W.A .Keerthirathne(RN,BScN,PGDDE,Dip Teaching & Sup,Dip in Edu,Mgt & Leadership,Dip in Psy) Special Grade Nursing Tutor PBCN

1. Quality management
in
Emergency Care
Department
W.A .Keerthirathne(RN,BScN,PGDDE,Dip Teaching
& Sup,Dip in Edu,Mgt & Leadership,Dip in Psy)
Special Grade Nursing Tutor
PBCN

2. is a nursing specialty in
which nurses care for
patients in the emergency
or critical phase of
their illness or injury.

3.  Emergency Nursing is a specialty in which nurses
care for patients in the emergency or critical phase of
their illness or injury and are adept at discerning life-threatening
problems, prioritizing the urgency of
care, rapidly and effectively carrying out resuscitative
measures and other treatment, acting with a high
degree of autonomy and ability to initiate needed
measures without outside direction, educating the
patient and his family with the information and
emotional support needed to preserve themselves as
they cope with a new reality. These activities may be
carried out in a variety of settings and not necessarily
in an "Emergency Room."

4. Every other specialty of nursing,
 a patient arrives with a diagnosis by a physician and the
nurse must manage patient's care according to that
diagnosis,
 Emergency nurses work with patients diagnosis has not yet
been made and the cause of the problem is not known.
 Emergency nurses frequently contact patients in
the emergency department before the patient sees a
physician.
 In this situation, the nurse must be skilled at rapid,
accurate physical examination, early recognition of life-threatening
illness or injury, the use of advanced
monitoring and treatment equipment, and in some cases,
the ordering of testing and medication according to
"advance treatment guidelines" or "standing orders" set out
by the hospital's emergency physician staff.

5.  . How is "Emergency Nursing" different from other
nursing?
 An Emergency Nurse is hold high degrees of
knowledge and skills, with diagnostic and decision-making
power to effectuate urgently needed activities
in autonomous or in the closely-collaborative with
other health professionals. An Emergency Nurse is
capable of providing a broad spectrum of skills that in
other settings would be delegated to other health care
workers. Without disregarding the critical activities,
Emergency Nurses commonly triage and treat less
urgent problems, providing care and treatment of
those injuries or illnesses, and providing the
educational and psychosocial evaluations and support
to return the patient successfully

7.  High level of value or excellence
 How good or bad some thing

8.  The combine and unceasing
effort of everyone

9.  The combine and continuous effort of
every one ,health care professionals,
patients and their families, payers
,researchers, educators and planners
 to make changes that will leads to
better patient outcome(health),
 better system performance(care)
 and better professional
development(learning)

10.  Concept is complex
 Main goal is to change performance not to
discover new knowledge.
 To do their work, improve it.
 Change in care process and routine work in
health care
 All improvement require changers but not
every change is improvement.
 Do more carefully.
 Faster ,better, more effective and safer

11.  Patients in emergency care not always satisfied
with the care
 Nursing care describe as instrumental and non-holistic.

12.  Information
 Respect and empathy
 Pain relief
 Nutrition
 Waiting time
 General atmosphere
 Patent safety
 Cost effectiveness
 Evidenced based practice

13. 2. Determine solution
I Identify a problem
7. Document and educate 3. Implement solution
6. review accordingly 4. Communicate the process
5. Monitor and analyse

14.  Safety
 Timely Access
 Equitable
 Efficacy
 Efficient
 Patient Centered

15.  How can you improve a system to achieve
better results in the 6 pillars of quality?

16.  You need a good understanding of
the system
 You need to understand where it is
failing - Identify what is wrong
Make sure it is the step that needs
fixing
Then you can implement a change to
the “system”

17.  System = any assembly of procedures,
resources and routines to carry out a specific
activity

18.  To understand a system and identify what is
wrong with it Map it out!

19.  Use a flow chart/diagram
 Use different perspectives (a
doctor’s perspective is different to a
nurse’s or a porter’s to a patient’s
perspective)

21. 1. The Aim: What are we trying to
accomplish? (How good do we want to
get and by when?)
2. The Measures: How will we know a
change is an improvement?
3. The Changes: What change can we
make that will result in improvement?

22. What are we trying to accomplish?
How will we know that a change is
an improvement?
What change can we make that will
result in improvement?
ACT PLAN
STUDY
DO
MODEL FOR IMPROVEMENT

23.  Plan a change
 Do the change
 Study the results
 Act on the results
ACT PLAN
STUDY
DO

24.  Eight fundamental
priority rights to
improve quality of
emergency
department

25.  Health care staff who are
appropriately trained and qualified
to deliver emergency care, with the
early involvement of senior doctors
with specific expertise in E M where
life-threatening/changing illness
(physical or mental) or injury is
suspected.

26. 1. Properly equipped (for example with monitoring
equipment and supplies)
2. Appropriate compliance with hygiene
3. Infection control measures reduce the incidence of
hospital acquired infection for the anticipated
number of patients and all commonly presenting
conditions, as well as less common but predictable
emergencies.

27. 3.Adequate space to provide the necessary patient
care in an environment that is secure and
promotes patient privacy and dignity;
4. Acutely ill and injured patients should not be
routinely cared for in hallways or non-equipped
overflow spaces.

28.  At all levels of ED function, from
managerial/administrative levels to the
frontline, the importance of critical thinking in
decision making should be recognized and
emphasized.

29.  To ensure early recognition of those patients
requiring immediate attention and prompt
time critical interventions, and the timely
assessment, investigation and management of
those with emergency conditions

30.  Patient-centred care with an emphasis on
relieving suffering, good communication and
the overall experience of patients and those
accompanying and/or caring for them.

31.  Optimal outcomes from treatment within the
ED for all patients presenting with emergency
healthcare needs.

32.  Which enables the patient to access timely and
appropriate emergency care, and which
continues to support them after they have left
the ED. There should be strong links to the
community including education and
prevention, alongside the promotion of public
health.

33.  From community and hospital-based
healthcare teams, and managers of the ED,
who should ensure that the above
arrangements are sustainable. There should be
established and agreed mechanisms to monitor
standards and compliance, with action taken if
an ED falls short.

34.  Appropriate access and utilization of, diagnostic
support services (e.g. plain radiography,
ultrasound, CT scanning and laboratory services)
by EM doctors when needed for the immediate
diagnosis of life threatening conditions
 Expertise in critical care in collaboration with
colleagues from anaesthesia and intensive care
 Early access to specialist inpatient and outpatient
services to assure appropriate on-going evaluation
and treatment of patients with emergency care
needs

35.  Appropriate duration of stay in the ED to
maximise patient care and comfort, and to
optimise clinical outcomes
 Additional services to enhance the quality and
safety of emergency care. Such as short-stay/
observation facilities, alternative patient
pathways, social and mental health services or
associated outpatient activity.
 However excellent ED care is the constant
development of innovative and enhanced
services to support the delivery of quality and
safety.

36.  Safe - Avoiding harm to patients .
 Effective -Providing services based on
scientific knowledge to all who could benefit, and
refraining from providing services/care to those
not likely to benefit.
 Patient-centred -Providing care that is respectful of
and responsive to individual patient preferences,
needs, and values .
 Timely -Reducing waits and sometimes harmful
delays .
 Efficient -Avoid waste (personnel, ressources,
finance).
 Equitable -Providing care that does not vary in
quality because of personal characteristics .