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Chapter 10 Quality and Safety Copyright © 2015. F.A. Davis Company History and Overview • Historical trends and

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issues • Political influences • The Institute of Medicine (IOM) and the Committee on the Quality of Health Care in America Copyright © 2015. F.A. Davis Company Trends and Issues • • • • • • Economic Societal demographics and diversity Regulation and legislation Technology Health-care delivery and practice Environmental and globalization Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company 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 Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company 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 Copyright © 2015. F.A. Davis Company 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) Copyright © 2015. F.A. Davis Company Six Aims for Improving Quality in Health Care • Health care should be – Safe – Effective – Patient-centered – Timely – Efficient – Equitable Copyright © 2015. F.A. Davis Company 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 Copyright © 2015. F.A. Davis Company Evaluation of Health Care • Structure • Process • Outcomes Copyright © 2015. F.A. Davis Company Risk Management • Service occurrence • Serious error • Sentinel event Copyright © 2015. F.A. Davis Company The Economic Climate in the Health-Care System • Economic perspective • Regulation and competition • Nursing labor market Copyright © 2015. F.A. Davis Company Factors Influencing Economic Climate • • • • Economic Regulation Competition Nursing labor market Copyright © 2015. F.A. Davis Company 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 healthcare system Copyright © 2015. F.A. Davis Company Types of Errors • • • • Diagnostic Treatment Preventive Other Copyright © 2015. F.A. Davis Company Types of Events • Near miss • Adverse • Accident Copyright © 2015. F.A. Davis Company Causes of Errors • • • • • Medication errors Falls Hand-off errors Diagnostic and surgical errors Health-care acquired infections Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company Culture of Safety • • • • Roles of leadership, individuals, and teams Event reporting systems Methods Organizations, agencies, and initiatives Copyright © 2015. F.A. Davis Company 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. Copyright © 2015. F.A. Davis Company Health-Care System Reform • Role of nursing in system reform – The ANA’s Agenda – Influence of Nursing Copyright © 2015. F.A. Davis Company 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! Copyright © 2015. F.A. Davis Company
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