Quality Improvement Strategies in Healthcare, Exams of Nursing

Download Quality Improvement Strategies in Healthcare and more Exams Nursing in PDF only on Docsity! 1 C157 and C128 combined test with 70 questions answers with rationales Analyze each question and choose the best response. Record your rationale for each choice. 1. Quality improvement assumes that: a. Most problems with service delivery result from process difficulties, not individuals. b. Frequent inspection is necessary to improve quality. c. Employees generally try to avoid work. d. Top management leads all quality improvement activities. Response A is correct. QI starts with the assumption that errors occur as a result of system failures, not individual errors. We should eliminate response C. In response B, frequent inspection might help ensure quality control over the process we have now, but will not help us exceed the capability of the existing process to improve quality. In response D, top management would be the CEO and senior management—there is not enough of them to go around to lead ‘all’ QI activities. 2. The term “quality” as used in quality improvement usually refers to: a. Characteristics of a product or service that bear on its ability to satisfy stated or implied needs. b. A product or service free of deficiencies. c. Having a high degree of excellence. d. All of the above. Although each of the definitions provided are different ways in which we think of attribute of “quality”, quality improvement focuses on delivering quality services or products as determined by the customer. Therefore, in QI, high “quality” rests on the ability to satisfy customer needs. A product or service that is free of deficiencies or has a high degree of excellence but does not meet the customer needs would not be considered a “quality” result (we would think of it as wasteful). Note also the IHI “Triple Aim”: • Improving the patient experience of care (including quality and satisfaction); • Improving the health of populations; and • Reducing the per capita cost of health care. 3. The major difference between traditional “quality assurance” activities (e.g., keeping track of the total number of different procedures conducted in your practice, rates of adverse outcomes) and “quality improvement” activities is that quality improvement also focuses on: a. People and competency. b. Analysis of data. P a g e 1 | 32 2 C157 and C128 combined test with 70 questions answers with rationales c. Performance measures. d. Systems and processes. While quality improvement strategies also stress the importance of data analysis, rely on performance measures to benchmark progress, and occasionally assess individual capabilities, one of its key principles is the focus on systems and processes (rather than individuals or products) to introduce positive change to an organization’s performance. 4. Effective quality improvement does not require: a. Leadership and commitment from management with long-term vision. b. An increased emphasis on inspection of individuals’ work. c. Increased investment on employee education and training. d. Scientific redesign of processes/services Quality improvement strategies focus primarily on systems and process changes, but this does not mean that inspection of the results of individuals’ work or how well people perform in the existing systems should be ignored. Note: We’re talking about inspecting ‘work’ not a person. Inspection or observation is a scientific method used in evaluating how systems and processes are working and can provide clues on how or where to improve. So while we wouldn’t ignore the need to inspect individuals work, we also wouldn’t increase our emphasis on this aspect of the process. Strong leadership, team commitment, and enhanced education and training are all very necessary for effective QI interventions to succeed. 5. A leadership style that is said to motivate employees, and that optimizes the introduction of change is: a. Autocratic – A clear top-down approach where a single individual has complete power of decision-making and little discussion is had for external input. b. Consultative – A style where leaders engage subordinates/peers in the decision-making and problem-solving process, but ultimately make the final decisions for the team. c. Participatory – An approach where leaders interact with other participants as peers, engaging them in the decision-making process and playing an equal role in the process as others and jointly carrying out the problem solving activities. d. Democratic – An open style of running a team where leaders facilitate discussion among all members, encourage ideas to be shared, and consider everyone’s input in order to make final decisions for the team. Bringing about change in health care settings often involves the participation of all staff. Each professional plays a role in satisfying the organization’s customer (i.e., patients) since the responsibility for the care provided is shared. Therefore, whoever leads a quality effort practice should be prepared to take a central but equal (team-oriented) role in the activities identified for establishing change. Shared governance