Deck 17: Quality and Safety

Question 1

A type of process or structure whose application reduces the probability of adverse events resulting from exposure to the health care system across a range of conditions or procedures is:

A) risk adjustment.
B) a sentinel event.
C) a patient safety practice.
D) a performance measure.

Answer 1

a patient safety practice.

Question 2

Responding to a code called in the psychiatric unit where she works, a staff nurse finds that a patient has committed suicide. The staff nurse correctly identifies this as a:

A) benchmark incident.
B) quality improvement issue.
C) performance breach.
D) sentinel event.

Answer 2

sentinel event.

Question 3

A successful enterprise risk management (ERM) program will (select all that apply):

A) identify risks.
B) improve quality.
C) prevent damage.
D) control occurrences.
E) control legal liability.

Answer 3

identify risks.
prevent damage.
control occurrences.
control legal liability.

Question 4

The industry-based model for quality management and measurement whose premise is that operational waste needs to be eliminated is:

A) Six Sigma.
B) ISO 9000.
C) Lean Enterprise.
D) Baldrige National Quality Award Program.

Question 5

Tenets embraced by health care professionals and promoted by health care leaders and organizations such as TJC and the IOM include which of the following (select all that apply)?

A) People and systems are the problems, not processes.
B) Quality measurement and monitoring is everyone's job.
C) Quality cannot be enhanced by nonpunitive work cultures.
D) Standardization of processes is key to managing work and people.
E) The impetus for quality monitoring is not primarily for accreditation or regulatory compliance.

Question 6

Which of the following responses from the nurse manager is consistent with a culture that promotes patient safety?

A) "We make sure that we don't have any errors on this unit."
B) "We identify who made the error and take corrective action."
C) "We provide remedial training for all staff on the unit when there is an error."
D) "We report any serious error to The Joint Commission and use their experts to help us find the root cause of the problem."

Question 7

The Baldrige National Quality Award (BNQA) establishes a set of performance standards that define a total quality organization. The standards in areas of excellence include (select all that apply):

A) leadership.
B) strategic planning.
C) environment of care.
D) human resource focus.
E) medication management.

Question 8

Hospitals must submit specific quality performance data regarding Medicare patients or risk:

A) an increase in federal tax.
B) decreased payments.
C) fewer physician referrals.
D) sanctions by The Joint Commission (TJC).

Question 9

The purpose of a root-cause analysis (RCA) is to:

A) discipline the staff involved in the patient safety event.
B) disclose the medical error to the patient/patient's family.
C) identify the person(s) responsible for committing the error.
D) identify the systems issues that led to a sentinel event.

Question 10

Attributes of high-performance organizations (HPOs) include (select all that apply):

A) accreditation by TJC.
B) a commitment to obtaining Magnet designation.
C) strategic thinking that anticipates customer needs and market changes.
D) leaders who communicate a strong and clear mission and vision to employees.
E) creative and improvisational problem solving to address failures or near misses.

Question 11

Which of the following is an example of a nurse-sensitive indicator?

A) Cardiac patient mortality
B) Hospital-acquired pressure ulcers
C) Pulmonary embolus after knee surgery
D) Iatrogenic pneumothorax after central line placement

Question 12

Mercy Hospital compares its surgical site infection rate to General Heart Hospital, which is known as a best-in-class hospital for its surgical site infection rates. Mercy Hospital studies General Heart Hospital's methods for reducing surgical site infection rates and uses that information to improve its own performance. This quality performance method is called:

A) benchmarking.
B) evidence-based practice.
C) enterprise risk management.
D) continuous quality improvement.

Question 13

The degree to which health services for individuals and populations increases the likelihood of desired health outcomes that are consistent with current professional knowledge is known as the:

A) care delivery quotient.
B) excellence index.
C) quality of health care.
D) standard of care.

Question 14

Which comment by the nurse manager would indicate that the hospital places a high value on patient safety?

A) "We have safety posters throughout the hospital that encourage people to report problems."
B) "We have monthly safety in-services."
C) "We encourage patients and families to participate in The Joint Commission's Speak Up program."
D) "All employees are required to update their knowledge of safety practices each year."

