1. Chapter 10 Quality and Safety

2. Objectives
Discuss the findings/conclusions of the IOM and Committee on Quality of Health Care in America investigation.
Examine the Rules for Health-Care Reform in the 21st Century.
Identify HOM’s Aims for Improving Quality in Health-Care.
Explore various aspects of Quality Improvement (QI).

3. Objectives
Discuss the processes of Continuous Quality Improvement (CQI) and the nurse’s role in QI measures and quality health care.
Investigate strategic planning’s role in Quality Improvement.
Differentiate commonly used structured care methodologies (SCMs)
Discuss how the various SCMs can be used to improve quality care.

4. Objectives
Discuss how critical pathways are used in the delivery of care and can be used to measure patient outcomes.
Examine the aspects to be evaluated in health care CQI: structures, processes, and outcomes.
Explore risk management in health care and explain the role of the nurse in risk management.

5. Objectives: Examine varying aspects related to an incident report.
Review the aspects of documentation related to an incident reporting.
Differentiate the categorization of risk events.
Discuss the economic perspective in Health- Care Systems and its regulation.

6. Identify the factors increasing and containing costs of health care.
Objectives
Identify the factors increasing and containing costs of health care.
Examine factors associated with the Nursing Labor Market.
Identify various types of errors.

7. Objectives
Examine characteristics associated with a Culture of Safety.
Identify and discuss National Patient Safety Goals and Core Measures.
Examine the ANA nursing sensitive quality indicators in acute care settings.
Identify IOM core competencies for health
professionals.

8. History and Overview Historical trends and issues
The Institute of Medicine and the Committee on the Quality of Health Care in America
Objective:
Discuss the history of quality and safety within the U.S. healthcare system.
Analyze historical, social, political, and economic trends affecting the nursing profession and the healthcare delivery system.
OUTLINE:
HISTORY AND OVERVIEW
Historical Trends and Issues
The Institute of Medicine and the Committee on the Quality of Health Care in America

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

10. 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

11. Focus Areas of To Err is Human
The IOM recommended (Box 10-3)
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

12. Crossing the Quality Chasm Conclusions
The gaps between actual care and high- quality care could be attributed to key inter-related 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

13. 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
Patient is source of control of care
Knowledge is shared and free-flowing
Decisions are evidence-based

14. 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

15. 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. healthcare system.
Analyze historical, social, political, and economic trends affecting the nursing profession and the healthcare delivery system.
Explain the importance of quality improvement to the nurse, patient, organization, and healthcare 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

16. 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)

17. 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.

18. 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

19. Evaluation of Health Care
Structure
Process
Outcomes

20. Risk Management
Service occurrence
Serious error
Sentinel event

21. 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 healthcare delivery system.
Explain the importance of quality improvement to the nurse, patient, organization, and healthcare delivery system.
Promote the role of the nurse in the contemporary healthcare 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

22. Factors Influencing Economic Climate
Regulation
Competition
Nursing labor market

23. 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. healthcare system.
Analyze historical, social, political, and economic trends affecting the nursing profession and the healthcare 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 healthcare delivery, and enhance the nurse’s knowledge base.
Promote the role of the nurse in the contemporary healthcare 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 HC System
Government Agencies
Healthcare Provider Professional Organizations
Non-profit Organizations and Foundations
Quality Organizations
Integrating Initiatives and Evidenced-based Practices into Client Care

24. 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

25. Types of Events
Near miss
Adverse event
Accident

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

27. 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. healthcare system.
Analyze historical, social, political, and economic trends affecting the nursing profession and the healthcare 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 healthcare 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 healthcare environment.
OUTLINE:
Health Care System Reform
Role of Nursing in System Reform
The ANA’s Agenda
Influence of Nursing

28. 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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