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C-ONQS exam Format | C-ONQS Course Contents | C-ONQS Course Outline | C-ONQS exam Syllabus | C-ONQS exam Objectives

Exam Code: C-ONQS

Certification Name: NCC Certified Obstetric and Neonatal Quality and Safety (C-ONQS)

Issuing Organization: National Certification Corporation (NCC)

Exam Type: Computer-based- multiple-choice questions

Number of Questions: ~150-175 (including unscored pilot questions)

Duration: 3 hours

Passing Score: Scaled score (typically around 70-75% correct)



I. Methods to assess organization- institutional and environmental culture and patient experience

- Healthcare quality improvement goals

- Domains of quality

- Timeliness

- Effectiveness

- Patient centered

- Efficiency

- Safety

- Equitability

- Dimensions of quality (Donabedian)

- Structure

- Process

- Outcome

- System goals

- Population health

- Patient experience

- Healthcare



- Adverse events and event reporting

- Monitoring and procedure surveillance

- Incident/safety reports

- Near misses

- Root cause analysis

- Mortality and morbidity

- Methods of event reporting

- Video

- Direct observation

- Auditing

- Patient reported events

- Institutional processes and priorities

- Regulatory

- Certifications

- Accreditation

- Peer-review

- Assessment strategies

- Defining population

- Assembling teams

- Reviewing literature

- Identifying measures

- Assessing patient/family perspective

- Assess and Improve organizational culture

- Culture

- Just culture



II. National Quality and Safety Standards and Clinical Guidelines

- Awareness of legal/statutory and national quality and safety standards and clinical practice guidelines in obstetrical and neonatal care

- Perinatal core measures

- GBS guidelines

- Guidelines to prevent hospital associated infections

- Guidelines for perinatal care current edition

- AWOHNN guidelines Maternal health



III. Quality and Safety metrics to identify state of performance- gaps and opportunities

- General quality and safety principles and terminology

- Quality assurance versus quality improvement

- Quality versus safety

- Metrics

- outcome

- process

- structure

- access

- Risk adjustment

- Benchmarking

- Gap analysis

- Participation and shared decision making

- Systems thinking

- Methodologies of data display

- How to implement and evaluate data collection strategies

- Process tools

- Huddle tools

- Trigger tools

- Chart review



I. Quality and Safety aims- tools- checklists and communication strategies

- Human psychology and cognition

- Situational awareness

- Violations of process/protocols

- Risk taking

- Fear of repercussions

- Cognitive biases

- Attention and distractions

- Stress

- Burn out and fatigue

- Safety climate

- Briefings

- Family involvement councils

- Committees

- Collaborations and effective communication strategies

- Standardized communication

- Handoffs

- SBAR

- I-PASS

- Debriefing

- Care transitions



II. Team function- leadership- empowerment

- Leadership skills

- Self-awareness/management

- Mentoring

- Sustainability

- Succession and transition planning

- Communication and conflict management

- Change management

- Principles and concepts of teams

- Team development

- Structures and function

- Diversity and inclusivity

- Collaboration

- Mutual respect

- Information diffusion

- Team meetings

- Code of conduct



III. Training exercises- learning principles- mock codes and simulation

- Effective learning/teaching principles

- Adult learning principles

- Generational learning styles

- Remote or distance learning methodologies

- Interprofessional

- Use and principles of simulation

- Unit drills

- Simulated care processes



IV. Advocating for ongoing resources- risk management

- Methods for determining human resource needs

- Hours per patient day

- Work hours per unit of service

- Work hours per birth

- Clinician to patient ratio

- Standards for staffing

- Human factors that impact the work environment

- EMR

- Medical devices

- Alarm fatigue

- Distractions

- Interruptions

- Overcrowding

- Noise

- Ergonomics of procedures

- Patient census acuity

- Staffing

- Fatigue

- Work arounds

- Design of systems and processes

- Relevant aspects of structural design standards

- Layout and design

- Resource placement

- Lighting

- Signage and way finding



V. Inform and disseminate outcome data- benchmarking and transparency

- Various methods for educating and disseminating QNS data to various stakeholders

