Chapter 20 Patient Safety and Quality Initiatives in Informatics

Chapter 20  Patient Safety and Quality Initiatives in Informatics

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. An important component of the informatics infrastructure is:
a.
establishment and adoption of standards to support semantic interoperability.
b.
defined standard value sets, groupings, aligners, and attributes.
c.
organizations enabled to set individual standards for quality measurement and reporting.
d.
variation in the types of data used to populate the quality metrics.

ANS: A
Establishment and adoption of standards at multiple levels are important components of the informatics infrastructure. The standard quality metrics must define standard value sets, taxonomies, concept codes, attributes, and data structures. Organizations must adopt the same standards for quality measurements and reporting. Standard clinical content needs to be adopted and used in the electronic systems, and the content should be represented by standard data terminologies.

DIF: Cognitive Level: Remember REF: pp. 324-326

2. When evaluating quality and patient safety, which approach defines the framework for Patient Safety and Quality Research Design (PSQRD)?
a.
Outcomes are driven mainly by Meaningful Use directives.
b.
Consideration of current managerial processes has no effect on patient outcomes.
c.
Patient safety is best achieved by minimizing changes to existing processes.
d.
Quality and safety are based on organization structure, management and clinical processes, and their linkages to patient outcomes.

ANS: D
Quality is based on organizational structure, process, and their linkages to patient outcomes. Consideration of current managerial processes in place has a latent effect on patient outcomes. The framework for PSQRD builds upon Donabedian’s structure-process-outcome model to support evaluation of an intervention from the pre-implementation testing phase, through implementation, and evaluation. In the case of a health information technology (IT) intervention, the expanded framework supports understanding of where the health IT intervention is most likely to have an effect, within the organizational causal chain of quality and safety events. The PSQRD framework provides a means to categorize interventions according to areas of the causal chain targeted (e.g., the structure, the management or clinical processes, and the patient outcomes or throughput that are targeted by the intervention or that drive adoption and use of the intervention in clinical practice).

DIF: Cognitive Level: Remember REF: pp. 327-328

3. Why is the PSQRD a useful framework for research and practice?
a.
It explains why using computer applications is the best way to support better patient outcomes.
b.
It supports implementation, performance improvement, and rigorous research methodologies.
c.
It ensures successful implementation of a clinical process change.
d.
It increases communication among clinical staff.

ANS: B
PSQRD is a useful framework for quality and safety projects whether or not they use health information technology as a tool. While the PSQRD framework may improve communication and implementation, a critical strength of this framework is its systems approach and comprehensive strategy for ongoing monitoring and evaluation. The PSQRD framework provides a means to introduce health IT interventions in a systematic way, and it serves as a reminder to incorporate measures of success across the causal chain. This approach supports implementation, performance improvement, and research projects with an appreciation for the effects and the limitations of health IT and other intervention components. Adoption of the PSQRD framework for both research and organizational implementations will provide a means to plan for successful implementation and to collect data on the structural and process factors that may affect adoption and use of health IT interventions and ultimately patient outcomes. This type of measurement is appropriate for both research-based and operational implementations of health IT.

DIF: Cognitive Level: Remember REF: pp. 330-331

4. A nurse forgets to walk a patient during the nurse’s shift. This is an example of an error of:
a.
commission.
b.
omission.
c.
condition.
d.
remission.

ANS: B
Forgetting to do something that is required for a patient would be considered an error of omission. Doing the wrong thing would be considered an error of commission. Condition and remission are not considered error types.

DIF: Cognitive Level: Apply REF: p. 324