Question 1

The director of quality improvement reports that the hospital will soon be using "dashboards" as part of the quality management process. How should the staff interpret this information?

Accepted Answer

1. The "dashboards" in this scenario are not associated with automobiles.
2. Dashboards are electronic tools that provide ease of access to real-time or retrospective data.
3. Dashboard is not an acronym.
4. Dashboards are not part of the electronic medical record.

Question 2

As part of the process of promoting quality improvement, the nursing manager is comparing data between two hospitals on average length of stay for a total hip replacement. This comparison is an example of which process or step?

Accepted Answer

1. Benchmarking is the comparison of data with other reliable sources internally and externally with the goal of quality improvement.
2. Standards are written statements that define a level of performance. An outcome standard involves the end results of care given.
3. An indicator is a tool to measure the performance of structure, process, and outcome standards.
4. Standards are written statements that define a level of performance. Process standards are those connected with the actual delivery of care.

Question 3

The nursing task force is developing measurable goals for each client on the orthopedic unit. The statement "Each client will have a written assessment and plan of care document within eight hours of admission" is an example of which component of quality management?

Accepted Answer

1. An indicator is a tool used to measure the performance of a structure, process, or outcome standard.
2. A structure standard is related to the physical environment and the organization as opposed to the delivery of nursing care.
3. Benchmarking is the process of comparing data with other reliable sources internally and externally in order to improve quality of care.
4. A process standard is a written statement that defines actual delivery of nursing care to a specific population.

Question 4

Which quality improvement initiatives would help the healthcare organization meet Institute of Healthcare Improvement (IHI) goals? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

Accepted Answer

1. No waste is an IHI goal.
2. Increasing the educational preparation of nurses is not an IHI goal.
3. No unwanted waiting is an IHI goal.
4. Employee attendance is not an IHI goal.
5. No needless pain or suffering is an IHI goal.

Question 5

Efforts to increase nurses' use of evidence-based practice (EBP) to improve client care in the hospital have failed. Which answers are nurses likely to give when asked why this is occurring? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

Accepted Answer

1. Lack of interest on the part of nurses is not a reason EBP is not used.
2. Lack of time is a barrier to using EBP that is consistent across settings.
3. The need for autonomy over the nurse's own practice can be a barrier to using EBP.
4. Inability to find and assess evidence is a barrier to using EBP.
5. Lack of support from administration is a barrier to using EBP.

Question 6

The nurse manager orienting newly hired nurses has explained the organization's blame-free environment. Which remark by one of the nurses indicates understanding of the policy?

Accepted Answer

1. If the nurse is involved in at-risk or reckless behavior that results in an error, action will be taken.
2. Incident reports are not the first step after making a mistake.
3. Failure to report personal mistakes or the mistakes of others is an at-risk behavior and is not tolerated in a blame-free environment.
4. Mistakes should be reported and reflected upon so that the same mistakes will not be made again.

Question 7

Which situation represents an exception to the blame-free environment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

Accepted Answer

1. Exceptions include failure to report an adverse event or error, criminal acts, false reporting, or refusing to participate in a system designed to prevent errors. Changing nursing notes is illegal unless specific protocols are followed, which would be unlikely on a routine basis.
2. Human errors are handled by the just culture of the blame-free environment. Overlooking an order is a human error.
3. Human errors are handled by the just culture of the blame-free environment. Client accidents are considered human errors.
4. Exceptions include failure to report an adverse event or error, criminal acts, false reporting, or refusing to participate in a system designed to prevent errors.
5. Human errors are handled by the just culture of the blame-free environment. Miscounting errors are considered human errors.

Question 8

After shift change the nurse discovers that a client's IV heparin has been turned off at the IV controller. The amount of fluid left in the IV bag indicates that the client received half of the dose ordered. Which statement should be documented in the client's medical record?

Accepted Answer

1. The documentation in the chart should be a statement of the facts as well as the client's physical status after the incident.
2. The word "accidentally" should not be used to document incidents.
3. The nurse is not certain the IV was turned off by the previous shift, so that entry should not be used.
4. The fact that an incident report was completed should not be documented.

Question 9

Immediately following a barium swallow, a client noticed hives and a feeling of shortness of breath. Although there were no known allergies to food or drugs prior to this incident, the diagnosis was an allergic reaction to the preservatives in the barium. Which is the correct risk category for this incident?

Accepted Answer

1. A medication error occurs when a medication or fluid is omitted, the wrong dose is administered, or the medication is administered to the wrong client.
2. A medical-legal incident occurs when a client or family refuses treatment as ordered.
3. Any incident occurring before, after, or during a procedure is categorized as a diagnostic procedure complication.
4. Complications from diagnostic or treatment procedures are a high-risk area in healthcare and are reported as incidents.

Question 10

Which situation is an example of the overall goal of quality management in today's healthcare activities?

Accepted Answer

1. The focus of quality management is on ways to prevent problems and improve quality of care. Identification of failed standards is reactive, not proactive.
2. The focus of quality management is on ways to prevent problems and improve quality of care. Assessment of problems within the organization was the focus of quality management in the past.
3. The focus of quality management is on ways to prevent problems and improve quality of care. Identifying inefficient employees is reactive, not proactive.
4. The focus of quality management is on ways to prevent problems and improve quality of care. This nurse may have prevented a fall.