- Annual reports

- Presentations

- Publications

- Public reporting

- Websites

- Social/other medias

- Share data on key quality indicators with colleagues/organizations to improve

- Education campaigns

- Peer

- Benchmarking/accountability



I. Selecting and monitoring key quality metrics

- Prioritize opportunities for improvement

- Relative importance to different stakeholders

- Patient- family- provider- facility- healthcare- system- payor

- Develop goal statements

- Specific

- Measurable

- Achievable

- Relevant

- timebound

- Types of metrics

- Outcome

- Process

- Structure

- Access

- Patient experience

- Patient satisfaction

- Balancing measures and metrics

- Unintended consequences of metrics

- Balancing measure to mitigate unintended consequences

- Outcome- process and structure measures

- Familiarity with common methods for quality and safety improvement initiatives

- Models for improvement

- PDSA/PDCA

- Improve

- Six sigma

- Lean



II. Identify population- measures and data collection

- Project team formation and dynamics

- Identification of stakeholders

- Identification of champions

- Influencer model

- Patient/family perspective

- Appraise and prioritize literature relevant to project

- Randomized trials

- Meta-analysis

- Expert opinion

- Observational studies

- Consensus documents



- Improvement process

- Selection of interventions

- Planning implementation

- Tracking of improvements

- Data definitions

- Data collection

- Data quality assurance

- Graphs and tables

- Analysis

- Interpretation



III. Integration into workflow- error prevention strategies and auditing

- Errors and Risk reduction strategies and use of cognitive aids

- Bundles

- Checklists

- Flow sheets

- Timeouts

- Guidelines

- Structured communication

- Patient identification

- Barcodes

- E-prescribing

- Computerized physician order entry

- Medication administration processes

- Human milk handling processes

- Blood product administration processes

- Food and nutrition safety

- Errors and Risk reduction strategies and use of cognitive aids

- Feedback

- Surveillance



I. Tools of evaluation (Fishbone- flow chart- run chart- control charts)

- Evaluation of outcomes and performance improvement

- Run charts

- Control charts

- Dashboards

- Interpret data

- Role of technology in quality improvements

- Data standardization and retrieval

- Standardization of EMR



II. Evaluate the balance between quality- outcomes and cost

- Understanding the interplay between costs- quality and value from the perspective of various stakeholders

- Monetary

- Non-monetary

- Patient and family experience

- Value equals quality divided by cost

- Identification of waste

- Duplication

- Tools to identify waste

- Wait times



III. Strategies for sustainment and positive change

- Recognition of threats to implementation and sustainability

- Fatigue

- Project fatigue

- Backsliding

- Knowledge exclusivity

- Large scale implementation without testing

- Research models

- Knowledge degradation

- Lack of upper-level support/commitment

- Lack of team integrity

- Lack of personnel

- Competing priorities

- Disruptive behavior

- Hierarchical professional behaviors

- Steps in project sustainability

- Communication

- Reporting

- Ongoing ownership

- Celebration of success

- Modification of data collection and review



I. Adverse events- disclosures- transparency- patient trust and risk mitigation

- Elements of effective disclosure

- Mandatory versus voluntary disclosure

- Disclosure of errors and near misses

- Explanation as to why error occurred

- How effects will be minimized

- Steps to prevent recurrences

- Apology

- Acknowledgement of responsibility

- Distinguishing different types of error including system error- blameless human error (inadvertent)- and accountable human error (at risk- reckless- intentional harm)

- Differentiating human error from system error

- Differentiate between human error- at risk behavior- and reckless behavior

- Understanding and mitigating psychological harm experience by the patient and second victims

- Second victims

- Debriefing

- Communication strategies

- Counseling- employee assistance

- Support groups

- Emotional support



II. Professional and ethical issues

- Ethical principles as they apply to patients- families- providers and organizations

- Patient/family access

- Fairness- truthfulness- justice- beneficence- nonmaleficence- autonomy

- Awareness of differences between quality improvement projects and research

- Human subject protections

- IRB or local approval mechanism

- Compare research to quality improvement

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