Module 1 Flashcards
safety and quality (233 cards)
1
Q
What should be done to avoid a medication error?
A
- Patient-Centered Care: Focus on individualized treatment plans considering patients’ unique risks and histories.
- Evidence-Based Practices: Utilize guidelines for medication dosages and monitoring protocols for patients with high-risk conditions.
- Transparency and Reporting: Encourage error reporting and learning from sentinel events to prevent recurrence.
- Interdisciplinary Collaboration: Ensure open communication among nurses, physicians, and administrators.
- Proactive Risk Assessment: Evaluate individual patient risks (e.g., sleep apnea) before administering high-risk treatments.
- Continuous Monitoring after administering a medication
- Support Systems: Address systemic issues like understaffing, communication breakdowns, and lack of standardized protocols to minimize preventable errors.
2
Q
Define healthcare quality
A
Healthcare quality is the measure of how well healthcare services for individuals and populations:
- Increase the likelihood of desired health outcomes.
- Align with current professional knowledge (IOM, 2001).
3
Q
Characteristics of High Qualtiy Care
A
Characteristics of High-Quality Care (**STEEEP **Framework)
* Safe: Avoid harm to patients from the care intended to help them.
* Timely: Reduce delays in receiving care.
* Effective: Provide services based on scientific knowledge to all who could benefit.
* Efficient: Avoid waste of equipment, supplies, ideas, and energy.
* Equitable: Provide care that does not vary in quality due to personal characteristics, such as race, ethnicity, or socioeconomic status.
* Patient-Centered: Care that respects and responds to individual patient preferences, needs, and values.
4
Q
What is high quality health care defined is according to the AHRQ
A
Expanded Definition by AHRQ
Healthcare quality is doing “the right thing, at the right time, in the right way, to achieve the best possible results” (AHRQ, 2011).
5
Q
Tell me the levels at which healthcare quality can be assessed
A
Patient Level:
* Focus on individual patient outcomes.
* Encourage patient engagement and shared decision-making.
Healthcare-Delivery “Microsystems” Level:
* Improve specific units or teams (e.g., surgical team, acute-care unit).
* Enhance coordination and teamwork at the frontline of care delivery.
Organizational Level:
* Strengthen hospitals and healthcare systems to adopt best practices.
* Develop policies and programs to standardize care delivery.
* Regulatory and Financial Environment Level:
* Create supportive environments through regulation and financing.
* Encourage adherence to safety and quality standards via incentives and penalties.
6
Q
How are errors defined?
A
Errors are defined as “an act of commission (doing something wrong) or omission (failing to do the right thing) leading to an undesirable outcome or significant poten- tial for such an outcome”
7
Q
What is an adverse event?
A
An adverse event is any undesirable experience in healthcare that results in:
- Harm to the patient requiring additional monitoring, treatment, or hospitalization.
- Death, disability, or loss of bodily function lasting beyond seven days or still present at discharge (IOM, 1999).
8
Q
Explain preventable adverse events
A
- Reflect care below standard practices.
- Often involve errors that could have been avoided with proper safety measures.
9
Q
What is the criteria for reporting adverse events?
A
Adverse events associated with medications or medical devices must be reported when they result in:
- Death.
- Life-threatening reactions.
- Initial or prolonged hospitalization.
- Significant, persistent, or permanent change in function.
- The need for medical or surgical intervention.
10
Q
Where do you submit an adverse report after it has happened?
A
FAERS (FDA Adverse Event Reporting System): FDA FAERS Link
MedWatch: MedWatch Link
11
Q
What is a sentinel event?
A
A sentinel event is any unexpected occurrence in healthcare that results in:
* Death.
* Permanent harm.
* Severe temporary harm requiring intervention to sustain life (TJC, 2017a).
12
Q
What are examples of sentinel events?
A
- Surgery on the wrong patient or site.
- Suicide in a hospital or shortly after discharge.
- Retention of a surgical instrument or foreign object.
- Delays in treatment.
- Medication errors resulting in harm.
13
Q
What are most common sentinel events reported?
A
The most commonly reported sentinel events include:
- Retention of foreign body (400 cases).
- Wrong-site surgery (325 cases).
- Falls and suicide (300 cases each).
- Delays in treatment (250 cases).
- Medication errors (100 cases).
14
Q
Explain reporting of sentinel events
A
- Voluntary Reporting: Healthcare organizations are encouraged, but not required, to report sentinel events to The Joint Commission (TJC).
- Organizational Policy: Events must first be reported internally according to the institution’s protocols.
- Root Cause Analysis (RCA): Healthcare organizations are expected to conduct comprehensive analyses, implement risk-reduction strategies, and monitor outcomes.
15
Q
What are causes of errors by humans?
A
- Incompetency or lack of training.
- Inexperience or insufficient education.
- Fatigue and burnout among clinicians.
16
Q
What are causes of error because of systemic issues
A
- Poor communication among healthcare teams.
- Inaccurate documentation or failure to update patient records.
- Language and cultural barriers.
- Complex or new procedures and severe medical conditions.
16
Q
What are causes of error due to environmental factors?
A
- High-stress or urgent conditions.
- Inadequate staffing or resource shortages.
17
Q
What is the AHRQ
A
Agency for Healthcare Research and Quality (AHRQ)
- Focus: Producing evidence to improve healthcare safety, quality, and accessibility.
Initiatives:
* Promoting research for better care models.
* Providing guidelines and tools for evidence-based practice.
18
Q
What is CMS
A
Centers for Medicare and Medicaid Services (CMS)
- Focus: Promoting efficient healthcare delivery and outcomes.
