Quality, Patient Safety, Communication, and Recordkeeping (2023)

The provision of respiratory care has never been more critical, especially in an era where respiratory illnesses are a leading cause of hospitalization and death globally.

Within this intricate healthcare environment, four pillars—Quality, Patient Safety, Communication, and Recordkeeping—stand as fundamental components that collectively determine the efficacy and integrity of respiratory care.

While quality focuses on the level of excellence and the appropriateness of the care provided, patient safety emphasizes minimizing risks associated with treatment.

Effective communication, both among healthcare providers and between providers and patients, is paramount for accurate diagnosis and suitable care plans.

Lastly, meticulous recordkeeping is essential for tracking patient history, treatments administered, and for medico-legal safeguards.

This article delves into the profound impact of these four pillars on respiratory care, highlighting the significance of each and suggesting best practices for healthcare providers.

What is Quality in Respiratory Care?

Quality in respiratory care refers to the provision of effective, safe, and efficient services that meet or exceed the current professional knowledge and standards.

It encompasses a broad range of factors, including but not limited to clinical excellence, timeliness of care, patient-centeredness, and adherence to evidence-based guidelines.

Here are some of the key components that define quality in respiratory care:

Clinical Excellence

This involves the application of the latest evidence-based practices and technological advancements in respiratory care.

It ensures that respiratory therapists and other healthcare providers are well-equipped with the knowledge and skills needed to provide the best possible treatments for conditions like asthma, COPD, respiratory failure, and other pulmonary issues.

Timeliness and Accessibility

Quality care also means that services are accessible and provided in a timely manner. Delays in the diagnosis or treatment of respiratory issues can lead to poor outcomes.

The system should be designed in such a way that patients receive timely consultations, diagnostic tests, and treatments.

Patient-Centered Care

Quality respiratory care should focus on individual patient needs, preferences, and values.

This involves creating care plans tailored to each patient and considering their unique health conditions, lifestyle, and other factors that might influence the effectiveness of the treatment.

Safety

High-quality respiratory care is also synonymous with patient safety. This involves minimizing the risks associated with procedures like mechanical ventilation, bronchoscopies, and medication administration, among others.

Protocols should be in place to detect and prevent errors that could harm the patient.

Cost-Effectiveness

While the primary aim is always the well-being of the patient, cost considerations cannot be ignored. Quality respiratory care should aim to provide the most effective treatment in the most economically sustainable manner.

This does not mean compromising on care but using resources wisely to achieve the best outcomes.

Continuous Improvement

Quality is a dynamic attribute; hence, there must be mechanisms for constant evaluation and improvement.

Regular audits, patient feedback, and outcome assessments are essential for ensuring that the highest standards are maintained and updated as new information becomes available.

Summary: Quality in respiratory care is a multi-dimensional construct that involves the skill level of healthcare providers, the efficiency and safety of the healthcare system, and the experience of the patients. It is an ongoing process that aims for the continuous improvement of all aspects of respiratory care.

Quality Assurance vs. Quality Control

Quality assurance (QA) and quality control (QC) are two terms frequently used in healthcare, manufacturing, and various service industries, often interchangeably.

However, they refer to distinct processes aimed at ensuring a high-quality end product or service.

Both contribute to the overall goal of delivering a product or service that meets established standards of quality, but they differ in focus, methods, and the stages at which they are implemented.

Here is a breakdown of the differences between quality assurance and quality control:

Quality Assurance

• Preventive in Nature: QA is a proactive process that aims to improve and establish processes to deliver quality products or services.
• Process-Oriented: It is concerned with the methodology and standards of how a product is created or a service is provided.
• Planning and System Development: QA involves establishing a system for achieving quality and includes planning, system development, and procedural documentation.
• Management System: Often part of a broader Quality Management System (QMS), QA involves high-level strategies and objectives.
• Cross-Departmental: Generally involves multiple departments and is part of an organization-wide effort to improve quality.
• Continuous Improvement: Emphasizes ongoing training, development, and process optimization.
• Methods: Involves methods such as Total Quality Management (TQM), Six Sigma, or ISO certifications.
• Example in Healthcare: Developing standard operating procedures (SOPs) for diagnosing a specific condition, from patient intake and consultation to treatment.

