Question 1

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

Accepted Answer

1. The Joint Commission accredits hospitals.
2. The Joint Commission accredits long-term care facilities.
3. Schools of nursing are accredited by the National League for Nursing or the American Association of Colleges of Nursing.
4. The Joint Commission accredits home care agencies.
5. The Joint Commission accredits 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?

Accepted Answer

1. The areas that are being evaluated should be ones that are common to similar institutions. Commonality is essential to make sharing of information possible.
2. Benchmarking is designed to work on all aspects of the operations of the institution.
3. Benchmarking uses information from different but similar healthcare institutions. Everyone involved in benchmarking must be willing to share information about their institution.
4. The idea is to share data so that an external database and best practice information can be developed.

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.

Accepted Answer

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?

Accepted Answer

1. Work environment issues are problems such as staffing levels and mix, patterns of workload; work design, availability and maintenance of equipment, and administrative and managerial support. This nurse has been unable to get necessary education because of staffing issues.
2. Task issues are problems such as availability and use of protocols and availability and accuracy of test results.
3. Individual staff member factors include knowledge and skills, motivation and attitude, and physical and mental health. This nurse does lack essential knowledge, but the reason for this lack is a staffing problem, which speaks to work environment.
4. Organization and management issues are such factors as financial resources and constraints, policy standards and goals, safety culture, and priorities.

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.

Accepted Answer

1. Strong leadership helps to provide a safe healthcare system. If the unit leadership is weak all processes of the unit are affected, including safety.
2. There are limits to which people can be expected to work. Exceeding those limits increases the likelihood of error.
3. Effective team functioning can work to improve safety as nurses "look out for one another" even during times of maximum workload.
4. This is the punitive, traditional method of dealing with error.
5. A learning environment encourages all staff members to perform at their highest level.

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.

Accepted Answer

1. As long as the obstetric and pediatric patients were private pay this care could continue. Some insurance companies will not pay for care in a non-accredited organization and the organization could not receive Medicaid funds.
2. In order to serve as a training facility for medical students, the facility must be accredited.
3. In order to serve as a clinical site for nursing students, the facility must be accredited.
4. As long as all the patients were private pay this care could continue. Some insurance companies would not pay for care and no federal funds (Medicare/Medicaid) could be accepted.
5. The organization must be accredited to receive federal funding.

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.

Accepted Answer

1. The arrival of a patient DOA is not a sentinel event.
2. Suicide attempts are classified as sentinel events.
3. This patient was assigned a DNR status, so the patient's death is not a sentinel event.
4. Cardiac arrest in labor and delivery is a sentinel event.
5. This patient was not referred to specialist care and then died. This is a sentinel event.

Question 8

Which initiative focuses on unit safety?

Accepted Answer

1. Healthcare Cost and Utilization Program, collects and examines national data about cost and utilization.
2. Taxonomy of Error, Root Cause Analysis, and Practice, a nursing initiative from the National Council of State Boards of Nursing collects error data from HCOs nationally focused on nursing practice.
3. Comprehensive Unit-Based Safety Program-a collaborative effort focused on a unit's safety.
4. Nursing Database of Nursing Indicators-national database about nursing care.

Question 9

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

Accepted Answer

1. RRTs are teams of critical care experts who come to the bedside of patients who are not in intensive care. The ED generally has experts present, so this team would not be used.
2. RRTs are teams of critical care experts who come to the bedside of patients who are not in intensive care. This patient is already in ICU.
3. This patient is not on a unit where critical care experts would normally work. This patient would be a candidate from treatment by a RRT.
4. RRTs are hospital based and would not be available to this patient.

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?

Accepted Answer

1. FMEA does not focus on individual nurses.
2. FMEA does not focus on individual incidents or nurses.
3. FMEA does not focus on one unit at a time.
4. FMEA focuses on safety in systems and prevention of accidents moving away from the individual focus.

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?

Accepted Answer

1. Handoffs do not refer to delivery of medication from pharmacy.
2. Handoffs occur when a patient is transferred from one care setting to another. Communication is essential at these times.
3. Handoffs are not associated with physician orders.
4. Handoffs are not associated with admission H&Ps.

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?