is a feature of Magnet hospital status; this is a staff- leader P a g e 2 | 32 5 C157 and C128 combined test with 70 questions answers with rationales analysis. Hospital ratings are usually based on a suite of indicators—some built from quantitative data and some from qualitative data. 12. Of the following, two statistics are essential for identifying opportunities for performance improvement. These are: a. Frequency counts and modes. b. Variance and distributions. c. Mean and median values. d. Data ranges and standard deviations. Unlike the other responses listed (which are also important elements of analysis for QI), variance and distribution data are key for discerning areas with the greatest potential for improvement. The greater the variance and the more varied the distribution of services provided, the greater the opportunity for improvement – more bang for the buck! The goal being to implement processes that minimize variance in performance and make higher, yet achievable, results more consistent. 13. Comparisons of your data against the top performers in your region/industry describe the process(es) of: a. External benchmarking. b. Internal benchmarking. c. Neither external nor internal benchmarking. d. Both internal and external benchmarking. External benchmarking is when an organization compares its performance data to that of a similar organization in the region (or competitor in the market). Internal benchmarking is when an organization compares its own current performance to its past performance in order to assess its improvement over time. Both approaches are good for setting desired performance targets. 14. Benchmarking creates objective measures of performance that are based on: a. Past performance targets within an organization. b. Performance of a competing external organization. c. Some external universal performance target established by the industry. d. All of the above. Setting targets for achievement (i.e., benchmarking) can be accomplished using any of the approaches listed here. Internal benchmarking (or baseline goals) uses past performance targets to set new targets going forward, whereas external benchmarking can be done either by comparing one’s performance to that the highest performing peers, or by adopting the target set, for example, by a national effort or organization targeting in on a specific QI effort. 15. Of the following quality tools, which would be most useful for identifying a problem in a process that could benefit from a quality improvement strategy? a. Control chart P a g e 5 | 32 6 C157 and C128 combined test with 70 questions answers with rationales b. Histogram c. Flow chart d. Run chart A flow chart (or process map) would be very useful for examining the steps in a process failure to identify a root cause. 16. A patient has a terminal illness. Against the family's wishes, the patient requests a "do not resuscitate" order. Which ethical principle supports the patient's decision? a. Autonomy b. Beneficence c. Justice d. Nonmaleficence The patient is looking for self-determination—autonomy would support this. 17. Which ethical conflict places the equitable access to health care against actions that produce the greatest good? a. Autonomy versus paternalism b. Fairness versus altruism c. Justice versus utilitarianism d. Veracity versus fidelity Responses A and D should be eliminated—we’re not talking about truth, self-determination, loyalty, or treating others like children. Fairness and altruism have more to do with our emotions and concerns about others. Justice is about equality or equity; utilitarianism deals with actions resulting in the greatest good for the greatest number of people. 18. Four strategies that promote staff empowerment are adopting a shared vision, team building, relinquishing administrative control, and: a. counseling the staff frequently. --?! b. delegating final decisions to the staff. –the leaders need to retain final authority/responsibility c. providing detailed instructions of a proposed plan.—micromanaging/needs to elicit team input d. rewarding performance that adheres to high standards. 19. The nurse executive is the chair of a new performance improvement team whose purpose is to address patient flow through the emergency department. A laboratory team member openly blames emergency department nurses for a long turnaround time in obtaining patient test results. To which phase of group development does the nurse executive attribute the blaming behavior? a. Forming—the team is brought together P a g e 6 | 32 7 C157 and C128 combined test with 70 questions answers with rationales b. Norming—team members begin to resolve differences c. Performing—team members begin to obtain results d. Storming—refers to the conflict-ridden stage of team development 20. The nurse executive develops a balanced scorecard for nursing practice by emphasizing: a. consistency over time b. customer feedback. c. financial performance. d. internal and external benchmarks. The critical characteristics that define a Balanced Scorecard: • focus on the strategic agenda of the organization concerned • selection of a small number of data items to monitor • mix of financial and non-financial data items. 