Deck 22: Quality Improvement and Patient Safety

Question 1

The number of IV site infections has more than doubled on a nursing unit. The staff determine common causes include the site is cleaned using inconsistent methods, dressing frequently becomes wet when patient showers, IV tubing is not changed every 48 hours per protocol, and inadequate hand washing of RN prior to insertion. A bar graph demonstrates the frequency in descending order, with 80% of infections being attributed to inadequate hand washing. The quality tool used is a:

A) cause-and-effect diagram.
B) run chart.
C) Pareto chart.
D) flowchart.

Answer 1

Pareto chart.

Question 2

Regardless of the term used to describe high-quality health care, the focus of quality is:

A) what the consumer needs and wants.
B) economical care.
C) having the greatest technologic advancement.
D) services equally distributed among populations.

Answer 2

what the consumer needs and wants.

Question 3

The surgical team arrives in the operating room and one member states, "Everyone stop. Let's identify the patient and operative site. Now does anyone have any questions or concerns?" This process is known as:

A) time-out.
B) a critical pathway.
C) special cause variation.
D) lean methodology.

Answer 3

time-out.

Question 4

A group of nurses is presenting the importance of high-quality care during a system-wide meeting of medical-surgical nurses. They point out a finding of the Quality Chasm that:

A) being insured has little effect on a person's longevity and the quality of care received.
B) lobbyists for the drug companies are able to gain permission for the use of new drugs within 1 year of their discovery.
C) although a greater number of lawsuits stem from medication errors, more people actually die from human immunodeficiency virus (HIV) and acquired immunodeficiency disease syndrome (AIDS).
D) medication-related errors place a tremendous financial burden on the U.S. health care system.

Question 5

A nurse is asked to "float" to a telemetry floor and is to place a patient on telemetry monitor. The nurse is unfamiliar with placement of EKG leads and would consult which type of chart to learn the correct placement?

A)
B)
C)
D)

Question 6

Which of the following occurrences would be classified as a sentinel event?

A) A postpartum patient who elects to breastfeed only twice daily develops mastitis.
B) A newly diagnosed diabetic patient self-injects insulin in the abdominal area rather than the upper thigh as instructed by the patient educator.
C) A nurse assisting with the delivery of twins places the "Twin 1" name tag on the second-born twin, causing the first-born twin to undergo surgery that was scheduled for the other twin.
D) A nurse administers 3 units of regular insulin rather than 3 units of NPH insulin subcutaneously, resulting in a drop in the patient's serum glucose from 160 to 100 mg.

Question 7

According to the Quality Chasm report:

A) health care providers should be proactive rather than reactive to patient needs.
B) common needs rather than individual preferences should be the priority.
C) medical information should be confined to the primary care provider.
D) specialized providers or case managers should control health care decisions.

Question 8

Each month data on admission assessments that are based on the following standard are entered: "All patients will be assessed by an RN within 2 hours of admission." The target goal for this standard is 97% compliance. Data are displayed on a graph that shows number and time of admission assessments and compliance variation limits. This pictorial representation is:

A) Pareto chart.
B) control chart.
C) deployment chart.
D) top-down flowchart.

Question 9

Institute for Healthcare Improvement (IHI) proposed a process for quality improvement with steps known as "PDCA." When explaining the steps to a group of nurses interested in improving the process of medication reconciliation for heart failure patients with high rates of recidivism, the instructor states:

A) P stands for process. Following a top-down flowchart provides the steps for reviewing patient medications taken at home compared to those prescribed during hospitalization.
B) D stand for deviation, which is an alteration in the expected drugs ordered.
C) C is for check if the process for change worked. Was there an improvement in accurate reconciliation? And what was learned? A stands for algorithm, which includes all steps of the process.
D) A stands for algorithm, which includes all steps of the process.

Question 10

A hospital is concerned that the number of medication errors has increased significantly in the past year. A project revealed four causes of medication errors. The above chart was used to help staff and administration know where to focus efforts to reduce errors. Which process improvement tool is used in this situation?

A)Run chart
B)Pareto chart
C)Flowcharts
D)Cause-and-effect diagrams

Question 11

A team of experienced nurses work together to develop algorithms that are converted into checklists to ensure standardization of commonly performed procedures. The focus of this team is primarily on which Institute of Medicine (IOM) competency?

A) Safety
B) Timely
C) Equitable
D) Patient-centered care

Question 12

A nurse is assisting with the delivery of twins. The first infant is placed on the scale to be weighed. The physician requests an instrument stat. The nurse turns to hand the instrument to the physician, and the infant falls off the scale. When evaluating the incident, the nurse and her manager list contributory factors such as the need for two nurses when multiple births are known, and the location of the scale so far from the delivery field. These nurses are performing a(n):

A) standardization of care.
B) root cause analysis.
C) process variation.
D) analysis of a deployment flowchart.

Question 13

An organization's emergency preparedness task force meets to discuss how it should react in case of a terrorist attack and develops a disaster evacuation plan that details how each department will assist individuals in reaching safety. This type of diagram is referred to as a:

A) Pareto chart.
B) control chart.
C) top-down flowchart.
D) deployment chart.

