Quality assurance in healthcare delivery


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  • European Foundation for Quality Management (EFQM)
  • A public recognition of the achievement of accreditation standards by a healthcare organisation, demonstrated through an independent external peer assessment of that organisation’s level of performance in relation to the standards.” Independent, voluntary programs, multi-disciplinary assessment of health care functions and organisations developed specifically for health care.
  • ALPHA- Agenda for Leadership in Programs for Healthcare Accreditation: global approach for aligning Healthcare Accreditation Standards and Processes
  • Quality assurance in healthcare delivery

    1. 1. Quality Assurance in Healthcare Delivery; A MUST for Safety of End Users Dr Olufemi Aina Master TeamSTEPPS Trainer Aesculapius Healthcare Consultants (AHC)
    2. 2. Our Goals- Aesculapius Healthcare Consultants (AHC) • Broaden Patient Safety Knowledge in Nigerian Hospitals • Develop Patient Safety Culture in our Hospitals by deploying TeamSTEPPS Patient Safety Strategies
    3. 3.  Healthcare Quality Assurance  Developments in Quality Assurance  Need for Safety Assessment in Hospitals  Entrenching Patient Safety in our Healthcare System  TeamSTEPPS Patient Safety Strategies  Quality Assurance ensures Safety
    4. 4. Components of Quality Care Thus Safety is the foundation upon which all other aspects of Quality Care are built. Institute of Medicine (IOM) considers patient safety ―indistinguishable from the delivery of quality health care.‖ Safe Effective Patient Centred Efficient Equitable Timely
    5. 5. End Users of Healthcare Service • Patients and Family Members • Healthcare Provider and its Professionals
    6. 6. Quality Assurance is that set of activities that are carried out to previously Set Standards to monitor and improve Performance so that the care provided is as Effective and as Safe as possible.
    7. 7. Quality Assurance in Healthcare Component of Quality Management that ensures the Right things are being done- based on Standards and Established Goals. Systematic Process of checking if a Healthcare Service is meeting Specified Requirements Helps reduce waste and unnecessary activities and improve Service Delivery
    8. 8. Quality Assessment Methods System Performance  Health Priorities, System Planning, Financing And Resource Allocation done at National Level & Global Level.  General Environment Of The Country, Legislation & Other Regulatory Mechanisms, Professional Recognition and Overall Quality Management. Institutional and Clinical Performance External Assessment  ISO, Accreditation, Licensing, EFQM, Peer Review Internal Self-assessment  Patients Rights, Risk Management, Clinical Governance, Clinical Audit, Performance Indicators & Benchmarking
    9. 9. Healthcare Quality Assurance Strategies Process IssuingOrganization Objectof Evaluation Standards Components Licensure Mandatory Government Individualand Organization MinimumStandardstoensurea MinimumRiskEnvironmenttoHealth andSafety RegulationstoensureMinimum Standards,CompetenceandOn- siteInspection Certification Voluntary AuthorizedBody Organizationor Component ISO9001Standardstoensure ConformancetoIndustryStandards Organizationtodemonstrate Services,TechnologyorCapacity Accreditation Voluntary UsuallyNonGovernmental- RecognizedTools Organization MaximumAchievableLevelto stimulateImprovementovertime CompliancewithPublished StandardsandOnsiteEvaluation ComparingHealthcareQualityImprovementStrategies
    10. 10. 4 Tenets of Quality Assurance • Oriented toward meeting the needs and expectations of the Patients and other Users. • Focused on systems and processes. • Use data to analyse service delivery processes. • Encourage a team approach to Problem Solving and Quality Improvement.
    11. 11. Developments in Quality Assurance  1859- Florence Nightingale introduced the first standards in nursing care during the Crimean War  1913-American College of Surgeons(ACS)- Minimum Standards for Hospitals  1951-Joint Commission- ACS , American College of Physicians, American Hospital Association, Canadian Medical Association, American Medical Association  1966-Avedis Donabedian- ‗Evaluating the Quality of Medical Care’ Structure| Process | Outcome 1998- International Society for Quality in Healthcare (ISQUA) ALPHA Program 2004-WHO- World Alliance for Patient Safety
    12. 12. Comparing Quality and Safety Quality Safety Degree of the realisation of the reasons that the Patient has come to the care hospital e.g. patient comes to Hospital for an Operation Results which are not the reasons for the Patient coming e.g. ‘not catching an infection’ and he is implicitly confident he will not run the risk of this happening.
    13. 13. Need for Safety Assessment Institute of Medicine Report Impact of Error:  44,000–98,000 annual deaths occur as a result of errors  Medical errors are the leading cause, followed by surgical mistakes and complications  More Americans die from medical errors than from breast cancer, AIDS, or car accidents  7% of hospital patients experience a serious medication error Cost associated with medical errors is $8–29 billion annually. Federal Action: By 5 years;  medical errors by 50%,  nosocomial by 90%; and eliminate ―never- events‖ (such as wrong-site surgery)
    14. 14. Medical Errors Still Claiming Many Lives 20/01/2005 By Elizabeth Weise, USA TODAY As many as 98,000 Americans still die each year because of medical errors. The researchers blame the:  Reluctance to admit Errors Billing System that Reward Errors Lack of Leadership Complexity of Health Care Systems 14 05/18/2005 …little progress towards the goal Leape and Berwick, JAMA May 2005 Hospitals have taken steps to reduce medical errors and injuries. Examples:  Computerized prescriptions: 81% decrease in errors.  Including pharmacist in medical team: 78% decrease in preventable drug reactions.  Team training in delivery of babies: 50% decrease in harmful outcomes — such as brain damage — in premature deliveries. Source: Journal of the American Medical Association Improvements
    15. 15. WHO- African Region WHO- African Region Adverse events 4% to 16% of all hospitalized patients Developing Countries estimated 5% to 10% of patients acquire one or more infections Risk 2 to 20 times higher than in developed countries. Sentinel Events Surgical Care- > 50% of Adverse Events, Unsafe injections, blood and medicines African Countries Mali 18.9%, Tanzania 14.8%, Algeria 9.8% Drugs 25% of medicines are counterfeit, poly-pharmacy, inappropriate use of antimicrobials; overuse of injections, lack of prescription guidelines, inappropriate self-medication, non-adherence to dosing regimes.