Accepted Answer

1. The visitors will talk with administration, but will be most interested in interviewing direct care providers.
2. The visitors will talk with nurse managers, but will be most interested in interviewing direct care providers.
3. The visitors will talk with department managers, but will be most interested in interviewing direct care providers.
4. The most likely group to be interviewed is direct care providers. The visitors will want to talk to those who provide care, not those who have designed the systems of care.

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.

Accepted Answer

1. LTC staff members are among the most likely to experience violence.
2. Neurological ICU is not an area that experiences the most violence.
3. Cardiac telemetry unit staff members are not prone to experience violence.
4. ED staff members are among the most likely to experience violence.
5. Mental health unit staff members are among the most likely to experience violence.

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?

Accepted Answer

1. The nursing assistant is practicing outside his or her scope of practice. The hospital is allowing this to occur, so the hospital is also breaking the law.
2. The nursing assistant is practicing outside his or her scope of practice.
3. The hospital is allowing the nursing assistant to practice outside his or her scope of practice. This is breaking the law.
4. Both are breaking the law.

Question 15

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

Accepted Answer

1. The nurse should understand disease process, but this is not the most frequent cause of FTR.
2. The nurse should never give a medication or provide an intervention or treatment without knowing its purpose. However, this is not the most common reason for FTR.
3. FTR is most often a result of failure to monitor the patient. If the patient is monitored adequately, failures such as the other options can be noted and acted upon quickly, perhaps effecting patient outcomes.
4. The nurse should understand and follow physician orders if accurate. However, failure to do so is not the most common reason for FTR.

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?

Accepted Answer

1. Handoffs are times in the care process when a patient is moved from one care setting to another.
2. When there is a breakdown or problem, staff often figure out ways to get the work done without really analyzing what is going on. The staff may think this saves time, but it often does not. This is often a time of increased errors.
3. This is part of the Failure Modes and Effects Analysis (FMEA) system, which provides a systematic, proactive method for evaluating a process to identify where and how it might fail and to assess the relative impact of different failures in order to identify the parts of the process that are in most need of change.
4. A "never event" is an event identified by Medicare that occurs to extend the patient's hospitalization, but that should have been avoidable.

Question 17

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

Accepted Answer

1. Some of the reasons for errors in this area are time pressures, fatigue, understaffing, lack of knowledge about the drug and/or the patient, documentation, and systems failure. This nurse may be fatigued secondary to long work hours and decreased sleep time.
2. Lack of knowledge about the drug is a common reason for medication errors. This nurse is using an acceptable method to learn about the medication.
3. The standard is to document the medication administration immediately after giving the medication. This nurse is trying to follow policy. Breakdowns in policy or systems can encourage error.
4. Time pressure and constant interruption lead to error. This nurse has attempted to decrease these factors by working 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.

Accepted Answer

1. The traditional approach to medication error has been punitive and blaming. This manager's response is not supportive of the nurse who made this error.
2. This nurse is trying to discover what in the system allowed the mistake to be made. This is the quality improvement approach to error.
3. The physician is trying to discover how the mistake occurred and is trying to find ways to prevent further error. This is the quality improvement approach to error.
4. Unfortunately, this is a common thought for nurses and is related to the punitive nature of many medication error policies.
5. This risk manager is also looking for blame and not focusing on the system problem that allowed the errors to occur.

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.

Accepted Answer

1. Utilization review and management is the process that evaluates the necessity of the healthcare services provided for specific patients or patient populations.
2. Medication reconciliation is done jointly by nursing and the pharmacy and is not a UR focus.
3. UR evaluates the appropriateness of care provided.
4. Cost should be a secondary factor in UR. The focus is quality of care.
5. Efficiency of provision of care is evaluated by UR.

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.

Accepted Answer

1. Quality report cards are used to track and report performance data.
2. The goal of using these report cards is to increase the transparency of quality data. The idea is that this transparency will encourage providers and organizations to work harder to provide quality care.
3. Report cards are costly from the perspective of collection of data, analysis, and sharing the results with others.
4. There is no guarantee that publishing quality data will impact patient choices for healthcare.
5. These report cards are not individual, but rather are organization wide reports on quality.

Quiz 18: Implementing Healthcare Quality Improvement