Role: - Establishing quality benchmarks linked to reimbursement.
- Incentivizing safety through penalties for preventable harm (e.g., hospital-acquired infections).
19
Q
What is the FDA
A
Food and Drug Administration (FDA)
- Focus: Ensuring the safety and efficacy of drugs, medical devices, and food.
Role: - Monitoring adverse events through systems like FAERS and MedWatch.
- Partnering with healthcare providers to address risks.
20
Q
What does the institute for safe medication practices do? (ISMP)
A
Prevents medication errors through:
* National Medication Errors Reporting Program.
* Collaboration with pharmaceutical companies to improve labeling and packaging.
21
Q
What does the national academy of medicine do? (NAM)
A
- To Err is Human: Highlighted the prevalence of preventable harm.
- Crossing the Quality Chasm: Proposed systemic reforms for high-quality care.
- The Future of Nursing: Advocated for expanded nursing roles in complex healthcare systems.
22
Q
What does the national quality forum do? (NQF)
A
Establishes standardized performance measures.
Promotes certified practices to reduce adverse events (e.g., reducing hospital readmissions).
23
Q
What does the institute of healthcare improvement do? (IHI)
A
Motivates change through innovative care models.
Campaigns like:
* 5 Million Lives Campaign: Focused on preventing harm.
* Triple Aim Initiative: Aims for improved health, better care, and reduced costs.
24
What is the Joint Commission? (TLC)
Provides hospital accreditation.
- Develops safety tools like:
* Sentinel Event Policy.
* National Patient Safety Goals.
* Root Cause Analysis (RCA2).
24
What does the Leapfrog Group do?
Rates hospital safety and performance via:
* Leapfrog Hospital Safety Grades.
* Leapfrog Hospital Surveys.
25
What does healthcare financial management association do?
Healthcare Financial Management Association (HFMA)
- Represents healthcare finance leaders.
- Addresses patient concerns through initiatives like the **Value Project**:
* Access: Make care affordable and available.
* Safety: Prioritize harm reduction.
* Outcomes: Improve recovery rates.
* Respect: Treat patients as individuals, not cases.
26
# 1.
How does the CMS measure quality and safety?
Focus: Ensures patients receive evidence-based care across clinical conditions like stroke, pneumonia, and heart failure.
27
How does AHRQ measure quality?
Focus: Measure the quality of inpatient care and identify areas for improvement.
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How does the AHRQ measure safety?
Identify potentially preventable adverse events in hospitals.
29
How does the NQF and ANA measure quality
Measure the quality of nursing care and its impact on patient outcomes.
30
# 1.
How does the NQF and ANA measure quality
- Measure the quality of nursing care and its impact on patient outcomes.
- Example: Monitoring falls, catheter-associated urinary tract infections (CAUTIs), and pressure injuries.
31
How does NCQA HEDIS measure quality
Evaluate the effectiveness of care in outpatient and managed care settings.
32
How are outcomes improved by patient satisfaction scores?
| hospital consumer assessment of healthcare providers and systems HCAHPS
- understands patient needs
- enhances communication (build trust)
- tailored care
- improving pain management
33
how can outcomes be improved by reviewing quality and safety of care
Identify trends, standarize protocols, promote staff education, enhance teamwork, foster accountability
34
How can we reduce variation in healthcare quality?
* Standardizing Care: Implement evidence-based guidelines to reduce inconsistencies
* Promoting Equitable Access: Advocate for policies and interventions
* Educating Patients: Provide tailored education to ensure that care aligns with patient preferences and medical evidence
* Optimizing Resources: Avoid overuse or underuse of treatments and technologies
35
# 1.
What areas should you be absolutely transparent about when reporting?
* Clinical Quality – Reporting performance against established clinical standards.
* Resource Use and Efficiency – Tracking resource utilization to optimize care delivery.
* Patient Experience – Ensuring patients’ perspectives are included in evaluations.
* Professionalism and Ethics – Maintaining trust through clear professional conduct.
* Facility Recognition and Accreditations – Demonstrating adherence to national standards.
* Financial Relationships – Disclosing ties between healthcare professionals, organizations, and industries.
36
What are the challenges associated with error reporting?
* Fear of Punishment: due to fear of punitive consequences, including financial penalties and professional repercussions.
* Cultural: A blaming environment discourages open reporting of errors and proactive discussions.
* System Complexity: Errors often stem from systemic issues rather than individual negligence.
37
What is the point of reporting if it was a success?
- reinforces effective system of care
- demonstrates commitment and builds trust with employees
- encourages sustained efforts
38
How much do errors cost
17 billion per year
39
how many hospitalized patients experience adverse events
1/4
40
Sentinel events and never events are used to financially penalize hospitals by whom and for what
insurers and CMS
* for pressure ulcers if serious (bedsores)
* catheter infections
* wrong site injuries
41
What is QSEN and what is the 6 competencies of nurses
The Quality and Safety Education for Nurses (QSEN) initiative outlines six essential competencies for nurses:
*Patient-Centered Care- Focus on understanding and respecting each patient’s preferences, needs, and values.
*Teamwork and Collaboration
Foster communication and partnership across interprofessional teams.
*Evidence-Based Practice (EBP)
Integrate best research evidence with clinical expertise and patient values.
*Quality Improvement (QI)
Identify and implement strategies to improve healthcare processes and patient outcomes.
*Safety
Minimize risk through system effectiveness and individual performance.
*Informatics
Use technology to manage and communicate information and enhance decision-making.
42
What are some proactive systematic approaches to reduce errors?
