patient safety assignment quizlet

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Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr.

Patient Safety and Quality: An Evidence-Based Handbook for Nurses.

Chapter 1 defining patient safety and quality care.

Pamela H. Mitchell .

Affiliations

• Introduction

The goal of this chapter is to provide some fundamental definitions that link patient safety with health care quality. Evidence is summarized that indicates how nurses are in a key position to improve the quality of health care through patient safety interventions and strategies.

• Quality Care

Many view quality health care as the overarching umbrella under which patient safety resides. For example, the Institute of Medicine (IOM) considers patient safety “indistinguishable from the delivery of quality health care.” 1 Ancient philosophers such as Aristotle and Plato contemplated quality and its attributes. In fact, quality was one of the great ideas of the Western world. 2 Harteloh 3 reviewed multiple conceptualizations of quality and concluded with a very abstract definition: “Quality [is] an optimal balance between possibilities realised and a framework of norms and values.” This conceptual definition reflects the fact that quality is an abstraction and does not exist as a discrete entity. Rather it is constructed based on an interaction among relevant actors who agree about standards (the norms and values) and components (the possibilities).

Work groups such as those in the IOM have attempted to define quality of health care in terms of standards. Initially, the IOM defined quality as the “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” 4 This led to a definition of quality that appeared to be listings of quality indicators, which are expressions of the standards. Theses standards are not necessarily in terms of the possibilities or conceptual clusters for these indicators. Further, most clusters of quality indicators were and often continue to be comprised of the 5Ds—death, disease, disability, discomfort, and dissatisfaction 5 —rather than more positive components of quality.

The work of the American Academy of Nursing Expert Panel on Quality Health focused on the following positive indicators of high-quality care that are sensitive to nursing input: achievement of appropriate self-care, demonstration of health-promoting behaviors, health-related quality of life, perception of being well cared for, and symptom management to criterion. Mortality, morbidity, and adverse events were considered negative outcomes of interest that represented the integration of multiple provider inputs. 6 , 7 The latter indicators were outlined more fully by the National Quality Forum. 8 Safety is inferred, but not explicit in the American Academy of Nursing and National Quality Forum quality indicators.

The most recent IOM work to identify the components of quality care for the 21st century is centered on the conceptual components of quality rather than the measured indicators: quality care is safe, effective, patient centered, timely, efficient, and equitable. Thus safety is the foundation upon which all other aspects of quality care are built. 9

• Patient Safety

A definition for patient safety has emerged from the health care quality movement that is equally abstract, with various approaches to the more concrete essential components. Patient safety was defined by the IOM as “the prevention of harm to patients.” 1 Emphasis is placed on the system of care delivery that (1) prevents errors; (2) learns from the errors that do occur; and (3) is built on a culture of safety that involves health care professionals, organizations, and patients. 1 , 10 The glossary at the AHRQ Patient Safety Network Web site expands upon the definition of prevention of harm: “freedom from accidental or preventable injuries produced by medical care.” 11

Patient safety practices have been defined as “those that reduce the risk of adverse events related to exposure to medical care across a range of diagnoses or conditions.” 12 This definition is concrete but quite incomplete, because so many practices have not been well studied with respect to their effectiveness in preventing or ameliorating harm. Practices considered to have sufficient evidence to include in the category of patient safety practices are as follows: 12

• Appropriate use of prophylaxis to prevent venous thromboembolism in patients at risk
• Use of perioperative beta-blockers in appropriate patients to prevent perioperative morbidity and mortality
• Use of maximum sterile barriers while placing central intravenous catheters to prevent infections
• Appropriate use of antibiotic prophylaxis in surgical patients to prevent postoperative infections
• Asking that patients recall and restate what they have been told during the informed-consent process to verify their understanding
• Continuous aspiration of subglottic secretions to prevent ventilator-associated pneumonia
• Use of pressure-relieving bedding materials to prevent pressure ulcers
• Use of real-time ultrasound guidance during central line insertion to prevent complications
• Patient self-management for warfarin (Coumadin®) to achieve appropriate outpatient anticoagulation and prevent complications
• Appropriate provision of nutrition, with a particular emphasis on early enteral nutrition in critically ill and surgical patients, to prevent complications
• Use of antibiotic-impregnated central venous catheters to prevent catheter-related infections

Many patient safety practices, such as use of simulators, bar coding, computerized physician order entry, and crew resource management, have been considered as possible strategies to avoid patient safety errors and improve health care processes; research has been exploring these areas, but their remains innumerable opportunities for further research. 12 Review of evidence to date critical for the practice of nursing can be found in later chapters of this Handbook.

