across the country to enact measures to enhance health care for all
-Empowers nurses by encouraging them to take action and make sure their opinions are heard and understood by Congress and the public
-Provides structure and coordination for nurses across the country to be involved in grassroots lobbying
Health Care Reform
refer to policy initiatives to effect significant changes in how health care is delivered and paid for
uninsured
50% have no regular source of health care
more likely to delay or ignore needed treatment
more likely to be hospitalized
The patient protection and affordable care act (PPACA)
-increases access & provides insurance protections such as elimination of co-pay for preventative services
- eliminates preexisting condition barriers
IOM future of nursing report
nurses should practice to the full extent of their education and training
-achieve higher levels of education
-be full partners with other health professionals
- require better data collection and information infrastructure
just culture
intersection of a culture of safety and accountability
components of a just culture
leadership committed to the goal of zero harm
organizational safety culture where all staff can speak up about things that would negatively impact the org
employs process improvement tools to address the improvement opportunities they find out and drive significant and lasting change
Quality Improvement
Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems.
culture
psychological safety
accountability
teamwork & communication
negotiation
Learning system
transparency
reliability
improvement and measurement continuous learning
Agency for Healthcare Research and quality (AHRQ)
federal agency
produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable
Institute of Medicine (IOM)
founded in 1970
AKA national academy of medicine
improve health by advancing science nationally and globally
7 key patient safety and quality reports
to err is human
crossing the quality chasm
health professions education
keeping patients safe
improving quality of health care for mental and substance use conditions
preventing med erros
future nursing
institute for healthcare improvement (IHI)
improve health and care worldwide
system w/o errors, waste, delay and unsustainable costs
National Quality Forum (NQF)
promote and ensure patient protections and healthcare quality through measurement and public reporting
The joint commission
improve healthcare for the public
highest quality and value
JACHO non for profit
deemed medicare and medicaid services
Quality and Safety Education for Nurses (QSEN)
addresses the challenge to prepare nurses with the competencies needed to continuously improve the quality of care in their work environments
QSEN competencies
Patient-Centered Care
Teamwork and Collaboration
Evidence-Based Practice
Quality Improvement
Safety
Informatics
Quality Assurance Process
improve quality
discover/correct errors
inspect nurse activities, chart audits
department personnel
set by QA team with input from staff
Quality Improvement process
improve quality
prevent errors
review nurse activities, innovation, staff development
interprofessional team
set by QI team with input from staff and patients
Comprehensive systematic approach managing quality and risk
prevents errors before they occur
identifies and corrects errors
optimize patient outcomes
mitigates adverse events
Swiss Cheese Model
Every step in a process has the potential for failure, to varying degrees.

Each layer is a defense against potential error impacting the outcome.
6 domains of health care quality
safe, effective, patient-centered, timely, efficient, equitable
safe
avoiding harm to patients from the care that is intended to help them
effective
providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit
patient-centered
providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions
timely
reducing waits and sometimes harmful delays for both those who receive and those who give care
efficient
avoiding waste, including waste of equipment, supplies, ideas, and energy
equitable
providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and SES
Standards of quality care
nurse practice acts
accreditation standards
governmental bodies
healthcare advisory groups
internal/external performance measurements
institutional guidelines
research or EBP
Continuous Quality Improvement & Total Quality Management Examples
leaders, managers and followers must be committed to QI
Goal of TQM is to improve systems not blame
customers define quality
CQI focuses on outcomes
Donabedian Model
steps in QI process
Identify needs
Assemble interprofessional team
Collect data
Establish outcomes and quality indicators
Select and implement plan
Evaluate
Fishbone Diagram
group
consists of two or more individuals who interact and are interdependent
team
group of people sharing leadership of and working together on a specific project
Effective team characterisitcs
small
all stakeholders represented
must be empowered to problem solve
comfortable in empowering teams
demonstrates commitment
provide organizational support
Communication barriers that impact team functioning
distractions
inadequate knowledge
poor planning
differences in perception
emotions and personality
leadership
promoting an atmosphere of trust where contributions are valued and consensus is fostered
transparency
patient safety problems aren't swept under the rug. team members have a high degree of confidence that the organization will learn from problems and use staff feedback to improve the system
faireness
people know they will not be punished or blamed for a system-based error
responding to adverse events
care for the patient
do not assign blame
remain objective
4 steps after an adverse event
care for the patient
communicate with the patient
report the event to appropriate parties
document in the medical record
4 components of an apology
acknowledgement
explanation
expression of remorse and humility
reparation
Second victim
caregivers need after an event:
early identification of suffering
provision of ongoing emotional support from peers
coordination of the institutions' overall event response to include gossip control
inviting members to be on the improvement team
benchmarking
the process of measuring the organization's products, services, cost, procedures, etc. against competitors or other organizations that display a "best in class" record.
