Flashcards in Lecture 11 Quality control Deck (28):
Activities that evaluate, monitor, or regulate services rendered to the consumer.
If nursing is to strive for excellence, quality control criteria should be _
Pushed to *optimal levels*, rather than minimally acceptable levels.
Health care quality
The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.
Steps in the process of quality control
1. The criterion or standard is determined.
2. Information is collected to determine if the standard has been met.
3. Educational or corrective action is taken if the criterion has not been met.
1. The process of measuring products, practices, and services against best-performing organizations.
2. Used for standard development and performance improvement.
Predetermined levels of excellence that serve as guides for practice; established by an *authority* and communicated to and accepted by the people affected by them.
ANA Standards of Practice
1. Assessment - collection of data.
2. Diagnosis - analyze assessment data to determine diagnoses or issues.
3. Outcomes identification - identify expected outcomes for an individualized plan.
4. Planning - develop a plan to attain the expected outcomes.
5. Implementation - implement the plan.
6. Evaluation - evaluate progress toward the attainment of outcomes.
ANA Standards of Professional Performance (1 of 2)
1. Ethics - practices ethically and integrates ethical provisions.
2. Education - attains the knowledge and competency that reflects current nursing practice.
3. Evidence-based practice and research - integrates evidence and research findings into practice.
4. Quality of practice - enhances the quality and effectiveness of nursing practice.
5. Communication - communicates effectively in a variety of formats in all areas of practice.
ANA Standards of Professional Performance (2 of 2)
1. Leadership - in the practice setting and in the profession.
2. Collaboration - with the patient, family, and others in the conduct of nursing practice.
3. Professional practice evaluation - evaluate own practice in relation to professional practice standards.
4. Resource utilization - factors related to safety, effectiveness, cost, and impact on practice.
5. Environmental health - practices in an environmentally safe and healthy manner.
A systematic and official examination of a record, process, structure, environment, or account to evaluate performance.
Outcome audits analyze _
What results occurred, if any, as a result of specific nursing interventions.
Process audits measure _
How nursing care is provided; assumes a connection between quality of care and process (i.e., established policies, medication reconciliation).
Structure audits focus on _
The relationship between quality of care and structure (i.e., staffing, wait times, etc.).
Total quality management (TQM) or continuous quality improvement (CQI)
1. A philosophy that assumes that production and service focus on the individual and that *quality can always be better*.
2. Identifying and doing the right things, the right way, the first time, and *problem-prevention planning* (as opposed to inspection and reactive problem solving) lead to quality outcomes.
Toyota Production System (TPS)
1. A production system built on the complete *elimination of waste* and focused on the pursuit of the *most efficient production method* possible.
2. Solving problems at the time they occur, and determining the root cause, can prevent larger problems.
3. Usually requires a change in organizational culture, values, and roles.
Quality measurement as an organizational mandate
1. Accountability for the internal monitoring of quality and patient safety has increased exponentially over the last 30 years.
2. This has fostered a *culture of quality* within institutions, which is also highly *data driven*, due to the use of statistics.
3. Changing government and licensing regulations affect quality control and standard setting.
Professional standards review organizations mandate _
Certification of the need for a patient's admission and continuous review of care.
Prospective payment system (PPS)
A hospital payment system with *predetermined reimbursement* for services given (regardless of the actual cost).
Diagnosis-related groups (DRGs)
Predetermined payment schedules reflecting historical costs for the treatment of *specific patient conditions*.
Although the PPS helped to contain rising health care costs, critics have argued that _
The system promotes abbreviated hospital stays and services leading to a reduced quality of care.
The Joint Commission
1. Mandated that all hospitals have a quality assurance program in place by 1981 to include all clinical departments, disciplines, and practitioners.
2. Agenda for Change (1990s) - shifted the focus of the accreditation process from organizational structure to *organizational performance or outcomes*.
The mission of The Joint Commission is to _
Continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.
To augment the core measures and promote specific improvements in patient safety, The *Joint Commission* issues the _ annually.
National Patient Safety Goals (NPSGs).
1. An unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof.
2. The Joint Commission maintains a database of these and their underlying causes.
Core measures (Joint Commission)
1. Valid, reliable, and evidence-based data sets initially (2002) addressing quality of care for acute myocardial infarction, pneumonia, heart failure, and the surgical care improvement project.
2. Later (2013) expanded to include perinatal services, stroke, venous thromboembolism, etc., and will likely be expanded further.
The organization that confers *voluntary* accreditation to managed care organizations is _
The National Committee for Quality Assurance (NCQA).
The Leapfrog Group
1. A growing conglomeration of non-health care Fortune 500 company leaders who are committed to modernizing the current health care system.
2. Has identified four evidence-based standards that they believe will provide the greatest impact on *reducing medical errors*: (1) Computerized physician-provider order entry; (2) evidence-based hospital referral; (3) ICU physician staffing (intensivists); and (4) the use of Leapfrog Safe Practices scores.