Question 14

During the night, a patient fell in the bathroom and sustained a hip injury. The patient was very upset because of being unable to attend a granddaughter's wedding in 2 days. The team looked at the process and determined that the patient had been medicated with a narcotic, had urinary urgency so had not taken the time to put on shoes, failed to turn on the light because the door to the hall let in some light, and stumbled over a towel that had been placed to collect water leaks caused by construction that was in progress to replace damaged sinks. Which factor was a special cause variation?

A) Failure to take time to put on shoes due to urgency
B) Unsteady gait due to narcotic administration
C) Poor lighting that led to decreased vision
D) Improper construction that caused the leak and towel placement

Question 15

Patients with heart failure have extended lengths of stay and are often readmitted shortly after they have been discharged. To improve quality of care, a type of "road map" that included all elements of care for this disease and that standardized treatment by guiding daily care was implemented. This road map is referred to as a(n):

A) benchmark.
B) critical pathway.
C) algorithm.
D) case management.

Question 16

A nurse is removing a saturated dressing from an abdominal incision and must cut the tape to remove the dressing. The nurse accidentally cuts the sutures holding the incision, and evisceration occurs. In quality improvement, this incident is best identified as a:

A) root cause.
B) sentinel event.
C) variation in performance.
D) causal factor.

Question 17

A nonprofit organization that distributes to governmental agencies, the public, business, and health care professionals knowledge related to health care for the purpose of improving health is the:

A) Institute for Safe Medication Practices.
B) Institute of Medicine.
C) National Committee for Quality Assurance.
D) The Joint Commission.

Question 18

A patient is ordered a low-protein, low-calorie diet but the patient's family brings fish, lentils, and unleavened bread for a meal to observe a cultural practice. The nurse works with the dietitian to adjust the next few meals to accommodate for this variance. This situation would represent:

A) a sentinel event.
B) an adverse event.
C) patient-centered care.
D) the communication technique of "call-out."

Question 19

The staff on a nursing unit notes that patient satisfaction varies from month to month. They plot the degree of patient satisfaction each month for 1 year to determine when the periods of greatest dissatisfaction are occurring. The staff uses which type of graph?

A) Time plot
B) Pareto chart
C) Flowchart
D) Cause-and-effect diagram

Question 20

A nurse is preparing to administer a medication by using the vastus lateralis site and is unfamiliar with the process. A step-by-step reference that shows how to complete the process is called a:

A) deployment flowchart.
B) top-down flowchart.
C) Pareto chart.
D) control plot.

Question 21

Nurses, physicians, and social workers finalize the plan of care and coordinate discharge for a homeless person who will need wound care and follow up over the next 4 weeks. Each member contributes based on his or her area of expertise but also recognize other members' strengths. Which of the QSEN competencies are being demonstrated?

A) Quality improvement
B) Evidence-based practice
C) Teamwork and collaboration
D) Patient-centered care

Question 22

While taking a shower, a patient pushes the emergency light. When the nurse arrives, the patient complains of feeling dizzy and unsteady. The nurse turns to reach for the patient's walker and the patient falls, hitting the right side of the face resulting in loss of vision in the right eye. This scenario represents a _______ event.

Question 23

Nurses working on an orthopedic unit use personal digital assistants (PDAs) to review medications prior to administration to reduce potential drug interactions. Software is also installed that provides video clips of common procedures performed by nurses. Nurses on this unit are best demonstrating which QSEN competencies?

A) Patient-centered care
B) Informatics
C) Teamwork
D) Quality improvement

Question 24

Which of the following statements concerning the Institute of Medicine (IOM) competencies is correct?

A) Each competency is mutually exclusive.
B) The competencies focus on individual efforts to reduce errors.
C) Physicians lead the team to achieve each competency.
D) The competencies address both individual and system approaches to transform care.

Question 25

Quality is defined by the ____________.

Question 26

A nurse educator is explaining to licensed staff that health care is no longer safe and describes The Quality and Safety for Nursing (QSEN) recommended competencies for educating nursing professionals. These include: (select all that apply)

A) advanced health assessment techniques.
B) patient-centered care.
C) prescriptive pharmacology content.
D) quality improvement.
E) safety.

Question 27

An interdisciplinary team is evaluating the hospital's care of patients admitted with a myocardial infarction (heart attack) compared to national standards. The team analyzes the hospital's clinical indicator, which would be: (select all that apply)

A) aspirin order within 24 hours of discharge.
B) patient teaching related to stopping smoking completed prior to discharge.
C) beta blocker administered upon arrival.
D) support of employer to modify stress in workplace.
E) patient's willingness to adhere to a strict cardiac diet after discharge.

Question 28

A patient with complicated diabetes is scheduled for a below the knee amputation at 7 AM. The surgical team adheres to the 2012 National Patient Safety Goals by implementing which protocols? (select all that apply)

A) The surgical team asks the patient to verify his or her name, type of surgery, and limb to be removed.
B) Ask each member of the surgical team to provide a copy of licensure and, if applicable, certification to patient and family.
C) The surgical team uses the chart number and name/hospital number to ensure they have the correct patient.
D) Mark the procedure site with "X" and again ask the patient to verify correct site.
E) After arrival in the operating room, perform a "time-out" for final identification of patient and operative site along with agreement of what procedure is scheduled.