APC EXAM 2- Dr. Z

What are the three main aspects of healthcare quality from a medical perspective?

What are the two main aspects of healthcare quality from a patient perspective?

• medical:

  • increase probability of positive outcomes

  • decrease probability of negative outcomes

  • correspond with current medical knowledge

• patient:

  • offers the patient what they want

  • provides the patient with what they need

What is quality by inspection/ quality control?

• activities designed to ensure adequate quality by INSPECTION

• improvement solely by inspection

• focuses on the defect found

What is quality assurance?

• ensures standards of quality are being met by INSPECTION

• improvement based on performance to meet a specific standard

• focuses on dealing with the outlier

Compare quality by inspection and quality assurance:

• which is reactive? which is defensive?

• do they require inspections?

• improvements focus on what?

• limitations?

both are:

• reactive AND defensive

• requires inspection to identify outliers or defects

• improvements focus on inspection findings

• no process improvement

• no variation prevention (aka problems within the system will not be detected… a limitation)

What is continuous quality improvement (CQI)?

• definition

• what type of shift?

• reactive or proactive?

• short term or long term?

• requires what kind of participation?

• focuses on doing what?

• promotes a punitive or non-punitive system?

• def: continual improvement processes associated with providing a good or service that meets or exceeds customer expectations

• paradigmatic shift

• proactive

• continuous—> never ending

• requires organization-wide participation

• focuses on preventing and reducing internal sources of variations

• promotes a non-punitive system to the individual

Definition of six sigma?

quality management program AND a statistical measure

What does six sigma assume as a quality management model?

What is it used as a statistical measurement?

• assumes that defects are responsible for the cost of poor quality

• used to compare quality across processes and across organizations

Worldwide standards for quality management and quality assurance = ISO ______.

9000

What are the seven steps to the model for improvement? Which are the 3 FUNDAMENTAL STEPS?

1. forming the team

2. SETTING AIMS*

3. ESTABLISHING MEASURES*

4. SELECTING CHANGES*

5. testing changes

6. implementing changes

7. spreading changes

*= fundamental step

For each of the fundamental steps for the model for improvement, list their “question”.

three fundamental steps with their questions:

3. SETTING AIMS- “What are we trying to accomplish?”

4. ESTABLISHING MEASURES- “How will we know that a change is an improvement?”

5. SELECTING CHANGES- “What change can we make that will result in improvement?”

What are the 6 aims for improvement? describe them.

1. safe (avoid injuries to pts.)

2. effective (match care to science)

3. patient-centered (honor the individual/choice)

4. timely (reduce wait)

5. efficient (reduce waste)

6. equitable (close racial/ethnic gaps in health status)

mnemonics: “SEE PET”

What are the 4 steps in the PDSA Cycle?

1. Plan

2. Do

3. Study

4. Act

Explain EACH step in the PDSA:

• (lowkey i think she’ll just ask about the steps in general and not specifics)

1. Plan

   • state the objective of the test

   • make predictions

   • develop plan—> who, what, when, where, what data to collect?

2. Do

   • do the test on a small scale, do the test frfr

   • document problems and unexpected observations

   • begin analysis of data

3. Study

   • complete analysis of the data, compare to predictions

   • summarize/reflect

4. Act

   • refine the change, prepare a plan for the next test

   • determine what modifications should be made

State the conclusion of NPSF’s “Free from Harm: Accelerating Patient Safety Improvement Fifteen Years after To Err is Human” based on the eight recommendations necessary for achieving total systems safety.

• conclusion: CALL TO ACTION

  • safety= top priority and the 8 recommendations give a framework

  • critical that everyone works together to adopt a systems approach to safety

  • efforts to create a world free from harm

WHAT are the four foundational and interdependent areas prioritized as essential to create total systems safety in IHI’s “Safer Together: A National Action Plan to Advance Patient Safety”?

1. culture, leadership, and governance

2. patient and family caregiver engagement

3. workforce safety and well-being

4. learning system

What are the 6 leadership domains?

