QUALITY ASSURANCE

By-Mr. ASHOK BISHNOIAssist. Professor, JINR

Quality Assurance

A system for monitoring outcome of professional

intervention and departmental activities, which are

compared with established standards to evaluate

and document appropriateness of practies.

Need for Quality Assurance

Professional FactorsCode of ConductAutonomy AccountabilityInter-professionalismMoral issues

Social / Political Factor

Public awarenessSocial expectationLegislationAccreditationInternational pressure

Economical Factors

Demographic changes

Resource-distribution

STANDARDS

Professionally developed expressions

It is a degree of excellence.

It is a model for imitations.

Definition of Standards

A standard is a means of determining what something should be in case of nursing practice.

Standards are the establish criteria for the practice of nursing.

Standards are statement for nursing practice. Standards specifies what is necessary for

high quality practice (ANA1973)

Process of Quality Assurance

Setting Standards.

Apprising actual achievement.

Planning for improvement.

Taking action when required.

Quality Wheel

Act

Set Standards

Plan Appraisal

Need of Standards

Provides direction for nursing performance. Provide systematic approach for nursing care. Provides for evaluating nursing practice. The patient’s right to have excellent nursing care Helps in supervision and guide staff to improve. Helps justify demands for resource allocation. Help classify nurses area of accountability at different

levels

Need of a Standards

Nurses need to define and describe their

practice because of their statutory , legal and

social responsibility to give best possible

care to patient and client.

Purposes of Standards

Purposes of Standards

Evaluating the quality of practice. To coordinate and unify. Identify the element of independent function of practice. Provide a basis for planning and evaluating programs Inform the society of our concern for the improvement of

nursing practice. Assist public in understanding what to expect from nursing

practice. Provide a means by which member of different health

profession can coordinate their efforts in the improvement of health care.

Health employers to understand what expect from the practitioner .

Stimulate and encourage nursing personnel to promote and support education, studies and research

In general

Nursing care standard are important to : Improve the quality of nursing care, Decrease the cost of nursing care. Promote a basis for determining

Types of Standards

Normative standards : These standards are descriptive of practices which are considered ideal by authority . These standards describe higher quality of practices. e.g. standards set by professional association.

Empirical standards : These standards description of practices which are in actual practice in large number of setting and which agreed upon and achievable .e.g. standards set by law enforcement bodies and regulatory bodies- like health department and licensures bodies.

Approaches of Standards

Structure Standards

Process Standards

Outcome Standard

Structure Standards ( Institution Oriented)

The structure standards related to… Polices, goals, objectives Staffing, number, type, training, qualification, job

responsibilities. Recording system Administrative set up – line of communication Equipment and supplies Budgeting Physical facilities. Building etc.

Process Standards

Nursing activities .Identifies personal need , disease-related needs and therapy related needs.

Identify framework Technical skill Evaluate the result.

Outcome standards

Descriptive statements of result

qualitative and quantitative

positive or negative

STEPS IN STANDARD FORMATION

Organize small group of nurses who meet periodically.

Decide on the area for work out standards Review, revise philosophy, purposes, and

objective of patient care. Review nursing theories / existing nursing care

practice, nursing process and identify your client for service; client’s role, approaches and strategies for nursing care services.

……cont.

write the statement Discuss that they are made feasible. Devise a mechanism for determining the

achievement of the standards. Determine the validity by giving to the expert. Try out the standard to determine the feasibility

and validity. The standards are put into practice and quality

care is audited.

Criteria of Standards

criteria specifies clearly and precisely the level of performance which has to be achieved to satisfy the standard. Criteria can be based on the types of standard. i.e. structure, process, and outcome .

AMOUR Principles of criteria (In Quality Assurance)

Achievable Measurable Observable Understandable Reasonable

EVALUATION OF NURSING CARE

Two major functions of evaluation of nursing services are:

To ascertain the nature and effects of nursing care.

To decide whether or not the observed effects attain acceptable standards of nursing care.