* Use Checklists: ensuring all safety steps are followed.
* Implement Standardized Communication Tools: SBAR reduces variability and errors.
* Establish a Culture of Safety
43
What are effective responses to adverse events?
* Apologizing to the patient and family.
* Waiving costs related to the event and follow-up care.
* Reporting the event to external agencies.
* Conducting a root-cause analysis to understand why the event occurred.
* Using patient and family input to gather evidence.
* Informing the patient and family about measures to prevent recurrence.
* Providing support for caregivers involved.
* Performing annual reviews of policies for accountability.
44
How can nurses help with errors?
* Detect and prevent errors before they affect the patient.
* Lead quality improvement initiatives at the bedside.
* Advocate for systems improvements based on observed gaps in care.
45
What are challenges to ensure high quality care
Complexity of Healthcare Systems
Multiple healthcare providers and sources of information increase the potential for errors.
Patients receiving care across different settings are especially vulnerable to errors.
Resiliency of Nurses and Patients
Nurses often create workarounds to address inefficiencies, potentially leading to inconsistent outcomes.
Patients sometimes tolerate errors (e.g., taking the wrong medication without immediate effects), which does not guarantee long-term safety or quality.
Variation in Healthcare Delivery
Unwarranted variations in safety and quality can lead to disparities in patient outcomes.
Cost and Accessibility Issues
The affordability and availability of healthcare, as highlighted by the U.S. healthcare system, remain significant barriers to achieving equitable care.
46
Institute of Medicine (IOM) six aims for improving quality
**STEEP**
Safe
Prevent harm to patients during care delivery.
Example: Implementing strict infection control measures.
Timely
Minimize delays in receiving care.
Example: Streamlining appointment scheduling processes.
Effective
Use evidence-based practices to ensure the best outcomes.
Example: Administering beta blockers post-myocardial infarction as per guidelines.
Efficient
Reduce waste and ensure cost-effective care.
Example: Using generic medications when appropriate.
Equitable
Ensure care quality does not vary by race, gender, or socioeconomic status.
Example: Providing equal access to preventive screenings for all demographics.
Patient-Centered
Respect individual preferences and involve patients in decision-making.
Example: Customizing treatment plans based on cultural and personal preferences.
47
What is the IOM's reccommendation for redesigning healthcare?
The IOM emphasized that transforming the healthcare system requires meeting six critical challenges:
1. Redesigning Care Processes
Streamlining workflows to eliminate inefficiencies.
2. Effective Use of Information Technology
Leveraging EHRs for improved coordination and error reduction.
3. Managing Clinical Knowledge and Skills
Continuous education and training for healthcare providers.
4. Developing Effective Teams
Fostering interprofessional collaboration to improve care delivery.
5. Coordinating Care Across Settings
Ensuring seamless transitions between different care providers and facilities.
6. Incorporating Performance Metrics
Using data to measure outcomes and hold providers accountable.
48
Worldwide, is the united states ahead or behind other industrialized nations in terms of healthcare outcomes
behind, despite having the highest per capita healthcare spending
49
How does the US compare statistically to others
shorter life expectancy (78 y/o vs 82)
higher infant mortality rates
greater prevalence of chronic diseases (68% w 2+ diseases vs 33%)
49
Why does the US spend so much on healthcare?
higher cost of medical technology, pharm drugs, and services.
50
What does the joint commission international do
* Identifying patients correctly.
* Improving communication among healthcare providers.
* Ensuring the safety of high-alert medications.
* Promoting safe surgeries.
* Reducing healthcare-associated infections.
* Preventing falls.
50
What are global innovations in patient safety?
Joint Commision International
WHO (world health organization)
OECD's health care quality indicator project
51
What does the WHO do
developed the International Patient Safety Classification Framework to standardize safety definitions and indicators.
52
What does the OECD do
OECD's Health Care Quality Indicator Project facilitates cross-country comparisons and shares best practices.
53
What are the challenges associated with global healthcare being high quality?
1. Inconsistent Use of Patient Safety Terms:
* Variation in definitions and measurement methods across countries complicates global benchmarking.
2. Complications in Surgery:
* Common surgeries in patients over 50, such as pacemaker implantation and colectomies, have reported complications ranging from infections to hematomas. For example:
* Pacemaker implantation: 2.2% incidence of hematoma.
* Colectomy: 12.4% risk of infection.
3. Resource Allocation:
* High costs of technology and pharmaceuticals strain budgets, reducing funds for broader preventive measures.
53
What does world healthcare overview imply for nursing?
Preventing Surgical Complications:
Nurses should implement targeted care strategies for high-risk populations, particularly those over 50, to minimize complications like infections and blood clots.
Standardizing Practices:
Utilize international frameworks such as the JCI goals and WHO classification to align care delivery with global safety benchmarks.
Patient Education and Advocacy:
Educate patients about managing chronic conditions and the importance of preventative care to reduce hospital readmissions and improve outcomes.
Data-Driven Improvements:
Leverage insights from global metrics and case studies to identify gaps and design interventions for improving safety and quality.
54
What is the cost of ensuring quality and safety?
1. Hospital costs for safety and accreditation
2. personnel costs
3. outpatient costs
55
What is a joint commission accreditation
* Involves meeting rigorous standards, conducting surveys, and maintaining detailed documentation.
* Represents 0.03% to 1% of a hospital's operating budget, based on size and services provided.
56
What is a Magnet Accreditation?
Average total investment of $2.1 million over several years, including surveys and documentation submission.
57
What is a baldrige award?
## Footnote
hospital accreditation
* Initial certification cost: $400.