21. A nurse executive sponsors a multidisciplinary team that is charged with educating patients scheduled for total joint replacement surgery, about topics including what to expect after discharge. What is the nurse executive's response when encountering resistance from team members? a. Direct the mid-level managers to reemphasize the vision to their direct reports b. Encourage the first-level managers to reinforce the vision to the team members c. Gather together the various disciplines and listen to their concerns about the project d. Reeducate the team members about how their role affects the outcome of the team Response C is the only one that respects the perspective of the team members and engenders participation. 22. The nurse executive receives notice that critical supplies have not arrived before a three-day holiday weekend. Due to a computer system error, “just-in-time" supplies were not queued for delivery. The nurse executive's next action is to: a. conduct an internal audit of supplies, compared to patient usage and census, before requesting assistance from materials management. b. contact the materials manager to expedite the delivery of supplies before the end of the work day. c. direct the department managers to negotiate for needed supplies, and allocate resources according to department census. d. mobilize personnel to facilitate the purchase of needed supplies from the available vendors. P a g e 7 | 32 10 C157 and C128 combined test with 70 questions answers with rationales e. All of the above f. A, B, and D g. B, C, and D 31. If data are plotted over time, the resulting chart will be a (A) Run chart (B) Histogram (C) Pareto chart (D) Poisson distribution Improvement takes place over time. Determining whether an improvement has actually happened and if it has been sustained requires observing data to determine patterns over time. Run charts typically use a line graph to show data over time. The run chart below depicts a baseline measurement and the response to steps in the improvement process: Pareto charts and Histograms (the next two graphs shown below) look very similar. Both typically involve bar graphs and help depict the frequency or distribution of data. P a g e 10 | 32 11 C157 and C128 combined test with 70 questions answers with rationales A Poisson distribution can help us look at recurring events over a fixed timeframe: P a g e 11 | 32 12 C157 and C128 combined test with 70 questions answers with rationales 32. The following diagram is best described as a: (A) Run chart (B) Flow chart (C) Control chart (D) Checklist P a g e 12 | 32 15 C157 and C128 combined test with 70 questions answers with rationales (D)Provide tools and information to help MSNs build and utilize quality systems and processes. Responses a, b, and d are reasonable goals for QI education of MSNs. Individual healthcare organizations and settings have their own mechanisms for initiating QI activities and providing approval. 38. Rank order, from first to last, the following training design steps. 1. Prepare training materials. 2. Define training objectives. 3. Determine course structure and sequence. 4. Establish consensus on needs. (A) 2, 1, 4, 3 (B) 2, 4, 1, 3 (C) 4, 2, 3, 1 (D) 4, 3, 1, 2 Determining needs (the aim) is the first step again. After that, we can define objectives, develop the course structure, and then prepare the training materials. 39. An MSN wants to implement Leadership Rounds in the hospital, to include participation of the CEO. This initiative would provide an informal way for senior leaders to talk with front-line staff about safety issues in the organization and to encourage reporting of errors. All of the following are benefits of having the CEO involved in these rounds EXCEPT (A) Increased understanding by the CEO of the organization’s state of affairs. (B) Improved motivation of subordinates through personal participation of the CEO. (C) Improved human relations between the CEO and front line staff. (D) Improved dissemination of information throughout the organization. Leadership Rounds are basically an opportunity for senior leaders, like the CEO, to demonstrate their organization’s commitment to building a culture of safety by engaging in direct communication with frontline staff—it is not an optimal method for disseminating information. For more information, see the IHI website: http://www.ihi.org/resources/pages/tools/patientsafetyleadershipwalkrounds.aspx 40. In order to be successful in the role of change agent, an MSN should do all but one of the following? (A) Understand and respect peoples’ needs. (B) Learn from previous unsuccessful efforts to transform the organization. (C) Maintain commitment to the mission and vision of the organization. (D) Communicate change initiatives only to senior management. Dissemination of information in a change initiative should not be limited to senior management. Responses a through c will help ensure success of the project as well as success of the change agent. 