Chapter 21 - Quality Improvement

Q: What are the six characteristics of quality health care as defined by the Institute of Medicine (IOM)?

A: Safe, effective, patient-centered, timely, efficient, and equitable.

Q: What is Quality Improvement (QI) in health care?

A: A systematic, data-driven approach to improve care processes and patient outcomes within specific clinical settings.

Q: How does QI differ from research?

A: QI focuses on local, immediate improvement in processes using existing knowledge, while research seeks to generate generalizable new knowledge.

Q: Why is QI necessary in health care?

A: Historical errors (e.g., cocaine drops, lobotomies, mercury use) show the need for systematic, evidence-based improvement.

Q: What is the goal of the Joint Commission’s National Patient Safety Goals?

A: To improve patient safety by addressing specific problems and promoting evidence-based solutions.

Q: What role do accreditation bodies play in QI?

A: They ensure organizations meet established standards, which drives QI efforts (e.g., TJC, DNV).

Q: What are “Never Events” in health care?

A: Serious, preventable incidents (e.g., wrong-site surgery) that should never occur and are targeted by QI initiatives.

Q: How do nurses contribute to QI?

A: Nurses identify care gaps, implement changes, monitor outcomes, and align efforts with unit and organizational goals.

Q: Which historical figures influenced modern nursing QI?

A: Florence Nightingale, Rufaida Al-Aslamia, and Mary Anne Bickerdyke.

Q: What are examples of external drivers for quality improvement?

A: Accreditation standards, CMS incentives, performance-based payment systems.

Q: What are the six QSEN competencies?

A: Patient-centered care, teamwork & collaboration, EBP, QI, safety, and informatics.

Q: What does the QSEN competency "Patient-Centered Care" involve?

A: Respecting patient values, seeing care through the patient's eyes, and protecting access to personal records.

Q: What does the QSEN competency "Teamwork and Collaboration" involve?

A: Understanding roles, seeking help appropriately, and ensuring safe handoffs.

Q: What does the QSEN competency "Quality Improvement" involve?

A: Participating in root cause analyses and understanding process changes to improve care.

Q: What does the QSEN competency "Safety" involve?

A: Using strategies to reduce reliance on memory, such as checklists and double checks.

Q: What does the QSEN competency "Informatics" involve?

A: Using technology to monitor outcomes and respond to clinical alerts.

Q: Name at least four national strategy levers used in QI.

A: Public reporting, health IT, certification/accreditation, performance-based payment.

Q: How do financial incentives influence QI?

A: They reward providers who meet performance targets or deliver cost-effective care (e.g., CMS, Core Measures, HCAHPS).

Q: What is performance measurement in QI?

A: The use of standardized tools to track care quality and outcomes across settings.

Q: What is public reporting in QI?

A: Sharing hospital performance data with consumers to promote transparency and accountability (e.g., CMS Star Ratings).

Q: What is benchmarking in QI?

A: Comparing local performance against national standards to identify areas for improvement.

Q: What are nurse-sensitive quality indicators?

A: Measures like falls, pressure injuries, and catheter-associated infections that reflect nursing care quality.

Q: What databases track nursing-sensitive outcomes?

A: NDNQI, CalNOC, VA Nursing Outcomes Database.

Q: What are common QI models used in nursing?

A: Total Quality Management (TQM), Lean, Six Sigma, and Clinical Microsystems.

Q: What are the four basic QI steps?

A: Assess, analyze, improve, and evaluate.

Q: What are key QI tools used by health care teams?

A: Flowcharts, fishbone diagrams, control charts, and root cause analysis.

Q: What leadership style supports QI culture?

A: Transformational leadership—encourages innovation, collaboration, and continuous improvement.

Q: In a heart failure QI audit, what were the key focus areas?

A: Education, intake/output, daily weights, and meals—requiring consistent shift documentation.

Q: What can patient satisfaction scores reveal in QI?

A: Trends in communication, responsiveness, and quality of service—helping identify improvement targets.

Q: In which era did nurses first champion quality health care?

A: 1850s

Q: Which tool helps identify when performance is below a set standard?

A: Benchmarking

What is Agree II?

Developed to assist in evaluating guideline quality, and provide methodological strategy for guideline development (Widely used to evaluate applicability of guideline to practice)

Clinical Practice Guidelines provide which level of evidence?
A. Level IV
B. Level VI
C. Level VII
D. Level VIII

C. Level VII Clinical Practice Guidelines based on systematic reviews or research evidence