chapter 10
Quality and Safety
OBJECTIVES
After reading this chapter, the student should be able to:
■Discuss the history of quality and safety within the U.S.
health-care system.
■Analyze historical, social, political, and economic trends
affecting the nursing profession and the health-care delivery
system.
■Explain the importance of quality improvement (QI) for the
nurse, patient, organization, and health-care delivery system.
■Discuss the role of the nurse in continuous quality improve-
ment (CQI) and risk management.
■Examine factors contributing to medical errors and
evidence-based methods for the prevention of medical errors.
■Explain the use of technology to enhance and promote safe
patient care, educate patients and consumers, evaluate
health-care delivery, and enhance the nurse’s knowledge base.
■Describe the effects of communication on patient-centered
care, interdisciplinary collaboration, and safety.
■Promote the role of the nurse in the contemporary
health-care environment.
OUTLINE
History and Overview
Historical Trends and Issues
The IOM and the Committee on the Quality of Health
Care in America
Quality in the Health-Care System
QI
Using CQI to Monitor and Evaluate Quality of Care
QI at the Organizational and Unit Levels
Strategic Planning
Structured Care Methodologies
Critical Pathways
Aspects of Health Care to Evaluate
Structure
Process
Outcome
Risk Management
The Economic Climate in the Health-Care System
Economic Perspective
Regulation and Competition
Nursing Labor Market
Defining and Identifying the Nursing Shortage
Factors Contributing to the Nursing Shortage
Safety in the U.S. Health-Care System
Types of Errors
Error Identification and Reporting
Developing a Culture of Safety
Organizations, Agencies, and Initiatives Supporting
Quality and Safety in the Health-Care System
Government Agencies
Health-Care Provider Professional Organizations
Nonprofit Organizations and Foundations
Quality Organizations
Integrating Initiatives and Evidenced-Based Practices
into Patient Care
Health-Care System Reform
Role of Nursing in System Reform
The ANA’s Agenda
Influence of Nursing
Conclusion131