The National Quality Forum attempted to bring clarity and concreteness to the multiple definitions with its report, Standardizing a Patient Safety Taxonomy . 13 This framework and taxonomy defines harm as the impact and severity of a process of care failure: “temporary or permanent impairment of physical or psychological body functions or structure.” Note that this classification refers to the negative outcomes of lack of patient safety; it is not a positive classification of what promotes safety and prevents harm. The origins of the patient safety problem are classified in terms of type (error), communication (failures between patient or patient proxy and practitioners, practitioner and nonmedical staff, or among practitioners), patient management (improper delegation, failure in tracking, wrong referral, or wrong use of resources), and clinical performance (before, during, and after intervention).

The types of errors and harm are further classified regarding domain, or where they occurred across the spectrum of health care providers and settings. The root causes of harm are identified in the following terms: 8

• Latent failure—removed from the practitioner and involving decisions that affect the organizational policies, procedures, allocation of resources
• Active failure—direct contact with the patient
• Organizational system failure—indirect failures involving management, organizational culture, protocols/processes, transfer of knowledge, and external factors
• Technical failure—indirect failure of facilities or external resources

Finally, a small component of the taxonomy is devoted to prevention or mitigation activities. These mitigation activities can be universal (implemented throughout the organization or health care settings), selective (within certain high-risk areas), or indicated (specific to a clinical or organizational process that has failed or has high potential to fail).

• Nursing As the Key to Improving Quality Through Patient Safety

Nursing has clearly been concerned with defining and measuring quality long before the current national and State-level emphasis on quality improvement. Florence Nightingale analyzed mortality data among British troops in 1855 and accomplished significant reduction in mortality through organizational and hygienic practices. 14 She is also credited with creating the world’s first performance measures of hospitals in 1859. In the 1970s, Wandelt 15 reminded us of the fundamental definitions of quality as characteristics and degrees of excellence, with standards referring to a general agreement of how things should be (to be considered of high quality). About the same time, Lang 16 proposed a quality assurance model that has endured with its foundation of societal and professional values as well as the most current scientific knowledge (two decades before the IOM definition was put forth).

In the past, we have often viewed nursing’s responsibility in patient safety in narrow aspects of patient care, for example, avoiding medication errors and preventing patient falls. While these dimensions of safety remain important within the nursing purview, the breadth and depth of patient safety and quality improvement are far greater. The most critical contribution of nursing to patient safety, in any setting, is the ability to coordinate and integrate the multiple aspects of quality within the care directly provided by nursing, and across the care delivered by others in the setting. This integrative function is probably a component of the oft-repeated finding that richer staffing (greater percentage of registered nurses to other nursing staff) is associated with fewer complications and lower mortality. 17 While the mechanism of this association is not evident in these correlational studies, many speculate it is related to the roles of professional nurses in integrating care (which includes interception of errors by others—near misses), as well as the monitoring and surveillance that identifies hazards and patient deterioration before they become errors and adverse events. 18 Relatively few studies have had the wealth of process data evident in the RAND study of Medicare mortality before and after implementation of diagnosis-related groups. The RAND study demonstrated lower severity-adjusted mortality related to better nurse and physician cognitive diagnostic and treatment decisions, more effective diagnostic and therapeutic processes, and better nursing surveillance. 19 , 20

Further, when we consider the key role of communication or communication lapses in the commission of error, the role of nursing as a prime communication link in all health care settings becomes evident. The definition of “error chain” at PSNet clearly indicates the role of leadership and communication in the series of events that leads to patient harm. Root-cause analyses of errors provide categories of linked causes, including “(1) failure to follow standard operating procedures, (2) poor leadership, (3) breakdowns in communication or teamwork, (4) overlooking or ignoring individual fallibility, and (5) losing track of objectives.” 21 This evidence was used in developing the cause portion of the National Quality Forum’s patient safety taxonomy and is further discussed in other chapters of this book.