* Total application, supplemental, and site visit fees: $44,660–$88,060.
58
As much as accreditation costs, are consequences better or worse
consequences financially, reputational, and clinical costs are much worse
59
What personnel are used for quality
Quality improvement (QI) and informatics roles are critical in driving safety and efficiency:
* Director of QI: $109,293 annually (average salary).
* Nursing Informatics Specialist: Over $100,000 annually.
Direct care roles like nurses and nurse practitioners play a key role in bedside safety:
* Registered Nurse: Median salary of $68,450.
* Nursing Assistant: Median salary of $26,590.
60
Outpatient costs
Improved chronic disease management saves money in the long run.
For example, diabetic patients cost 327 annually but three times as much from diabetic complications if they are managed effectively
61
What are financial impacts of poor quality?
Common Hospital-Acquired Conditions (HACs) include **adverse drug events, falls, pressure ulcers, and healthcare-associated infections.**
44% of HACs are preventable, with significant costs saved by reducing their occurrence:
Preventing HACs has led to billions in national healthcare savings (AHRQ, 2015).
61
What are consequences of adverse events?
Complications from surgeries for patients over 50 often lead to **costly hospital readmissions:**
**Addressing these complications effectively reduces readmission costs** and improves patient outcomes.
62
Ultimately how does hospital save money?
Careful maintenance and quality checks to prevent complications
63
What is SBAR?
a culture of safety through team-based approaches like SBAR (Situation, Background, Assessment, Recommendation) communication.
64
What is the Balrige Award Health Care Criteria for Performance Excellence?
awards healthcare organizations for good quality:
* Leadership: Commitment of upper management to lead the organization and engage with the community.
* Strategy: Development and implementation of strategic plans.
* Customers: Building and maintaining strong relationships with patients and stakeholders.
* Measurement, Analysis, and Knowledge Management: Using data effectively for performance improvement.
* Workforce: Empowering and involving the workforce in achieving excellence.
* Operations: Managing and improving core processes.
* Results: Demonstrating outcomes in areas such as customer satisfaction, financial performance, and social responsibility.
* Core Values: Baldrige-recognized organizations are seen as role models, showcasing efficient operations, engagement with stakeholders, and a commitment to continuous improvement.
65
What is the Magnet Recognition Program?
The Magnet Recognition Program, awarded by the American Nurses Credentialing Center (ANCC), is often regarded as the gold standard for nursing excellence. Achieving this recognition involves:
* Professional Practice: Demonstrating superior clinical nursing practices.
* Innovation: Fostering a culture of continuous improvement.
* Evaluation: Undergoing a rigorous review process to validate adherence to high standards.
66
What is the pathway to excellence program?
Pathway to Excellence Program: This program offers a more accessible alternative for organizations seeking recognition. It evaluates healthcare organizations on six standards:
* Shared decision-making.
* Leadership.
* Safety.
* Quality.
* Well-being.
* Professional development.
67
Leadership in Nursing IOM's recommendations un 2010
* Removing practice barriers to enable nurses to work to the full extent of their education.
* Expanding nurse residency programs.
* Doubling the number of nurses with doctoral degrees.
* Promoting interprofessional collaboration and lifelong learning.
68
IOM's recommendation in 2015 follow up
* Building partnerships across healthcare professions.
* Prioritizing diversity in the nursing workforce.
* Expanding pathways to baccalaureate and advanced degrees.
* Fostering leadership roles for nurses in care delivery redesign and policy.
68
next half. of module 1 is pgs 339 to 375 ch 12
69
How to engage a patient in self care management
* educate them, explain risks, use visual aids because if they understand, they will adhere to care plan.
* invovle the patient in decision making
* set achievable goals and celebrate small successes
70
What can a nurse do to keep a patient safe?
* Ensure walking aid is within reach.
* conduct regular rounds to keep an eye on them
* Coordinate with dietician to reduce their temptation
* supply personal hygiene items
70
What can other health professionals do to keep safety
coordinate with physical therapist, pharmacist, and dietitian
educate staff, reinforce policies, make sure high risk patients recieve closer monitoring
implement a flagging system for behaviors that compromise safety. use a checklist that includes assessments of mobility, cognition, and adherence
Early discharge planning to ease the transition and coordinate with home healthcare or community resources
71
what can a healthcare system do to keep a patient safe?
ensure leadership provides staffing, promote a blame free environment, track indicents on a dashboard, create a careplan that coordinates care betwwen healthcare professionals, and include bedside nurses in discussions about improvment in quality
72
What types of human error are there?
Understand human error.
Errors can be unconscious (automatic behaviors, memory lapses) or conscious (decision-making breakdowns such as work-arounds).
Unconscious errors often stem from environmental factors (e.g., distractions, time pressures) and internal factors (e.g., fatigue, anxiety).
73
What are some ways to mitigate human error?
Leverages knowledge of human limitations and cognitive functions to create safer processes and systems.
Example: Design of user-friendly medication administration systems that minimize reliance on memory.
74
What is prospective vs retrospective analysis?
Prospective (Looking Forward): Identify potential risks before they result in harm (e.g., simulation training, hazard analysis).
Retrospective (Looking Backward): Analyze errors or near misses to identify causes and prevent recurrence.
74
How can you reduce risk in the environment?
Reduce distractions and noise in critical areas like medication preparation zones. standardize equipment across units to minimze errors from assumptions.
75
What is a tool to reduce error?
