2025 National Patient Safety Goals
The National Patient Safety Goals are authored by this organization.
Who is The Joint Commission (TJC)?
NDNQI
What is National Database of Nursing Quality Indicators
-Individual Tracer Activity (Unit based - QAPI questions)
-Program-Specific Tracer/Sessions
-Document Review Sessions
-Life Safety Code Building Assessment
What are elements of the survey process?
(Can be reviewed/investigated at any time)
Patients on 1:1 for SI must have their environment assessed for these risks.
What are ligatures?
This is done in EPIC along with a VOICE report after a patient fall.
What is the Post Fall Assessment documentation?
Two Patient Identifiers.
What is name and date of birth?
-Falls (with and without injury)
-Hospital-Acquired Pressure Injury (HAPI)
-Hospital-Acquired Infections (HAI)
-Discharge Planning-
-Patient Satisfaction (HCAHPS)
What are some NDNQI Indicators?
-Priority Measures
-Priority Performance Improvement (Data Driven - Rationale)
-Multidisciplinary collaboration
What will be the focus of TJC QAPI Unit Tracer?
What is Sharps Container?
You document this Y/N at the end of each blood transfusion.
What is a reaction?
Infection Prevention sets this goal at 100%.
What is Hand Hygiene Compliance?
Structure, Process, Outcome!
What are the components of the Nursing Professional Practice Model?
-What quality assurance measures do you follow, and why?
-What are you doing to improve your performance?
-What are your performance improvement priorities?
-What is your rationale for your performance improvement priorities (i.e., why is this important?)
What are TJC QAPI Unit Questions that could be asked of you?
You generate this for a broken printer or copier.
What is a ticket?
On the restrained patient, you assess these every 30 minutes.
What is pulse and circulation?
Identifying health care disparities in the patient population; creating a written plan.
What are ways to improve health care equity?
A collection of standardized, evidence-based measures of health care quality that can be used to track clinical performance related to structure, process or outcomes of care.
What are nursing indicators?
Open-book test:
-Whiteboard/CD2 Board
-Phone-a-friend
What are THINGS TO REMEMBER?
Must be cleaned after use on every patient and documented in the device.
What is the glucometer?
You document this before and after pain medication administration.
What is Pain Assessment and Re-Assessment?
Making sure the correct surgery is done on the correct patient and at the correct place on the patient’s body. Marking the correct place on the patient’s body where the surgery is to be done. Pausing before the surgery to make sure that a mistake is not being made (Time Out).
What is the Universal Protocol?
Nursing Communication:
1.Nurses treat with courtesy/respect.
2.Nurses listen carefully to you.
3.Nurses explain in a way you understand.
What are survey questions given to patients on discharge?
A comprehensive information management system for graphically displaying an at-a-glance view of key performance metrics to monitor, identify trends and inform ongoing processes and improvements
What is a Quality Assurance System (QAS)?
Used to monitor refrigerator temperatures.
What is Temp Track?
The amount of time after which you MUST document on a 1:1 observation.
What is 15 minutes?