DNP Glossary: Quality, Safety and Evidence-based Practice (EBP)
Adverse Event: An injury resulting from a medical intervention. (Reason, 1990 and IOM, 2000. p 210) or An event that results in unintended harm to the patient due to an act of commission or omission rather than the underlying disease or condition of the patient. (IOM, 2004, p 327)
Adverse Drug Event: An injury resulting from medical intervention related to a drug (IOM, 1999) or simply "an injury resulting from the use of a drug." (Nebeker, JR, Barach, P, and Samore MH, 2004)
AHRQ: Agency for Health care Research and Quality. Go to http://www.ahrq.gov/.
Aims for Improvement: Health care should be safe, effective, patient-centered, timely, efficient, and equitable. (IOM, 2001, chapter 2)
Bad Outcome: Failure to achieve a desired outcome of care. (IOM, 2000. p 210)
Case-Control Study: A type of research that retrospectively compares characteristics of an individual who has a certain condition (e.g. hypertension) with one who does not (i.e., a matched control or similar person without hypertension); often conducted for the purpose of identifying variables that might predict the condition (e.g., stressful lifestyle, sodium intake). (Melnyk & Fine out-Overholt, 2010, p 572)
Case Study: An intensive investigation of a case involving a person or small group of persons, an issue, or an event. (Melnyk & Fineout-Overholt, 2010, p 572)
Cause Map: A visual explanation of why an incident occurred. It connects individual cause-and-effect relationships to reveal the system of causes within an issue. It identifies all of the causes and different options for solutions rather than focusing on one cause and one solution to a problem. It is one method of root-cause analysis. (think reliability, 2009)
Clinical Inquiry: A process in which clinicians gather data together using narrowly defined clinical parameters; it allows for an appraisal of the available choices of treatment for the purpose of finding the most appropriate choice of action. (Melnyk & Fineout-Overholt, 2010, p 572)
Clinical Practice Guidelines: Systematically developed statements to assist clinicians and patients in making decisions about care; ideally the guidelines consist of a systematic review of the literature, in conjunction with consensus of a group of expert decision-makers, including administrators, policy makers, clinicians, and consumers who consider the evidence and make recommendations. (Melnyk & Fineout-Overholt, 2010, p 572)
Close Call: An event or situation that could have resulted in an adverse event (or accident) but did not, either by chance or through timely intervention. Also referred to as a near miss or good catch. (U.S. Department of Veterans Affairs, 2002)
Cohort Study: A longitudinal study that begins with the gathering of two groups of patients (the cohorts), one that received the exposure (e.g., to a disease) and one that does not, and then following these groups over time (prospective) to measure the development of different outcomes (diseases). (Melnyk & Fineout-Overholt, 2010, p 573)
Commission: The act of doing something.
Critical Inquiry: Theoretical perspectives that are ideologically oriented toward critique of and emancipation from oppressive social arrangements or false ideas. (Melnyk & Fine out-Overholt, 2010, p 573-574)
Culture: Shared knowledge and behavior of people who interact within distinct social settings and subsystems. (Melnyk & Fineout-Overholt, 2010, p 574)
Data and Safety Monitoring Plan: A detailed plan for how adverse effects will be assessed and managed.
Electronic Medical Record (EMR): A collection of a patient's medical information in a digital (electronic) form that can be viewed on a computer and easily shared by people taking care of the patient. (Used interchangeably with Electronic Health Record although the EMR is a subset of HER – The electronic medical record is often just one health care system's record rather than the entire health record for an individual.) (National Cancer Institute, 2009)
Error: The failure of a planned action to be completed as intended (i.e., error of execution), and the use of a wrong plan to achieve an aim (i.e., error of planning) (IOM, 2000). It also includes failure of an unplanned action that should have been completed (omission). (IOM, 2004, p 330 & IOM, 2004, p 360)
Evidence: Scientific evidence is a replicable and generalizable observation that can be experienced nearly identically by independent people from different places and at different times. (IOM, 2004, p 330) Also see Levels of Evidence.
Evidence-Based Practice (EBP): The integration of the best research evidence with clinical expertise and patient values. (Sackett, et al, 2000, p 1)
Evidence-Based Practice Model: The LCC nursing program has adopted the Melnyk & Fineout-Overholt seven step evidence-based practice model: Cultivate a spirit of inquiry.
- Ask the burning clinical question in PICOT format.
- Search for and collect the most relevant best evidence.
- Critically appraise the evidence.
- Integrate the best evidence with one's clinical expertise and patient preferences and values in making a practice decision or change.
- Evaluate outcomes of the practice decision or change based on evidence.
- Disseminate the outcomes of the EBP decision or change. (Melnyk & Fineout-Overholt, 2010, p 11)
Expert Opinion: Recommendations from persons with established expertise in a specific clinical area often based on clinical experience; not considered a research method because systematic (or critical) inquiry is lacking. (Kruszewski, 2009)
Generalizability: The extent to which the findings from a study can be generalized or applied to the larger population. (Melnyk & Fineout-Overholt, 2010, p 576)
Good Catch: See close call or near miss.