A checklist to prevent omissions
implement bar code scanning for medication administration to ensure five rights (patient, med, dose, route, time)
76
how to reduce error by training?
train staff on new equipment or protocols
77
how to reduce errors from workarounds/shortcuts?
design systems that make it easier to follow correct protocols than to bypass them
78
Examples of risk mitigation?
whiteboards for communication, standarize equipment, technology driven safety systems, encourage reporting of near misses
79
How can teamwork keep a patient safe?
- collaboration
- psychological safety
- value each other
- 3 W's method (what i see, what i am concerned about, what I want)
- TeamSTEPPS (evidence based training)
80
# 1.
What is utilization management (UM)?
* UM evaluates the appropriateness of care levels throughout a patient’s healthcare journey, from admission to discharge.
* Aims to ensure evidence-based, efficient care while preventing overuse, underuse, or misuse of resources.
* UM assesses resource management to help leadership make informed decisions
80
Define overuse
* Providing healthcare services that are unnecessary and not supported by clinical needs.
* Example: Performing surgery when non-invasive treatments would suffice.
* Risks: Increases costs and potential harm to patients.
80
Define underuse:
* Definition: Failing to provide necessary care that could improve patient outcomes.
* Example: Not prescribing beta-blockers to a heart attack patient upon discharge.
* Risks: Missed opportunities for improved health and increased complications.
81
Define Misuse
* Definition: Errors in diagnosis, treatment, or care processes that result in avoidable complications.
* Example: A patient develops a post-surgical infection due to inadequate hygiene protocols.
* Risks: Adverse events that could have been prevented.
82
What is an aggregate review?
Analyzes trends across multiple adverse events, such as falls, to identify common root causes.
Example: Identifying that falls frequently occur during shift changes due to delayed responses to alarms.
82
What is a risk management strategy?
* Partner with Risk Management (RM) to conduct root cause analysis (RCA).
* Implement proactive strategies like Healthcare Failure Mode and Effect Analysis (HFMEA):
* Example: Assess potential risks in IV chemotherapy administration and establish safety protocols.
82
How to identify and address errors systematically?
* Fishbone diagrams, RCA, HFMEA
* balance indivudal accountability with system level improvements
* aggregated data reviews and continuous monitoring
* collaborate as a team and prevent overuse, underuse, and misuse
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83
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What is a Bundle in clinical tools?
A small set of evidence-based practices used as standards of care.
## Footnote
Example: Central Line Bundle for daily review and removal of unnecessary lines.
85
What is a Routine in clinical tools?
A series of standard actions followed in specific situations.
## Footnote
Example: Hourly rounding programs improve responsiveness and reduce falls.
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What is a Checklist in clinical tools?
A list of reminders to prevent errors due to memory lapses.
## Footnote
Example: WHO Surgical Safety Checklist ensures correct patient, procedure, and incision site.
87
What is a Pathway in clinical tools?
Evidence-based algorithms for clinical management tailored to patient needs.
## Footnote
Example: Total Knee Arthroplasty Pathway outlines clinical milestones and timeframes.
88
What is a Protocol in clinical tools?
Predetermined steps for managing single conditions, adaptable to patient needs.
## Footnote
Example: Nurse-driven protocol for evaluating and discontinuing unnecessary urinary catheters.
89
What is a Guideline in clinical tools?
Evidence-based recommendations for managing or preventing specific diseases.
## Footnote
Example: Diabetes Mellitus Management Guideline for individualized blood glucose monitoring.
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What is the primary goal of organizations that collect, analyze, and share evidence-based practices in healthcare?
To standardize clinical practices and enhance patient safety.
## Footnote
These organizations aim to improve healthcare outcomes through evidence-based strategies.
91
What unique feature does the Registered Nurses Association of Ontario (RNAO) provide?
Mobile downloads of nursing best practice guidelines.
## Footnote
This feature allows nurses to access best practices conveniently on mobile devices.
92
What does the Cochrane Collaboration host?
The world's largest library of international guidelines.
## Footnote
Cochrane is known for its extensive collection of healthcare research and systematic reviews.
93
What methodology does the Joanna Briggs Institute use?
Systematic methodologies to assess healthcare research.
## Footnote
This approach ensures that the assessments are comprehensive and reliable.
94
What type of information does the U.S. National Library of Medicine (NICHSR) share?
Information on health services research, clinical guidelines, and technology assessments.
## Footnote
This information aids healthcare professionals in making informed decisions.
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What type of information does the Joanna Briggs Institute distribute?
Evidence-based nursing and healthcare information for providers and consumers.
## Footnote
This distribution helps both healthcare providers and patients access reliable information.
96
What is the primary goal of safety initiatives in healthcare?
To reduce errors and improve patient safety by leveraging standardized tools and fostering a culture of safety.
97
Who is involved in healthcare safety initiatives?
Collaboration among leadership and staff.
98
What is an example of a medication safety initiative?
Avoid abbreviations prone to misinterpretation, e.g., 'qd' or 'MS.'
99
Fill in the blank: Safe patient handling initiatives use _______ to prevent falls during ambulation.
gait belts with handles
100
What does CUSP stand for?
Comprehensive Unit-Based Safety Program
101
What is an example of addressing alarm fatigue in healthcare?
Implement wireless alarm notification devices and split-screen monitors to improve safety.
102
What organization sponsors the initiative for safe medication practices?
Institute for Safe Medication Practice (ISMP)
103
Which organization focuses on safe patient handling?
Association of Safe Patient Handling Professionals (ASPHP)
104
Which agency is involved in research related to healthcare quality?
Agency for Healthcare Research and Quality (AHRQ)
105
Fill in the blank: The Johns Hopkins Hospital is associated with _______.