Patient safety is the cornerstone of high-quality health care. Much of the work defining patient safety and practices that prevent harm have focused on negative outcomes of care, such as mortality and morbidity. Nurses are critical to the surveillance and coordination that reduce such adverse outcomes. Much work remains to be done in evaluating the impact of nursing care on positive quality indicators, such as appropriate self-care and other measures of improved health status.

• Cite this Page Mitchell PH. Defining Patient Safety and Quality Care. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 1.
• PDF version of this page (55K)

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The Nurse-Patient Assignment

Purposes and decision factors.

Allen, Stephanie B. PhD, RN, NE-BC

Author Affiliation: Assistant Professor, Pace University, Pleasantville, New York.

The author declares no conflicts of interest.

Correspondence: Dr Allen, Lienhard School of Nursing, L310, 861 Bedford Rd, Pleasantville, NY 10570 ( [email protected] ).

OBJECTIVE: 

Identify purposes and decision factors of the nurse-patient assignment process.

BACKGROUND: 

Nurse-patient assignments can positively impact patient, nurse, and environmental outcomes.

METHODS: 

This was an exploratory study involving interviews with 14 charge nurses from 11 different nursing units in 1 community hospital.

RESULTS: 

Charge nurses identified 14 purposes and 17 decision factors of the nurse-patient assignment process.

CONCLUSIONS: 

The nurse-patient assignment is a complex process driven by the patient, nurse, and environment. Further study is needed to identify factors linked to patient safety, nurse, and environmental outcomes.

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Development of a nursing assignment tool using workload acuity scores, transitioning from nurse-patient ratios to workload intensity staffing: what..., a practical guide to making patient assignments in acute care, measuring patient acuity: implications for nurse staffing and assignment, sleep deprivation and error in nurses who work the night shift.

• Reducing Health IT Burden
• 1.1 Understand EHR contracts
• 1.2 Select an EHR
• 1.3 Adopt and implement your EHR
• 1.4 Optimize workflow
• 1.5 Migrate your data
• 2.1 Learn about certification criteria
• 2.2 Review certified health IT products
• 2.3 Use APIs to ease information exchange
• 2.4 Understand information blocking
• 2.5 Report issues with certified health IT
• 3.1 Use APIs to support access to health information
• 3.2 Send patient information securely
• 3.3 Leverage automatic alerts
• 3.4 Facilitate transitions of care
• 3.5 Follow health IT standards
• 4.1 Prescription drug monitoring programs and health IT integration
• 4.2 Electronic prescribing of controlled substances
• 4.3 Smartphone Apps
• 4.4 Alignment to regulations
• 4.5 Additional opioid and PDMP resources
• 5.1 Check out the Patient Engagement Playbook
• 5.2 Explore other patient engagement resources
• 5.3 Learn more about telehealth
• 6.1 What is Value Based Care?
• 6.2 Learn about the Quality Payment Program (QPP)
• 6.3 Stay on top of the Merit-Based Incentive Payment System (MIPS)
• 6.4 Understand Alternative Payment Models (APMs)
• 6.5 Explore Promoting Interoperability
• 6.6 Find support for your small practice
• 6.7 Strengthen primary care with CMS Primary Cares Initiative and CPC+
• 7.1 Protect personal health information
• 7.2 Explore more privacy and security resources
• 7.3 Perform a risk assessment of your practice

8.1 Use health IT to improve patient safety

8.2 learn about usability, 8.3 improve quality with ehr technology.

• 9.1 Support long-term and post-acute care
• 9.2 Improve care in rural areas
• 9.3 Reduce health disparities
• 10.1 Address social determinants of health
• 10.2 Strengthen care management
• 10.3 Use population health management tools
• 10.4 Support public health data reporting
• 10.5 Participate in a patient registry
• 11.1 Find resources for behavioral health IT
• 11.2 Find resources for pediatric health IT
• 12.1 Find technical assistance options
• 12.2 Explore Health IT training resources
• Share Your Feedback

Quality & Patient Safety

In this section.

Learn how to:

• Use health IT to improve patient safety
• Improve the usability of your EHR
• Improve healthcare quality with EHR technology

Quality healthcare means doing the right thing — for the right patient, at the right time, in the right way — to achieve the best possible results. Patient safety practices protect patients from accidental or preventable harm associated with healthcare services.

