Deck 18: Implementing Healthcare Quality Improvement

Question 1

Which organizations are subject to accreditation by the Joint Commission? Select all that apply.

A) Hospitals
B) Long-term care facilities
C) Schools of nursing
D) Home care agencies
E) Office-based surgical practices

Answer 1

Hospitals
Long-term care facilities
Home care agencies
Office-based surgical practices

Question 2

The healthcare corporation is considering using benchmarking as a way to improve quality. What concept is essential to this process?

A) The corporation should choose unique, corporation-specific areas to include in benchmarking.
B) Benchmarking is designed to work best on management-level initiatives.
C) In order for benchmarking to be effective, the corporation must be willing to share information.
D) This process will build an internal database on which future decisions will be based.

Answer 2

In order for benchmarking to be effective, the corporation must be willing to share information.

Question 3

Place the key steps of the continuous quality improvement (CQI) process in their most logical order.

A) Collect data.
B) Implement the plan.
C) Develop a plan.
D) Analyze and summarize data.
E) Implement corrective actions.
F) Share data with staff.

Answer 3

C,B,A,D,F,E
Explanation: 1. After data is generated in step two, data collection occurs in step three.
2. The second step is implementation. This implementation will generate data for the next step.
3. The first step of this process is to work within the units, services, departments, and organization to develop a CQI plan.
4. The fourth step is to analyze and summarize the data collected in the previous step.
5. The final step, before the process starts again, is to implement corrective action on any identified problems. This will direct the beginning of the new CQI cycle.
6. Once data has been analyzed and summarized, the fifth step is to share the information with staff.

Question 4

The unit has been so understaffed that the nurse has been unable to attend education sessions on new medications that physicians will be prescribing for the treatment of hypertension. This situation is likely to result in a medication error resulting from which contributing factor?

A) Work environment
B) Task
C) Individual staff member
D) Organization and management

Question 5

The risk manager has noted an increase in error rate for a nursing unit over the last year. Which factors should the risk manager investigate? Select all that apply.

A) How strong is the unit leadership?
B) Are nurses being asked to fulfill unreasonable work assignments?
C) How well does the unit staff function as a team?
D) Who on the unit is making the most mistakes?
E) Does an environment of learning exist on the unit?

Question 6

The administration of a healthcare organization (HCO) is concerned about the increasing costs of Joint Commission accreditation. One administrator suggests, "Let's just withdraw from the process." What should the administrative staff consider prior to acting on this suggestion? Select all that apply.

A) The HCO could no longer offer obstetric or pediatric services.
B) The HCO could no longer serve as a training center for medical students.
C) The HCO could no longer offer clinical experiences for nursing students.
D) The HCO could no longer offer emergency services.
E) The HCO could no longer receive any federal funds.

Question 7

The risk manager is providing education on identifying sentinel events for the nursing staff. Which scenarios would be good examples for the risk manager to use? Select all that apply.

A) A patient is received dead on arrival from an automobile accident.
B) An inpatient attempts to jump from the hospital's rooftop garden.
C) A patient dies after being assigned a do not resuscitate (DNR) status.
D) A woman suffers cardiac arrest during the delivery of a viable infant.
E) A patient who suffered head trauma was admitted to the regular medical unit and dies.

Question 8

Which initiative focuses on unit safety?

A) HCUP
B) TERCAP
C) CUSP
D) NDNQI

Question 9

Which patient is most likely to benefit from using a rapid-response team (RRT)?

A) A 10-year-old in the Emergency Department
B) A 51-year-old in the Cardiac Intensive Care Unit
C) A 73-year-old on a urology unit
D) A 43-year-old in a physician's office

Question 10

The nurse executive announces to the nurse managers that the hospital will soon begin using failure modes and effects analysis (FMEA) to analyze errors. What should the nurse managers tell the staff about this new initiative?

A) If you make an error, expect that the FMEA system will investigate you.
B) If there are two errors in one category, such as falls, the nurses involved will be investigated.
C) We will not have to worry about this system until our turn comes up in the unit rotation.
D) All of the hospital systems will be a part of this initiative.

Question 11

During a meeting with nurse managers, the risk manager for the hospital says, "Approximately 60% of our patient care errors can be directly attributed to poor handoffs." What situation should the nurse managers address to improve these statistics?

A) One person per shift should be responsible for receiving medications that are delivered from the pharmacy.
B) The staff should work on clarity of information communicated when a patient is transferred from one care setting to another.
C) More care should be taken in interpreting physician orders.
D) The nursing staff must complete admission history and physicals in a timelier manner.

Question 12

The quality improvement director is scheduling education sessions for new employees about Joint Commission Accreditation visits. The director should explain that which group is most likely to be interviewed during the accreditation visit?

