Deck 6: Managing and Improving Quality

Question 1

The director of quality improvement reports that the hospital will soon be using "dashboards" as part of the quality management process. How should the staff interpret this information?

A) Surveyors are driving to clients' homes to collect data on hospital visits.
B) This electronic tool makes it easy to aggregate and display data.
C) "Dashboard" is an acronym for the topics covered in client satisfaction surveys.
D) The "dashboard" is a screen on the electronic medical record that can be accessed for quality improvement information.

Answer 1

This electronic tool makes it easy to aggregate and display data.

Question 2

As part of the process of promoting quality improvement, the nursing manager is comparing data between two hospitals on average length of stay for a total hip replacement. This comparison is an example of which process or step?

A) Benchmarking
B) Outcome standard
C) Indicator
D) Process standard

Answer 2

Benchmarking

Question 3

The nursing task force is developing measurable goals for each client on the orthopedic unit. The statement "Each client will have a written assessment and plan of care document within eight hours of admission" is an example of which component of quality management?

A) Indicator
B) Structure standard
C) Benchmark
D) Process standard

Answer 3

Process standard

Question 4

Which quality improvement initiatives would help the healthcare organization meet Institute of Healthcare Improvement (IHI) goals? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) The amount of material opened and wasted for surgical procedures will drop by 25% this fiscal year.
B) The number of nurses who hold a bachelor's degree will increase by 10% this year.
C) Wait times in the emergency department will decrease by 15% this year.
D) Employee absences will drop by 10% this year.
E) Fewer than 5% of clients will report inadequate pain control while hospitalized.

Question 5

Efforts to increase nurses' use of evidence-based practice (EBP) to improve client care in the hospital have failed. Which answers are nurses likely to give when asked why this is occurring? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) "I'm not interested in this program."
B) "I don't have time to finish everything I already have to do each shift."
C) "I don't want to practice nursing just like everyone else."
D) "The library at our hospital doesn't have many journals."
E) "If administration wanted us to use EBP, they would get us some more nurses to share the work."

Question 6

The nurse manager orienting newly hired nurses has explained the organization's blame-free environment. Which remark by one of the nurses indicates understanding of the policy?

A) "If I make a mistake and report it, I will not be reprimanded or punished."
B) "When I make a mistake, I should immediately fill out an incident report."
C) "It is left up to each employee to self-monitor so we do not report others' mistakes."
D) "When I make a mistake, I should report it and look for ways to prevent it from recurring."

Question 7

Which situation represents an exception to the blame-free environment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) A nurse routinely changes nursing notes after a client is discharged.
B) A physician order is overlooked on a newly admitted client.
C) An unlicensed assistant drops a client.
D) A nurse does not complete an incident report after a medication error.
E) A nurse miscounts narcotics.

Question 8

After shift change the nurse discovers that a client's IV heparin has been turned off at the IV controller. The amount of fluid left in the IV bag indicates that the client received half of the dose ordered. Which statement should be documented in the client's medical record?

A) IV heparin restarted. Physician notified. Client's vital signs unchanged.
B) IV heparin restarted at a rate to catch up dosage accidentally deleted.
C) IV heparin turned off by previous shift. Restarted.
D) IV heparin restarted and incident report completed.

Question 9

Immediately following a barium swallow, a client noticed hives and a feeling of shortness of breath. Although there were no known allergies to food or drugs prior to this incident, the diagnosis was an allergic reaction to the preservatives in the barium. Which is the correct risk category for this incident?

A) Medication error
B) Medical-legal incident
C) Procedure complication
D) This incident does not fall into a risk category.

Question 10

Which situation is an example of the overall goal of quality management in today's healthcare activities?

A) The nurse manager realizes a policy was ineffective in reducing incidents.
B) The administrator walks around making a list of potential problems.
C) The human resources department fires nonproductive employees.
D) The nurse wipes up a spilled drink before clients are allowed to enter a room.

Question 11

The nurse is assigned to the Risk Management Team. Which events would be addressed by this team? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) A client's hand is injured during an arterial blood gas draw.
B) A client's family is dissatisfied with the breakfast just served.
C) A client leaves the hospital against medical advice (AMA).
D) A client claims he is not ready to be discharged.
E) The family does not want a client to be transferred from the intensive care unit (ICU).

Question 12

The hospital organization has developed a philosophy based on the client, organizational involvement, quantitative measurement of outcomes, and processes for improvement. In which quality management process are these characteristics typically seen?

A) Continuous quality improvement (CQI)
B) Total quality management (TQM)
C) Plan, Do, Check, Act (PDCA cycle)
D) Six Sigma

Question 13

In which ways can nurse managers reduce risks for the organization? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Investigating a complaint about nursing care from a client's spouse
B) Encouraging nurses to cut corners when possible
C) Talking to physicians about ways to improve client care
D) Keeping staff members on task throughout the workday
E) Making sure staff members work minimal overtime

Question 14

Which is the most effective method of creating a blame-free environment?

A) Work to develop a just culture within the organization.
B) Make sure all nurses agree to report every mistake.
C) Set up a self-reporting board so that all employees will know that everyone makes mistakes.
D) Ensure nurse managers keep a list of how often each employee makes a mistake.

Question 15

The following documentation was entered in the client's medical record: "The client was found lying on the floor. Dr. X was notified. Apparently, the restraints were improperly applied." Which statement best describes this documentation?

A) Appropriately written
B) Inappropriate because it places blame on an individual
C) Inappropriate because it does not include that the client's family was notified
D) Appropriately written because it only documents the facts

Question 16

Which situation would be included in reporting for Joint Commission mandatory national client safety goals? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) The average wait time in the emergency department has increased by 5 minutes over last year's average.
B) A client is left waiting in the hallway because the transport person did not make contact with the client's nurse.
C) A nurse gives a medication by the wrong route.
D) A client developed sepsis after insertion of a urinary catheter.
E) Surgery is done on a client's right eye instead of the left eye.

