Optimizing patient care: Steps to Success
Step 1 Conduct patient care outcomes review
Step 2 Conduct evaluations of the organization's use of seclusion, restraints, and protective devices
Step 3 Conduct evaluations of laboratory services and the use of blood products
Step 4 Conduct evaluations of
Critical factor in optimizing the care of patients
Organization's ability to improve:
1. patients' understanding of their health,
2. their ability to care for themselves,
3. their independence, and their quality of life.
Goal of Performance Improvement in healthcare
to design and implement systems that provide consistency and quality in all of the patient care processes performed to improve each individual patient's health
Core processes involved in care, treatment, and services to patients are:
1. Assessing patient needs
2. Planning care, treatment, and services
3. Providing the care, treatment, and services that the patient needs
4. Coordinating care, treatment, and services
Activities utilized in providing the four core processes include:
1. Assessing and providing appropriate access to levels of care
2. Providing interventions based on the plan of care developed in conjunction with the patient and significant others
3. Teaching patients what they need to know about their care, treatment,
The cornerstone of good patient care is:
The initial assessment
Which determines the patient's appropriateness for admission to the facility and the level of care to be rendered.
Community standards & accrediting & licensing entities require collection of what information in the initial patient assessment for admission?
1. Physical, psychological, and social assessment
2. Nutrition and hydration status
3. Functional status (how well an individual performs ADLs
4. Social, spiritual, & cultural variables that influence the patient's and family members' perceptions of their
Most hospitals require a medical history and physical examination be completed by a physician within:
24 hours of admission or within 30 days prior to admission.
If a physical exam is within 30 days of admission an updated physical to note any changes needs to be done within 24 hours of admission.
A functional screening is also completed for each patient
Staff are assigned to accomplish interventions for each _________, and a _______ ______ for completion or frequency of intervention is identified
goal, time frame
The care pathway defined
the specific treatment and its timing and frequency.
Many healthcare facilities use a system of care based on established national clinical standards for treatment interventions, which have been extensively researched
Care pathways have become the basis for the core measures monitoring program currently required for:
Joint commission accreditation and Centers for Medicare and Medicaid Services (CMS) participation
Organizations can prepare for and seek special accreditation as centers of excellence in the evaluation and treatment of specific commonly occurring conditions such as:
stroke, or myocardial infarction, or specialized procedures such as myocardial revascularizaion
Goal of each core team is to deliver:
high-quality clinical care to the patients assigned to it.
The flow of patient care is
cyclical
1. Assessment to treatment planning
2. Treatment planning to care or service
3. Coordination of care when improvement is demonstrated
4. Reassessment when the patient is referred, transferred, or discharged
Coordinating care services includes:
1. Resolving conflicts in scheduled appointments
2. Preventing duplication of services,
3. ensuring care is administered within a time frame that meets the patient's needs
Patient care outcomes are reviewed to improve:
1. Safety of care
2. Quality of care
3. Identify issues related to medical necessity for treatment
4. Appropriateness of care
A means of outcomes review initiative is called:
The ORYX initiative
The ORYX initiative was introduced by:
The Joint Commission in 1977
The ORYX initiative includes:
Core measure sets based on the services the healthcare organization provides
The ORYX initiative is required by
The Joint Commission and Medicare participants by CMS.
Core measure sets include:
1. Surgical Care Improvement Project
2. Heart Failure
3. Acute Myocardial Infarction
4. Pneumonia Measures
5. Hospital Outpatient Department
6. Children's Asthma Care
7. Hospital-Based Inpatient Psychiatric Services
8. Venous Thromboembolism
9. substance
Laboratory Services are regulated by established protocols from the:
Clinical Laboratory Improvement Amendments (CLIA) and the Centers for Disease Control and Prevention (CDC)
The Joint Commission has provided a list of National Patient Safety Goals (NPSGs) related to:
1. Patient Identification
2. Proper labeling
3. Transfusion reactions
4. Timeliness of results reporting
NPSG 01.01.01 states that:
Two patient identifiers are used when administering medications, blood, or blood components
Containers used for blood and other specimens are labeled in the presence of the :
Patient
Before a blood product transfusion is initiated what are the steps?
1. patient is matched to the blood product, and the blood product is matched to the order using either a two-person verification process or an automated identification technology like bar coding.
2. When using a two-person verification process, one indivi
Because of its complexity and impact on the patient care process cycle, what is one of the most important areas for examination with respect to PI?
Medication systems and processes
What leads to the largest number of risk management and legal situations in the healthcare industry?
