Question 1

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

Accepted Answer

Correct:The customer determines quality on the basis of his or her unique perception of high-quality care.
Incorrect:b.High-quality health care can be inexpensive,but if it does not meet the criteria established by the consumer,then it is not high-quality health care.
c.Although technologic advancements may indeed facilitate superior diagnostics,unless the patient perceives that the technology was an indicator of quality or that it improved quality,then it is not the focus.
d.The perception of quality is unique among individuals.

Question 2

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:

Accepted Answer

Correct:A sentinel event is an unexpected occurrence that could result in serious physical or psychological injury to the patient,including the possibility of returning to surgery and a prolonged length of stay.
Incorrect:a.A root cause analysis is the process by which basic or causal factors that underlie variation in performance,such as a sentinel event,are identified,but this process is not the event itself.
c.A variation results from the lack of perfect uniformity in the performance of any process,but when the variation is this serious,it is referred to as a sentinel event.
d.Causal factors are the underlying causes of the event,not the actual event.

Question 3

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

Accepted Answer

Correct:Medication-related errors for hospitalized patients cost roughly $2 billion annually.
Incorrect:a.Uninsured Americans exhibit consistently worse clinical outcomes than the insured,and they are at increased risk for dying prematurely.
b.The lag between the discovery of more effective forms of treatment and their incorporation into routine patient care averages 17 years.
c.Medical errors kill more people per year than breast cancer,AIDS,or motor vehicle accidents.

Question 4

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):

Accepted Answer

Correct:A critical pathway determines the best order and timing of interventions provided by health care team members for a particular diagnosis.
Incorrect:a.A benchmark is a process used in quality improvement to evaluate different aspects of a process in relation to best practices,with the goal of improving performance.
c.An algorithm represents a decision path that a practitioner might take for a particular condition.
d.Case management is a type of health care delivery that matches the most appropriate services to the patient's care needs in the most efficient,effective manner,often with the use of a critical pathway or a clinical guideline.

Question 5

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?

Accepted Answer

Correct:A special cause variation is an uncommon variation that is unstable and unpredictable,is not under statistical control,and is related to a clearly identified single source,which in this scenario is the construction project.
Incorrect:a.Urinary urgency is not an uncommon or unpredictable variation.
b.Safety measures should be instituted when a narcotic is administered,especially to older adult patients whose ability to metabolize and eliminate the drug may be altered.
c.Lighting was available,but it was not used.

Question 6

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:

Accepted Answer

Correct:A top-down flowchart shows the sequence of steps in a job or process such as medication administration.
Incorrect:a.A deployment flowchart shows the detailed steps involved in a process and the people or departments that are involved at each step in the process; this is not involved in this scenario.
c.The Pareto chart is used in quality improvement to indicate that 80% of problems usually stem from 20% of causes; it displays data so that a few problems are easily depicted and facilitates improvement that focuses on those few.
d.A control plot is a run chart that has a center-line and added statistical control limits; it helps reveal specific types of change within a process,rather than providing a sequencing of steps.

Question 7

In differentiating between early efforts of quality assurance and present-day quality improvement efforts, which statement is correct? Quality assurance:

Accepted Answer

Correct:Early efforts focused on identified problems and were reactive rather than proactive.
Incorrect:a.Quality assurance focused on specific incidents rather than on broad system improvements.
b.With quality assurance,only a few people such as auditors focused on problems,and administration only later recognized the importance of proactive initiatives involving all members of the health care team.
c.Early efforts of quality assurance focused on identified problems rather than on avoiding future problems.

Question 8

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.)

Accepted Answer

Correct:The 2012 National Patient Safety Goal includes universal precautions to ensure patient safety and prevent sentinel events.Methods to identify patient and surgical procedure are required.
Incorrect:b.The health care providers do not provide copies of license and certification to patient or family:verification is the responsibility of the employing agency.

Question 9

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:

Accepted Answer

Correct:The Institute of Medicine is a nonprofit organization whose mission is to advance and disseminate to the government,the corporate sector,the professions,and the public scientific information that will improve human health.
Incorrect:a.The Institute for Safe Medication Practices is a nonprofit organization that is an educational resource only for the prevention of medication errors.
c.The National Committee for Quality Assurance is the accrediting body for health maintenance organizations.
d.The Joint Commission is a national agency that conducts surveys and certifies compliance with established standards for inpatient and ambulatory facilities.

Question 10

According to the Quality Chasm report:

Accepted Answer

Correct:Quality is based on predicting patient needs rather than reacting to needs.
Incorrect:b.Care that is based on individual needs and preferences predicts satisfaction with care.
c.Providers and the patient should have access to information so they can make well-informed decisions.
d.The patient,not the providers/managers,should have control over health care decision-making.

