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Quality assurance in nursing

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THE EXPENSE OF QUALITY IS AN INTERACTIVE PROCESS BETWEEN CUSTOMER & PROVIDER. QUALITY ASSURANCE USUALLY FOCUSES ON MATERIAL, GOOD WORK & SERVICE PROVIDED EFFECTIVELY. ANY LACK IN SERVICE PROVIDED CAUSES DECREASE IN QUALITY

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Quality assurance in nursing

  1. 1. QUALITY ASSURANCE IN NURSING Presented By Mr. Migron Rubin M.Sc. Nursing Ist Year Pragyan College of Nursing
  2. 2. • D QUALITY ASSURANCE IN NURSING
  3. 3. INTRODUCTION THE EXPENSE OF QUALITY IS AN INTERACTIVE PROCESS BETWEEN CUSTOMER & PROVIDER. QUALITY ASSURANCE USUALLY FOCUSES ON MATERIAL, GOOD WORK & SERVICE PROVIDED EFFECTIVELY. ANY LACK IN SERVICE PROVIDED CAUSES DECREASE IN QUALITY.
  4. 4. QUALITY It is degree to which health services for individuals & population increase the likelihood of desired health outcomes & are consistent with current professional knowledge. -Joint Commission on Accreditition of health care organization ,2002 (JCAHO)
  5. 5. ASSURANCE It is statement or indication that inspires confidence.
  6. 6. QUALITY ASSURANCE • Quality assurance is an on-going, systematic, comprehensive evaluation of health care services & impact of those services on health care services. -Kozier • Quality assurance is defined as all activities undertaken to predate & prevent poor quality. -Neetvert
  7. 7. NURSING The unique function of nurse is to assist in individual sick or well in performance of those activities contributing to health or its recovery or to a peaceful death that he would perform unaided if he had necessary strength will or knowledge & to do this in such a way as to help him to gain independence as rapidly as possible.” - Virginia Henderson
  8. 8. OBJECTIVES • To ensure the delivery of quality client care. • To demonstrate efforts of health care providers to provide good results. • To formulate plan of care. • To evaluate achievement of nursing care.
  9. 9. • To support delivery of nursing care with administrative & managerial services. • To explain quality assurance models as pre- requisite for quality nursing care. • To state code of ethics & professional conduct for nurses in India.
  10. 10. • To appreciate importance of practicing standard safety measures. • Plan & conduct patient teaching sessions. • To identify appropriate management techniques to be used for managing resources in given situation.
  11. 11. PURPOSES • It is required to introduce code of ethics & professional conduct for nurses in India. • To prepare staff nurse for implementation quality assurance model in nursing. • To provide best care to patients by maintaining standards.
  12. 12. PRINCIPLES 1. Customer focus- It focuses on patient’s care with standard & recent medical knowledge. 2. Leadership – It helps to inculcate qualities of leadership in staff. 3. Involvement of People- It should involve maximum nursing staff so that standards can be maintained.
  13. 13. 4) Process approach- There should be a systematic & planned approach to provide quality care. 5) Factual approach to decision making- There should be fact or appropriate reason in taking certain decision for quality assurance of patient.
  14. 14. APPROACHES TO QUALITY ASSURANCE 1. Methods for measuring performance: As nursing care is delivered within a framework of independent relationships with physicians and a multiplicity of other health care personnel .The most commonly used methods of nursing care are task analysis and quality control.
  15. 15. 2) Measuring actual performance: It is an ongoing repetitive process with the actual frequency dependant on the type of activity being measured. It is better to clarify the purpose of the measurement and to measure performance on a continuous basis.
  16. 16. 3) Comparing results of performance with standards and objectives and identifying strengths and areas for correction: The standards and objectives and methods of measurement have been set ,if performance matches standards and objectives , managers may assume that things are under control if performance is a contrary to standards and objectives, action is necessary.
  17. 17. 4) Acting to reinforce strengths or success and taking corrective action as necessary: Positive aspects needed to be identified in order that they may e translated into encouragement and motivation for the nursing members involved in achieving them.
  18. 18. DEVELOPMENT OF A QUALITY ASSURANCE PROGRAM • Foster Commitment of Quality • Conduct a Preliminary Review of Quality- Related Activities • Develop the Purpose and Vision for the Quality Assurance Effort • Determine level and scope of initial Quality Assurance Activities • Assign responsibility for Quality Assurance
  19. 19. • Allocate resources for quality assurance • Develop a written quality Assurance plan • Critical Management System • Disseminate Quality Assurance Experience • Manage Change
  20. 20. APPROACHES FOR QUALITY ASSURANCE PROGRAM Approaches of quality assurance are divided into 2 types: 1. General Approach 2. Specific Approach
  21. 21. GENERAL APPROACHES It involves large governing of official body’s evaluation of person’s or agency’s ability to meet standard at a given time. 1. CREDENTIALING - It is process of determining & maintaining nursing standards.