(as defined in “Leading a Culture of Safety: A Blueprint for Success”)

1. establish a compelling VISION for safety

2. Value TRUST, RESPECT, AND INCLUSION

3. Select, develop, and ENGAGE YOUR BOARD

4. Prioritize safety in selection and DEVELOPMENT OF LEADERS

5. Lead and reward a JUST CULTURE

6. Establish organizational BEHAVIOR EXPECTATIONS

What is the key concept AND primary goal defined in “Leading a Culture of Safety: A Blueprint for Success”?

• key concept: building trust respect, and enthusiasm for improvement through behaviors and principles that focus on bettering systems issues while requiring fair and inclusive practices by all

• goal: ZERO HARM to pts., families, and the workforce

What are the 3 common types of safety cultures?

1. punitive

2. blame-free

3. just

For EACH of the common types of safety cultures describe them:

Punitive	Focuses On: Major Flaw: Issues:
Blame-free	Focuses On: Major Flaw: Issues:
Just	Focuses On: Benefit: Accountability:

Punitive	Focuses On: individual Major Flaw: every error blamed on an individual regardless Issues: fear to report errors, no learning from mistakes, poor psych safety
Blame-free	Focuses On: institution/process/systems Major Flaw: fails to hold practitioners accountable Issues: those repeating the same errors are not held accountable
Just	Focuses On: individual + systems Benefit: balances punitive and blame-free cultures Accountability: leaders and employees

MUE or medication use evaluations includes all medications and all aspects of medication use including what?

prescribing, dispensing, administering, monitoring, and outcome

What is the definition of an MUE? purpose?

• tool used to promote the systematic improvement in medication-related performance in a healthcare setting

• purpose: performance improvement method that aims to optimize patient outcomes through evaluation and improvement of medication use

MUEs can be broad or narrow. What does that mean?

• narrowly focused—> focusing on a specific drug and or disease state

• broadly focused—> designed to cover an entire class or indication of meds

What are the 2 types of outcomes in MUEs?

1. therapeutic outcomes—> patient-centered outcomes

   • clinical events, quality of life, outcomes= efficacy, incidence, rates

2. process outcomes—> processes related to medication use

   • prescribing, dispensing, admin, monitoring= frequency, cost

PRACTICE:

Evaluating the incidence of major bleeding in pt. treated with thrombolytic therapy is an example of what kind of outcome?

a. process outcome

b. therapeutic outcome

b.

PRACTICE:

Evaluating the frequency of use of thrombolytic therapy in inappropriate candidates is an example of what kind of outcome?

a. process outcome

b. therapeutic outcome

a.

What are common MUE objectives?

• improve pt. safety

• assess vale of innovative practices

• meet quality or regulatory standards

• minimize cost

Performance improvement frameworks like FOCUS-PDCA are used by healthcare organization to improve what areas in patient care?

• safety

• efficacy

• quality

• efficiency

What do the letters of FOCUS-PDCA stand for?

F- find

O- organize

C- clarify

U- understand

S- select

-

P- plan

D- do

C- check

A- act

What are some criteria for prioritizing and selecting medications or healthcare processes that require evaluation or MUEs? (aka what would make one med chosen over another to be evaluated)

(sorry there’s so many, but it’s a LO)

• high risk medications

  • known/suspected to cause ADRs

  • used in the tx of higher risk pts. or hasn’t been evaluated in high-risk populations

• safety concerns

  • interacts with other meds, foods, or procedures

  • subject of FDA recall, safety alert, withdrawal, or not even FDA approved

  • potentially toxic at normal doses

• impact on patient care

  • affects large # of pts.

  • crucial component of care for a specific disease

  • drugs that have (-) or no therapeutic impact

• cost/ compliance

  • under consideration for a formulary change

  • med or process is expensive

  • determination if clinicians are complying with formulary

• others:

  • new/ innovative processes

  • evaluating pharmacist-directed collaborative practices

  • analytic tools or scoring systems suggest the need for intervention

If MUE outcomes are undesired/negative, what steps should be done next?

• understand causes of process variation—> conduct root cause analysis, consider the “5 WHYS”

• Develop idea to address the root cause of process variation—> use FACES tool (FACE= feasibility, acceptability, cost/benefit, effectiveness)

What are high reliability organizations?

• idk how imp

refer to organizations or systems that operate in hazardous conditions but have fewer than their fair share of adverse events (ex: air traffic controllers)

What is situational awareness?

• idk how imp

refers to the degree to which one's perception of a situation matches reality