41. Which of the following is the first priority when starting a quality improvement initiative? (A) Assign team goals. P a g e 15 | 32 16 C157 and C128 combined test with 70 questions answers with rationales (B) Develop strategies. (C) Identify an aim. (D) Make sweeping organizational changes to support quality. We first need to develop a time-specific, measurable aim or goal. For more see: http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementHowtoImprove.aspx 42. Which of the following is the LEAST effective safety approach for a patient-centered healthcare organization to take? (A) Urge employees to do it right the first time. (B) Establish a quality council that includes patients. (C) Implement team-building throughout the organization. (D) Examine processes and establish controls to increase efficiency, reliability, and safety. Response ‘a’ is not a systems approach to improving patient safety—the focus should not be on individuals. Response ‘b’ is good because it includes patients as a stakeholder. Team-building and examining processes are good approaches to improving systems. 43. Which of the following is one advantage of team decision-making? (A) Ease of arriving at a decision (B) Reduced potential for conflict (C) Increased acceptance of decisions (D) Increased productivity Team work is not always easy and does not guarantee a reduction in conflict. In fact, “storming” is one of the early phases in team development (phases are form-storm-norm-perform). We hope that team decision-making will eventually increase our productivity, but finding time to participate in team meetings or other activities often does the opposite (at least in the short term). C is the best response. 44. The wide scale collection of patient weight into a large dataset is primarily used to measure and improve healthcare for which type of group? (A) Family health (B) Extended family health (C) Population health (D) Individual health The keywords here are “wide-scale” and “large dataset”. C is the best response—the others (involving a single family or individual) are too limited. 45. In interpreting the run chart below, all of the following are true EXCEPT P a g e 16 | 32 17 C157 and C128 combined test with 70 questions answers with rationales (A) More than a year of data is represented in the chart. (B) The highest rate of infection reported was about 8%. (C) The data points in red indicate a rise in infection rates from April through December. (D) The data points in green indicate a decrease in infection rates over two separate time periods. (E) The green dotted line is located at about a 4.5% infection rate; this is the target or benchmark. (F) The blue dotted line is located at about a 3% infection rate; this is the target or benchmark. Response ‘e’ is located at about the 4.5% infection rate, but this is the “mean” or average of the values presented in the chart. The blue line at the 3% mark is the actual target rate—the rate that helps to describe the aim of this project. Only four data points are on or below the target rate. 46. A primary care provider refers a patient to a specialist. The specialist treats the patient and then sends the patient with a report back to the primary care provider. A manual (paper-based) system was used in this referral process. Which of the following statements about manual systems is true? Manual systems for referrals or other transitions in care: (A) Decrease the complexity of the referral process and reduce opportunities for human error. (B) Often result in more efficient work-flow processes. (C) Never result in missed appointments and lost revenue. (D) Are known to reduce delays in patient care. (E) Often involve no agreement on who is responsible for closing the loop (ensuring that referral information is exchanged provider-to-provider). Paper-based systems for referral often do the opposite of responses a through d. Closing the loop is a significant problem, not only for referrals, but for other transitions in care that involve hand-offs between providers of different healthcare institutions. 47. A patient's right to make informed decisions includes all of the following except: P a g e 17 | 32 20 C157 and C128 combined test with 70 questions answers with rationales response—we want to know that the recommendation will be a cure for the problem. Here is an article: http://www.hermanmiller.com/research/research-summaries/sound-practices-noise-control- in-the- healthcare-environment.html 50. Historically, which group is closely aligned with the financial success of healthcare organizations and therefore is designated the leader for most clinically-based innovations? (A) Nurses (B) Administration (C) Physicians (D) Admitting Administration & admitting can be eliminated as having no direct clinical role—they might assume a leadership role in business innovations. Nurses typically don’t earn the revenue; providers do (although this is changing somewhat).  51. The Health & Human Services dept established a National Strategy for QI in Healthcare. This national quality strategy (NQS) has the triple aim of better care, healthy people/healthy communities, and affordable care. To further this triple aim, one of the NQS priorities is to promote effective communications and coordination of care . The following goals were established: 1 Improve the quality of care transitions and communications across care settings. 