Exam 3: Dimensions of Nursing Rasmussen (Graded A+ actual test)

Annie Goodrich - First dean of the Army School of Nursing. quality (Part of Quality of Care) - A level of excellence of care based upon pre- established criteria. Institute of Medicine (IOM) (Part of Quality of Care) - "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge" -FIRST report in 2000, To Err Is Human: Building a Safer Health System - Three accepted elements: structure, process, and outcome, while care should be safe, effective, clientcentered, timely, efficient, and equitable. - 98,000 people die a year from adverse or medical error (sense this report, safety has increased) - The report recommended a 4-tiered approach: o 1. Establish leadership, research, tools, and protocols to enhance the safety knowledge base. o 2. Develop a public mandatory national reporting system and encourage participation in voluntary reporting systems. o 3. Use oversight organizations, health-care purchasers, and professional organizations to increase performance standards and expectations for safety improvements. o 4. Implement safety systems at the point of care delivery in health-care organizations. - SECOND report in 2001, Crossing the Quality Chasm o Focused on developing a new health-care system that improved quality of care. o 6 aims for improvement, concluding that care should be: 1. Safe: Avoiding injuries to clients from the care that is intended to help them. 2. Effective: Providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit. 3. 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.4. Timely: Reducing waits and sometimes harmful delays for both those who receive and those who give care. 5. Efficient: Avoiding waste, including waste of equipment, supplies, ideas, and energy. 6. Quitable: IOM recommendations to improve error reduction and quality (Part of Quality of Care) - Establish leadership, research, tools, and protocols to enhance the safety knowledge base. Develop a public mandatory national reporting system and encourage participation in voluntary reporting systems. IOM recommendations to improve error reduction and quality (Part of Quality of Care) - Use oversight organizations, health- care purchasers, and professional organizations to increase performance standards and expectations for safety improvements. Implement safety systems at the point of care delivery in health-care organizations. quality of care - the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge IOM- 98,000 - Nurses are in a pivotal position to positively influence quality and safety at local, state, and national levels. IOM estimated that 98,000 people die per year due to adverse events and medical errors in hospitals. Methods to Improve Quality of Care - Quality assurance (QA) Continuous quality improvement (CQI) Total quality management (TQM) HCAHPS Leapfrog groupQuality indicators (QIs) Risk management (Quality Care) - Focuses on identifying, analyzing, evaluating risks Reduces risk to decrease harm to clients When an adverse event does occur, attempts are made to minimize losses. Is interdisciplinary(relating to more than one branch of knowledge) in nature Includes aspects of detection, education, and intervention Nursing staff is key to any risk management program High risk areas include: Medication errors Complications from tests and treatments Falls Refusal of treatment or refusal to sign treatment Root Cause Analysis (RCA) - determines underlying cause of adverse events; used after incident to uncover primary cause tracks events leading to error, identifies faulty systems, and processes and develops a plan to prevent further errors. aka:analysis National Client Safety Goals - Improve accuracy of client identification.Improve effectiveness of communication among caregivers. Improve safety of using medications. Reduce risk of health-care-associated infections. Identify client safety risks inherent in its patient population. Sentinel Events - an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury includes loss of limb or function. Sentinel events are NOT the same as errors. Indicate the need for immediate investigation and response. Quality and Safety Education for Nurses (QSEN) - The Quality and Safety Education for Nurses (QSEN) project address the challenge of preparing future nurses with the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare systems within which they work. Using the QSEN model contributed to the adoption of quality and safety competencies as core practice values Built on five competencies developed initially by the Institute of Medicine (IOM).: Patient-Centered Care Teamwork and Collaboration Evidence-Based PracticeQuality Improvement Safety Informatics See Chapter 4 for more detail Agency for Healthcare Research and Quality (AHRQ) - One of the Department of Health and Human Services agencies that supports RESEARCH to improve the quality of health care. Helps people make more informed health-care decisions MISSION: The Agency for Healthcare Research and Quality's (AHRQ) mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used. Charged with developing partnerships that create long-term improvement in U.S. health care. RESEARCH GOAL: To measure those improvements in terms of client outcomes, decreased mortality, improved quality of life, and cost-effective quality care. FOCUS is in THREE AREAS: Safety and quality: risk reduction by promoting quality care Effectiveness: improved health outcomes by using evidence to make informed health care decisions Efficiency: translating research into practice to increase access and to decrease costs Quality Improvement Organization (QIO) - MISSION: Improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries.FEDERAL PROGRAM Designed to review medical care, verify its necessity, and assist Medicare and Medicaid beneficiaries with complaints about quality of care. Three core functions for QIO; 1. Improving the quality of care for beneficiaries (recipients). 2-3: Protecting the integrity of the Medicare Trust Fund by ensuring that Medicare pays only for services and goods that are reasonable and necessary and that are provided in the most appropriate setting. Medicare - A program added to the Social Security system in 1965 that provides hospitalization insurance for the elderly and permits older Americans to purchase inexpensive coverage for doctor fees and other health expenses.