Johns Hopkins
106
True or False: Safety initiatives in healthcare rely solely on technology to improve patient safety.
False
107
What is workforce bullying?
Negative behaviors such as verbal abuse, nonverbal dismissiveness, and condescending communication
108
How does workforce bullying impact patient safety?
Decreased collaboration and communication compromise care quality and increase the risk of errors
109
What staffing challenges are associated with workforce bullying?
Higher staff turnover and difficult recruitment due to negative workplace experiences
110
What is a potential outcome of higher staff turnover due to workforce bullying?
Disruptions in unit cohesion
111
How might new staff respond to workplace bullying?
They may mimic bullying behaviors as a survival strategy
112
What can perpetuate an unhealthy work environment in healthcare?
Organizational norms that allow bullying behaviors to continue
113
What educational approach is recommended to address workforce bullying?
Promote education and strategies for managing workplace violence
114
True or False: Workforce bullying has no significant impact on patient safety.
False
115
Fill in the blank: Workforce bullying includes _______ such as verbal abuse.
negative behaviors
116
How to address workforce bullying?
Consult the American Psychiatric Nurses Association Task Force on Workplace Violence. Foster a culture where communication is encouraged and power hierarchies do not deter staff from reporting issues
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What do healthcare rankings provide?
Data-driven insights into hospital performance and safety cultures
119
How can healthcare rankings help staff?
Enable staff to focus resources on areas requiring improvement
120
What is the first step in using rankings to improve safety?
Data Analysis
121
What can be identified through data analysis in healthcare rankings?
Trends, such as an increase in hospital-acquired infections
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What should be linked to trends identified in healthcare data?
Specific causes, such as high staff turnover
123
What is an actionable step to address trends in hospital-acquired infections?
Implement hospital-wide education programs on infection prevention
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What is another actionable step to improve safety in healthcare settings?
Foster interprofessional teamwork to address identified risks
125
True or False: Power hierarchies deter staff from reporting issues.
False
126
What is Safe Nurse Staffing?
Appropriate nurse-to-patient ratios based on patient acuity to ensure safe and effective care
## Footnote
Safe nurse staffing is crucial for maintaining quality patient care and safety.
127
What are the implications of adequate nurse staffing?
Better patient outcomes, fewer adverse events, and reduced mortality
## Footnote
Adequate staffing is linked to improved overall healthcare quality.
128
How is NHPPD calculated?
By dividing total nursing hours by the number of patients
## Footnote
NHPPD stands for Nursing Hours Per Patient Day, a key metric in staffing calculations.
129
What is one actionable step nurses can take regarding staffing ratios?
Advocate for proper staffing ratios
## Footnote
Nurses play a vital role in ensuring adequate staffing for patient safety.
130
What is Medication Safety?
Strategies to prevent harm from medication errors
## Footnote
Medication safety is essential in reducing adverse drug events.
131
What is an example initiative for medication safety?
ISMP Programs
## Footnote
ISMP stands for the Institute for Safe Medication Practices, which promotes safety in medication use.
132
What are some strategies for medication safety?
* Promote medication error reporting
* Use of 'smart' IV pumps
* Pharmacy-prepared doses for high-risk medications
## Footnote
These initiatives help minimize the risk of medication errors.
133
What is the single most effective method to prevent healthcare-associated infections?
Hand hygiene
## Footnote
Hand hygiene is critical for infection control in healthcare settings.
134
What are challenges related to hand hygiene compliance?
Low compliance among healthcare workers
## Footnote
Ensuring compliance is necessary for effective infection control.
135
What strategy can improve hand hygiene compliance?
Direct observation and reminders from peers
## Footnote
Peer reminders can foster a culture of accountability in hand hygiene practices.
136
What defines Nurses with Impairing Conditions?
Conditions such as substance use disorders or psychiatric issues that compromise safe practice
## Footnote
These conditions can affect a nurse's ability to perform their duties safely.
137
What support is available for nurses with impairing conditions?
Alternatives-to-discipline programs for early intervention
## Footnote
Boards of Nursing often provide support to help nurses rehabilitate while ensuring patient safety.
138
What is one actionable step nurses can take to support colleagues with impairing conditions?
Support colleagues through appropriate referrals
## Footnote
Encouraging colleagues to seek help can promote a safer work environment.
139
What should be the immediate response when unsafe staffing is identified in a long-term care facility?
Notify the supervisor of unsafe staffing and request specific support like extending shifts or engaging PRN staff.
## Footnote
PRN staff refers to 'pro re nata' or 'as needed' staff.
140
What are proactive solutions to address low staffing situations?
Advocate for increased staffing budgets and establish protocols for handling low-staff situations.
## Footnote
Proactive solutions aim to prevent future staffing issues rather than just responding to current problems.
141
What should be monitored to ensure patient safety in a long-term care facility?
Track adverse events such as falls, medication errors, or delayed care, and regularly review patient satisfaction and quality metrics.
142
What are bundles in clinical tools?
Bundles simplify evidence-based practices for consistent application, such as the central line care bundle.
143
What is the purpose of checklists in patient safety?
Ensure critical tasks are not missed, exemplified by surgical safety checklists.
144
How do protocols contribute to patient safety?
Protocols standardize care pathways, such as nurse-driven urinary catheter removal.
145
What role must leadership play regarding patient safety?
Leadership must prioritize safety as a standing agenda item.
146
What responsibilities do nurses have in maintaining patient safety?
Engage in training, adhere to protocols, and report deviations.
147
What should nurses educate patients about?
Available resources, like CMS’s Hospital Compare.
148
How can nurses participate in staffing discussions?
