APA Format
1. In the last century, what historical, social, political, and economic trends and issues have influenced today’s health-care system?
2. What is the purpose and process of evaluating the three aspects of health care: structure, process, and outcome?
3. How does technology improve patient outcomes and the health-care system?
4. How can you intervene to improve quality of care and safety within the health-care system and at the bedside?
2. Select one nonprofit organization or one government agencies that influences and advocates for quality improvement in the health-care system. Explore the Web site for your selected organization/agency and answer the following questions: •
What does the organization/agency do that supports the hallmarks of quality? •
What have been the results of their efforts for patients, facilities, the health-care delivery system, or the nursing profession? •
How has the organization/agency affected facilities where you are practicing and your own professional practice?
Chapter 10
Quality and Safety
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History and Overview
• Historical trends and issues
• Political influences
• The Institute of Medicine (IOM) and the
Committee on the Quality of Health Care in
America
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Trends and Issues
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Economic
Societal demographics and diversity
Regulation and legislation
Technology
Health-care delivery and practice
Environmental and globalization
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Statement of Quality of Care
The IOM concluded that
1. Quality can be defined and measured.
2. Quality problems are serious and extensive.
3. Current approaches to quality improvement are
inadequate.
4. There is an urgent need for rapid change.
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Focus Areas of To Err Is Human
The IOM recommended to
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Enhance knowledge and leadership regarding safety.
Identify and learn from errors.
Set performance standards and expectations for safety.
Implement safety systems within health-care
organizations.
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Crossing the Quality Chasm
Conclusions
• The gaps between actual care and high-quality
care could be attributed to key interrelated areas
in the health-care system.
– The growing complexity of science and technology
– An increase in chronic conditions.
– A poorly organized delivery system of care and
constraints on exploiting the revolution in information
technology
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Ten Rules to Govern Health-Care Reform for the 21st
Century
1. Care is based on a continuous healing
relationship.
2. Care is provided based on patient needs and
values.
3. The patient is the source of control of care.
4. Knowledge is shared and free-flowing.
5. Decisions are evidence-based.
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Ten Rules to Govern Health-Care Reform for the
21st Century (cont’d)
6. Safety as a system property.
7. Transparency is necessary; secrecy is harmful.
8. Anticipate patient needs.
9. Waste is continually decreased.
10.Cooperation between health-care providers.
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Quality in the Health-Care
System
• Quality improvement
• Using CQI to monitor and evaluate quality of care
• Quality improvement at the organizational and unit
levels
• Aspects of health care to evaluate
• Risk management
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Quality
The Institute of Medicine (IOM) defines quality as
“the degree to which health services for individuals
and populations increase the likelihood of desired
health outcomes and are consistent with current
and professional knowledge”
(IOM, 2001, p. 232)
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Six Aims for Improving Quality in
• Health care should be
– Safe
– Effective
– Patient-centered
– Timely
– Efficient
– Equitable
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Health Care
QI vs. CQI
• QI
– Began with Florence Nightingale
– Structured organizational process
– Included evidence-based methods for gathering data
and achieving goals
• CQI
– Purpose
– Identify, collect data, analyze, evaluate, change
– Responsibility
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Evaluation of Health Care
• Structure
• Process
• Outcomes
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Risk Management
• Service occurrence
• Serious error
• Sentinel event
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The Economic Climate in the Health-Care
System
• Economic perspective
• Regulation and competition
• Nursing labor market
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Factors Influencing Economic Climate
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Economic
Regulation
Competition
Nursing labor market
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Safety in the U.S. Health-Care
System
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Types of errors
Error identification and reporting
Developing a culture of safety
Organizations, agencies, and initiatives supporting
quality and safety in the health-care system
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Types of Errors
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Diagnostic
Treatment
Preventive
Other
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Types of Events
• Near miss
• Adverse
• Accident
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Causes of Errors
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Medication errors
Falls
Hand-off errors
Diagnostic and surgical errors
Health-care acquired infections
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The Nursing Shortage and Patient
Safety
• More acutely ill patients are in the hospital
setting.
• Decreased number of qualified nurses increases
the chance of errors.
• Short staffing and increased workload contribute
to errors.
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Culture of Safety
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Roles of leadership, individuals, and teams
Event reporting systems
Methods
Organizations, agencies, and initiatives
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Root Cause Analysis
• Determine what influenced the consequences.
• Establish tightly linked chains of influence.
• At every level of analysis determine the necessary
and sufficient influences.
• Whenever feasible drill down to root causes.
• Know that there are always multiple root causes.
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Health-Care System Reform
• Role of nursing in system reform
– The ANA’s Agenda
– Influence of Nursing
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Role of Nursing in Health-Care Reform
• American Nurse’s Association
– Nursing’s agenda for health-care reform
– ANA’s health-care agenda
• You
– Become informed
– Plan
– Take action!
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