A) Hospital administration
B) Nurse managers
C) Department managers
D) Direct care providers

Question 13

The risk manager of a healthcare organization is concerned about the amount of violence against healthcare workers that is occurring nationwide and would like to offer education sessions to staff. Which groups of staff are most at risk for experiencing violence and therefore should receive this education earlier rather than later in the schedule? Select all that apply.

A) Long-term care staff
B) Neurological Intensive Care staff
C) Cardiac telemetry unit staff
D) Emergency Department staff
E) Mental health unit staff

Question 14

After four nurses retire, the small hospital has insufficient nurses to staff the hospital 24 hours a day, seven days per week. A nursing assistant begins to assume many nursing activities to help with the staffing problem. Who is breaking the law in this case?

A) Both the nursing assistant and the hospital.
B) The hospital, but not the nursing assistant.
C) The nursing assistant, but not the hospital.
D) Neither the nursing assistant nor the hospital.

Question 15

Failure to rescue (FTR) is most commonly a result of which other failure?

A) Failure to understand the disease process.
B) Failure to understand the purpose of an intervention or treatment.
C) Failure to monitor patient status.
D) Failure to follow physician orders.

Question 16

The hospital has adopted a medication administration system that has a series of checks and balances designed for patient safety. The system works well, but is time consuming. Nurses have discovered shortcuts around the safeguards. This is an example of which situation?

A) A handoff
B) A workaround
C) An effects analysis
D) A "never event"

Question 17

Which situation is most likely to result in the nurse making a medication error?

A) The nurse has worked three 12-hour shifts in three days.
B) The nurse uses an online program to access medication information.
C) The nurse insists on documenting medication administration immediately after giving the medication.
D) The nurse prepares medications for administration in a secluded area.

Question 18

The nurse made a medication error. Which statement reflects the traditional "blame game" approach to such errors? Select all that apply.

A) The nurse manager says, "You have to complete the incident report and notify the patient's physician. You made the error, not me."
B) The nurse says, "Why did I make this error?"
C) The physician says, "Is there some way we can prevent this type of error from happening again?"
D) The nurse thinks, "The patient is okay, so I won't tell anyone this happened."
E) The risk manager says, "How many errors has this nurse made this year?"

Question 19

The nurse has taken a position in the utilization review (UR) department of a hospital. This nurse can expect to be involved in evaluating which care components? Select all that apply.

A) Was the care provided necessary?
B) How much medication did the patient receive?
C) How appropriate was the care provided?
D) How much did each procedure cost to provide?
E) How efficiently was care provided?

Question 20

The hospital Administrative team holds an employee meeting to announce that the hospital will support the use of quality report cards. What should the employees expect from this announcement? Select all that apply.

A) This report card will provide specific performance data about the organization at specific intervals.
B) The goal of using these report cards is to improve the organization's services.
C) These report cards will be an inexpensive way to let the community know about the organization's quality.
D) Using these report cards will increase the average daily census of the organization.
E) These report cards will be used internally as a means of documenting performance evaluations.

Question 21

In comparing current Joint Commission accreditation and accreditation done in the past, what are some approaches that have been reduced? Select all that apply.

A) Scheduled survey visits
B) Use of a more focused approach
C) Including nursing staff
D) Develop a plan for the survey
E) Taking a punitive approach to errors

Question 22

Measurement of access to care integrates ________, ________, and ________.

Question 23

The hospital's risk management department has identified patient falls as the event most likely to result in financial risk to the organization. Which activities should this group initiate? Select all that apply.

A) Providing education on completing incident reports on patient falls.
B) Holding staff education sessions on fall risk assessment.
C) Initiating a self-reporting system on near-fall events.
D) Developing a procedure by which falls incidents are investigated within four hours of occurrence.
E) Posting patient names and fall risk category on a wall in the nursing station.

Question 24

The newly licensed nurse asks a more experienced nurse if it is advisable to carry personal malpractice insurance. Which reply, made by the experienced nurse, is the most accurate?

A) "It is not necessary since the hospital carries a blanket policy."
B) "It is necessary only for advanced practice nurses like nurse midwives and certified registered nurse anesthetists."
C) "Every nurse should carry personal independent malpractice insurance."
D) "Carrying insurance is a good way to get sued."

Question 25

Which statement about the effect of healthcare quality report cards is accurate?

A) They have been shown to have a direct influence on consumer healthcare decisions.
B) These report cards are generally not accessible to consumers.
C) Releasing information via these report cards does not guarantee changes in quality.
D) Most consumer healthcare choices are now based on facts from these report cards rather than opinion.