Deck 17: Healthcare Quality: a Critical Health Policy Issue

Question 1

The Institute of Medicine (IOM) uses two dimensions in the quality matrix to describe quality. Which factors are included in the first dimension? Select all that apply.

A) Patient-centeredness
B) Effectiveness
C) Timeliness
D) End-of-life care
E) Staying healthy

Answer 1

Patient-centeredness
Effectiveness
Timeliness

Question 2

Which statements regarding the Consumer Bill of Rights, Protections, and Responsibilities are accurate? Select all that apply.

A) This was an initiative of President Clinton's Presidential Advisory Commission on Consumer Protection and Quality in the Healthcare Industry.
B) Patient privacy was considered during this work.
C) The United States still does not have a consumer bill of rights, protections, and responsibilities.
D) The work focused on patient issues, but did not address practitioner qualifications.
E) This has been the most successful of the programs to come out of that decade of work.

Answer 2

This was an initiative of President Clinton's Presidential Advisory Commission on Consumer Protection and Quality in the Healthcare Industry.
Patient privacy was considered during this work.
The United States still does not have a consumer bill of rights, protections, and responsibilities.

Question 3

The nurse commits an error while caring for a patient who receives Medicare benefits. The error results in a complication that is on the Centers for Medicare and Medicaid Services' "never list." What is the implication of this error?

A) The nurse will be investigated by the state's Board of Nursing.
B) The nurse's employment will be terminated.
C) Medicare will not pay for the cost of the complication.
D) The patient will have to share the cost of the care for the complication with Medicare.

Answer 3

Medicare will not pay for the cost of the complication.

Question 4

What has been the historical importance of the Institute of Medicine (IOM) reports since 1999?

A) They stimulated the development of strategies that will improve quality of care.
B) They are responsible for accrediting hospitals and other types of healthcare organizations.
C) They establish minimum standards and benchmarks for healthcare organizations.
D) They support research designed to improve the outcomes and quality of healthcare.

Question 5

The nurse works with breast cancer survivors in a "Reach for Recovery" program. Which portion of the Institute of Medicine's (IOM) focus on quality care does this work represent?

A) Staying healthy
B) Getting better
C) Living with illness or disability
D) Coping with palliative care or end-of-life issues

Question 6

Which information would be used to monitor the process element of a hospital's quality?

A) The average daily census reports
B) Changes in community health status
C) Total percentage of nursing department salary hours paid to registered nurses
D) Patient satisfaction survey results regarding interaction with clinicians

Question 7

The patient develops postoperative pneumonia when the physician fails to order respiratory therapy treatments after surgery. Which type of quality problem does this situation most clearly represent?

A) Misuse
B) Error of planning
C) Underuse
D) Error of benefit

Question 8

Which phrase best explains the Institute of Medicine's (IOM) 21^st century rule, "Care based on continuous healing relationships?"

A) Sharing of information
B) Patient-centered care
C) Access is critical
D) Care based on evidence

Question 9

Which statement, made by a staff nurse, indicates that the nurse understands the meaning of Medicare HACs?

A) "I am a very good nurse, so it is unlikely that one of my patients would experience one of these events."
B) "It is so hard when a patient experiences one of these events since they are not survivable."
C) "Thankfully, most nurses will never see a patient experience one of these events."
D) "I am working on the safety committee to help prevent the occurrence of these events."

Question 10

The medical center quality improvement director issues a report on the "opportunity" costs of errors occurring in the organization. Which situation would be included in this report? Select all that apply.

A) A patient sustained a fracture when he falls after being incorrectly restrained.
B) A laboratory test must be repeated because the technician ran the specimen incorrectly.
C) A medicine error necessitates that the patient be dialyzed.
D) The patient says, "A nurse nearly let me die, so I don't trust nurses anymore."
E) The physician enters discharge orders incorrectly and the patient spends another day in the hospital.

Question 11

Which factors are evidence of an increased interest in quality care? Select all that apply.

