N108: Transition to the Registered Professional Nurse Role Study Guide • Utilization review: This is used to determine whether the patient’s care was appropriate. In other words, it determines whether the care was properly utilized. A utilization review looks at more than whether care was effective, but rather if resources were appropriately used. This type of review can also be used by an agency to prove to outside sources that funding was used appropriately. • Professional literature: This determines other standards. Research that is reported in nursing journals set standards that nurses are expected to meet. In order to maintain quality of care, nurses should use the findings of research. A nursing practice problemmight be solved by searching the literature in nursing journals for research in that area. The nurse reading the research should evaluate the research and assess the solutions for their utility and value in their own practice. The nurse should evaluate studies for cost, staff needed, and the impact on the staff and agency. Nurses should anticipate the consequences in implementing any change as suggested by the studies. If a nurse wishes to improve care on their particular unit, he/she might research the literature for ways to re-write policy to improve care. Evidence-based research refers to the idea that therapy and treatment that was proven in clinical research should be used in the care of patients. • Documentation: This is an important tool for assessing the quality of care. The only evidence of the actions performed by the nurse is the documentation in the patient’s record. Documentation ensures good care through continuity of care from episode to episode and provider to provider. Additionally, the record could be used as evidence in a malpractice suit or discipline of the nurse’s license. A third reason is that the document can serve as a record for compensation. From a legal standpoint, document only what was actually done, seen, or what the nurse has direct knowledge of. Subjective statements, conclusions, or summaries should be avoided. Entries should be written clearly, timed, dated, and signed in black ink. Errors should be corrected with a single line through the error so that the writing underneath is still readable. It is better to document short entries more often than to document one long entry once a shift. • Risk management: This is the process of quality improvement that minimizes unsafe care to the patient in order to manage risk to the patient and agency. Risk management staff works to identify risks, monitor organization systems, review and appraise safety protocols that are in place, as well as monitor laws and codes that affect patient care. This can be done through the use of audits, incident reports, and various other types of assessments on a daily basis which will measure quality of care and allow for intervention to improve the care. • Consumer involvement: Consumers are more involved in assessing quality of care than they were in the past. Consumers have more information about their health than they did in the past. Therefore, they have the knowledge and the power they need to address concerns about the quality of their care. • Hospital Consumer Assessment of Healthcare Providers and Systems Initiative (HCAHPS): HCAHPS is part of Medicare’s new value-based purchasing program, which is an effort to shift to reimbursement models that pay for high-quality care rather than a high quantity of care. HCAHPS itself is a survey instrument that aims to measure patient satisfaction with the entire hospital experience. The HCAHPS survey section on nurses’ communication has been found to have the greatest impact on overall patient satisfaction and likelihood to recommend the hospital to family and friends.