2 Improve the quality of life for patients with chronic illness and disability by following a current care plan that anticipates & addresses pain and symptom management, psychosocial needs, and functional status. 3 Establish shared accountability and integration of communities and health care systems to improve quality of care & reduce health disparities. Nursing leadership in a 750 bed tertiary care facility has been advised that quality measures affecting reimbursement are going to be captured to assess progress toward these goals, so a program is needed to improve the coordination of care as patients transition to other care settings . What role should the QI team have in a program to improve communication and care transitions? (A) Determine if current practice meets the metrics established for the measure or if this is a QI program needed to improve the quality of care delivered. (B) Determine whether facilities receiving patients are interested in a QI program initiated by the sending facility. (C) Check with patient families of discharged patients to ensure home care contacted them in a timely fashion and had the necessary information to provide high quality care. (D) Check each patient discharged for a two-week period to a skilled nursing facility or an assisted living facility to be sure the correct paperwork was sent or transmitted to the facility. P a g e 20 | 32 21 C157 and C128 combined test with 70 questions answers with rationales Some key words/phrases are underlined in this question. This is a huge facility—having the QI team check discharges even for just a 2-week period (as in response d) could be a time-consuming activity and would still not solve the problem of “shared accountability” in care transitions. In addition, sent or transmitted doesn’t mean actually received by a human being—this is often the problem with care transitions. It’s called closing the loop. The first response would tend to check on how well we’re meeting reimbursement requirements or possibly the care delivered in the facility—it doesn’t address communication or care transitions. The third one is either limited to only home care patients (which doesn’t include the healthcare facilities some patients get discharged to) or potentially we’d be checking every discharged patient (and we know not all patients need home care). In questions like this, make sure that your response will fully address the actual problem (or in this case, problems). 52. In reflecting on the role of MSN mentor, which of the following statements is not true? (A) The mentor nurtures and develops the mentee’s capacity for self-reflection and self-direction. (B) Mentoring relationships are task focused; when the tasks are completed the relationship comes to a close. (C) A mentor who understands how to provide vision and how to support and challenge the mentee can help the mentee grow and develop. (D) The mentoring relationship is a learning partnership that focuses on developing the mentee’s abilities and thinking. (E) Some preceptors are also mentors; being a mentor is not dependent on being a preceptor. The preceptor relationship is task focused (not the mentor relationship). A mentor typically holds an unofficial role as a new nurse’s trusted advisor. The mentor supports and nurtures the new nurse, usually checking in frequently to see how he/she is progressing. But there are no specific milestones or deadlines that must be met. The mentor is concerned about the nurse becoming an asset to the nursing profession as a whole, more than becoming an asset to any specific organization, unit, or job. A preceptor typically has an assigned duty of monitoring the training and evaluating the performance of a new nurse. A preceptor works with the new nurse for a defined period of time to assist the novice in acquiring new competencies required for safe, ethical and quality practice on a particular unit or for a particular type of job. At the end of the defined period of time, the preceptor is usually asked to help evaluate the novice and determine whether the individual is ready to work independently or needs additional time to train and prepare (as in an extension of the probationary time for a new job). When things go well, a preceptor may become a mentor to the new nurse (assuming that a relationship of trust has developed). P a g e 21 | 32 22 C157 and C128 combined test with 70 questions answers with rationales 53. By focusing on the patient, we can achieve the IHI Triple Aim. The Triple Aim is, simply stated, to create: (A) better outcomes, great patient experiences, and reduced costs (B) higher revenues, reduced turnover, and lower costs (C) lower revenues, higher costs, and lower patient satisfaction (D) better outcomes, reduced costs, and higher revenues For more, see: http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx 54. An MSN needs to assign a staff member to assist a medical director in the development of a quality program for a newly established service. Which of the following staff members is MOST appropriate for this