Together, care quality and patient safety improvement activities can help healthcare teams achieve the 6 aims described in the Institute of Medicine’s publication Crossing the Quality Chasm: A New Health System for the 21st Century . It states that care should be:

• Patient-centered

Compared with paper records, electronic health records (EHRs) facilitate improvements to healthcare quality and safety. EHRs gives clinicians — as well as patients and their proxies — access to relevant patient information.

EHR systems also offer integrated best-practice support in the form of electronic clinical decision support (CDS). CDS gives care teams general and person-specific information — intelligently filtered and organized — at the appropriate times. This improves care outcomes by making timely information — that supports sound decisions — available to the care team.

A properly implemented EHR helps clinicians more easily track patients from one point of care to another and document all care they receive. It also has automated functionalities that improve patient care and safety, such as:

• Electronic prescribing
• Drug-drug interaction checks
• Drug-allergy interaction checks

EHR and population health

EHR systems also play a role in improving population health. They process large amounts of aggregate health data and can support both trend and outlier analysis. This lets clinicians and public health professionals take action to improve outcomes.

As we look to improve our nation’s health, these population health activities become increasingly important. And as new care models evolve and focus on both population and patient outcomes, EHRs make meeting quality-reporting program requirements more efficient.

Clinicians can use automated EHRs to harvest performance measurements from data routinely captured in the course of care. We refer to electronic clinical quality measures (specified in standard format for automatable, interoperable electronic reporting from the EHR) as eCQMs.

Like all powerful tools, EHR systems carry risk with use. However, you can minimize unintended consequences by following best practices for the design, implementation, user training, and use of your EHR.

Planning is essential to get the most out of your EHR investment and to ensure its safe use. The resources provided throughout this playbook provide clinicians with a starting place to use their EHR to improve care quality and safety.

“Patient safety” refers to freedom from accidental or preventable injuries associated with healthcare services, and an electronic health record (EHR) system provides tools to help clinicians improve patient safety.

EHRs play an integral role in larger systems composed of the clinical team, the patient, and the daily supporting workflows. When analyzing EHR safety, be sure to consider the entire system as a whole.

SAFER Guides

The ONC Safety Assurance Factors for EHR Resilience (SAFER) Guides recommendations illustrate what you need to do to achieve safe and effective EHR implementation and use. The recommendations should be considered proactive risk assessments that aim to mitigate and minimize EHR-related safety hazards. Each SAFER Guide consists of between 10 to 25 recommended practices that can be assessed as “fully implemented,” “partially implemented,” or “not implemented.” Implementing recommended practices helps you ensure safe use of the EHR.

Examples accompanying each recommendation are designed to help EHR users and developers meet each recommendation. Meeting SAFER recommendations is a team effort and requires users in your practice, those responsible for setting up your EHR, and, sometimes the EHR software developer to work together. The EHR developer might also have an EHR-specific manual for those responsible for configuring and implementing the EHR that can help your team meet the recommendations.

Many recommendations require adjusting specific EHR configuration parameters, and others involve strengthening workflows — the steps your office takes to deliver care to your patients. So, your practice should review your internal policies and procedures to ensure that you are addressing the SAFER recommendations directly under your control. For example, you should make sure that your practice has a well-thought-out paper-based system for documenting your activities and ordering new medications, tests, and procedures when your EHR is unavailable (see the Contingency Planning Guide [PDF — 13.2 MB] ). In small practices that use a remotely hosted (cloud-based) EHR solution, the clinicians should ask those responsible for configuring and maintaining their EHR to document which of the SAFER recommendations they have implemented.

Are you looking for more guidance? This paper, written by the authors of the SAFER Guides , outlines a step-by-step approach for conducting an EHR safety assessment.

ONC organizes SAFER Guides into 3 broad groups:

• Foundational
• Infrastructure
• Clinical process

Foundational guides:

High Priority Practices [PDF — 4.5 MB] * : This guide helps you assemble and equip a safety team to determine the safety practices you need to address first — and then decide which SAFER Guides to use next.

Organizational Responsibilities [PDF — 4.3 MB] * : This guide, designed primarily for larger healthcare organizations, focuses on human behavior and relationships. It’s organized differently than the other guides and includes principles that apply to people who have responsibility for patient safety in EHR-enabled healthcare organizations.