Quality Control

• Corrective in Nature: QC is a reactive process and kicks in when a product is ready or when the service is being offered.
• Product-Oriented: Focuses on examining the end product or service to ensure it meets the quality standards.
• Testing and Inspection: QC typically involves testing units of the end product or monitoring service delivery and taking corrective actions based on the results.
• Specific Operation or Stage: Usually implemented during or after the production of the item or delivery of service, not generally an ongoing, continuous activity.
• Department-Specific: Often the responsibility of a specific team or department tasked with inspecting and testing quality.
• Immediate Corrections: Addresses specific defects and aims for immediate solutions to particular problems.
• Methods: Includes various types of inspections, tests, and audits.
• Example in Healthcare: Inspecting the functionality and calibration of respiratory care equipment like ventilators and spirometers before they are used for patient care.

Summary: While QA aims to establish a system and processes to prevent defects and improve quality, QC seeks to identify and correct defects in the finished products or services. Both are crucial for delivering a high-quality product or service but operate at different stages and focus on different aspects of the quality process.

Quality and Patient Safety Practice Questions

1. What is the value of a service or product that refers to the sum of its properties that serve to satisfy the needs of its consumer?
Quality

2. What are the key areas of potential risk for patients and co-workers?
Patient movement and ambulation; electrical and fire hazards; and general safety concerns

3. What is the correct technique for lifting an object?
Bend your legs and keep your spine straight

4. How do you monitor the patient during patient ambulation?
Monitor the patient’s color, breathing, strength, and level of consciousness; also, monitor for pain and shortness of breath

5. How do you move a patient up in bed with the patient’s assistance?
Have the patient dig in with their heels, then lift and pull

6. What represents the greatest danger to you or your patients when an electrical shock occurs?
The electrical current

7. What do the harmful effects of an electrical current depend on?
The amount of current, the path it takes, and the duration the current is applied

8. What should all electrical equipment be connected to?
They should be connected to grounded outlets with 3-wire cords.

9. What does the third (ground) wire prevent?
It prevents a dangerous buildup of voltage that can occur on the metal frames of some electrical equipment.

10. When are hospital fires considered to be very serious?
When they occur in patient care areas and when supplemental oxygen is in use

11. What air conditions make it easier for materials to burn?
Materials can burn more easily in oxygen-enriched air.

12. What three conditions must exist for a fire to start?
(1) Flammable material must be present, (2) Oxygen must be present, and (3) Flammable material heated to or above the ignition temperature

13. Is oxygen flammable?
No, but it greatly accelerates the rate of combustion

14. How does burning speed increase?
With an increase in concentration or partial pressure of oxygen

15. What does RACE stand for?
Rescue, alert, contain the fire, and evacuate

16. What is a key component of disaster preparedness?
It involves learning to transport and transfer critically ill patients safely.

17. What are the physical hazards resulting from improper storage or handling of cylinders?
An increased risk of fire, an explosive release of high-pressure cylinders, and the toxic effect of some gases

18. What is the best way to store and transport cylinders?
Use appropriate racks or chained containers

19. How should you never store compressed gas cylinders?
Never store gas cylinders without support

20. What is lean management in healthcare?
It is a philosophy that aims to get rid of waste and activities that add little or no value.

21. What is considered non-verbal communication?
Gestures, facial expressions, eye contact, voice tone, space, and touch

22. What are examples of a two-patient identifier system?
Name and birthday

23. How must all healthcare personnel correctly identify patients before initiating patient care?
Using a two-patient identifier system

24. What involves the use of gestures and posture to communicate one’s attentiveness?
Attending

25. What is a technique that is useful in confirming that understanding is occurring between the parties involved in the interaction?
Paraphrasing

26. What begins with an admission of misunderstanding on the part of the listener, with the intent of being able to understand the message better?
Requesting clarification

27. What involves confirming or disapproving the more subtle components of a communication integration, such as messages that are implied?
Perception checking

28. What is HIPPA, and when was it enacted?
HIPPA stands for Health Insurance Portability and Accountability Act, and it was enacted in 1996.