  22. 22. Functional Components Of Credentialing Process According to Hinsvark, credentialing process has 4 functional components:- 1. To produce a quality product. 2. To confer a unique identity. 3. To protect provider & public. 4. To control the profession
  23. 23. 2. LICENSURE Individual licensure is a contract between profession & state in which profession is granted control over entry into & exists from profession & over quality of professional practice.
  24. 24. 3. ACCREDITATION Accreditation is the act of granting credit or recognition especially to an educational institution that maintains suitable standards.
  25. 25. 4. CERTIFICATION Certification is usually a voluntary process within the professions. A person’s educational achievement, experience & performance on examination are used to determine person’s qualification for functioning in an identified specialty area.
  26. 26. SPECIFIC APPROACHES Quality assurances are methods used to evaluate identified instances of provider and client interaction 1. Peer review committee- These are designed to monitor client specific aspects of care appropriate for certain levels of care. The audit is used by peer review committee to ascertain quality of care.
  27. 27. 2. NURSING AUDIT – Nursing audit is evaluation of patient care through analysis of written records maintained by nurses in patient’s treatment profile. - Avtar Brar
  28. 28. GOALS OF NURSING AUDIT • To improve quality of health care. • To promote improved communication among nurses & other health team members. • To improve quality of nursing care. • To detect & analyze problems & errors.
  29. 29. NURSING AUDIT PROCESS
  30. 30. ADVANTAGES OF NURSING AUDIT • Provides quality of nursing • A patient is assured of good services. • It will give valuable and pertinent information for the staff. • It will lead to between co-operation and communication among the nurse & health team.
  31. 31. • It will help each professional nurse for her self evaluation. • It helps the administration as better planning. • It will reduce the incidence of medical legal complication. • It will broaden and strengthen nursing service.
  32. 32. 3.Utilization Review Utilization review activities are directed towards assuring that care actually needed and that the cost appropriate for the levels of care provided
  33. 33. TYPES OF UTILIZATION REVIEW • Prospective: It is an assessment of the necessary of care before giving services. • Concurrent: A review of the necessity of care while the care is being given. • Retrospective: It is analysis of the necessity of the services received by the client after the care has being given
  34. 34. 4.Evaluation Studies Donabedian’s Structure-Process-Outcome model Donabedian introduced 3 major method of evaluating quality care:-
  35. 35. 1. Structural evaluation This method evaluates setting & instruments used to provide care such as facilities, equipments & characteristics of administrative organization & qualification of health provider. The data can be obtained from existing documents.
  36. 36. 2. Process Evaluation This method evaluates activities as they relate to standards & expectations of health providers in management of client care. Data is collected through direct observations, review of records, audit etc.
  37. 37. 3.Outcome Evaluation The net changes that occur as a result of health care or net results of health care. The data of this method can be collected from vital statistics records such as death certificate or telephone client interview, mailed questionnaire & client records.
  38. 38. MODELS OF QUALITY ASSURANCE System Model System model is used for implementation of unit based quality assurance program. It involves making changes in organizational structure & individual roles. In system model, task is broken down into manageable components based on defined objectives.
  39. 39. Basic Components of System Models • Input- The input can be compared to the present state of systems. • Throughput- It is developmental process. • Output- It is finished product or result. • Feedback- It is essential component of system because it maintains & nourishes growth.
  40. 40. ANA Quality Assurance Model Identify values Identify standards & criteria Secure measurement Make measurement Identify course of action Choose action Take action Reevaluation
  41. 41. PDCA CYCLE PDCA CYCLE PLAN DO CHECK ACT
  42. 42. FACTORS AFFECTING QUALITY ASSURANCE IN NURSING CARE
  43. 43. QUALITY IMPROVEMENT • Quality improvement is defined as an approach to the continuous study & improvement of process of providing health care services to meet the needs of clients & others. -Joint commission on accreditation of health care organization (JCAHO)
  44. 44. PRINCIPLES • It requires continuous quality improvement. • Knowledge of customer expectation needs. • Processes of customer supplier relationship. • Belief in people. • Statistical analysis. • Costs of poor quality.
  45. 45. CONDITIONS IN WORK ENVIRONMENT • Employer’s involvement. • Improvement. • An environment that support taking risk. • Team work. • Data collection & analysis skills. • Group interaction skills. • Structure & management to enable improvement. • Tools to facilitate improvement.
  46. 46. COMPONENTS OF QUALITY IMPROVEMENT PROGRAMS • Establish responsibility & accountability. • Define scope of service for clinical area. • Define key aspects of service for clinical area • Develop quality indicators to monitor outcomes & appropriateness of care delivered. • Establish threshold for evaluation of indicators. • Collect & analyze data from monitoring activity.
  47. 47. • Evaluate results of monitoring activities to determine the need for change in practice. • Resolve problems through development of action plans. • Reevaluate to determine if plan was successful. • Communicate quality improvement results to organization.