Hand-Off: The process of moving patients and their information from one provider or site to another. (IOM, 2007).
Harm: When risks outweigh benefits. (Melnyk & Fineout-Overholt, 2010, p 576)
Hierarchy of Evidence: A mechanism for determining which study designs have the most power to predict cause-and-effect. The highest level of evidence is systematic reviews of RCTs, and the lowest level of evidence is expert opinion and consensus statements. (Melnyk & Fineout-Overholt, 2010, p 576)
Informatics: How data, information, knowledge, and wisdom are collected, stored, processed, communicated, and used to support the process of healthcare delivery to clients, providers, administrators, and organizations involved in healthcare delivery. (Melnyk & Fineout-Overholt, 2010, p 577)
IOM: Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. Found at http://www.iom.edu/. (IOM, 2000)
Latent Error: Errors in the design, organization, training, or maintenance that lead to operator errors and whose effects typically lie dormant in the system for lengthy periods of time. (IOM, 2000. p 210)
Levels of Evidence: A ranking of evidence by the type of design or research methodology that would answer the question with the least amount of error and provide the most reliable findings. Leveling of evidence, also called hierarchies, vary by type of question asked. An example is provided
Medical Error: Mistake that harms a patient. Adverse drug reactions, hospital-acquired infections and wrong site surgeries are examples of preventable medial errors. (Robert Wood Johnson Foundation, 2009)
Medication Error: Any error occurring in the medication-use process. IOM, 2004, p 360; Bates, 1995)
Misuse: Misuse occurs when an appropriate process of care has been selected, but a preventable complication occurs and the patient does not receive the full potential benefit of the service. Avoidable complications of surgery or medication use are misuse problems. A patient who suffers a rash after receiving penicillin for strep throat, despite having a known allergy to that antibiotic, is an example of misuse. A patient who develops a pneumothorax after an inexperienced operator attempted to insert a subclavian line would represent another example of misuse. (Robert Wood Johnson Foundation, 2009)
National Guidelines Clearinghouse: A comprehensive database of up-to-date English language evidence-based clinical practice guidelines, developed in partnership with the American Medical Association, the American Association of Health Plans, and the Association for Health care Research and Quality. Found at http://www.guideline.gov/. (Melnyk & Fineout-Overholt, 2010, p 578)
Near Miss: An error of commission or omission that could have harmed the patient, but serious harm did not occur as a result of chance (e.g., the patient received a contraindicated drug but did not experience an adverse reaction), prevention (e.g., a potentially lethal overdose was prescribed, but a nurse identified the error before administering the medication), or mitigation (e.g., a lethal drug overdose was administered but discovered early and countered with an antidote). Also referred to as a close call or good catch. (IOM, 2007, p 332)
"Never-Events": "Never-Events" are errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients, and that indicate a real problem in the safety and credibility of a health care facility. Examples are: surgery on the wrong body part; foreign body left in a patient after surgery; mismatched blood transfusion; major medication error; severe 'pressure ulcer' acquired in the hospital; and preventable post-operative deaths. (National Quality Forum, 2009)
Omission: Neglecting to do something; failure to act; neglect of duty; and/or leaving something undone.
Overuse: Overuse describes a process of care in circumstances where the potential for harm exceeds the potential for benefit. Prescribing an antibiotic for a viral infection like a cold, for which antibiotics are ineffective, constitutes overuse. The potential harm includes adverse reactions to the antibiotics and increases antibiotic resistance among bacteria in the community. Overuse can also apply to diagnostic tests and surgical procedures. (Robert Wood Johnson Foundation, 2009)
Patient Preferences: Values the patient holds, concerns the patient has regarding the clinical decision/treatment/situation, and choices the patient has/prefers regarding the clinical decision/treatment/situation. (Melnyk & Fineout-Overholt, 2010, p 579)
Patient Safety: Freedom from accidental injury; ensuring patient safety involves the establishment of operational systems and processes that minimize the likelihood of errors and maximizes the likelihood of intercepting them when they occur. (IOM, 2000. p 211)
Peer Reviewed: A project, paper, study, etc. is reviewed by a person(s) who is a peer to the author and has expertise in a subject. (Melnyk & Fineout-Overholt, 2010, p 579)
PICOT Format: A process in which clinical questions are phrased in a manner that yields the most relevant information; P = patient population; I = Intervention or issue of interest; C = Comparison intervention or status; O = Outcome' T = Time frame for (I) to achieve the (O). (Melnyk & Fineout-Overholt, 2010, p 579)
Primary Studies (literature): Studies that collect original data. Primary studies are differentiated from systematic reviews that summarize the results of primary studies. (DiCenso, Guyatt & Ciliska, 2005, p 564).
