Quality control : Refers to the activities that are used to evaluate, monitor or regulate services rendered to the client.Quality management : Refers to the system of management of quality with in the institution - the design, structure and functioning of the quality systemQuality Assessment : Involves assessing the standards of an institution against external criteria Quality audit : Refers to the systematic & official examination of record, process, structure, environment or account to evaluate performance.
Standards : : Standards are desired & achievable levels of performance against which actual performance in practice is compared.Quality Improvement : This is a process that uses clinical and technical skills to produce service. The focus is on whole systems, not just on the performance of individual.
“ Quality Assurance refers to the process ofachieving excellence in the service rendered toevery client” “ Quality Assurance is the defining ofNursing practice through well written Nursingstandards and the use of those standards as abasis for evaluation on improvement of clientcare”- Marker (1998)
According to Jonas (2002), the two main Objectives are :- To ensure the delivery of quality client care To demonstrate the efforts of the health care providers to provide the best possible resultsOther specific Objective of the Nursing process are :- Formulate plan of care Attend to the patient’s physical and non-physical needs Evaluate achievement of Nursing care Support delivery of Nursing care with Administrative and Managerial Services
There are two different approaches to ensure Qualitya) Quality by Inspectionb) Quality as Opportunity
A. GENERAL APPROACH: Credentialing Licensure Accreditation CertificationB. SPECIFIC APPROACHES: Peer Review Standard Nursing Audit
Standard is a Quantitative or Qualitative measure against which someone or something is judged, compared or used to service as a exampleThe ANA Standard of Practice Include:– Standard 1 : Data collection Standard 2 : Nursing diagnosis Standard 3 : Goals Standard 4 : Priorities & prescribed Nursing approach Standard 5 : Nursing action (health maintenance) Standard 6 : Nursing action (maximize health capabilities) Standard 7 : Evaluation (progress or lack of progress is assessed)
RETROSPECTIVE AUDITS: This refers to an in depth assessment of quality after the patient has been discharged and uses the patients chart as the source of data.CONCURRENT AUDITS: Its an evaluation method to inspect the Nursing staff’s compliance with predetermined standards and criteria while the nurses are providing care.OTHER AUDITS: a) Internal Audit b) External Audit
I. A SYSTEMATIC MODEL FOR IMPLEMENTATION OF UNIT BASED QUALITY ASSURANCEBasic Components of system are Input Throughout Output Feed back
1) Establishment of standards or criteria2) Identify the information relevant to criteria.3) Determine ways to collect information4) Collect and analyze information5) Compare collected information with established criteria6) Make judgment about quality7) Provide information and if necessary take corrective action regarding findings of appropriate sources8) Determine ways to collect the information
Lack of resources Personnel problems Improper maintenance Unreasonable patient and attendants Absence of well informed population Absence of accreditation law Lack of incident review procedures Lack of goods & hospital information system Absence of patient satisfaction surveys Lack of nursing care records Miscellaneous factors
C. LANG (1976) : This was subsequently adapted and developed by the ANA Stages include:- Identify and agree values Review literature, Known Quality Assurance program Analyze available programs Determine most appropriate quality assurance program Establish structure,plans,outcome criteria and standards Evaluate current levels of Nursing practice against ratified structures Identify & analyze factors contributing to results Ratify criteria and standards Select appropriate actions to maintain or improve care Implement selected actions Evaluate Quality Assurance programme