PRINCIPLES OF EVALUATION

Relevance Comprehensiveness Problem solving Validity Generalizability Appropriateness Effectiveness Efficient

TOOLS AND TECHNIQUE USED FOR EVALUATING NURSING CARE

Patient care Centered tool /Methods

Nursing audit.

Patient care centered tool / technique methods

Observation By giving opinion : questionnaire to patient

relatives and or staff. Interviewing patient and relatives. Nursing round

NURSING AUDIT

Nursing audit is the nurse’s formal, systematic written appraisal of the quality of nursing services indicated in the care records of discharged patient .

Structure audit : physical facilities, equipment and supplies, the personnel.

Process audit : Focused on the order in which events occur, i.e. procedure of giving care.

Outcome audit : Looks at the status of the patient as a result of care provided.

Uses/ Advantages of Nursing Audit

biographical index assured of good services staff improvement in quality of nursing cooperation self evaluation. better planning reduce medico-legal complications broaden and strengthen nursing service

Disadvantages

It is considered as a source of punishment by professional group.

Medico-legal important-they feel that these will be used in court of law as any document can be called for in court of law for clear, adequate and efficient evidences.

Using Results of Nursing AuditFor Nursing care service.

Modifying nursing care plans and the nursing care process

Implementing a program for improving documentation

Focusing supervisory attention upon areas of weakness identified

Focusing on nursing round and term conferences Designing responsible orientation and in service

education program

Using Results of Nursing AuditFor Nursing Administration

Provide evaluation of particular program Support requests for accreditation Serves as basis for planning new

program Serve to identify area of strength and

weakness Determine the influence of varied

staffing pattern. May be used as data

Using Results of Nursing AuditFor Nursing Supervisor and Head Nurse

Identify area of needed patient care improvement

Provide basis for planning in-service education program

Identify/ supervision needs of a staff member who give direct care to the patient.

Using Results of Nursing AuditFor Staff Nursing

Provide a self examination of care in their specific nursing unit or setting

Identify particular type of care in which practice may be improved merely by increase attention and conscientiousness.

Identify type of care in which improvement will depends on the staffing acquiring additional knowledge and skill.

STEPS IN DEVELOPING QUALITY ASSURANCE

Approval of the program Taskforce or committee to be appointed Orientation program to be agreed for the committee

member to familiarize with the purpose principles, methods etc.

Examine their belief and behavior concerning quality control through workshop.

Explore the difference in nursing values through open confrontation

Two major categories of approaches

General Approach : It examines the ability of the agency to meet criteria or standards.

Specific Approaches : These are methods used to evaluate provider and client interaction

Beneficiaries of Quality Assurance Program

The recipients of care who receive safe effective satisfying services.

The care providers because evaluating offers opportunity to promote personal and professional growth.

The agencies – which obtain data for planning cost containment and legal protection.

The profession – quality assurance program promotes development of standards and protocol and generations of new knowledge.

Factor Affecting Quality Assurance

Lack of Resources- Infrastructure equipment. Personal Problem Improper Maintenance Absence of well informed populace Absence of Accreditation Absence of conducting patient satisfaction

survey. Lack of nursing care records. Miscellaneous Factors Indian publication nursing are very few Lack of adequate nurse administrator

ROLE AND RESPONSIBLITES OF A NURSE ADMINISTRATION IN DEVELOPING QUALITY ASSURANCE SYSTEM

Deciding upon the philosophy . Make certain that you as well as your nurses

know what you wish to evaluate and why Formulate objectives Set standards Enlist expert guidance plan carefully and select the evaluation tools

suitable to the unit Work cooperatively Publish the report of the result of evaluation of

care

NURSES ROLE IN QUALITY ASSURANCE

Planning risk factor

identification, resource mobilization

, goal setting

Implementing

standards monitoring

and reporting

Evaluating changes in standards , policies , outcome ,

goal attaintment

NURSES ROLEIN

QUALITY ASSURANCE

CONCLUSION

Sound evaluation tool alone will not be sufficient to improve the quality. To attain the goal of providing optimum quality care nurses themselves make them to ready by critical thinking and by developing and implementation a quality assurance program in their hospital so as to provide a scientific care which is combined with humanitarian approach.