Question 17

The nurse is working on a unit with a blame-free environment and makes an error that puts a client at risk. What should the nurse do first?

A) Discuss it with the other nurses on duty.
B) Immediately report the incident to the supervisor.
C) Ensure the client's safety as fully as possible.
D) Say nothing as no one saw the incident.

Question 18

Which part of Six Sigma is vastly different from other quality management programs?

A) Six Sigma has a client focus.
B) Data drive the program.
C) Failure is tolerated.
D) Management is proactive.

Question 19

Which statement reflects a characteristic common to all methods of quality management?

A) Each method uses all staff members in the organization.
B) None of the methods are designed to place blame on an individual.
C) All methods provide clinical information.
D) Most methods focus on cost containment.

Question 20

A client has been told that chemotherapy must be postponed until he is hydrated. The client refuses the IV hydration and demands to go home. How would the nurse best categorize this situation?

A) Non-reportable incident
B) Medical-legal incident
C) Client dissatisfaction with care
D) Medication error

Question 21

The continuous quality improvement (CQI) coordinator is establishing quality measures for a unit. These measures would be written according to which criteria? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) The CQI coordinator has read two research studies that show the process improves client outcomes.
B) The CQI coordinator has evidence that a particular practice is effective in decreasing length of stay.
C) The CQI coordinator has used the process in practice for more than two years.
D) The process being measured produces a desirable outcome.
E) There are very few unexpected bad effects from the process.

Question 22

A nurse manager is orienting newly hired staff nurses to the organization's total quality management program. As part of orientation, the manager has assigned the nurses to interview the organization's internal customers. Which group would the nurses interview? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Newly hired radiology technicians
B) People who are visiting clients admitted within the last two days
C) Physicians who have admitting privileges
D) Nurses who have worked at the facility more than five years
E) Vendors who supply disposable medical equipment to the hospital

Question 23

A hospital increased its RN-to-client ratio one year ago. What effects is the hospital likely to see as a result of that choice? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) The cost of providing care has decreased.
B) There has been a decrease in client deaths.
C) The average length-of-stay for clients has increased.
D) The overall quality of care has increased.
E) The nosocomial infection rate has dropped.

Question 24

The leader of a continuous quality improvement (CQI) team has asked that an information packet be distributed to members of the resource group. The secretary would prepare packets for which people? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) The CQI coordinator
B) The hospital CEO
C) The vice-president in charge of finance
D) Members of the CQI team
E) The team leader

Question 25

The procedures for managing client pain are being investigated as part of the hospital's total quality management program. Whom should the manager plan to invite to this meeting? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) The hospital CEO
B) A representative from the pharmacy
C) A representative from the medical staff
D) A staff nurse who works with clients in pain
E) A representative from social services

Question 26

The nurse manager on the obstetrical unit is adopting Total Quality Management (TQM). Which characteristics are associated with TQM? Note: Credit will be given only if all correct choices and not incorrect choices are selected. Select all that apply.

A) Boundaryless collaboration
B) Involve the total organization
C) Focus on client
D) Identify key processes
E) Use quality tools and statistics for measurement

Question 27

The daughter of a hospitalized client comes to the nurse manager's office with a complaint about the care provided on the previous shift. What is the manager's first action?

A) Call the nurse from the last shift to participate in a conference call about the complaint.
B) Ask the daughter to explain what happened.
C) Tell the daughter that the last shift was understaffed and apologize for any problems that might have occurred.
D) Ask the daughter what can be done to improve the situation.

Question 28

A risk manager generally uses root-cause analysis to investigate incidents. What are the likely outcomes of this action? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) There is disagreement over the cause of the incident.
B) There are insufficient resources to make needed changes to prevent similar incidents.
C) The system or process causing the incident is identified and corrected.
D) Improvements to the system are widespread.
E) Sufficient evidence is acquired so that management is comfortable in making needed changes.

Question 29

The nurse manager receives a report that a medication was given to the wrong client. This is called a(n) ________ and will be reviewed with the physician and risk management committee member.

Question 30

Which statement regarding the use of electronic medical records (EMR) is accurate as associated with quality improvement?

A) EMR has strong linkage to improving quality.
B) Much more research must be done before the impact of EMR on quality can be determined.
C) EMR does not affect the quality of care provided.
D) Although no research into the impact on quality exists, EMR must continue as it is federally mandated.

Question 31

A nurse manager is looking for evidence-based information regarding wound care. Which criteria should be used to evaluate the usefulness of an intervention? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Is there evidence that the intervention has been used in hospitals of similar size to the one where the manager practices?
B) Can the manager find two or more research studies that support the use of the intervention?
C) Is the intervention one that the manager has seen used in the past?
D) Are the authors of the research articles well-known experts in the field?
E) Is the research study that recommends the intervention rigorous in design and execution?

Question 32

Which data would be of most interest to an organization using Lean Six Sigma as a means of quality improvement?

A) Almost 85% of call lights are answered within 4 minutes.
B) Results of pain medication administration are documented 95% of the time.
C) Nursing overtime hours increased by 25% in the last quarter.
D) In the last 6 months, overall client satisfaction scores have increased by 15%.

Question 33

Which statement reveals the most dangerous result of using measured standards as part of the CQI process?

A) A nurse complains, "Collecting this data takes so much time."
B) A radiology technician says, "CQI is lots of work."
C) A nurse manager says, "I'm not going to change this process, because I'd have to change the CQI monitors."
D) The laboratory technician says, "Writing these CQI reports is boring."