project a. a newly hired staff member who has demonstrated competence and has time to complete the task b. a knowledgeable staff member who works best on defined tasks c. a motivated staff member who is actively seeking promotion d. a competent staff member who has good interpersonal skills Rationale: This is basically a question about delegation. The objective in delegation is to give a task to someone who can handle it efficiently, effectively and without a lot of oversight--so that the delegator does not turn in to the doer! In option a, the newly hired staff member would not have the contacts necessary to start a quality program in a new service. In option b, the staff member who needs defined tasks would not have the level of initiative needed to start a new program. In option c, the motivated staff member might not be the best choice to develop a new program because they intend to move on to another position (and the MSN might need to assign someone else to this eventually). The staff member with good interpersonal skills (option d) is the best choice—this person can work with others and has demonstrated competence. 55. A surgeon’s wound infection rate is 32%. Further examination of which of the following data will provide the MOST useful information in determining the cause of this surgeon’s infection rate? a. mortality rate b. facility infection rate c. use of prophylactic antibiotics d. type of anesthesia used Rationale: This question is asking for a ‘cause’ for this particular surgeon. The cause can be found by examining process. Options a and b refer to high level outcome measures—these tell us about all patients in this facility, not just this surgeon. Option d refers to a process but it is not directly attributable to the problem of infection. Option c also refers to a process and we know that use of prophylactic antibiotics is known to reduce incidence of infection. Option c is the best response because we can use this information to inform this particular surgeon’s practice (his process). 56. Pharmacy and Nursing are having difficulty developing an action plan for medication errors. Pharmacy Services states that Nursing Services cause the majority of P a g e 22 | 32 25 C157 and C128 combined test with 70 questions answers with rationales In addition, Option a would not be highly specific to discharge planning—multiple providers place documentation in progress notes and not just for purposes of discharge planning. Options c and d involve referrals to discharge planning— P a g e 25 | 32 26 C157 and C128 combined test with 70 questions answers with rationales a referral is a notification that discharge planning is needed; this would occur prior to any interventions being implemented by a discharge planner. 60. A primary purpose of an information management system is to allow an organization to a. save time b. centralize demographics c. reduce cost d. evaluate data Rationale: Information management systems are primarily used to collect and evaluate data —of all types: patient care information, dates and times of care delivery, outcomes of care, costs of goods and services, multiple revenue streams and cost centers, payroll, etc. Such evaluation often leads to greater efficiency and cost reduction. Information management systems can also yield benefits like a centralized location of data—demographics being just one type of data centrally stored. 61. Which of the following monitors provides patient outcome information? a. healthcare-acquired infection rate b. nursing care documentation compliance c. antibiotic therapy discontinuation compliance d. equipment malfunction rate Rationale: Options b, c, and d are all referring to process measures that might tell us what we can improve our accuracy or efficiency. Option A is the only outcome measure; it will help tell us how patients are doing. 62. The surgery department's monthly case review revealed twenty-six records meeting the criteria. Six records did not meet the criteria. When calculating the incidence risk, the denominator is a. 6 b. 20 c. 26 d. 32 Rationale: This is a thought problem—it is telling you that 26 records in the review did meet criteria (compliant records), so you can’t have 6 records out of that 26 that also did not meet criteria (noncompliant records). So the 6 records that did not meet criteria would be an additional amount (6 records that did not meet criteria + 26 records that did meet criteria = 32 total records). The denominator in a calculation of rate is always the total number in the group being examined. Numerator - The upper part of a fraction - For example, the number of records that were compliant 26 Denominator - The lower part of a fraction used to calculate a rate or ratio - For example, total number of records in the audit 32 Rate Numerator/Denominator (26/32 = Compliance Rate) 81% 63. Flowcharts are primarily used in quality improvement to a. analyze causal factors of process dispersion b. understand the overall process or system being audited c. distinguish variations in a process over time d. determine process capability and uniformity P a g e 26 | 32 27 C157 and C128 combined test with 70 questions answers with rationales Rationale: A flowchart is an illustration of a process—it allows us to understand it better (see diagram below for a simple example). Breakdowns in process or causal factors of such breakdowns can be identified in a flowchart but not before the process itself is mapped out and understood. A flowchart will not provide information of process variations that occur over time. It may help you look at process capability, efficiency, and standardization to provide insight into opportunities for improvement of the process—but again, the process itself must be mapped out and understood first. 