    16. 16. WHO- Patient Safety Practice • Processes or structures which, when applied, reduce the probability of adverse events resulting from exposure to the health-care system across a range of diseases and procedures. • Healthcare-associated infection is a global problem with over 1.4 million people suffering at any given time. • Medical errors result in numerous preventable injuries and deaths. • Inadequate Patient Safety Data in African Region
    17. 17. Need for Safety-Personal Experience • Young NYSC dr. in a GH, many years ago: ordered IM drugs, nurse uncomfortable, even though gave lower dose- respiratory arrest, called and answered promptly. • Young Father in a PH, Lagos: 2 years ago: overworked nurse (esp. with reports), set up IV line, suction didn’t work, sucked manually
    18. 18. Entrenching Patient Safety in Our Healthcare System  Focus on Patient Safety Performance Goals in Hospitals  Reward Patient Safety Achievement by Hospitals  Government to support Patient Safety Advocacy Groups  Patient Safety Forum between Health Professionals & Patient Groups Accreditation: ensure Sector- wide Quality Assurance System in Healthcare. Forward thinking AGPMPN is embarking on Patient Safety and Quality Management Program Accreditation standards will include Patient Safety Standards and Patient Safety Performance Goals
    19. 19. The Components of a Patient Safety Program 19
    20. 20. Classification of Medical Errors- Near Miss Near Miss is defined as an act could have harmed the patient but did not do so as a result of: • Chance e.g. patient received a contraindicated drug but did not experience an adverse drug reaction • Prevention e.g. a potentially lethal over-dose was prescribed, but a nurse identified the error before administering the medication • Mitigation e.g., a lethal drug overdose was administered but discovered early and countered with an antidote.
    21. 21. Classification of Medical Errors- Adverse Events Adverse Events cause harm to patients—causing a large number of injury, disability, and death. Errors of Commission • Prescribing a medication that has a potentially fatal interaction with another drug the patient is taking. Errors of Omission • Failing to prescribe a medication from which the patient would likely have benefited, which may pose an even greater threat to health.
    22. 22. Why Do Errors Occur—Some Obstacles  Workload fluctuations  Interruptions  Fatigue  Multi-tasking  Failure to follow up  Poor handoffs  Not following protocol & standard operating procedures  Poor Leadership  Breakdown in Communication  Breakdown in Teamwork  Losing track of Objectives  Excessive professional courtesy  Complacency  High-risk phase  Task (target) fixation
    23. 23. Healthcare System focused on Patient Safety • Prevents Errors • Learns From The Errors That Do Occur • Is Built On A Culture Of Safety that Involves Health Care Professionals, Organizations, And Patients.
    24. 24. ―Initiative based on evidence derived from team performance…lev eraging more than 25 years of research in military, aviation, nuclear power, business and industry…to acquire team competencies‖ Team Strategies & Tools to Enhance Performance & Patient Safety
    25. 25. Quality Assurance ensures Safety by assessing: Adverse Event Reporting Patient Safety Culture Leadership Support of Patient Safety Adverse Event Analysis Adverse Event Prevention Communication and Feedback Patient Involvement in Care Environment of Care
    26. 26. Accreditation Standards  Hospital has a Patient Safety Program  Hospital Risk Management Program  Specific Prevention Programs  Transfusion Safety Program Procedures for identifying Patients Correctly Conducts Periodic Patient Safety Training Effective Communication Techniques Ensures Safety of High- Alert Medications
    27. 27. Accreditation Standards  Ensures Correct-Site, Correct-Procedure, Correct- Patient Surgery  Procedures for reducing Health Care–Associated Infections  Hand Hygiene Standards  Reduce Patient Harm Resulting from Falls  Conducts Risk Management & Infection Prevention for Healthcare Professionals  Hospital has Procedures for handling, storage, preparation & distribution of foodstuffs  Ensures Radiation Safety  Ensures Injection Safety
    28. 28. The AGPMPN Quality Program Components of the AGPMPN Quality Program are : • Patient Safety • Staff Safety • Quality Management • Performance Excellence
    29. 29. Goals of The AGPMPN Quality Program • First Professional Group to deploy an intensive Quality Management and Patient Safety Program across board • Influence all Healthcare Professionals and Service Delivery in Nigeria. • Build capacity for transformation across the entire AGPMPN Membership with Peer Monitoring and Performance Management. • Become Point of reference in Health in Nigeria and Africa as a whole. • Activate Paradigm Change in Nigerian Healthcare
    30. 30. Thank You