A) Increased legislation
B) A change in focus of the major purchasers of healthcare
C) Initiatives by healthcare professional organizations
D) An increased number of accreditation organizations
E) A major decrease in the number of malpractice lawsuits

Question 12

Which statement, made by a staff nurse, reflects correct identification of the primary goal of quality improvement (QI)?

A) "This process will save us money."
B) "I like that this intervention saves time."
C) "It seems as if the physicians like our new charting system."
D) "My patients do better since we are using this system."

Question 13

Select the option that reflects the focus of the "U" portion of the Joint Commission's "Speak Up" program.

A) Use education to remain healthy.
B) Undergo as few medical procedures as possible.
C) Use accredited healthcare organizations.
D) Understand your medication regimen.

Question 14

The quality improvement nurse is working to increase the efficiency of resource utilization in the medical center. This nurse is focusing on which element of healthcare quality?

A) Process
B) Structure
C) Outcome
D) Function

Question 15

The nurse is interested in educating patients to become active participants in their own healthcare. Which information should the nurse review to develop a program for the hospital?

A) "Speak Up: Help Prevent Errors in Your Care."
B) Crossing the Quality Chasm.
C) To Err Is Human: Building a Safer Health System.
D) Envisioning the National Healthcare Quality.

Question 16

The faculty of a school of nursing has decided to follow the guidelines listed by the Institute of Medicine (IOM) Health Professions Education report. Which competencies should the faculty include in the school curriculum? Select all that apply.

A) How to use informatics
B) Information on working in interprofessional teams
C) How to tailor care to be patient-centered
D) The application of quality improvement to practice
E) How to use evidence-based information in practice

Question 17

Information from To Err is Human: Building a Safer Health System (Institute of Medicine, 1999) indicates that at least 44,000 Americans die each year as a result of a medication error. Nurses from which setting could closely apply this information to their personal practice?

A) Hospitals
B) Long-term care
C) Home health
D) Intensive care units
E) Ambulatory care

Question 18

A serious medication administration error occurred on the unit last night. What statement, made by the nurse manager, reflects the current focus of quality improvement (QI) related to this situation?

A) "Was this a nursing error or a physician error?"
B) "How did the error occur?"
C) "Who gave the medication?"
D) "What pharmacist was on duty?"

Question 19

The nursing student is writing a paper on the Institute of Medicine's (IOM) 2001 report, Crossing the Quality Chasm. Which options reflect aims of this report that the student should include? Select all that apply.

A) Timeliness
B) Effectiveness
C) Reimbursement
D) Equality
E) Safety

Question 20

High reliability organizations are best described by which statement?

A) An HCO that is ranked high in a national report card about healthcare quality
B) An HCO that views a near miss as a sign we are catching errors
C) Reliability in an organization requires that managers consider staff input
D) When operations are viewed as effective this is good sign

Question 21

What is true of quality in healthcare?

A) It is easy to define.
B) It is easy to measure.
C) It is complex.
D) It is unachievable.

Question 22

The hospital's quality improvement department focuses on measuring structure, process, and outcomes and identifying errors and hazards in the care provided. What other foci should the department develop to become an effective quality improvement program? Select all that apply.

A) Assessing current practices and comparing them to what is done in other facilities.
B) Designing and testing interventions to improve quality.
C) Finding better resources for funding of initiatives.
D) Helping practitioners identify methods of improving personal practice.
E) Helping the facility recruit and retain qualified nurses.

Question 23

A nurse works as a reviewer of Medicare claims. In this capacity, the nurse frequently denies these claims. What is the primary rationale for this action?

A) It helps to protect the Medicare Trust Fund.
B) It serves to control unnecessary testing.
C) It keeps physician practice from becoming too independent.
D) It helps ensure that nursing care is safe.

Question 24

The healthcare provider is aware that an error was made in the care of a hospitalized patient. The provider is aware that information about the error would make it less likely that the same or a similar error would happen to another patient. However, the provider is fearful of retribution regarding the error. To which group should the provider consider reporting this information?

A) Patient Safety Organization (PSO)
B) Joint Commission
C) National Institute of Health (NIH)
D) Health Resources and Services Administration (HRSA)