Question 15

The risk manager wants to illustrate the causes that have been leading to an increase in patient misidentification. The most appropriate tool to use is a:

A) pareto chart.
B) control chart.
C) fishbone diagram.
D) detailed flowchart.

Question 16

A framework for understanding health care improvement has been proposed by the IOM Committee on Quality of Health Care in America. The aims for health care quality improvement propose that health care systems ensure that care is (select all that apply):

A) safe.
B) timely.
C) efficient.
D) cost-controlled.
E) patient-centered.

Question 17

A nursing quality improvement supervisor is proposing to enhance the current quality improvement program. One of the most important themes that a nursing quality improvement supervisor should consider is:

A) budgetary considerations.
B) collaboration between health care teams.
C) regular staff training programs.
D) suggestions from patients.

Question 18

Which of the following are never events (select all that apply)?

A) A minor medication error
B) A foreign object left in the body during surgery
C) Surgery on the wrong body part
D) A mismatched blood transfusion
E) Hip fracture acquired in the hospital
F) Pressure ulcer acquired in the home
G) Catheter-associated urinary tract infection
H) Surgical site infection

Question 19

"To provide the best care to every patient every day through integrated clinical practice, education, and research" is an example of a(n):

A) accountability agreement.
B) mission statement.
C) organizational standard.
D) vision and value proposal.

Question 20

Sentinel event alerts are published by TJC to do which of the following?

A) Allow facilities to learn from sentinel events that have occurred in other facilities and incorporate recommendations for prevention into their policies.
B) Notify hospitals that if a sentinel event occurs during an alert, the hospital will be subject to withdrawal of Medicare and Medicaid certification and reimbursement.
C) Prevent a near-miss from occurring.
D) Assist hospitals to find national standardized performance measures to benchmark themselves against other similar hospitals.

Question 21

Nurse managers can create an environment that is devoted to health care safety by doing which of the following (select all that apply)?

A) Adopting and embracing the concept of disciplining staff who commit errors
B) Learning the concepts and tools related to quality improvement and quality assurance
C) Becoming a role model for staff and peers in practicing health care safety concepts
D) Encouraging staff to be constantly vigilant in identifying potential risks in the care environment
E) Creating a sense of partnership with patients and families to promote communication about safety concerns and soliciting their suggestions to correct and prevent potential risks

Question 22

TJC requires accredited organizations to participate in their core measure initiative. The current core measure sets include (select all that apply):

A) stroke.
B) tobacco treatment.
C) pneumonia measures.
D) iatrogenic pneumothorax.
E) venous thromboembolism.
F) acute myocardial infarction.

Question 23

_____ is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.

Question 24

Quality planning establishes the design of a product, service, or process that will meet customer, business, and operational needs to produce the product before it is produced. Quality planning follows a universal sequence of steps. List the universal sequence of steps in order.

A) Identify customers and target markets.
B) Discover hidden and unmet customer needs.
C) Develop a service or product that exceeds customers' needs.
D) Transfer these designs to the organization and the operating forces to be carried out.
E) Translate these needs into product or service requirements: a means to meet their needs.
F) Develop the processes that will provide the service, or create the product, in the most efficient way.

Question 25

A Healthcare Failure Modes and Effects Analysis (HFMEA) for a new bar-coding system is being conducted by an interdisciplinary team. List the steps of the HFMEA in the correct order.

A) Identifying prevention strategies
B) Endorsing action plans for implementation
C) Assessing risk points within the process steps
D) Flowcharting the steps of the process being studied
E) Designing out the most critical of the potential failures
F) Recommending process improvements for prevention of the failures
G) Ranking key risk points in terms of their impact on the potential failure of the system
H) Reporting action plans for implementing prevention strategies to the enterprise leaders

Question 26

The improvement process in which an organization measures its strategies, operations, or internal process performance against that of best-in-class organizations within or outside its industry, determines how those organizations achieved their performance levels, and uses that information to improve its own performance is known as _____.

Question 27

Principles of a fair and just culture include (select all that apply):

A) zero tolerance for reckless behavior.
B) reduction of personal accountability and discipline.
C) recognition that competent professionals make mistakes.
D) errors and unintended events being reported unless no patient harm occurs.
E) acknowledgment that even competent professionals develop unhealthy norms.