Leadership Exam 4
Chapter 2: Safe Care
I. Objectives
a. Identify the key organizations leading patient safety movements in the United States.
b. Value the need for a focus on patient safety.
c. Apply the concepts of today’s expectations for how patient safety is implemented.
II. Key Organizations Addressing Safety and Quality Standards
IOM: 7 Key Reports (Institute of Medicine)
a. To Err is Human (2000)
b. Crossing the Quality Chasm (2001)
c. Health Professions Education: A Bridge to Quality (2003)
d. Keeping Patients Safe: Transforming the Work Environment of Nurses (2004)
e. Improving the Quality of Health Care for Mental and Substance-Use Conditions (2005)
f. Preventing Medication Errors (2006)
g. Future of Nursing: Leading Change, Advancing Health (2010)
III. Aims of providing health care (STEEEP)
a. Safe
b. Timely
c. Effective
d. Efficient
e. Equitable
f. Patient-centered
IV. Health Professions Education Competencies (IOM, 2003)
a. Provide patient-centered care
b. Work in interdisciplinary teams
c. Employ evidence-based practice
d. Apply quality improvement
e. Utilize informatics
V. IOM Future of Nursing: Leading Change, Advancing Health (2010)
a. The future of nursing recommendations
i. Remove scope of practice barriers
ii. Expand opportunities for nurses to lead and diffuse collaborative improvement efforts
iii. Implement nurse residency programs
iv. Increase the proportion of nurses of which with a BSN to 80% by 2020
v. Double the number of nurses with a doctorate by 2020
vi. Ensure that nurses engage in lifelong learning
vii. Prepare and enable nurses to lead change to advance health
viii. Build an infrastructure for the collection and analysis of interprofessional healthcare workforce data
VI. Key Organizations Addressing Safety and Quality Standards: Agency for Healthcare Research and Quality
a. Agency for Healthcare Research and Quality
i. Primary federal agency devoted to quality, safety, efficiency, and effectiveness of health care
ii. Resource for providers, researchers, and consumers
VII. A-Z Quick Menu
a. AHRQ Home Clinical Information Consumers & Patients Funding Opportunities
b. Data & Surveys Research Findings Specific Populations Quality & Patient Safety
c. Health ITPublic Health Preparedness About AHRQ
d. Events & Announcements
e. Mission & Budget
f. Strategic Plan
g. Organization & Contacts
h. Map & Directions
i. Job Vacancies
j. Order Publications
k. Special Interest
l. Grants On-Line Database
m. Knowledge Transfer/Implementation
n. Nursing Research
o. PDA Applications
,VIII. TeamSTEPPS (AHRQ)
a.
IX. Five Steps for Safer Health Care
a. Ask questions if you have doubts or concerns.
b. Keep and bring a list of ALL medications you take.
c. Get the results of any test or procedure.
d. Talk to your doctor about which hospital is best for your health needs.
e. Make sure you understand what will happen if you need surgery.
X. Key Organizations Addressing Safety and Quality Standards (Cont.)
a. National Quality Forum
i. Membership-based organization designed to develop and implement a national strategy for
healthcare quality management and reporting
b. Example of NQF Project
i. Nursing Home Project
1. This NQF project seeks to identify and endorse outcome, process, and/or structural
measures and patient experience of care surveys that specifically address nursing home
quality measures for public reporting and quality improvement. This project also will
provide maintenance for current NQF-endorsed® nursing home measures.
c. The Joint Commission
i. Formally known as JCAHO
ii. Not-for-profit organization that accredits healthcare organizations
iii. Has “deemed” status from the Centers for Medicare and Medicaid Services (CMS)
iv. An organization that meets The Joint Commission standards is deemed to have met the CMS sets.
d. DNV/NIAHO
i. Internationally based organization that provides accreditation in a variety of fields
ii. Direct competitor to Joint Commission; surveys annually
iii. QSEN Communication Example
e. Magnet Recognition Program
i. National designation
ii. Focuses on quality care
f. Institute for Healthcare Improvement
i. Not-for-profit
ii. Dedicated to rapidly improving care through mechanisms such as rapid cycle change projects
XI. Nurse-Sensitive Care Standards
a. Patient-centered outcome measures
i. Death among surgical inpatients with treatable serious complications (failure to rescue)
ii. Pressure ulcer prevalence
iii. Patient falls
iv. Falls with injury
v. Restraint prevalence
vi. Urinary catheter associated infection rate for ICU patients
vii. Central line cathether associated bloodstream infection rate for ICU patients
viii. Ventilator associated pneumonia rate for ICU and NICU patients
b. Nursing-centered intervention measures
i. Smoking cessation counseling for AMI
ii. Smoking cessation counseling for HF
iii. Smoking cessation counseling for PNA
c. System-centered measures
i. Skill mix
ii. Nursing care hours per patient day
iii. Practice environment scale nursing working index (PES-NWI)
iv. Voluntary turnover
, XII. Diffusion theory (Rogers, 2003)
a. Key idea
i. A process of communication about innovation to share information over time and among a group of
people
ii. Allows for non-linear change
iii. More complex change is less likely to be adopted
iv. Early adopters serve as role models
b. Application to practice
i. Engage key leaders in change to infuse the energy from early adopters
ii. Using twitter in the hospital culture to engage employees to communicate changes quickly
XIII. Meaning for Leading and Managing
a. Looking at the culture of safety from multiple views
b. Stopping and concentrating to understand complexity of situations
c. Thinking through various scenarios
d. Five core competencies (IOM, 2003)
XIV. Tips for Patient Safety
a. Use the IOM competencies to frame your actions.
