Deck 10: Issues of Quality and Safety

Question 1

The director of CQI has called a meeting of all the interprofessional team members on your floor. Based on last quarter's statistics, the readmission rate of patients who have infections after hip replacements for osteoarthritis is twice that of patients for the first half of the year. The director has requested that the staff identify members who wish to be CQI team members investigating this problem. You, the staff nurse, have volunteered to be a member of the team. The team will consist of the physical therapist on the unit, a physician's assistant who works with the hospital orthopedic surgeons, the clinical educator, the nursing case manager, and you.
Why were these people selected for the team?

Answer 1

Situation:
The director of Continuous quality improvement (CQI) conducted a meeting for the entire inter-professional team members. According to the last quarter's statistics, the rate of patients infected after hip replacements for osteoarthritis is twice that of the patients for the first half of the year. The director has addressed the staff members to form a CQI investigating the problem. Here, the team consists of a physical therapist, a physician assistant who works with the hospital orthopedic surgeons, clinical educator, nursing case manager, and nurse.
Following people were selected for the team to investigate the problem:
• Physical therapist: This member of the team is a health-care professional who diagnoses and treats individuals who have common disease.
• Physician assistant who work with the hospital orthopedic surgeons: Physician assistant is a member who assists the work within the hospital for orthopedic surgeons.
• Clinical educator: Clinical nurse educators help both patients and co-workers. This member is a clinical trainer who educates the fellow staffs in the hospital.
• Nursing case manager: This member organizes and coordinates the team in response to individual health-care needs along the illness.
• Nurse: They provide service designed to promote health, prevent illness of the patients, and achieve optimal recovery from health problems.

Question 2

Discuss the history of quality and safety within the U.S. health-care system.

Answer 2

History of quality and safety within the U.S health-care system is given below:
The roots of history on the quality and safety within the U.S health-care system started by the institute of medicine (IOM) is a private, non-profit organization chartered in 1970 by U.S government. The IOM experts in the health and scientific recommend for the purpose of improving health. This IOM supports for making government policy, the health-care system, health-care professionals, and consumers.
In 1998, the IOM National roundtable on health care quality released statement on quality of care. This helps to make urgent changes in the U.S health-care system. This IOM statement launched today's movement to improve quality and safety for the 21 st century U.S health-care system.
In 1998, the IOM charged the committee on the quality of health-care in U.S to develop a strategy to improve health-care quality in the coming decades (IOM 2000). The committee completed a systematic review and assessment of literature that highlighted and quantified server shortcomings in the health-care system.

Question 3

How have historical, social, political, and economic trends affected nursing practice? Give specific examples and their implications.

Answer 3

Nursing practice:
Nursing is a profession within the health care division which focuses on the care of patients to cure the disease.
Historical, social, political, and economic trends affecting the nursing practice is given below:
• Historical trends affecting in the nursing profession:
At the time of the global health-care reform, regulation at global, national, state, and local levels has been taken on a new significance. The main focus is to reduce cost and improve outcome influences the present movement towards safety and quality improvement.
Example: In todays condition reduction in cost of treatment leads to rise in quality and safety of improvement in health care organization.
• Social, an d political affecting the nursing profession:
In social and political factors there is an increase in numbers of racial and ethnic groups. This also increased the number of elderly, longer life expectancy and technology improvement in geriatric care.
Both elderly and minorities are the risk factors that are faced difficulties in access to care and payment for care. Certain Act is passed to reduce these disparities to have access to health.
Example: There are social service agencies that support free medical education to the public.
• Economic trends affecting the nursing profession:
The economic trends and other issues cause an affect to the health care delivery system. In U.S the cost of health care was criticized by business, government, and media as compared to other developed countries. The costs of research and cost on developing new treatments continue to rise due to increase in economic trends.
Example: The use of new technology and incorporation of electronic health are projected to decrease costs and improve clinical outcomes, quality, and safety.

Question 4

The director of CQI has called a meeting of all the interprofessional team members on your floor. Based on last quarter's statistics, the readmission rate of patients who have infections after hip replacements for osteoarthritis is twice that of patients for the first half of the year. The director has requested that the staff identify members who wish to be CQI team members investigating this problem. You, the staff nurse, have volunteered to be a member of the team. The team will consist of the physical therapist on the unit, a physician's assistant who works with the hospital orthopedic surgeons, the clinical educator, the nursing case manager, and you.
What data need to be collected to evaluate this situation?

Question 5

Analyze historical, social, political, and economic trends affecting the nursing profession and the health-care delivery system.

Question 6

What problems have you identified during your clinical experiences that could be considered issues to be addressed using CQI?

Question 7

The director of CQI has called a meeting of all the interprofessional team members on your floor. Based on last quarter's statistics, the readmission rate of patients who have infections after hip replacements for osteoarthritis is twice that of patients for the first half of the year. The director has requested that the staff identify members who wish to be CQI team members investigating this problem. You, the staff nurse, have volunteered to be a member of the team. The team will consist of the physical therapist on the unit, a physician's assistant who works with the hospital orthopedic surgeons, the clinical educator, the nursing case manager, and you.
What are the potential outcomes for patients with who have had hip replacements?

Question 8

Explain the importance of quality improvement (QI) for the nurse, patient, organization, and health-care delivery system.

Question 9

What SCMs have you seen implemented in practice? Which ones might you use to assist you in planning care? If you have not seen any, ask the nurse manager what is used on the unit.

Question 10

The director of CQI has called a meeting of all the interprofessional team members on your floor. Based on last quarter's statistics, the readmission rate of patients who have infections after hip replacements for osteoarthritis is twice that of patients for the first half of the year. The director has requested that the staff identify members who wish to be CQI team members investigating this problem. You, the staff nurse, have volunteered to be a member of the team. The team will consist of the physical therapist on the unit, a physician's assistant who works with the hospital orthopedic surgeons, the clinical educator, the nursing case manager, and you.
Develop a flowchart of a typical hospital discharge and readmission rate for patients who have had hip replacements.

Question 11

Discuss the role of the nurse in continuous quality improvement (CQI) and risk management.

Question 12

How do nursing organization care models affect quality and safety outcomes?

Question 13

Examine factors contributing to medical errors and evidence-based methods for the prevention of medical errors.

Question 14

Discuss the role of the nurse in CQI and risk management.

Question 15

Explain the use of technology to enhance and promote safe patient care, educate patients and consumers, evaluate health-care delivery, and enhance the nurse's knowledge base.

Question 16

Based on patient safety goals for the current year, what will you do to ensure adherence to these goals?

Question 17

Describe the effects of communication on patient-centered care, interprofessional collaboration, and safety.

Question 18

What are evidence-based practices that promote quality and safety within the health-care system?

Question 19

Promote the role of the nurse in the delivery of safe, effective quality care in today's health-care environment.

Question 20

Describe how regulatory agencies and accrediting agencies affect patient care and outcomes at the bedside.

Question 21

Review the nonprofit organizations and government agencies that influence and advocate for quality and safety in the health-care system. What do the organizations or agencies do that supports the hallmarks of quality? What have been the results of their efforts for patients, facilities, the health-care delivery system, and the nursing profession? How have the organizations or agencies affected your facility and professional practice?

Question 22

Explain how technology enhances and promotes safe patient care, educates patients and consumers, evaluates health-care delivery, and enhances the nurse's knowledge base in your practice and at your organization.

Question 23

How would you begin discussion on quality and safety issues with the nurse manager or colleague?

Question 24

What issues may arise when the care delivery system is changed? What does the RN need to consider when implementing these changes?