  48. 48. TOTAL QUALITY MANAGEMENT • It focuses the production and service, i.e.: the environment must be customer responsive. • It identifies and do the right things, the right way, the first time and the prevent problems. • In this, customer needs and experiences with the end product are constantly evaluated .
  49. 49. STANDARDS Standard is an established rule as basis of comparison in measuring or finding capacity, quality context & value of objects in same category.
  50. 50. Classification of nursing care standards 1) Structure standards • It involves setup of institution. • The philosophy, goals & objectives, structure of organization, facilities, equipment, qualification of employees are some of components of structure of organization.
  51. 51. 2) Process standard • It describes behavior of nurse at desired level of performance. • It involves activities concerned with delivering patient care.
  52. 52. 3)Outcome standard • An outcome standard measures changes in patient health status. • This change may be due to nursing care, medical care or as a result of variety of services offered to patient.
  53. 53. ROLE OF A NURSE • Role of nurse is to participate in quality improvement team. • Properly supervises & check whether patient is receiving proper care or not.
  54. 54. • Contribute innovation & improvement of patient care. • Participating in improvement projects &patient safety initiatives.
  55. 55. • Participating in CNE programs & in-service education programs. • Periodic & continuing appraisal & evaluation of health care situation of patient. • Participate in research works related to quality assurance. • Nurse identifies area where need improvement in delivery of care
  56. 56. RELATED RESEARCH 1) Development of an instructional quality assurance model in nursing science • Result- The result of instructional quality in nursing science program is in high level (level 4 & 5 according to rating scale). Generally all standards are in good level.
  57. 57. 2)Evaluation of quality assurance model for Public Health Nursing. • Project was conducted for one year period. The project was based on ANA Model for Quality Assurance & assessed standard for an overall Quality Assurance Program.
  58. 58. • Purpose of the study- To analyze baseline outcome criteria for a Quality Assurance Program and to implement and interface evaluation methodologies on Public Health Nursing (PHN) services within the IHS to:
  59. 59. 1) Identify the amount and kind of quality services provided and the strengths and barriers. 2) Provide recommendations for improvement in the quality of service. 3) Provide an action plan for implementing changes to improve the quality of PHN care to recipients.
  60. 60. • STUDY FINDINGS- Outcome criteria standards are being met in a high percentage of instances - in the 60 to 70 percentiles. • This was considered outstanding. • Patient Satisfaction Surveys indicated extremely high satisfaction with public health nursing services - in the 95 to 99 percentiles. • Peer Review and Utilization Review standards also showed a very high positive percentile ranking.
  61. 61. THEORY APPLICATION • FLORENCE NIGHTINGALE ENVIRONMENT THEORY Florence Nightingale was the first person to describe about standards of nursing (1859) in “Notes of nursing, what it is & what it is not”. In this, she wrote about change to achieve high standards.
  62. 62. . NNDCLIENTCLIENT HOUSING AIRLIGHT FOOD NOISE CLEANLINESS BEDDING VARIETY HEALTH OF HOUSE HOPES/EMOTIONS
  63. 63. MODEL APPLICATION STRUCTURE PROCESSOUTCOME
  64. 64. • SYSTEM- Diarrhoea control program • STRUCTURE • Trained community workers. • ORS packets. • Accessible health centres. • PROCESS • Education to mothers. • Rehydration therapy. • Diagnostic studies.
  65. 65. • OUTCOME • Number of children treated. • No. of complications arose. • No. of deaths due to diarrhoea.
  66. 66. A STRUCTURE PROCESS OUTCOMES (CAUSAL PAST) FUTURE PARTICIPANTS CARING RELATIONSHIP (TERMINAL OUTCOMES) 1. PROVIDER • PHENOMENALFIELD • DESCRIPTORS • LIFE EXPERIENCE 2. PATIENT /FAMILY • PHENOMENALFIELD • DESCRIPTORS • LIFE EXPERIENCE 3. SYSTEM • RESOURCES • WORKLOAD • ENVIRONMENT OF ORGANIZATION 1. PROVIDER • SATISFACTION • PERSONALGROWTH 2. PATIENT • QUALITY OF LIFE • SAFETY • SATISFACTION OF TREATMENT • KNOWLEDGE 3. UTILIZATION • RESOURCE • CONSUMPTION • COST IMMEDIATE OUTCOMES FEEL “CARED FOR” RELATIONSHIP CENTERED INDEPENDENT RELATIONSHIP PT. /FAMILY- NURSE + COLLABORATIVE RELATIONSHIP WITH HEALTH CARE TEAM NURSE PROFESSIONAL ENCOUNTERS
  67. 67. Presenter’s view
  68. 68. Point to be discussed Current Scenario of Quality Assurance in Government & Private Hospitals In Madhya Pradesh.
  69. 69. Summary

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