64. In what instance is it acceptable to obtain additional time for a corrective action? a. When the auditor cannot perform the audit as scheduled b. When the group being audited determines that the proposed corrective action is not cost effective c. When the corrective action plan requires more time than originally anticipated d. When there has been a change in personnel who perform the task P a g e 27 | 32 30 C157 and C128 combined test with 70 questions answers with rationales 68. Which QI goal is most effective for the QI team to use? a. the pt satisfaction score will increase by 10% b. the pt satisfaction score will exceed national averages c. the pt satisfaction score will improve from 62% to 98% d. the pt satisfaction score will be 95% by December 1 All of the responses point to data that refer to a rate or measure of improvement. Only one (response D) provides an additional piece of information that is important in setting a SMART goal: Specific— Measureable—Achievable (or Action-Oriented)—Realistic (or Relevant)—Time-bound. A good discussion of this is located here: http://www.communicatingwithpatients.com/articles/smart_goals.html Simply put, a goal without a deadline is “just a dream”. 69. The QI team is working together to identify the primary drivers of pt satisfaction regarding the nursing care that patients receive. One of the identified primary drivers of pt satisfaction was effective communication. What is the 1st thing the QI team should do with this information? a.develop strategies for effective communication b.implement a national program for effective communication c.establish a means for measuring effective communication d.remind staff of the importance of effective communication P a g e 30 | 32 31 C157 and C128 combined test with 70 questions answers with rationales In the “Plan” portion of the IHI PDSA cycle, after we decide what it is that we want to improve (this is the objective--in this case we want to improve “communication”), we need to establish how we’ll know a successful change occurred (our prediction needs to be based on data—a measurement that will show us that the proposed change resulted in the desired improvement in communication). Then we can brainstorm some ideas about steps we could take to accomplish the change (this would be the interventions we can implement that will result in the desired improvement in communication). Response C is the best answer. Response A is the actual intervention plan for the cycle (the who, what, when, where, etc. of how the change will be carried out). Then we would need to plan the who, what, when, where for the data collection. Response B has the keyword ‘implement’—indicating that this is part of the “Do” portion of the PDSA cycle. In response D, reminding staff puts the ‘blame’ on them when failure occurs (not a systems approach to improvement). We need to create systems and processes to support effective communication—and avoid depending solely on human memory (which will likely result in error). For more on the IHI model: http://community.wgu.edu/clearspacex/docs/DOC-13711 70.Based on observation, an NP believes that the rates of smoking and obesity are increasing in their patient population and wants to implement a program to address this issue in the ambulatory clinic. What is the 1st step the NP should take to determine if this belief is, in fact, a trend? P a g e 31 | 32 32 C157 and C128 combined test with 70 questions answers with rationales a. work with the practice manager to determine rates of smoking and obesity in the practice b. ask the other staff if they are seeing increasing numbers of patients who are smoking and/or obese c.ask patients if they feel that either smoking or obesity is affecting their lifestyle d. work with the staff to counsel each patient on the dangers of smoking and the risk factors of obesity The NP has a “belief” based on observations—but he/she lacks actual data (scientific evidence) to support the need for a new program to be implemented. It wouldn’t help to ask other people (responses B and C) about their beliefs (still no hard data) and in response D, it is too soon to begin working on the interventions (we don’t have data to show that this is an actual problem yet). A trend is typically demonstrated with a run chart. A run chart is a graph that displays observed data in a time sequence. Obtaining actual rates of smoking & obesity in the practice (response A) to establish a trend over time is the data that is needed to support the need for development of the new program. P a g e 32 | 32