Healthcare Systems and Population Health Flashcards

(28 cards)

1
Q

Model for Improvement

A

test changes through the plan-do-study-act cycle to evaluate change for effectiveness and any issues prior to being adopted by the entire organization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Deming’s 14 points for QI to control for variabilities in processes to achieve improvement

A

1) Constancy of purpose toward improvement = long term planning
2) Adopt the new philosophy = including management
3) Cease dependence on inspection = if variation reduced, errors will be reduced; no need for inspection
4) Single supplier = multiple suppliers equals increased variation
5) Improve constantly and forever = continuous QI
6) Training on the job = lack of training equals variation
7) Institute Leadership = leadership focuses on vision and models; supervision is meeting specific deliverables
8) Drive out fear = fear prevents workers from acting in best interest of organization
9) Break down barriers between departments = departments interdependent
10) Eliminate slogans = processes are what make the most mistakes
11) Eliminate management by objectives = production targets equals shortcuts and poor quality goods
12) Remove barriers to pride of workmanship = increased worker satisfaction
13) Institute education and self-improvement
14) Transformation is everyone’s job

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Essential Tools for QI - Cause and Effect Diagram (Ishikawa / Fishbone)

A

Graphically displays relationships of many causes contributing to an outcome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Essential Tools for QI - Driver Diagram

A

Visual display of what primary and secondary items contribute to achievement of an aim

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Essential Tools for QI - Failure Mode and Effects Analysis (FMEA)

A

Predicts where, how, and to what extent a system failure could occur so that improvements can be devised to prevent the failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Essential Tools for QI - Flowchart

A

Visual map of the steps in a process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Essential Tools for QI - Histogram

A

Displays continuous data over time to reveal variation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Essential Tools for QI - Pareto chart (80/20 rule)

A

Bar chart of contributing factors arranged from largest to smallest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Essential Tools for QI - Plan-do-study-act cycle

A

Documents testing a change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Essential Tools for QI - Project planning

A

Systematically plans the changes to be tested

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Essential Tools for QI - Run chart (control chart)

A

Graphs data over time (run chart) and with the addition of upper and lower control limits (control chart), helps distinguish causes of variation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Essential Tools for QI - Scatter diagram

A

Helps identify cause-and-effect relationship between two variables

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Technology Support

A

Barcode dispensing, automated dispensing, and other robotic supports.

Allow improved mgmt of inventory = reduced costs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Computerized Order Entry

A

Administration = right drug, right patient, right time.

Decision support systems for prescribers = right drug at right dose; also helps organization meet quality indicators.

QI programs and projects = ease of data collection.

Surveillance: abx, opioid, ADEs = reports can be generated by health records, can intervene in real time to increase patient safety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Formulary

A

Standardized list of meds = variability reduction and improves efficiency

TJC requires hospital to develop and approve criteria for identifying formulary meds.

Criteria: indication, effectiveness, drug interactions, ADEs, potential for errors and sentinel events, other risks, and cost.

P&T committee responsible: generic drugs preferred, restricted/PA for use of specific drugs, policy/procedure to obtain non-form meds, therapeutic interchange, med use criteria.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Medication Use Evaluation

A

Evaluation of med use processes and outcomes to improve safety, effectiveness, and costs.

Inter-professional QI program that is P&T responsibility.

17
Q

Surveillance - Abx Stewardship

A

Required by TJC - abx resistance and unnecessary use of abx.

IDSA - describes purpose = to be in compliance with evidence based guidelines. Also states who must be involved = ID Rph, physician, microbiologist, and infection control.

Required monitoring - redundant abx coverage, quarterly abx use, daily review of restricted agents, daily (de)escalation, IV:PO, PK monitoring, and renal dose adj.

18
Q

Surveillance - Adverse Drug Reaction (definition)

A

Any response to drug at doses normally used in humans.

19
Q

Surveillance - Adverse Drug Event (definition)

A

An injury resulting from a medical intervention related to a drug

20
Q

Surveillance - Medication Error (definition)

A

Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in control of the healthcare professional, patient, or consumer.

21
Q

Surveillance - Adverse Drug Reaction (Tools)

A

MedWatch (drugs) and VAERS (vaccines).

Naranjo algorithm and WHO Uppsala Monitoring Centre Scale = assess causality.

22
Q

Surveillance - Adverse Drug Event (Tools)

A

National Action Plan for ADE Prevention = identify significant ADEs and alight efforts to reduce ADEs

23
Q

Surveillance - Medication Error (Tools)

A

Most don’t lead to significant pt harm - those that do are also classified as ADRs or ADEs and reported there.

24
Q

ADRs, ADEs, and medication errors

A

They are all related and overlap

25
ADR reporting
Postmarketing surveillance for FDA
26
ADR vs ADE
All ADRs are ADEs. BUT, ADE definition includes OD. Some also include omission or underdose as ADEs.
27
Medication Errors
Deviation in dispensing and administering from prescribed order/script. As well as errors in prescribing and monitoring!
28
Surveillance - Pain assessment and management
TJC requires surveillance activities. Opioid stewardship ensures standards are being met. PDMP must be consulted in compliance with state law.