1. Aidah Abu Elsoud Alkaissi BSc law, RN, RNT, BSN, MSN, CCRN, CRNA, PhD Head of Nursing & Midwifery Department Faculty of Medicine & Health Sciences An-Najah National University

2.  After completing this chapter, students will be able to:  Discuss the relevance of the core competency: Apply quality improvement.  Describe the status of safety in health care today.  Explain the need for a blame- free culture of safety.  Identify staff safety issues in the health care workplace environment..  Examine how the Institute of Medicine (IOM) reports on safety and quality have an impact on nursing and health care delivery.

3.  The IQM competency: Apply Quality Improvement  Staff in health care  Quality health care

4.  The role of accreditation of health care organizations is related to the need to improve care  Nurses and nursing as a profession play major roles in ensuring that care is safe and that outcomes are reached

5.  The fourth health care profession core competency is to apply quality improvement (QI)  Identify errors and hazards in care, understand and implement basic safety design principles such as standardization and simplification ; continually understands and measure quality of care in terms of structure, process and outcomes in relation to patient and community needs, and design and test interventions to change processes and systems of care, with the objectives of improvement quality

6.  Each patient´s outcomes will be met  Figure 12-1 page 409 illustrates “Apply quality improvements: Key elements

7.  What it is and what can be done to better ensure safe care for all

8.  44,000- 98,000 American die each year as a result of human error  More people die as a result of medical errors than from motor vehicle accidents, breast cancer and Acquired immune deficiency syndrome (AIDS)  Health casts represent over one half of total national costs, which includes lost income, lost household production, disability and health care costs

9.  Complications may occur and increase costs  Some types of complications which were identified can prevented such as:  Falls  Hospital acquired decubiti  Performing the wrong procedure  Administering the wrong blood type

10.  Opportunity costs increase  Opportunity costs relate to situations in which diagnostic tests must be repeated or in which a change in the plan of care is needed because of adverse reactions to treatment  This may put the patient at greater risk for harm depending on the test and may increase costs of care

11.  Decrease in patient trust  The result is that patients and families are now questioning their care more  Some patients do not want to be in the hospital without having a family member or friend with them at all times  Patient trust level drops, and this has an impact on how he-she approaches future care  More patients are demanding that they be informed about their care and thus are more involved in the care process

12.  Changing the status of safety will require multiple planned strategies in practice and an increase in safety education in professional health care programs and staff training

13.  Read with students page 411-412 critical safety terms  Table 12-1 Simple rules for the 21stcentury  Page 412

14.  Is the report that followed To Err Is Human (IQM, 1999).  the report major message is rather health care system is in need of fundamentals improvement  New drugs, medical technology and informatics that have improved care and care option, more needs to be done  Read page 417, 418, 419

15.  keeping patient´s safety- transforming the work environment of nurses  read page 429