b. Keep current with the evidence and best practices.
c. Use only quality sources, especially Websites.
d. Read general nursing literature regarding other organizations’ work related to safety.
e. The STAR approach to patient safety
i. S-stop to concentrate on the task
ii. T-think about the task
iii. A-act to accomplish the task
iv. R-review how well the task was accomplished
XV. Discussion
a. Assume that you work in a facility that does not provide support (time off, tuition reimbursement, recognition
of educational achievement). How could you use this information to change workplace policies and practices?
Chapter 11: Caring, Communicating, and Managing with Technology
I. Objectives
a. Articulate the role of technologies in patient safety.
b. Describe the core components of informatics: data, information, and knowledge.
c. Analyze three types of technology for capturing data at the point of care.
d. Discuss decision support systems and their impact on patient care.
e. Explore the issues of patient safety, ethics, and information security and privacy within information
technology.
II. Technology Surrounds Us!
a. Health care’s future
b. Facilitates decision making
c. Improves efficacy and efficiency
d. Enhances patient safety and quality
e. Decreases healthcare costs
III. Types of Technologies
a. Biomedical
b. Informational
c. Knowledge
IV. Biomedical
a. Used for:
i. Physiologic monitoring (HR, BP, and other vitals)
ii. Diagnostic testing (ECG, blood gases, pulmonary function tests, ICP monitors)
iii. Drug administration (IV fluid and meds)
iv. Therapeutic treatments (implantable infusion pumps for pain, regulate I&O, ventilators)
V. Informational
a. Help healthcare providers……………..information and knowledge
i. Acquire
ii. Manage
iii. Analyze
iv. Disseminate
VI. Knowledge
Chapter 2: Safe Care
I. Objectives
a. Identify the key organizations leading patient safety movements in the United States.
b. Value the need for a focus on patient safety.
c. Apply the concepts of today’s expectations for how patient safety is implemented.
II. Key Organizations Addressing Safety and Quality Standards
IOM: 7 Key Reports (Institute of Medicine)
a. To Err is Human (2000)
b. Crossing the Quality Chasm (2001)
c. Health Professions Education: A Bridge to Quality (2003)
d. Keeping Patients Safe: Transforming the Work Environment of Nurses (2004)
e. Improving the Quality of Health Care for Mental and Substance-Use Conditions (2005)
f. Preventing Medication Errors (2006)
g. Future of Nursing: Leading Change, Advancing Health (2010)
III. Aims of providing health care (STEEEP)
a. Safe
b. Timely
c. Effective
d. Efficient
e. Equitable
f. Patient-centered
IV. Health Professions Education Competencies (IOM, 2003)
a. Provide patient-centered care
b. Work in interdisciplinary teams
c. Employ evidence-based practice
d. Apply quality improvement
e. Utilize informatics
V. IOM Future of Nursing: Leading Change, Advancing Health (2010)
a. The future of nursing recommendations
i. Remove scope of practice barriers
ii. Expand opportunities for nurses to lead and diffuse collaborative improvement efforts
iii. Implement nurse residency programs
iv. Increase the proportion of nurses of which with a BSN to 80% by 2020
v. Double the number of nurses with a doctorate by 2020
vi. Ensure that nurses engage in lifelong learning
vii. Prepare and enable nurses to lead change to advance health
viii. Build an infrastructure for the collection and analysis of interprofessional healthcare workforce data
VI. Key Organizations Addressing Safety and Quality Standards: Agency for Healthcare Research and Quality
a. Agency for Healthcare Research and Quality
i. Primary federal agency devoted to quality, safety, efficiency, and effectiveness of health care
ii. Resource for providers, researchers, and consumers
VII. A-Z Quick Menu
a. AHRQ Home Clinical Information Consumers & Patients Funding Opportunities
b. Data & Surveys Research Findings Specific Populations Quality & Patient Safety
c. Health ITPublic Health Preparedness About AHRQ
d. Events & Announcements
e. Mission & Budget
f. Strategic Plan
g. Organization & Contacts
h. Map & Directions
i. Job Vacancies
j. Order Publications
k. Special Interest
l. Grants On-Line Database
m. Knowledge Transfer/Implementation
n. Nursing Research
o. PDA Applications
,VIII. TeamSTEPPS (AHRQ)
a.
