Quality Assurance (Qa) Program, Bumed Inst 6010.13

Front 1

What is the Instruction for the Quality Assurance Program (QA)?

Back 1

BUMED INST. 6010.13

Front 2

Applicability: BUMEDINST 6010.13 applies to who?

True.

Back 2

BUMEDINST 6010.13 Applies to all health care personnel providing services in naval MTFs and DTFs, fixed and nonfixed.

True or False?

Front 3

Only Active Duty and Reserve medical and dental personnel are required to participate in ongoing monitoring and evaluation processes designed to assess the quality and appropriateness of the services they provide.
True of False?

Back 3

False.
Civilians are also required to follow this direction.

Front 4

Fixed MTFs and DTFs meeting applicable criteria must gain and maintain accreditation through who?

Back 4

(JCAHO) Joint Commission on Accreditation of Healthcare Organizations

Front 5

Routine QA program-related documentation must be maintained in a secure location for a period of ___ Years before disposal?

Back 5

5 Years

Front 6

Integrate, track, and trend QA information to identify significant patterns or processes which may need indepth review, adressed by CQI techniques or other interventions is found under what category:
1. Purpose
2. Applicability
3. Policy
4. Objectives
5. Requirements

Back 6

4. QA Program Objectives.

Front 7

The QA program is guided by a plan, at a minimum there are 7 articles included, is
Program rights one of the 7?

Back 7

NO... Program Objectives is.

Front 8

What does (ECOMS) Stand for?

Back 8

Executive Committee of the Medical Staff

Front 9

Under MTFs and DTFs, which of the following is incorrect?
1. Medical/Dental record review
2. Druge usage evaluation
3. Credentials review and privileging
4. Practice volume data
5. Metals Recovery evaluation

Back 9

5. Metals recovery Eval.

Front 10

How many Functions are Nursing staff and Administrative staff required to monitor?

Back 10

Three.
1. Quality and appropriatness of care by the use of clinicalindacators.
2. Pratice Volume Data.
3. Outcomes of facility-wide monitors; infection control, UR, and Safety review.

Front 11

What can be used as Monitoring and Evaluating Indicators?

Back 11

Clinical indicators as provided by the joint commission (JC)
Thoes developed Locally to monitor aspects of care in compliance with JC requirements,
Facility-wide occurance screening and department or service-spacific clinical occurrences.

Front 12

Under QA program committees, Inpatient fixed MTFs must have what 4 standing committees?

Back 12

1. ECOMS
2. QA Committee
3. Safety Committee
4. Infection control Committee

Front 13

Fixed Ambulatory care medical facilities must have what 2 QA Program Committees?

Back 13

1. ECOMS
2. QA Committee

Front 14

In QA, nonfixed medical facilities' privileging authority is required to have what committee?

Back 14

ECOMS

Front 15

In fixed and non fixed dental facilities the priviledging authority is required to appoint an ________?

Back 15

ECODS
Executive committee of the dental staff.

Front 16

Under Responsibilities, Chief, BUMED, is responsible for all of the following items except?
1. Interprets DOD, SECNAV, and CNO policies and provides guidance for Navy-wide QA Program Implementation.
2. Provides assistance with running QA programs in foreign MTFs.
3.Monitors implementation and coordination of medical and dental QA programs.
4. Provides consultation, educational support, and QA-related information to MTFs
5.Submits an annual QA program summary report
6. Maintains a Risk management database (RMDB)

Back 16

#2 is incorrect. BUMED does not deal with foreign MTFs.

Front 17

What are fleet commanders in chief (FLTCINCs) responsible for?

Back 17

Ensure that subordinate commands comply with 6010.13.

Front 18

what are Type commanders (TYCOM) responsible for?

Back 18

1. Implement and coordinate a TYCOM-wide QA program.
and
2. Ensure at a minimum, QA assist visits to each subordinate Medical and Dental command as required to maintain optimal QA program function.

Front 19

Officers incharge of Naval Healthcare Support Offices are responsible for what implementation of the QA Program?

Back 19

1. Provide technical support and assistance for QA-related issues on request to fixed and nonfixed MTFs and DTFs.
2. Provide Technical analysis and recommend corrective action per refrence.

Front 20

COs, OICs, SMDRs and SDDRs are requited to perform 3 important tasks under the QA program. What are they?

Back 20

1. Implement a comprehensive QA Program, guided by a writen plan.
2. must strive to maintain accreditation standards in compliance with the Joint commission.
3. Report all serious injury to the MTF or DTF database for annalysis and be reported to MED-3C4 using the malpratice Claims instruction.

Front 21

in accordance with the QA program, Naval School of Health Sciences, Bethesda MD must perform what 2 operations?

Back 21

1. Conduct 2 educational workshops each year in the principles, components, and management of QA programs for MTF personnel
2. Periodically evaluate and modify as necessary QA educational programs to meet user and management needs.

Front 22

Reporting requirements for the QA program MTFs,DTFs, must submit annual assements of the preceding fiscal year's QA program to _______with a copy to the _______ and _________.
This must be submited to BUMED by what day and month of each year?
Using what report?

Back 22

1. MED-3C4, Cognizant responsible Line Commander and HLTHCARE SUPPO.
2. (15 JAN)
3. (6010-25) Shore MTF/DTF Management Info Rpt format.