Question 11

The nurse is assigned to the Risk Management Team. Which events would be addressed by this team? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

Accepted Answer

1. Any reaction or injury associated with a diagnostic test must be reported as an incident.
2. The nurse manager can address the client's expectations related to meals. If no satisfaction can be obtained and the family continues to complain about meals, an incident report would be filed.
3. The physician and healthcare team are responsible for deciding if the client is ready to be discharged, based on the client's medical condition.
4. The physician and healthcare team are responsible for deciding if the client is ready to be discharged, based on the client's medical condition.
5. The physician and healthcare team are responsible for deciding if the client should be transferred from the ICU, based on the client's medical condition.

Question 12

The hospital organization has developed a philosophy based on the client, organizational involvement, quantitative measurement of outcomes, and processes for improvement. In which quality management process are these characteristics typically seen?

Accepted Answer

1. CQI is the actual process, not the philosophy, used to improve quality and performance.
2. TQM is a management philosophy emphasizing a commitment to excellence throughout the organization. It is founded on four core concepts: client, organizational involvement, quantitative measurement of outcomes, and processes for improvement.
3. The PDCA cycle is a scientific method used to build knowledge, make decisions, and improve quality outcomes within an organization. It is a process, not a philosophy.
4. Six Sigma is a quality management program that uses measures, goals, and management involvement to monitor performance and ensure progress. It is a process, not a philosophy.

Question 13

In which ways can nurse managers reduce risks for the organization? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

Accepted Answer

1. By investigating a complaint, the nurse manager may discover a true issue in the delivery of care. The manager may also gain a greater understanding of any underlying tensions that caused the spouse to make the complaint.
2. Cutting corners is a very real temptation in the high-paced environment in which nurses practice. The manager should not encourage this behavior as it is often risky and dangerous.
3. The nurse manager is in a position to discuss improvement of client care across disciplines.
4. The nurse manager can help make work more efficient by keeping staff members on task throughout the workday.
5. When staff members are tired from working overtime, they are more likely to make errors.

Question 14

Which is the most effective method of creating a blame-free environment?

Accepted Answer

1. A just culture provides an environment in which employees can question policies and practices, express concerns, and admit mistakes without fear of retribution.
2. Making sure all nurses agree to report every mistake is being punitive prior to mistakes and is not blame free.
3. A self-reporting board is a form of punishment and placing blame.
4. The manager should not be keeping lists in a blame-free environment.

Question 15

The following documentation was entered in the client's medical record: "The client was found lying on the floor. Dr. X was notified. Apparently, the restraints were improperly applied." Which statement best describes this documentation?

Accepted Answer

1. Documentation in the chart following an incident should be a statement of the facts; no blame should be placed.
2. The documentation is not appropriately written because it implies that someone was to blame for the incident.
3. The documentation must indicate that the physician was notified, not that the client's family was notified.
4. The documentation is not appropriately written; no blame should be placed.

Question 16

Which situation would be included in reporting for Joint Commission mandatory national client safety goals? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

Accepted Answer

1. Increased wait times are not included as a client safety goal.
2. Improving staff communication is one of The Joint Commission's national client safety goals.
3. Using medications safely is one of The Joint Commission's national client safety goals.
4. Preventing infection is one of The Joint Commission's national client safety goals.
5. Preventing mistakes in surgery is one of The Joint Commission's national client safety goals.

Question 17

The nurse is working on a unit with a blame-free environment and makes an error that puts a client at risk. What should the nurse do first?

Accepted Answer

1. It is not appropriate to discuss errors with others.
2. Reporting the incident to the supervisor is appropriate only after the client's safety is protected.
3. The client's safety is always the priority.
4. Ignoring the mistake if no one saw it is not ethical and may be dangerous.

Question 18

Which part of Six Sigma is vastly different from other quality management programs?

Accepted Answer

1. Most quality improvement programs are client focused.
2. Data drive most quality improvement programs.
3. One of the Six Sigma themes is aiming for perfection but tolerating failure.
4. Proactive management is common in most quality improvement initiatives.

Question 19

Which statement reflects a characteristic common to all methods of quality management?

Accepted Answer

1. All the staff members in the organization are expected to provide quality service, but not all staff members are included in quality management activities.
2. Quality management is not designed for the purpose of placing blame on an individual.
3. Quality management systems do not provide clinical information; they use the data from clinical information systems to determine a focus on quality improvement.
4. The focus of quality management is on more than cost containment; it also focuses on improving services to clients and fixing processes that are causing errors or compromising quality.

Question 20

A client has been told that chemotherapy must be postponed until he is hydrated. The client refuses the IV hydration and demands to go home. How would the nurse best categorize this situation?

Accepted Answer

1. Any incident that is unexpected or unplanned and that could potentially harm a client, family member, or staff is a reportable incident.
2. A medical-legal incident occurs when a client or family refuses treatment as ordered.
3. When a client or family member indicates general dissatisfaction with care and the situation cannot be resolved, an incident report is filed.
4. A medication error occurs when the nurse unintentionally omits a medication or fluid, gives the wrong dose, gives the dose at the wrong time, or gives the medication or fluid to the wrong client.

Quiz 6: Managing and Improving Quality