IX. Five Steps for Safer Health Care
a. Ask questions if you have doubts or concerns.
b. Keep and bring a list of ALL medications you take.
c. Get the results of any test or procedure.
d. Talk to your doctor about which hospital is best for your health needs.
e. Make sure you understand what will happen if you need surgery.
X. Key Organizations Addressing Safety and Quality Standards (Cont.)
a. National Quality Forum
i. Membership-based organization designed to develop and implement a national strategy for
healthcare quality management and reporting
b. Example of NQF Project
i. Nursing Home Project
1. This NQF project seeks to identify and endorse outcome, process, and/or structural
measures and patient experience of care surveys that specifically address nursing home
quality measures for public reporting and quality improvement. This project also will
provide maintenance for current NQF-endorsed® nursing home measures.
c. The Joint Commission
i. Formally known as JCAHO
ii. Not-for-profit organization that accredits healthcare organizations
iii. Has “deemed” status from the Centers for Medicare and Medicaid Services (CMS)
iv. An organization that meets The Joint Commission standards is deemed to have met the CMS sets.
d. DNV/NIAHO
i. Internationally based organization that provides accreditation in a variety of fields
ii. Direct competitor to Joint Commission; surveys annually
iii. QSEN Communication Example
e. Magnet Recognition Program
i. National designation
ii. Focuses on quality care
f. Institute for Healthcare Improvement
i. Not-for-profit
ii. Dedicated to rapidly improving care through mechanisms such as rapid cycle change projects
XI. Nurse-Sensitive Care Standards
a. Patient-centered outcome measures
i. Death among surgical inpatients with treatable serious complications (failure to rescue)
ii. Pressure ulcer prevalence
iii. Patient falls
iv. Falls with injury
v. Restraint prevalence
vi. Urinary catheter associated infection rate for ICU patients
vii. Central line cathether associated bloodstream infection rate for ICU patients
viii. Ventilator associated pneumonia rate for ICU and NICU patients
b. Nursing-centered intervention measures
i. Smoking cessation counseling for AMI
ii. Smoking cessation counseling for HF
iii. Smoking cessation counseling for PNA
c. System-centered measures
i. Skill mix
ii. Nursing care hours per patient day
iii. Practice environment scale nursing working index (PES-NWI)
iv. Voluntary turnover
, XII. Diffusion theory (Rogers, 2003)
a. Key idea
i. A process of communication about innovation to share information over time and among a group of
people
ii. Allows for non-linear change
iii. More complex change is less likely to be adopted
iv. Early adopters serve as role models
b. Application to practice
i. Engage key leaders in change to infuse the energy from early adopters
ii. Using twitter in the hospital culture to engage employees to communicate changes quickly
XIII. Meaning for Leading and Managing
a. Looking at the culture of safety from multiple views
b. Stopping and concentrating to understand complexity of situations
c. Thinking through various scenarios
d. Five core competencies (IOM, 2003)
XIV. Tips for Patient Safety
a. Use the IOM competencies to frame your actions.
b. Keep current with the evidence and best practices.
c. Use only quality sources, especially Websites.
d. Read general nursing literature regarding other organizations’ work related to safety.
e. The STAR approach to patient safety
i. S-stop to concentrate on the task
ii. T-think about the task
iii. A-act to accomplish the task
iv. R-review how well the task was accomplished
XV. Discussion
a. Assume that you work in a facility that does not provide support (time off, tuition reimbursement, recognition
of educational achievement). How could you use this information to change workplace policies and practices?
Chapter 11: Caring, Communicating, and Managing with Technology
I. Objectives
a. Articulate the role of technologies in patient safety.
b. Describe the core components of informatics: data, information, and knowledge.
c. Analyze three types of technology for capturing data at the point of care.
d. Discuss decision support systems and their impact on patient care.
e. Explore the issues of patient safety, ethics, and information security and privacy within information
technology.
II. Technology Surrounds Us!
a. Health care’s future
b. Facilitates decision making
c. Improves efficacy and efficiency
d. Enhances patient safety and quality
e. Decreases healthcare costs
III. Types of Technologies
a. Biomedical
b. Informational
c. Knowledge
IV. Biomedical
a. Used for:
i. Physiologic monitoring (HR, BP, and other vitals)
ii. Diagnostic testing (ECG, blood gases, pulmonary function tests, ICP monitors)
iii. Drug administration (IV fluid and meds)
iv. Therapeutic treatments (implantable infusion pumps for pain, regulate I&O, ventilators)
V. Informational
a. Help healthcare providers……………..information and knowledge
i. Acquire
ii. Manage
iii. Analyze
iv. Disseminate
VI. Knowledge