Actively participate and advocate for resources.
149
What should healthcare systems regularly review?
Staffing and safety metrics.
150
What culture should healthcare systems foster?
A culture of transparency that encourages reporting of errors and near-misses.
151
Fill in the blank: By integrating these strategies into practice, nurses and healthcare teams can enhance _______ safety.
patient
152
True or False: It is important for nurses to uphold a culture of accountability.
True
153
What is a key aspect of safe patient handling?
Use of evidence-based protocols for patient movement to reduce harm to patients and staff.
## Footnote
This protocol helps minimize injuries to both patients and healthcare staff during handling.
154
What type of equipment should be invested in for safe patient handling?
Ceiling-mounted lifts.
## Footnote
These lifts help facilitate safer movement of patients, reducing physical strain on staff.
155
What training should be provided to staff for safe patient handling?
Ergonomic training and protocols.
## Footnote
This training helps staff learn safe techniques for lifting and moving patients.
156
What is one action nurses should take regarding resources for patient handling?
Advocate for necessary resources and equipment.
## Footnote
This advocacy is crucial for ensuring a safe working environment for healthcare providers and patients.
157
What is a critical public health issue mentioned in the content?
Suicide prevention.
## Footnote
Addressing suicide requires a comprehensive approach to identify and mitigate risks.
158
What should be done when a patient is at risk for self-harm?
Always ask if the patient is considering self-harm.
## Footnote
Direct inquiry is essential for assessing the patient's mental state and risk level.
159
Name two risk factors for suicide.
* Previous suicide attempts
* Mental health diagnoses
## Footnote
These factors significantly increase the likelihood of suicidal behavior.
160
What higher-risk groups are identified for suicide risk?
* Armed forces members
* LGBTQ+ individuals
## Footnote
These groups often face unique stressors that can contribute to mental health challenges.
161
What is one intervention to prevent self-harm in healthcare settings?
Remove access to potential means of harm (e.g., sharp objects, ropes).
## Footnote
Reducing access to harmful items is a fundamental safety measure.
162
What nursing role is emphasized when risk factors are identified?
Act promptly when risk factors are identified.
## Footnote
Timely action can prevent potential crises and ensure patient safety.
163
Fill in the blank: Suicide prevention involves prospective and retrospective _______ identification.
[risk]
## Footnote
Identifying risks both before and after incidents is crucial for effective prevention strategies.
164
What should be modified in psychiatric units to prevent self-harm opportunities?
Remove hooks, unnecessary doors.
## Footnote
Environmental modifications can significantly enhance patient safety.
165
What should nurses educate colleagues and patients’ families about?
Suicide warning signs and prevention strategies.
## Footnote
Education is key to fostering a supportive environment and enhancing awareness.
166
What is a key essential for creating safe environments for cognitively impaired patients?
Use of door alarms
## Footnote
Door alarms help prevent wandering and ensure patient safety.
167
What type of alarms can be implemented to prevent falls?
Pressure-sensitive bed and chair alarms
## Footnote
These alarms alert caregivers when a patient attempts to get up unsafely.
168
What is a critical nursing action regarding environmental safety?
Report unsafe conditions immediately
## Footnote
Prompt reporting helps in mitigating risks to patients.
169
What is the definition of safe patient handoffs?
Transfer of patient care responsibility from one caregiver or team to another
## Footnote
This process is vital for continuity of care.
170
What is a risk associated with patient handoffs?
Potential for loss or misunderstanding of critical patient information
## Footnote
Miscommunication can lead to errors in patient care.
171
What standardized tool can be used during patient handoffs?
SBAR (Situation, Background, Assessment, Recommendation)
## Footnote
SBAR helps structure communication for clarity.
172
What does I PASS the BATON stand for in the context of patient handoffs?
A standardized handoff communication tool
## Footnote
It promotes structured and effective communication.
173
What communication behaviors should be displayed during patient handoffs?
Be clear, concise, and thorough
## Footnote
Effective communication reduces the risk of misunderstandings.
174
How should a nurse ensure safety and clarity during handoffs?
Use standardized handoff tools and encourage feedback
## Footnote
Verifying understanding is crucial for effective handoffs.
175
What regular maintenance is necessary to ensure environmental safety?
Eliminate physical hazards, such as uneven flooring
## Footnote
Regular checks can prevent accidents and injuries.
176
What advocacy role do nurses have regarding environmental safety?
Advocate for safety upgrades and modifications in the unit
## Footnote
Nurses play a key role in improving patient safety standards.
177
What does SBAR stand for?
Situation, Background, Assessment, Recommendation
178
What is the first component of SBAR?
Situation
179
What is included in the 'Background' component of SBAR?
Relevant patient history and context
180
What does the 'Assessment' component of SBAR entail?
Evaluation of the patient's current condition
181
What is the purpose of the 'Recommendation' component in SBAR?
To suggest a course of action
182
Fill in the blank: The infusion bag was hung an hour ago. The patient mentioned mild arm discomfort, so I positioned it on a _______.
pillow
183
What should be assessed during the next hour as per the SBAR example?
The site and patient condition
184
True or False: Interdisciplinary teamwork is essential for safe handling, suicide prevention, and patient handoffs.
True
185
What is the role of nurses in the context of interdisciplinary teamwork?
To collaborate for safe handling and patient care
186
What is the assessment section of SBAR
Assessing the patient
187
What is the response section of SBAR?
the follow through after the recommendation
188
What characteristics were noted about the infusion site?
No redness, swelling, or tenderness
189
What is the situation aspect of SBAR?