29. What are the general sections found in a patient’s medical records?
Admission data, physician orders, progress notes, medical records, and consultation notes

30. What would you find in the admission data?
The patient’s nearest of kin, admitting physician, and admission diagnosis

31. What would you find in the physician orders section?
You would find records of the physician’s orders and prescriptions.

32. What keeps a continuing account of the patient’s progress for the physician?
Progress notes

33. What is the number one thing you should never do on a medical record?
Never erase anything

34. What does SOAP stand for?
Subjective, objective, assessment, and plan of action

35. Disaster preparedness includes what?
It includes the transport and transfer of critically ill patients and the preparation for the loss of electricity.

36. What are documentation flow sheets designed to do?
They are designed to briefly report data and decrease the time spent on documentation.

37. Electricity moves from point A to point B due to differences in what?
Voltages

38. Extended bed rest can result in what?
Atelectasis

39. Fire extinguisher training includes learning which acronym?
PASS

40. Why are fires that occur in areas where oxygen is being used more dangerous?
They are more dangerous because oxygen speeds up the rate of combustion and makes everything catch on fire more quickly.

41. What are the general rules for recordkeeping?
Entries should be printed or handwritten, do not use ditto marks, do not erase, record each patient interaction and sign the entry, document patient complaints, do not leave blank lines, Use standard abbreviations only, use present tense, use proper spelling, document all important conversations, and be as accurate as possible.

42. High currents passing through the chest can cause what?
It can cause ventricular fibrillation, diaphragm dysfunction, and death.

43. What are some general rules for magnetic resonance imaging (MRI) safety?
No metal components or objects are allowed in the MRI suite, and you should use only MRI-compatible ventilators, oxygen supplies, and ancillary equipment.

44. Medical records can only be seen by who?
The patient or persons directly related to the improvement of the health of the patient

45. What is the most important aspect of safe patient care?
Effective communication

46. Most shock hazards are caused by what?
Inadequate grounding

47. What does OEA stand for?
Oxygen-enriched atmosphere

48. Oxygen is not flammable, but it can do what?
It can greatly accelerate the rate of combustion.

49. What does PASS stand for?
Pull, aim, squeeze, and sweep

50. What is the primary source of conflict?
Poor communication

51. Being successful as a respiratory therapist depends on what?
It depends on your ability to communicate well with patients and other members of the healthcare team.

52. What are some techniques for improving communication?
Share information rather than tell it, seek to relate to people rather than control them, value disagreement as much as agreement, and use effective nonverbal communication techniques.

53. What is the role of the respiratory therapist when it comes to the patient’s direct environment?
Our role is to position the equipment, tubing, and treatments out of the way as much as possible.

54. All health care personnel must use the “two patient identifiers” before initiating care, which include all of the following, except?
Room number

55. All of the following techniques can be used to improve one’s effectiveness as a sender of messages except:
Emphasize agreement over disagreement

56. All of the following techniques can be used to improve one’s listening skills, except which of the following?
Judge the sender’s delivery, not the content

57. Basic purposes of communication include all of the following except?
Change others’ values orientation

58. How can the risk of fire because of static electrical discharge in the presence of oxygen be minimized?
Maintain a high relative humidity in the area of use

59. If you make a mistake when charting a patient’s treatment, what should you do?
Draw a line through the mistake and write “error” above it.

