Home Uncategorized Discussion Topic Ch 10.

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Discussion Topic Ch 10.

Use at least 3 references. Minimum 500 words. APA format.

Read Chapter 10

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?

Quality and Safety
Chapter 10

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

OUTLINE:
HISTORY AND OVERVIEW
Historical Trends and Issues
The Institute of Medicine and the Committee on the Quality of Health Care in America
*

Trends and Issues
Economic
Societal demographics and diversity
Regulation and legislation
Technology
Health-care delivery and practice
Environmental and globalization

Statement of Quality of Care
The IOM concluded that
Quality can be defined and measured.
Quality problems are serious and extensive.
Current approaches to quality improvement are inadequate.
There is an urgent need for rapid change.

Focus Areas of To Err Is Human
The IOM recommended to
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.

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

Ten Rules to Govern Health-Care Reform for the 21st Century
Care is based on a continuous healing relationship.
Care is provided based on patient needs and values.
The patient is the source of control of care.
Knowledge is shared and free-flowing.
Decisions are evidence-based.

Ten Rules to Govern Health-Care Reform for the 21st Century (cont’d)
Safety as a system property.
Transparency is necessary; secrecy is harmful.
Anticipate patient needs.
Waste is continually decreased.
Cooperation between health-care providers.

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

Objectives:
Discuss the history of quality and safety within the U.S. health-care system.
Analyze historical, social, political, and economic trends affecting the nursing profession and the health-care delivery system.
Explain the importance of quality improvement to the nurse, patient, organization, and health-care delivery system.
Discuss the role of the nurse in continuous quality improvement (CQI) and risk management.
OUTLINE:
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
Strategic Planning
Structured Care Methodologies
Critical Pathways
Aspects of Health Care to Evaluate
Structure
Process
Outcome
Risk Management
*

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)

Six Aims for Improving Quality in Health Care
Health care should be
Safe
Effective
Patient-centered
Timely
Efficient
Equitable

Safe: avoiding injuries to patients from the care that is intended to help them.
Effective: providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and overuse).
Patient-centered: providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.
Timely: reducing waits and sometimes harmful delays for both those who receive and those who give care.
Efficient: avoiding waste, in particular waste of equipment, supplies, ideas, and energy.
Equitable: providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.
*

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

Evaluation of Health Care
Structure
Process
Outcomes

Risk Management
Service occurrence
Serious error
Sentinel event

The Economic Climate in the Health-Care System
Economic perspective
Regulation and competition
Nursing labor market

Objectives:
Analyze historical, social, political, and economic trends affecting the nursing profession and the health-care delivery system.
Explain the importance of quality improvement to the nurse, patient, organization, and health-care delivery system.
Promote the role of the nurse in the contemporary health-care environment.
OUTLINE:
THE ECONOMIC CLIMATE IN THE HEALTH-CARE SYSTEM
Economic Perspective
Regulation and Competition
Nursing Labor Market
Defining and Identifying the Nursing Shortage
Factors Contributing to the Nursing Shortage
*

Factors Influencing Economic Climate
Economic
Regulation
Competition
Nursing labor market

Safety in the U.S. Health-Care System
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

Objectives:
Discuss the history of quality and safety within the U.S. health-care system.
Analyze historical, social, political, and economic trends affecting the nursing profession and the health-care delivery system.
Examine factors contributing to medical errors and evidence-based methods for the prevention of medical errors.
Explain the use of technology to enhance and promote safe patient care, educate patients and consumers, evaluate health-care delivery, and enhance the nurse’s knowledge base.
Promote the role of the nurse in the contemporary health-care environment.
OUTLINE:
SAFETY IN THE U.S. HEALTH-CARE SYSTEM
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
Government Agencies
Health-Care Provider Professional Organizations
Non-Profit Organizations and Foundations
Quality Organizations
Integrating Initiatives and Evidenced-Based Practices into Client Care
*

Types of Errors
Diagnostic
Treatment
Preventive
Other

Diagnostic
Error or delay in diagnosis
Failure to employ indicated tests
Use of outmoded tests or therapy
Failure to act on results of monitoring or testing
Treatment
Error in the performance of an operation, procedure, or test
Error in administering the treatment
Error in the dose or method of using a drug
Avoidable delay in treatment or in responding to an abnormal test
Inappropriate (not indicated) care
Preventive
Failure to provide prophylactic treatment
Inadequate monitoring or follow-up of treatment
Other
Failure of communication
Equipment failure
Other system failure
*

Types of Events
Near miss
Adverse
Accident

Causes of Errors
Medication errors
Falls
Hand-off errors
Diagnostic and surgical errors
Health-care acquired infections

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.

Culture of Safety
Roles of leadership, individuals, and teams
Event reporting systems
Methods
Organizations, agencies, and initiatives

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.

Health-Care System Reform
Role of nursing in system reform
The ANA’s Agenda
Influence of Nursing

Objectives:
Discuss the history of quality and safety within the U.S. health-care system.
Analyze historical, social, political, and economic trends affecting the nursing profession and the health-care delivery system.
Examine factors contributing to medical errors and evidence-based methods for the prevention of medical errors.
Explain the use of technology to enhance and promote safe patient care, educate patients and consumers, evaluate health-care delivery, and enhance the nurse’s knowledge base.
Describe the effects of communication on patient-centered care, interdisciplinary collaboration, and safety.
Promote the role of the nurse in the contemporary health-care environment.
OUTLINE:
HEALTH-CARE SYSTEM REFORM
Role of Nursing in System Reform
The ANA’s Agenda
Influence of Nursing
*

Role of Nursing in Health-Care Reform
American Nurse’s Association
Nursing’s agenda for health-care reform
ANA’s health-care agenda
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