Question 11

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:

Accepted Answer

Correct:A time-out occurs in the operating room to ensure the entire surgical team identifies the patient,operative site,and possible concerns or questions about the procedure.
Incorrect:b.A critical pathway defines the optimal sequencing and timing of interventions by physicians,nurses,and other interprofessional team members when providing care for a patient with a particular diagnosis or procedure.
c.Special cause variation is a deviation that is unstable,unpredictable,and not in statistical control.
d.Lean methodology is a system that focuses on reducing waste,synchronizing workflows,and managing variability in production flows.

Question 12

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:

Accepted Answer

Correct:A deployment flowchart would show the detailed steps involved in the process and the people or departments that are to be involved at each step to assist individuals in reaching safety.
Incorrect:a.The Pareto chart displays data so that a few problems that cause the greatest variance are easily depicted and facilitates improvement that focuses on those few.
b.A control chart distinguishes between common and special cause variations and is basically a run chart with added statistical control limits.
c.The top-down flowchart simply lists the main steps and substeps of a process in a linear fashion and does not detail the departments or people needed.

Question 13

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):

Accepted Answer

Correct:A root cause analysis is a process by which factors that underlie variation in performance,including the occurrence or possible occurrence of a sentinel event,are identified.The purpose of root cause analysis is to identify improvements that can be implemented to prevent future occurrences.
Incorrect:a.Standardization of care is the process of developing and adhering to best known methods and repeating key tasks in the same way,thereby creating exceptional service with maximum efficiency.
c.Process variation looks at the steps in a process to determine how variation affects each step but does not identify causal events.
d.A deployment flowchart analysis looks at the steps of a process and determines which department is responsible for each step,but it does not identify causal events.

Question 14

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?

Accepted Answer

Correct:Pareto charts are used to prioritize areas to reduce medication errors.Eighty percent of all errors were caused by interruptions,so this should be the area of priority.
Incorrect:
a.Run charts help identify any changes that occur over time; also called a time plot.
c.Flowcharts reflect on a problem.
d.Cause and effect diagrams list all possible causes of an error or sentinel event.

Question 15

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?

Accepted Answer

Correct:The Pareto chart is used to prioritize interventions that caused the majority of the problems.
Incorrect:a.Time plots trend data over time.
b.Time plots trend data over time.
d.The cause and effect diagram lists possible causes of the problem.

Question 16

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.)

Accepted Answer

Correct:Clinical indicators are measurable items that reflect the quality of care provided and demonstrate the degree to which desired clinical outcomes are accomplished.National benchmarks are established according to guidelines related to quality care for patients admitted with heart attack and include:aspirin within 24 hours of admission,Angiotensin receptor blocker at discharge,stop smoking instruction given,and beta blocker administered upon arrival and discharge.These are all measurable.
Incorrect:d.It is not possible to measure the support of the employer to modify stress.
e.The patient may adhere to the cardiac diet while hospitalized but postdischarge behavior is not measurable and does not reflect on the quality of care provided in hospital.

Question 17

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?

Accepted Answer

Correct:A run plot,or time plot,graphs data in time order to identify any changes that occur over time.
Incorrect:b.A Pareto chart is used in quality improvement to display data so that a few problems that cause the greatest variance are easily depicted and facilitates improvement that focuses on those few.
c.A flowchart provides pictures of the sequence of steps in a process.
d.A cause-and-effect diagram lists potential causes,arranged by categories,to show their potential impact on a problem.It is not arranged by time.

Question 18

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:

Accepted Answer

Correct:Pareto charts are used to prioritize areas to reduce medication errors.Eighty percent of all errors were caused by interruptions,so this should be the area of priority.
Incorrect:a.Run charts help identify any changes that occur over time; also called a time plot.
c.Flowcharts reflect on a problem.
d.Cause and effect diagrams list all possible causes of an error or sentinel event.

Question 19

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:

Accepted Answer

Correct:Pareto charts are bar graphs that show causes contributing to a problem in descending order so the leading cause is easily recognized.
Incorrect:a.With the cause-and-effect diagram,all causes are listed but not in frequency of occurrence.
b.Run charts show data over time.
d.Flowcharts show steps in a process.

Question 20

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:

Accepted Answer

Correct:The control chart is a run chart that has a center-line and added statistical control limits that help to detect specific types of change needed to improve a process.
Incorrect:a.The Pareto chart is used in quality improvement to identify that 80% of problems usually stem from 20% of causes; it displays data so that a few problems are easily depicted and facilitates improvement that focuses on those few.
c.A deployment flowchart shows the detailed steps involved in a process and the people or departments that are involved at each step.
d.A top-down flowchart shows the sequence of steps in a job or process such as medication administration at a particular site,but it does not show variation limits.

Quiz 21: Quality Improvement and Patient Safety