Infrastructure guides:

Contingency Planning [PDF — 13.2 MB] * : This guide offers recommended safety practices for planned or unplanned EHR unavailability (downtime) — instances when clinicians or other end users can’t access all or part of the EHR.

System Configuration [PDF — 3.4 MB] * : This guide provides recommended safety practices for setting up (configuring) EHR hardware and software. Configuration includes the EHR system’s physical environment, the hardware and software infrastructure, and the maintenance processes. Configuring an EHR — which involves many decisions that profoundly influence performance and safety — must be handled by the configuration team.

System Interfaces [PDF — 3.7 MB] * : This guide covers recommended safety practices for optimizing system-to-system interfaces between EHR-related software applications. Maintaining enterprise- or community-wide clinical information systems involves integrating different software applications, often from different system developers. This guide helps organizations prioritize interface-related safety concerns.

Clinical process guides:

Patient Identification [PDF — 4 MB] * : This guide looks at safety practices associated with accurate patient identification. These safety measures ensure that the information entered into — and presented by — the EHR represents the correct person. Technology configurations alone can’t ensure accurate patient identification.

Computerized Provider Order Entry (CPOE) with Decision Support [PDF — 4.2 MB] * : This guide offers recommendations to improve medication safety and to ensure that clinicians who electronically order diagnostic tests and consultations remain in the communication loop.

Test Results Reporting and Follow-Up [PDF — 4 MB] * : This guide covers recommended safety practices for the electronic communication and management of diagnostic test results. Failure to appropriately follow up on diagnostic test results can lead to misdiagnosis, patient harm, and liability. These recommendations aim to improve diagnostic test reporting, documentation, and follow-up of test results.

Clinician Communication [PDF — 2.5 MB] * : This guide will help your practice use an EHR to reliably send and receive referrals and consultations, inpatient-to-outpatient transition communication, and clinical messages.

* Individuals using assistive technology may not be able to fully access information in this file. For assistance, contact ONC at [email protected] .

Other Safety Resources

Investigations of Health IT-related Deaths, Serious Injuries or Unsafe Conditions [PDF — 880 KB] A report by The Joint Commission.

Issue Brief: Recent Evidence that Health IT Improves Patient Safety [PDF — 481 KB]

Patient identification is essential to patient safety

Patient identification is essential to patient safety, and you can’t achieve either if you don’t have accurate demographic data in the patient record.

Today’s healthcare settings usually handle high patient volume. A clinician’s front-desk staff manages a large number of rapid check-ins and registrations each day, and they play a key role in creating and maintaining accurate demographic data.

The following training module illustrates common pitfalls associated with incorrect demographic data. It also suggests ways front-desk staff can minimize issues.

Overview Information about how to use patient demographic data for matching patient records, the issues that can occur with incorrectly matched data, and best practices for accurately capturing patient demographic data

Who it’s for Registrars, front-desk staff, and practice managers

When it’s used To train staff who collect patient demographic data on a regular basis

​Check out the Registrar and Front-Desk Patient Registration Training Module

The term “usability” comes up frequently during discussions about software, and it’s a very important part of a successful electronic health record (EHR) implementation. The International Organization for Standardization (ISO) defines usability as:

“The extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction in a specified context of use.”

In health IT, usability refers to how well the system supports the end user’s work and how much the user interface design helps people complete tasks while minimizing human error.

Recommended reading: Better EHR: Usability, Workflow and Cognitive Support in Electronic Health Records . This book — available as a free download in PDF or iBook format — addresses the usability and cognitive support issues related to EHRs. It was created by the National Center for Cognitive Informatics & Decision Making in Healthcare at the University of Texas, with funding support from the Office of the National Coordinator (ONC).

Quality improvement is an important, established practice in healthcare, and you can find opportunities to merge electronic health records (EHRs) with quality improvement throughout all phases of care. Here are three examples:

• Clinical decision support tools can help clinicians manage actionable information and make it available during care
• Electronic clinical quality measures (eCQMs) can help clinicians assess the proportion of their patients with well-controlled hypertension over time
• EHR systems can help streamline or even automate data sharing with clinical data registries that use the information to help clinicians choose the best courses of treatment

Below, we explain these capabilities and discuss how you can use your EHR to reach your quality improvement goals.