Documentation of care
This model defines practice based on diagnosis
Clinical practice standards
An established set of clinical decisions and actions taken by clinicians and other representatives of healthcare organizations in accordance with state and federal laws, regulation, and guidelines
Standards pf care
Joint commission 2015 Hospital NPSGs
1. Identify patient correctly
2. Improve staff communication
3. Use medicines safely
4. Use alarms safely
5. Prevent infection
6. Identify patient safety risks
7. Prevent mistakes in Surgery
8. Prevent patients from falling
9. Prevent bed sores
Universal protocol for surgery
1. Wrong person, wrong-site, and wrong procedure surgery can and must be prevented
2. A robust approach using multiple complementary strategies is necessary to achieve the goal of always conducting the correct procedure on the correct person, at the corre
Clinical guidelines
Attempt to standardize the care of a single condition across the entire country. A graphic tool used to communicate established standards of patient care for specific diagnoses
Evidence-based medicine
Attempts to identify the care processes or interventions that achieve the best outcomes in different types of medical practice
Pay for Performance (P4P) initiative
Providers under this arrangement are rewarded for meeting preestablished targets for delivery of healthcare services that improve quality and effeciency
Payment for care should be based on a
Patients needs rather than on the type of facility that provides the care
Hospital inpatient value-based purchasing program
The higher the hospital's performance or improvement during the performance period for a fiscal year, the higher the hospital's value based incentive payment for the fiscal year would be
Physician Quality Reporting System (PQRS)
A reporting program that uses a combination of incentive payments and negative payment adjustments to promote reporting of quality information by eligible professionals.
Outcome and Assessment Information Set (OASIS) data
Reports collected by Home health Agencies which are evaluated by CMS
Resident assessment data
Data that is collected on the residents in nursing homes and posted on Nursing Home Compare. These measures assess the residents' physical, clinical conditions and abilities, and preferences and life care wishes. This information shows how well nursing ho
The End Stage Renal Disease (ESRD) Quality Initiative
Promotes ongoing CMS strategies to improve the quality of care provided to ESRD patients
Patient Care Process Cycle emphasizes
1. Respect for patient values, preferences, and expressed needs
2. An emphasis on the providers' cultural competence, information and education regarding the patient's conditions under treatment
3. The modalities of treatment being utilized, access to car
Patient-centered healthcare system gives patients the ability to
1. communicate effectively and immediately with their providers
2. it provides patients access to information that is important and useful for them, when they need it
3. patient centered healthcare allows providers to look holistically at an individual an
Healthcare Effectiveness Data and Information Set (HEDIS)
Gathers a significant amount of information about the ambulatory care experiences of millions of health plan members from across the country
Healthcare Effectiveness Data and Information Set (HEDIS) gathers data in these areas:
1. Measures of effectiveness of care, such as immunization status, cholesterol screening, breast cancer screening, and fall risk management
2. Measures of access, adult access to preventive care, adolescent well care, prenatal and postpartum care
3. Measu
Who reports findings from HEDIS and to whom?
NCQA reports these findings to employers, who use the information to make decisions about contracts with health plans
Any sentinel event requires a credible root-cause analysis to be completed within
45 days of the incident
Sentinel Event Alert
A notification that defines processes and identifies measures that can be used to prevent errors and improve outcomes
Minimum Data Set (MDS)
Assesses long-term care residents and is mandated by the federal government since June 1998
Minimum Data Set structures the assessment of long-term care residents in the following areas:
1. Delirium
2. Cognitive loss/dementia
3. Communication
4. Vision function
5. ADLs function and rehabilitation potential
6. Urinary incontinence and indwelling catheter status
7. Psychosocial well-being
8.Mood and behavior symptoms
9. Activity-pursuit pat
Facility quality-indicator profile
A facility is provided this on the basis of the data gathered via the MDS, and it shows what proportion of the facility's residents have deficits in each area of assessment during the reporting period and, specifically, which residents have which deficits
Outcome and Assessment Information Set (OASIS)
CMS developed and maintains a list of core items for the comprehensive assessment of an adult home care patient. The data also help measure patient outcomes for outcome-based quality improvement. Home health agencies are required to electronically submit
Patients care outcome review criteria set.
A common QI toolbox technique Criteria sets are used to identify opportunities for improvement
Criteria sets
used to identify opportunities for improvement with respect to :
1. Appropriateness
2.Processes
3. Outcomes
of medical care and surgical procedures in healthcare facilities
The Joint Commission Core Measures
are an example of criteria sets that healthcare organizations use for ongoing patient care monitoring
Joint Commission Core Measures include
1. Acute Myocardial Infarction
2. heart Failure
3. Community Acquired Pneumonia
4. Pregnancy and Related conditions
The four core processes involved in the care of, treatment of, and services to patients
1. Assessing patient needs
2. Planning care, treatment, and services
3. Providing the care, treatment, and services that the patient needs
4. Coordinating care, treatment, and services
Standards of Care
An established set of clinical decisions and actions taken by clinicians and other representatives of healthcare organizations in accordance with state and federal laws, regulations, and guidelines
Clinical practice standards model
The descriptions of medical interventions for specific diagnoses in which treatment regimens and the patients' progress are evaluated on the basis of nationally accepted standards of care for each diagnosis
Pay for performance
A movement in healthcare reimbursement where providers are rewarded for meeting preestablished targets for delivery of healthcare services that improve quality and efficiency