p Value: The statistical test of the assumption that there is no difference between an experimental intervention and a control. p value indicates the probability of an event, given the assumption that there is no true difference. By convention, a p value of 0.05 is considered a statistically significant result. (Melnyk & Fineout-Overholt, 2010, p 580)
Quality of Care: Degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. (IOM, 1990 and IOM, 2000, p 211)
Quality Improvement: Process by which an organization improves or increases the quality of care in the institution and/or along the continuum of care. Improvements should be sought in the six areas described by the Institute of Medicine in the "Aims for Improvement." (Hoover, 2009)
Quantitative Research: The investigation of phenomena using manipulation of numeric data with statistical analysis. Can be descriptive, predictive, or causal. (Melnyk & Fineout-Overholt, 2010, p 580)
Random Sampling: Selecting subjects to participate in a study by using a random strategy (e.g., tossing a coin); in this method of selecting subjects, every subject has an equal chance of being selected. (Melnyk & Fineout-Overholt, 2010, p 580)
Randomized Controlled Trial (RCT): A true experiment (i.e., one that delivers an intervention or treatment in which subjects are randomly assigned to control and experimental groups); the strongest design to support cause and effect relationships. (Melnyk & Fineout-Overholt, 2010, p 581)
Reconciliation: Comparison of the medications a person is taking in one care setting with those being provided in another setting. (IOM, 2007, p 361) Root-Cause Analysis: An approach for identifying the underlying causes of why an incident occurred so that the most effective solutions can be identified and implemented. It's typically used when something goes badly, but can also be used when something goes well. Within an organization, problem solving, incident investigation and root-cause analysis are all fundamentally connected by three basic questions: What's the problem? Why did it happen? and What will be done to prevent it? (think reliability, 2009)
Secondary Literature: Sources that are not original studies or research but are a compilation or summary of primary studies. They usually follow a prescribed criteria or rating system. Examples are clinical practice guidelines and systematic reviews. (Hoover, 2009)
Sentinel Event: An unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase, "or the risk thereof" includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome. Such events are called "sentinel" because they signal the need for immediate investigation and response. (The Joint Commission, 2009)
Systematic Review: A summary of evidence, typically conducted by an expert or expert panel on a particular topic, that uses a rigorous process (to minimize bias) for identifying, appraising, and synthesizing studies to answer a specific clinical question and draw conclusions about the data gathered. (Melnyk & Fineout-Overholt, 2010, p 582)
Validity of Study Findings: Whether or not the results of a study were obtained via sound scientific methods. (Melnyk & Fineout-Overholt, 2010, p 583)
ReferencesBates, DW, Boyle DI, Vander Vliet MB, Schneider J, Leape L. (1995). Relationship between medication errors and adverse drug events. Journal of general internal medicine, 10(4): 100-205.
DiCenso, A.; Guyatt, Gordon; & Chiliska, Donna (2005). Evidence based nursing: A guide to clinical practice. Philadelphia: Mosby, Inc.
Hoover, Leslie (2009) Personal Communication. Lansing Community College, Michigan.
Institute of Medicine (IOM) (1990). Medicare:A strategy for quality assurance, volume II. Washington, D.C.: National Academy Press.
Institute of Medicine (IOM) (2000). To err is human: Building a safer health system. Washington, D.C.: National University Press.
Institute of Medicine (IOM) (2001). Crossing the quality chasm: A new health system for the 21 century. Washington, D.C.: National Academy Press.
Institute of Medicine (IOM) (2004). Patient safety: Achieving a new standard for care. Washington, D.C.: National University Press.
Institute of Medicine (IOM) (2007). Preventing medication errors. Washington, D.C.: National University Press.
Kruszewski, Ann (2009). Personal Communication. Howell, Michigan: EBP Nurse Consultants, LLC.
Melnyk, Bernadette Mazurek & Fineout-Overholt, Ellen (2010). Evidence-based practice in nursing & healthcare:A guide to best practice. Philadelphia: Lippincott Williams & Wilkins.
National Cancer Institute. Retrieved on 04/21/09 from http://www.cancer.gov /templates/db_alpha.aspx?expand=E
National Coordinating Council for Medication Error Reporting and Prevention (1998). What is a medication error? Retrieved 04/08/09 from http://www.nccmerp.org/about MedErrors.html
National Quality Forum. Retrieved on 04.20.09 from http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1863.
Nebeker, JR, Barach, P, and Samore MH (2004). Clarifying adverse drug events: A clinician's guide to terminology, documentation, and reporting. Annals of internal medicine, 140, 795-801.
Reason, James T. (1990). Human error. Cambridge, MA: Cambridge University Press.
Sackett, David L., Strauss, Sharon E., Richardson, W. Scott, Rosenberg, William, & Haynes, R. Bryan (2000). Evidence-based medicine: How to practice & teach EBM. London: Churchill Livingstone.
Robert Wood Johnson Foundation. Glossary of Health Care Quality Terms, Retrieved 03/16/09 from http://www.rwjf.org/quality equality/glossary.jsp
The Joint Commission: http://www.jointcommission.org/
think reliability. Root Cause Analysis, Retrieved on 04/15/09 from http:// think reliability.com/Root-Cause-Analysis-CM-Basics.aspx