QUALITY ASSURANCEQUALITY: DEGREE OF EXCELLANCEASSURANCE: MAKE SAFE

QUALITY ASSURANCESTANDARD SETTINGNURSING / CLINICAL AUDITOBJECTIVESAT THE END OF THE SESSION THE STUDENTS WILL BE ABLE TO: ACKNOWLEDGE THE IMPORTANCE OF QUALITY ASSURANCE

ACQUIRE AN UNDERSTANDING THE DEFINITION OF QUALITY

UNDERSTAND THE IMPORTANCE OF STANDARD SETTING

ACQUIRE THE KNOWLEDGE ON THE IMPORTANCE OF NURSING / CLINICAL AUDIT AND ITS PROCESS

QUALITY ASSURANCEPRIORITISING CLINICAL AUDIT TOPICS A review of the patients prospective on quality of care

An area of high cost, volumes or risk

Evidence of a serious quality e.g. : patient complaints, infection rates

The availability of systematic reviews of research or national clinical guidelines

QUALITY ASSURANCECONCEPTS OF QUALITY ASSURANCE PROVISION OF A PROFESSIONAL SERVICE CARRYING WITH IT OBLIGATION ON THE PROFESSIONAL TO SATISFY PATTIENTS / CLIENTS NEEDS AT ALL LEVELWHY QUALITY ASSURANCE IT IMPLIES IDENTIFICATION OF AREAS FOR IMPROVEMENT AND SELECTIVE ATTENTION TO THE DEVELOPMENT OF NEW TECHNIQUES IN AREAS OF GREATEST NEED

QUALITY ASSURANCESTEPS TO QUALITY ASSURANCE STANDARDS ARE SET QUALITY ASSURANCE PERFORMANCE OUTCOMES ARE CHECK AGAINST THESE STANDARDSIF THERE IS A SHORTFALL THIS IS USED AS A FEEDBACK TO CRITICAL PARTS OF THE SYSTEMALTERNATIVELY THE STANDARD MAYBE MODIFIED TO ONE THAT IS SCHIEVABLE

QUALITY ASSUARANCECONCERN FOR EXCELLENCE AND STANDARD FOCUSSING ON INDIVIDUALS CARE OR POPULATION SERVICE MUST REFLECT AN INTEREST IN THE PROVISION OF THE HIGHEST POSSIBLE QUALITY CARE IT SHOULD EXTEND TO ALL ASPECTS OF CARE INCLUDING THE TECHNICAL, THE INTERPERSONAL AND MORAL SPECIFICITY AND EXPLICITNESS THE ESSENCE OF HEALTH CARE QUALITY ASSURANCE STANDARD ARE SPECIFIED AND OPERATIONALISED AND MEASUREMENT TOOLS ARE DEVELOPED FOR THEIR APPRAISALCOMMITTMENT BOTH INDIVIDUALS AND ORGANISATIONS MUST BE POSITIVELY MOTIVATED TO IMPLEMENT QUALITY ASSURANCE AT THE ORGANISATIONAL LEVEL THERE MUST BE RECOGNITION THAT QUALITY ASSURANCE DOES NOT JUST HAPPEN IT MUST BE MANAGED

QUALITY ASSURANCESOCIAL VALUEINDIVIDUAL VALUEPROFESSIONAL VALUEINSTITUTIONAL VALUEQUALITY

QUALITY ASSURANCEAPPROPRIATENESSQUALITY IN HEALTH SERVICES / IN INDIVIDUALSEQUITYEFFECTIVENESSEFFICIENCYACCEPTABILITYTHE SERVICE OF PROCEDURE IS WHAT THE POPULATION OR THE INDIVIDUAL ACTUALY NEEDSA FAIR SHARE FOR ALL THE POPULATIONACHIEVING THE INTENDED BENEFIT FOR THE INDIVIDUAL AND FOR THE POPULATIONRESOURCES ARE NOT WASTED ON ONE SERVICE OR PATIENT TO DETRIMENT OF ANOTHERSERVICES ARE PROVIDED SUCH AS TO SATISFY THE REAONABLE EXPECTATIONS OF PATIENTS, PROVIDERS AND THE COMMUNITY