benchmarking benefits
learning from other organizations
what they do right
replicating the process
avoid "reinventing the wheel"
measuring against the "best in class"
Key elements of benchmarking
using metrics
expressed numerically, with target in mind
organization compares its own performance against goal
comparing self to external competition
reduces chance of being caught off guard
encourages competition
staff buy-in more likely when they understand process
reasons to benchmark
orgs cultivate strong points and diminish problem areas
goals set from outside info
includes emulation/revision instead of innovation
probable, valuable knowledge can be established
Requirements for benchmarking
buy-in
training
timeliness
6 steps of the benchmarking process
decide what to benchmark
understand current performance
plan
study others
learn from the data
use the findings
success factors
strategy that defines how an org position itself and competes
expressed in mission or vision statements
decreased cost and improved efficiency
includes list of critical activities that must be accomplished to realize vision
types of benchmarking
internal
competitive
functional
generic
internal benchmarking
takes place within organization
good for different locations
competitive benchmarking
The comparison of an organization's processes with those of competing organizations; outside orgs gather and evaluate the data
functional benchmarking
compares org to an org in a different industry that has a similar metric or process
generic benchmarking
looks beyond data set
focuses on general processes
three types of gaps
negative
parity
positive
negative benchmarking
external processes may be much better than internal processes, calls for major approvement
Parity benchmarking
process preformance may be about equal, needs further investigation to see if improvement can be made
positive benchmarking
internal process may be better than outside organizations - deserves recocognition
Additional gap analysis
necessary to determine root cause
gaps come from process practices, general business practiceness, organized and operational structure
Development and Implementation of Action Plans
specify tasks
sequence tasks
determine resource needs
establish task schedule
assign responsibility
describe expected results
specify methods for monitoring results
challenges with benchmarking
best in class is a moving target
not the only answer
not helpful for processes that don't offer much opportunity
not helpful if leadership feels threatened by the results
Emergencies
sudden, unforeseen events that threaten health or safety
Disasters
Little or no warning
Initially overwhelm available personnel and emergency services
Combined threat to life, public health, environment
Mass casuality
> 100
Multiple casualty
2-100
Pandemic
infection that spreads rapidly around the world
Emergency preparedness
Plans to prevent, respond to, and recover from emergencies
Surge capacity
Ability to rapidly meet increased demand for qualified personnel, resources
indirect victim
family member or friend or first responder
displaced person
have to be evacuated
refugee
have fled country home d/t famine, drought, war, civil unrest or natural disaster
Types of disasters
natural, man-made, combination
Man Made disasters
terrorism
civil unrest
explosions/bombings
structural collapse
toxic or hazardous spills
mass transit accidents
pollution
wars
Natural disasters
avalanches, blizzards, droughts, wildfires, earthquakes, tsunamis, hailstorms, heat waves, hurricanes, tornados, cyclones, volcanic eruptions
Terrorism
Use of force or violence against persons or property in violation of the criminal laws of the United States for purposes of intimidation, coercion, or ransom.
Characteristics of Disasters
frequency, predictability, preventability, imminence, scope and number of casualties, and intensity
Disaster Management cycle
Prevention
Mitigation
Preparedness
Response
Recovery
Primary prevention
aimed at preventing the occurrence of a disaster or limiting the consequences
secondary prevention
includes search, rescue and triage of victims
assessment of destruction and devastation
Tertiary Prevention
focuses on recovery and restoring the community to previous levels of functioning
All hazards mitigation (prevention)
reducing risks to people and property from natural hazards before and after they occur
warning systems. insurance
Prevention against natural disasters
Structural and non-structural measures
Professional preparedness
National Disaster Medical System (NDMS)
Disaster Medical Assistance Team (DMAT)
Medical Reserve Corps (MRC)
Community Emergency Response Team (CERT)
START triage system
a system that uses respirations, perfusion, and mental status assessments to categorize patients into one of four treatment categories; the letters stand for Simple Triage and Rapid Treatment
occur less than one min
site specific disaster zones
weapon releases and site-specific events
zones of safety
hot zone- initial site of incident
Warm zone
decontamination
Cold Zone
where decontaminated victims triaged, treated
Primary Agents of bioterrorism
bacillus antracis (anthrax)
Clostridium botulinum (botulism)
Yersinia pestis (plague)
viral hemorrhagic fevers
variola major (smallpox)
francisella tularensis (tularemia)
CBRNE
Chemical, Biological, Radiological, Nuclear, Explosive
YOU MIGHT ALSO LIKE...