Chapter 21: Quality Improvement and Patient Safety

Chapter 21: Quality Improvement and Patient Safety

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A nurse is preparing to administer a medication by using the vastus lateralis site and is unfamiliar with the process. A step-by-step reference that shows how to complete the process is called a:

ANS:  B

Correct: A top-down flowchart shows the sequence of steps in a job or process such as medication administration.

Incorrect:

1. A deployment flowchart shows the detailed steps involved in a process and the people or departments that are involved at each step in the process; this is not involved in this scenario.
2. The Pareto chart is used in quality improvement to indicate that 80% of problems usually stem from 20% of causes; it displays data so that a few problems are easily depicted and facilitates improvement that focuses on those few.
3. A control plot is a run chart that has a center-line and added statistical control limits; it helps reveal specific types of change within a process, rather than providing a sequencing of steps.

DIF:    Application    REF:   p. 375 | p. 382

2. A nonprofit organization that distributes to governmental agencies, the public, business, and health care professionals knowledge related to health care for the purpose of improving health is the:

ANS:  B

Correct: The Institute of Medicine is a nonprofit organization whose mission is to advance and disseminate to the government, the corporate sector, the professions, and the public scientific information that will improve human health.

Incorrect:

1. The Institute for Safe Medication Practices is a nonprofit organization that is an educational resource only for the prevention of medication errors.
2. The National Committee for Quality Assurance is the accrediting body for health maintenance organizations.
3. The Joint Commission is a national agency that conducts surveys and certifies compliance with established standards for inpatient and ambulatory facilities.

DIF:    Comprehension                               REF:   p. 376

3. A nurse is removing a saturated dressing from an abdominal incision and must cut the tape to remove the dressing. The nurse accidentally cuts the sutures holding the incision, and evisceration occurs. In quality improvement, this incident is best identified as a:

ANS:  B

Correct: A sentinel event is an unexpected occurrence that could result in serious physical or psychological injury to the patient, including the possibility of returning to surgery and a prolonged length of stay.

Incorrect:

1. A root cause analysis is the process by which basic or causal factors that underlie variation in performance, such as a sentinel event, are identified, but this process is not the event itself.
2. A variation results from the lack of perfect uniformity in the performance of any process, but when the variation is this serious, it is referred to as a sentinel event.
3. Causal factors are the underlying causes of the event, not the actual event.

DIF:    Application    REF:   p. 376

4. A nurse is assisting with the delivery of twins. The first infant is placed on the scale to be weighed. The physician requests an instrument stat. The nurse turns to hand the instrument to the physician, and the infant falls off the scale. When evaluating the incident, the nurse and her manager list contributory factors such as the need for two nurses when multiple births are known, and the location of the scale so far from the delivery field. These nurses are performing a(n):

ANS:  B

Correct: A root cause analysis is a process by which factors that underlie variation in performance, including the occurrence or possible occurrence of a sentinel event, are identified. The purpose of root cause analysis is to identify improvements that can be implemented to prevent future occurrences.

Incorrect:

1. Standardization of care is the process of developing and adhering to best known methods and repeating key tasks in the same way, thereby creating exceptional service with maximum efficiency.
2. Process variation looks at the steps in a process to determine how variation affects each step but does not identify causal events.
3. A deployment flowchart analysis looks at the steps of a process and determines which department is responsible for each step, but it does not identify causal events.

DIF:    Application    REF:   p. 376 | p. 388