QUALITY ASSURANCESTRUCTURETHE QUALITY CARE CAN BE STUDIED FROM THESE ASPECTSPROCESSOUTCOMECLINICAL (TREATMENT OF PATIENTS) CARENON CLINICAL ( MEETING THE PATIENT PERSONAL, SOCIAL, EMOTIONAL, SOCIAL NEEDS)CARE INCLUDESWHERE IS CARE CARRIED OUT

WHAT EQUIPMENT IS USEDWHO CARRIES OUT THE CARE

HOW IS IT CARRIED OUTWHAT IS THE END RESULTS?PERCIEVED BY PATIENTS / CLIENTSb) PERCIEVED BY PROFESSIONALS

QUALITY ASSURANCE A COURTESY

NON CLINICAL ( MEETING THE PATIENT) CAREBSURROUDINGS THAT SUGGEST COMPETENT HELPS IS AT HANDCREADY ACCES TO THE SUPPORT OF FAMILY AND FRIENDSDBEING TOLD WHAT WILL HAPPENED AND WHENELACK OF DELAYS

QUALITY ASSURANCECRITERIA FOR STANDARDS

A STANDARD IS A MEANS OF MEASURE RELEVANTUNDERSTANDABLEMEASUREBLEBEHAVIORALACCEPTABLEEXAMPLE OF A STANDARD

ALL OUT PATIENTS SHOULD BE SEEN BY A DOCTOR WITHIN 30 MINUTSOF THEIR APPOINTMENTS OR TOLD THE REASON FOR ANY DELAY

QUALITY ASSUARANCEINPUTPRODUCTIVE LINE MODEL OF HEALTH SERVICESPROCESSOUTPUTOUTCOMEACTIVITYRESOURCEPRODUCTIVITYHEALTH

QUALITY ASSURANCEDEFINITION IS THE SYSTEMATIC AND CRITICAL ANALYSIS OF THE QUALTY OF CLINICAL CARE INCLUDING THE PROCEDURES USED FOR DIAGNOSIS, TREATMENT AND CARE, THE ASSOCIATED USE OF RESOURCES AND THE RESULTNG OUTCOME AND QUALITY OF LIFE FOR PATIENTFUNDAMENTAL PRINCIPLES ASSOCIATED WITH CLINICAL AUDITCLINICAL AUDITIT SHOULD BE BE PROFESSIONALLY LED BE SEEN AS EDUCATIONAL PROCESS FORM A PART OF A ROUTINE CLINICAL PRACTICE BE BASED ON THE SETTING OF STANDARS GENERATE RESULTS THAT CAN BE USED TO IMPROVE OUTCOME OF QUALITY CARE INVOLVE MANAGEMENT IN BOTH THE PROCESS AND OUTCOME OF THE AUDIT BE CONFIDENTIAL AT THE INDIVIDUAL PATIENT / CLINICAL LEVEL BE INFORMED BY THE VIEWS OF PATIENTS / CLIENTS

QUALITY ASSURANCEOBJECTIVE OF CLINICAL AUDITTO IMPROVE PATIENT CARE BY INFORMING THE HEALTH CARE PROFESIONALS UNDERSTANDING OF THEIR CLINICAL PRACTICESBENEFIT OF CLINICAL AUDITCLINICAL AUDIT

PROMOTE A PATIENT-FOCUS APPROACH TO CARE

ENCOURAGE MULTI-PROFESSIONAL TEAMWORK

ENABLES OPEN DISCUSSION ABOUT PRACTICE AND LEARNING FROM MISTAKE

QUALITY ASSURANCEWHO DO THE AUDIT?IT MUST BE LED BY THE CLINICAL STAFF INVOLVED WITH THE ISSUE REVIEWED, IN COLLABORATION WITH MANAGERS, AUDIT STAFF AND PATIENTSCLINICAL AUDIT

QUALITY ASSURANCEIDENTFYING AN AREA FOR CLINICAL AUDIT REQUIRES CAREFUL THOUGHT IN THE SELECTION OF TOPICS

THE AREA IDENTIFIED MUST ADDRESS THE IMPORTANT ASPECTS OF CONCERNS ABOUT QUALITYCLINICAL AUDIT

QUALITY ASSURANCE1. DEFINING BEST PRACTICES4 TAKING ACTION TO IMPROVE2. IMPLEMENTING BEST PRACTICES3. MONITORING AND COMPARING AGAINST BEST PRACTICEMAIN STAGES OF CLINICAL AUDIT

