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  • Seminar On Quality Assurance in Nursing
  • Introduction:
  • TERMINOLOGIES: Quality : Its is a relative term that describes something with high merit or excellence which is compared to an accepted standard (degree of excellence). Quality care : means that the services provided match the needs of the population are technically correct, achieve beneficial results. Assurance : Those activities those make certain that services are actually provided (formal guarantee, certainty)
  • Cont. Standards of care : desired goals that can help in planning and evaluation of nursing practices Quality assurance: refers to process of achieving excellence in the service rendered to every client. Its also called quality control process
  • Cont. Quality improvement ; its a systematic approach to control and improve quality form the perspective of both professionals and clients. its also called total quality improvement or total quality management. Quality Circle: a participative management approach in which employees and managers share the responsibility for decision making and problem solving in client care.
  • Cont. Quality Indicators: Quality focused objective used as markers to determine whether a goal has been achieved and to measure client outcomes or process out comes. Audit : an organized effort where by practicing professional monitor , assess and make judgments about the quality and appropriateness of nursing care provided by peers are measured against professional standards of practice Bench marking: studying anothers processes in order to improve ones own processes
  • Cont. Peer review : An organized system by which peer professionals assess the quality of care being delivered. Credentiality: Formal recognition of a person as a professional with technical competence or of an agency that has met minimum standards of performance. Accreditation: process whereby a professional association or non-governmental agency grants recognition to a school or health care institution for demonstrated ability to meet predetermined criteria for established standards.
  • Historical dvpt : Quality assurance have been evident in nursing since the days of Florence Nightingale she was a pioneer in setting standards for nursing care. In 1860 Nightingale called for the development of a uniform method to collect and present hospital statistics to improve hospital treatment In later 1800s the impetus for establishing nursing schools in the U.S came from a desire to set standards that would upgrade nursing care
  • Cont. In 1900s efforts were begun to set similar standards for all nursing schools by various accrediting organization , two of the most influential organizations are ANA- American nurses association (1890) and NLN- National league for nursing (1952). From 1912-1939 the interest in quality nursing education led to the development of nursing organization involved in accrediting nursing programs. In 1892 Licensure has been a major issue in nursing.
  • Cont. In 1923, all states has permissive / mandatory laws directing nursing practice . After World War II the attention of the emerging nursing profession focused on establishing a scientific method of practice. In 1950s they brought the development of tools to reassure quality assurance. One of the first tool created was nursing audit .
  • Cont. In 1972, the congress for nursing practice was charged with developing standards to be used to institute quality assurance programs. In 1972, The Joint Commission on Accreditation of hospitals (JCAH) clearly stated the responsibilities of nursing in its description of standards for nursing services. The JCAH called on the nursing industry to clearly plan document and evaluate nursing care provided .
  • Cont. In mid 1980s JCAH became the joint commission on accreditation of health care organization (JCAHCO) and began developing quality control standards for home health nursing and hospital nursing. In 2007, it was renamed as The Joint Commission (TJC) .
  • DEFINITION: 1. Definition of quality assurance Quality assurance means delivery of efficient and effective medical care in accordance with the professional standards. 2. Definition of Quality Assurance in Nursing: Quality Assurance is the defining of nursing practice through well written nursing standards and the use of those standards as a basis for evaluation on improvement of client care (Maker 1998).
  • GOALS & PURPOSES: i) Goals: To ensure the delivery of quality client care To demonstrate the efforts of the health provider to provide the best possible results ii) Purpose of Quality Assurance: Sets standards for care. Help patients and potential patients by improving quality of care. Assess competence of medical staff, serve as an impetus to keep up to date and prevent future mistakes and Bring to notice of hospital administration the deficiencies and in correcting the causative factors Helps to exercise a regulatory function, restricting undesirable Procedures
  • Need for quality control: Quality control is essential to make the efficiency of health institutions possible through. a) Improvement of existing obsolete processes and procedures b) Improved layout of office and working environment c) Economy in human effort d) Suggesting the best use of money and material e) Improved design of the goods or services provided by the organization f) Improved performance g) Job satisfaction h) Improved flow of work i) Standardization of processes and products.
  • V. Approaches/ Techniques for Quality assurance: Two major categories of approaches exist in quality assurance they are: A. General B. Specific
  • Cont.. 1) Credentialing: It is generally defined as the formal recognition of professional or technical competence and attainment of minimum standards by a person or agency. Licensure: It is a contract between the profession and the state, in which the profession is granted control over entry into and exists from the profession and over quality of professional practice.
  • Cont. Accreditation: National league for nursing (NLN) a voluntary organization has established standards for inspecting nursing educations programs. In the part the accreditation process primarily evaluated on regencys physical structure, organizational structure and personal qualification. In 1990 more emphasis was placed on evaluation of the outcomes of care and on the educational qualifications of the person providing care.
  • Cont. Certification: Certification is usually a voluntary process with in the professions. A persons educational achievements, experience and performance on examination are used to determine the persons qualifications for functioning is an identified specialty area.
  • Cont. B. Specific Approach: 1. Peer Review Committee: These are designed to monitor client specific aspects of care appropriate for certain levels of care. The audit has been the major tool used by peer review committee to ascertain quality of care.
  • Cont. Nursing audit: An audit is an organized effort whereby practicing professionals monitor, assess, and make judgments about the quality and appropriateness of nursing care provided by peers as measured against professional standards of practice The tools include record reviews, checklist, questionnaires, and surveys.
  • Cont. Auditing can occur retrospectively, concurrently, or prospectively. Retrospective audit are performed after the patient receives the service. Concurrent audits are performed while the patient is receiving the service. Prospective audits attempt to identify how future performance will be affected by current interventions.
  • Cont.. The audit includes outcome audit , process audit, and structure audits: Outcome audit It can be defined as the end result of care, or how the patients health status changed as result of the intervention Process audit: Process audits are used to measure the process of care or how the care was carried out and assume that a relationship exists between the process used by the nurse and the quality of care provided.e.g. a process audit is used to establish whether fetal heart tones or blood pressures were checked according to an established policy
  • Cont. Structure audit: Structure audit assume that a relationship exists between quality care and appropriate structure. E.g. staffing ratios, availability of fire extinguishers in patient care areas would all be structure measures


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