Describing the patient’s current status and telling them that you are handing the patient off to go to a certain event
190
What is the point of SBAR?
Transferring a patient care responsibility from one caregiver to another. Reduces the risk for misunderstanding of critical patient information. Uses the standardized tools called SBAR. Another acronym is I pass the baton.
191
What is the purpose of Rapid Response Teams (RRTs)?
Intervene early during clinical deterioration to prevent cardiac arrests or unexpected deaths.
## Footnote
RRTs are activated by changes in patient condition, such as respiratory rate changes or abnormal lung sounds.
192
What triggers the activation of Rapid Response Teams (RRTs)?
Changes in patient condition, e.g., respiratory rate changes or abnormal lung sounds.
## Footnote
These changes are indicators that a patient may be deteriorating.
193
Who typically composes a Rapid Response Team (RRT)?
Critical care nurses, physicians, and respiratory therapists.
## Footnote
This multidisciplinary approach allows for comprehensive patient assessment and intervention.
194
What is one of the main goals of Rapid Response Teams (RRTs)?
Prevent failure to rescue.
## Footnote
Failure to rescue refers to clinicians not responding adequately to signs of patient deterioration.
195
True or False: The effectiveness of Rapid Response Teams (RRTs) in reducing hospital mortality is unanimously accepted.
False.
## Footnote
There is ongoing debate regarding the effectiveness of RRTs in this regard.
196
Why is teamwork important for the success of Rapid Response Teams (RRTs)?
Collaboration and communication are crucial for RRT success.
## Footnote
Effective teamwork enhances the ability to quickly assess and respond to patient needs.
197
What are the major biological hazards faced by healthcare staff?
Exposure to pathogens (e.g., drug-resistant infections)
## Footnote
Pathogens can lead to serious health risks for healthcare workers.
198
What chemical hazards do healthcare workers encounter?
Hazardous cleaning agents and drug exposures
## Footnote
Chemical hazards can cause a range of health issues from skin irritation to long-term health problems.
199
List three physical hazards that healthcare staff commonly face.
* Slips
* Trips
* Falls
## Footnote
These physical hazards can lead to serious injuries if not properly managed.
200
What ergonomic hazards can affect healthcare workers?
Repetitive tasks, patient handling, and musculoskeletal risks
## Footnote
Ergonomic hazards can lead to chronic pain and disability.
201
What psychological hazards are present in healthcare settings?
Workplace violence and stress from long shifts
## Footnote
Psychological hazards can significantly impact mental health and job performance.
202
True or False: Healthcare workers report the highest number of workplace injuries among private sectors.
True
## Footnote
This statistic highlights the critical need for safety measures in healthcare.
203
What types of injuries lead to high absenteeism and turnover among healthcare workers?
Musculoskeletal injuries, particularly back injuries
## Footnote
These injuries can result from physical strain and can be debilitating.
204
What is a risk reduction strategy for biological hazards?
Hand hygiene and proper use of personal protective equipment (PPE)
## Footnote
Effective hygiene practices are crucial in preventing infections.
205
Fill in the blank: To reduce chemical hazards, healthcare facilities should limit access to _______ and use alternatives.
hazardous materials
## Footnote
Using safer alternatives can significantly reduce risk.
206
What is a recommended strategy to address physical hazards in the workplace?
Promptly clean spills and maintain safe environments
## Footnote
Keeping the workplace clean and organized can prevent accidents.
207
How can ergonomic hazards be mitigated in healthcare settings?
Use assistive patient handling equipment and request ergonomic evaluations
## Footnote
Ergonomic evaluations can help identify risks and improve workplace design.
208
What strategies can be implemented to support mental well-being of healthcare workers?
Address workplace violence, provide sufficient time off
## Footnote
Mental health support is essential for sustaining staff well-being.
209
What is a core component of developing a culture of safety?
Leadership
## Footnote
Leadership involves empowering staff to report hazards and focusing on systemic solutions.
210
What should be tracked to guide safety improvements?
Safety metrics and adverse events
## Footnote
Tracking safety metrics helps in identifying areas for improvement.
211
What is the process of analyzing incidents in safety culture?
Risk Identification and Reduction
## Footnote
This includes both prospective and retrospective analysis of incidents.
212
What promotes effective communication in safety culture?
Teamwork
## Footnote
Encouraging collaboration among staff is essential for a safety-focused environment.
213
What training should healthcare staff receive for safety?
Training on safety protocols
## Footnote
This training is crucial for ensuring staff are prepared to handle safety issues.
214
What equipment should be used for safe patient handling?
Assistive equipment
## Footnote
Using assistive devices helps prevent injuries to both patients and healthcare staff.
215
What is a recommended practice for healthcare organizations regarding risk?
Conduct regular risk assessments
## Footnote
Regular assessments help identify and mitigate potential safety hazards.
216
What type of culture should be fostered to encourage reporting of errors?
A blame-free culture
## Footnote
A blame-free environment encourages staff to report errors and hazards without fear.
217
What do RRTs and safety initiatives do for patients?
Reduce adverse events and improve clinical outcomes
## Footnote
RRTs refer to Rapid Response Teams, which are designed to provide immediate assistance to patients in distress.
218
How do evidence-based safety measures benefit healthcare staff?
Protects healthcare workers from injuries and fosters a positive work environment
## Footnote
Evidence-based safety measures are practices supported by research that aim to enhance safety.
219
What is a key benefit of a strong culture of safety for organizations?
Reduces variations in care, improves teamwork, and enhances patient and staff safety
## Footnote
A strong safety culture encourages open communication and prioritizes safety at all levels.