Clinical Decision Support

“Clinical decision support” (CDS) refers to information and tools that support clinicians and patients as they make clinical decisions at the point of care. CDS could be as basic as using a reference text to double-check a treatment algorithm.

Within an EHR, CDS tools offer more sophistication. They can present both general and person-specific information, filtered and organized, at appropriate times to appropriate people, including clinicians, practice staff, and patients.

Examples of CDS tools in EHRs include:

• Health maintenance reminders
• Drug-drug and drug-allergy interaction checks
• Electronic presentation of clinical guidelines
• Condition-specific order sets
• Focused patient-data reports and summaries
• Documentation templates
• Diagnostic support such as differential diagnosis tools
• Contextually relevant reference information

It’s important to think about which CDS tools will help your practice the most. If you’re selecting an EHR, carefully review its CDS capabilities to see if it fits your needs. If you already have an EHR, work with your EHR developer to enable and optimize the available CDS tools that benefit your patients the most.

Clinical Decision Support and Diagnostic Imaging

Clinical decision support (CDS) helps physicians talk with patients about which imaging tests are appropriate for their situation. These tools can help avoid unnecessary medical tests, resulting in higher-quality patient care at a lower cost.

Go to the AMA STEPS Forward™ Clinical Decision Support and Diagnostic Imaging module

Clinical Quality Measures

Clinical quality measures (CQMs) gauge and track the quality of healthcare services to help find areas that need improvement, and payers are increasingly examining them. A practitioner’s CQM results are typically expressed as a ratio with a numerator and a denominator.

For example, a quality measure focusing on hypertension control for one doctor might have a denominator of “all patients with hypertension” and a numerator of “patients at target blood pressure.” CQMs also generally have a target percentage and are built on evidenced-based, professional guidelines.

A variety of quality improvement and public reporting programs, including the Centers for Medicare & Medicaid Services (CMS), rely on eCQMs. The Office of the National Coordinator (ONC) certifies the capability of health IT, including EHRs, to accurately calculate and report specified eCQMs.

Properly implemented EHR systems can calculate quality measures, and results can help clinicians with practice improvement. Results can also be transmitted to payers, thus streamlining quality reporting.

Properly implemented EHR systems can also help clinicians — especially those who participate in a clinical data registry — to measure and improve their care quality performance. EHRs extract and transmit data that is collected during normal care and documentation. Compared with manual methods, this makes it easier to abstract data, calculate measurements, and provide feedback.

Electronic Clinical Quality Improvement

Electronic clinical quality improvement (eCQI) uses a variety of processes, including health IT tools, to help improve care and to support better health. It uses technology effectively to sustain a continuous improvement cycle, and at its core is the traditional quality improvement process model.

Steps in the continuous improvement cycle include:

• Deliver care
• Measure care safety, quality, and outcomes
• Plan and implement interventions
• Monitor intervention results
• Adjust as needed to improve results

The next stage of healthcare quality includes advanced CDS and increased end-to-end electronic quality measurement and reporting. Rather than limiting quality improvement to retrospective measurement, CMS and ONC are working to provide standards that will incorporate evidence-based medicine and the patient’s own history, preferences, and data into CDS — for truly customized care.

Use the following tools and links to further your understanding of electronic clinical quality improvement.

Million Hearts ® : Facilitating quality care with EHRs

Million Hearts ® is a national initiative created by the Department of Health and Human Services, the Centers for Disease Control and Prevention, and CMS to fight cardiovascular diseases, which kill more than 800,000 Americans every year. Composed of 120 official partners and 20 federal agencies, its continuing mission is to optimize care, keep people healthy, and improve outcomes for priority populations.

The Million Hearts ® website contains a wide range of resources to help medical professionals educate, motivate, and monitor their patients. Under the site’s Tools menu, for example, you’ll find a section dedicated to health IT where you can download EHR optimization guides developed by ONC.