QUALITY ASSURANCECONCERN ABOUT THE PROVISION OF PRESSURE-RELEIVING DEVICES FOR THOSE IDENTIFIED AS HIGH RISK PATIENTS DEVELOPMENT OF PRESSURE SORESCLINICAL AUDIT OF PRESSURE SORES(ROYAL BROMPTON HOSPITAL 1991)HAS INCREASED HOSPITAL STAYINCREASED DISCOMFORTTHE COST IMPLICATIONS WERE EXTREMELY HIGH WITH A GRADE 4 PRESURE SORE ESTIMATING COST 25 000 TO TREAT

QUALITY ASSURANCE 50% OF THE PATIENTS POPULATION WERE AT RISK OF DEVELOPING PRESSURE SORE

A NUMBER OF MATTRESSES WERE IN POOR CONDITION

THERE WAS LACK OF KNOWLEDGE AMONGST WARD NURSES ON AREAS RELATED TO PRESSURE-RELEVING EQUIPMENT

LACK OF LIFTING AIDS ON THE WARDS DISCOURAGING NURSES FROM LIFTING AND TURNING PATIENTS

PAIN WAS LIKELY TO BE A CONTRIBUTING FACTOR AS PATIENTS WERE PREVENTED FROM MOVING IN BEDMAIN FINDINGSCLINICAL AUDIT OF PRESSURE SORES

An increased risk of costly litigation health authorities were being sued anywhere between 100 000 and 1 0000 000 by patients who had developed sores during their hospital stay .

All of the above reasons including that 95% of pressure sores are preventable, led to a clinical audit group for pressure area care being formed. Representatives of the multi-professional teams comprised of nurses, occupational therapists, physiotherapists and dietician.

PILOT AUDIT (1992) 8 mths from the raising of the first concerns through to completion of the objectives and criteria.

- A small convenience sample of 4 patients and 4 nurses were audited from each ward.

QUALITY ASSURANCE

Each year, the standard and the point prevalence study have been reviewed, re audited and local and hospital widw action plan devised to address new issues:

A matress replacement programme and the writing of a policy to maintain this.Identifying a nuerse rto coordinate both in-houseHold regular meetings with the link nurses to encourage information sharingThe initial audit 1992 identified the prevalence of pressure sores as being 19% of the patient population. Dropped dramaticcally over subsequent years, 1997 results are just 3% of the patient population, within the DoH guidelines (1993) stating a commitment to reduce the incidence of pressure sores in NHS by 5%.

OUTCOME MEASURE

QUALITY ASSUARANCE LETTERS FROM PATIENTS, COMLPLAINT OR COMMENTS FROM EXTERNAL AGENCIES

CRITICAL ACCIDENTS REPORTS WHERE NUMBERS OF STAFF HAVE DESCRIBED AND ANALYSED IMPORTANT CONCERNS FOLLOWING ONE INCIDENT

SUMMARIES OF TEAM MEEINGS OR GOOD ROUND WHERE ISSUE HAS BEEN DISCUSSED

INFORMATION FROM ROUTINE DATA SOURCES INCLUDING OF PATIENTS INVOLVED

PATIENTS STORIES OF FEEDBACK FROM FOCUS GROUP

DIRECT OBSERVATION OF CARE

AN OVERVIEW OF THE ASPECT OF CARE UNDER REVIEW

QUALITY ASSUARANCE LIST SOME TOPICS FOR CLINICAL AUDIT WHICH YOU THINK WOULD BE APPROPRIATE FOR YOUR CLINICAL AREA

CHOOSE A TOPIC FOR A CLINICAL AUDIT PROTECT IN A SPECIFIC CLINICAL AREA AND DEVELOP YOUR MONITORING TOOL

BRIEFLY WRITE REPORT ON THE AUDIT PROCESS AND RESULT OF THE AUDIT, AND RECOMMENDATIONGROUP WORK

QUALITY ASSUARANCEGROUP WORK