60. In the standard approach to hospital fires, the RACE plan has been suggested. What does the letter “C” stand for in this approach?
Contain

61. Information about a patient’s nearest kin, physician, and initial diagnosis can be found in which section of the medical record?
The admission sheet

62. Key barriers to effective interpersonal communication include all of the following except:
Similar perceptions of the problem

63. Lifting heavy objects is best done with which of the following techniques?
Use a straight spine and bent legs

64. Maintaining eye contact, leaning toward the patient, and nodding your head are all good examples of what communication technique?
Attending

65. Medical records are strictly confidential and are protected under what law?
HIPPA

66. A patient who is on a ventilator is going to be transported to MRI. Which of the following is the most important piece of equipment to have available in the MRI suite?
An MRI-compatible ventilator

67. A patient’s response to an interview question is initially unclear. Which of the following responses on your part would be most appropriate?
Please explain that to me again

68. A pulmonary specialist has been called in by an internist to examine a patient and help make a diagnosis. Where in the patient’s medical record would you look for the pulmonary specialist’s report?
The consultation sheet

69. A respiratory therapist is instructing a patient on a particular piece of equipment and should use which scenario to educate the patient?
The teach-back technique

70. What techniques are involved in helping ensure that understanding is taking place between the parties involved in an interaction?
Clarifying, paraphrasing, perception checking, and attending

71. A respiratory therapist who says, “Please explain that to me again” to a patient during an interview is using what interpersonal communication technique?
Clarifying

72. A respiratory therapist who says, “You seem to be anxious about your surgery” to a patient just admitted for bypass surgery is using what interpersonal communication technique?
Reflecting feelings

73. To check on the results of a patient’s recent blood work, you would go to which section of the medical record?
Laboratory sheet

74. To confirm a physician’s prescription for a drug that you need to give to a patient, you would go to which section of the medical record?
Physician’s order

75. To determine any recent trends in a patient’s pulse, respiration, or blood pressure, you would go to which section of the medical record?
Vital sign sheet

76. To determine the amount of urine excreted by a patient in the last 24 hours, you would go to which section of the medical record?
Intake and output (I & O) sheet

77. To determine the most recent medical status of a patient whom you are about to start treating, you would go to which section of the medical record?
Progress sheet

78. To find out what drugs or intravenous fluids a patient has received recently, you would go to which section of the medical record?
Medication record

79. What form of patient record is most designed to succinctly report data in a time-oriented format and to decrease the time needed for documentation?
Flowsheet

80. Where do most hospital fires initially start?
Most hospital fires start in the kitchen because, I mean, if you can’t take the heat, stay out of the kitchen.

81. Which of the following are unacceptable practices in medical recordkeeping?
Providing your own interpretation of a patient’s symptoms and charting several separate tasks under a single chart entry

82. Which of the following factors are most critical in determining when a patient can be ambulated?
The stability of their vital signs and the absence of severe pain

83. Which of the following factors can have an impact on the outcomes of therapeutic communication between patient and practitioner?
Verbal and nonverbal components of expression, environmental factors (e.g., noise, privacy), values and beliefs of both patient and practitioner, and sensory and emotional factors (e.g., fear, pain)

84. Which of the following is a method for communicating empathy to your patients?
The use of touch, the use of keywords, and the use of eye contact

85. Which of the following is an acceptable practice in medical recordkeeping?
Using standard abbreviations

86. Which of the following is true about fires in oxygen-enriched atmospheres?
They are more difficult to put out, they burn more quickly, and they burn more intensely.

87. Which of the following is used to report electrical current?
Amps

88. Which of the following organs is the most sensitive to the effects of electrical shock?
The heart

89. Which of the following statements is false about patient ambulation?
Patients with IV lines should NOT be ambulated

90. Which of the following strategies for conflict resolution represents a middle-ground strategy that combines assertiveness and cooperation?
Compromising

Final Thoughts

The critical nature of respiratory care demands a stringent focus on quality, patient safety, communication, and recordkeeping. These are not isolated elements but interconnected pillars that support and reinforce each other in delivering effective and safe respiratory care.

Quality ensures optimal outcomes, patient safety prevents avoidable errors, communication bridges gaps in care provision, and recordkeeping provides a tangible history for ongoing treatment and legal protection.

Fostering excellence in these key areas is not just the responsibility of respiratory therapists and physicians but a collective duty that involves administrators, nurses, and other allied healthcare professionals.

By prioritizing these pillars, healthcare institutions can substantially improve patient outcomes, decrease healthcare costs, and, most importantly, save lives.