You’ll also find other health IT guides and resources including:

• Clinical Quality Measures Alignment
• EHR Innovations for Improving Hypertension Challenge
• Guide for Implementing e-Referral Using Certified EHRs
• Guide to Improving Care Processes and Outcomes in Health Centers for Disease Control and Prevention
• Population Health Management Software: An Opportunity to Advance Primary Care and Public Health Integration
• “What Is a Patient Portal?” FAQ

Learn more about how you can use electronic health records (EHRs) to improve the quality of patient care. These resources will help you:

• Implement or optimize EHRs in your practice
• Understand how eCQI can help to improve care and support better health
• Use data to improve quality of care and outcomes
• Plan quality improvement goals and enhancements

eCQI Resource Center

Overview Access to extensive eCQI resources and connections to professionals dedicated to clinical quality improvement for better health, including introductory material describing the basic technical aspects of eCQM reporting in addition to in-depth technical details. ( Note: because of its technical information, this may not be as useful as an introductory resource)

Who it’s for Quality improvement professionals, health IT professionals, and clinicians who want to understand the technical specifications for eCQM reporting

When it’s used To plan an EHR implementation and to decide — or improve — upon clinical quality measures

Check out the eCQI Resource Center

Please see the Health Resources and Services Administration’s Guide to Improving Care Processes and Outcomes for additional resources. This webpage provides strategies and tools that health centers and their partners can use to enhance care that’s targeted for improvement, such as hypertension and diabetes control and preventive care.

Hypertension Control Change Package

Overview Process improvements designed for ambulatory clinical settings looking for optimal hypertension (HTN) control and information on how to use EHR systems to improve processes

Who it’s for Ambulatory practices

When it’s used To implement population health initiatives

Download Hypertension Control Change Package [PDF — 680 KB]

eCQI: What It Is and How It Can Help You

Overview Explanation of eCQI and how medical and health professionals can use this approach to optimize health IT applications in support of continuous quality improvement

Who it’s for Clinicians and health IT professionals

When it’s used To understand what a practice or organization needs to do to continuously improve clinical quality measures

Visit eCQI: What It Is and How It Can Help You website

Guiding Principles for Big Data in Nursing

Overview Information about the role nurses play in strategic planning and implementation of health IT, which includes capturing health and care data in a structured manner for care management and quality improvement purposes

Who it’s for Nurses, nursing leaders, and hospitals

When it’s used To plan and implement health IT or to consider big data and population health strategies

Download Guiding Principles for Big Data in Nursing [PDF — 503 KB]

Health IT-enabled eCQI (Ambulatory)

Overview A template for documenting and analyzing approaches to quality improvement in the ambulatory setting

Who it’s for Ambulatory clinicians and health IT implementers

When it’s used To plan quality improvement goals and enhancements

Download Health IT-enabled eCQI (Ambulatory) [PDF — 2.5 MB]

Health IT-enabled eCQI (Inpatient)

Overview A template for documenting and analyzing approaches to quality improvement in the inpatient setting

Who it’s for Inpatient clinicians and health IT implementers

Download Health IT-enabled eCQI (Inpatient) [PDF — 2.7 MB]

Learning Guide: Capturing High Quality Electronic Health Records Data to Support Performance Improvement

Overview Important considerations and implementation steps to help physician practices and communities improve EHR data quality

Who it’s for Physician practices, hospital systems and affiliated practices, and other clinician organizations responsible for delivering high-quality care to specific patient populations

When it’s used To implement EHR or to optimize EHR to improve the quality of data stored in EHR systems

Download Learning Guide: Capturing High Quality Electronic Health Records Data to Support Performance Improvement [PDF — 386 KB]

Section 8 Recap

Provide safe, effective, patient-centered, timely, efficient, and equitable care.

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Content last updated on: May 31, 2019

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Patient Safety: Rights of Registered Nurses When Considering a Patient Assignment

ANA Position Statement Approved : March 12, 2009

Summary The American Nurses Association (ANA) upholds that registered nurses – based on their professional and ethical responsibilities – have the professional right to accept, reject or object in writing to any patient assignment that puts patients or themselves at serious risk for harm. Registered nurses have the professional obligation to raise concerns regarding any patient assignment that puts patients or themselves at risk for harm. The professional obligations of the registered nurse to safeguard patients are grounded in the Nursing’s Social Policy Statement (ANA, 2003), Code of Ethics for Nurses with Interpretive Statements (ANA, 2001b), Nursing: Scope and Standards of Practice (ANA, 2004), and state laws, and rules and regulations governing nursing practice.

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