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:

Accepted Answer

Pareto charts are bar graphs that show causes contributing to a problem in descending order so the leading cause is easily recognized.

Question 2

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

Accepted Answer

The customer determines quality on the basis of his or her unique perception of high-quality care.

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:

Accepted Answer

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.

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:

Accepted Answer

Medication-related errors for hospitalized patients cost roughly $2 billion annually.

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?

Accepted Answer

The Pareto chart is used to prioritize interventions that caused the majority of the problems.

Question 6

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

Accepted Answer

Any procedure performed on a wrong person or organ constitutes a sentinel event.

Question 7

According to the Quality Chasm report:

Accepted Answer

Quality is based on predicting patient needs rather than reacting to needs.

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:

Accepted Answer

The control chart is a run chart that has a centerline and added statistical control limits that help to detect specific types of change needed to improve a process.

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:

Accepted Answer

C stands for check if the change improved the process and what was learned.

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?

Accepted Answer

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.

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?

Accepted Answer

Standardization contributes to safety and improves individual performance of care providers.

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):

Accepted Answer

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.

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:

Accepted Answer

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.

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?

Accepted Answer

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.

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):

Accepted Answer

A critical pathway determines the best order and timing of interventions provided by health care team members for a particular diagnosis.

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:

Accepted Answer

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.

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:

Accepted Answer

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.

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:

Accepted Answer

The nurse and dietitian are respecting patient values, preferences, and expressed needs.

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?

Accepted Answer

A run plot, or time plot, graphs data in time order to identify any changes that occur over time.

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:

Accepted Answer

A top-down flowchart shows the sequence of steps in a job or process such as medication administration.

Quiz 22: Quality Improvement and Patient Safety