Quality assurance in nursing

1. SEMINAR
ON
QUALITY ASSURANCE IN
NURSING
Submitted to:
Mr. Renukaprasanna M S
Asst Professor
Dept of Psychiatric Nursing
TMCON, TMU
Submitted by:
Ms Cindrella Burge
I Msc Nursing
Dept of Medical -Surgical
nursing
TMCON, TMU

2. AIM
At the end of the seminar, the group is able to
identify and describe the quality assurance in
the nursing.

3. SPECIFIC OBJECTIVES

4. 1. The group is able to define Quality and certain other
terms in relation to it.
2. The group is able to understand the concept of
quality in health care.
3. The group is able to state the principles of quality
assurance in nursing.
4. The group is able to recognize the factors affecting
quality assurance in nursing.
5. The group is able to summarize on the topic of
quality assurance in nursing.

5. TERMINOLOGY

6. 1. QUALITY - Degree of excellence.
2. ASSURANCE- A positive declaration to give
confidence / promise.
3. QUALITY ASSURANCE- The maintenance of a
desired level of quality in a service/ product,
especially by means of attention to every stage of
the process of delivery or production.
4. QUALITY ASSURANCE IN NURSING – A quality
assurance nurse looks for ways to improve
procedures within a health facility, with the goal of
improving patient care.

7. 5. QUALITY CONTROL – Activities that evaluate,
monitor, or regulate services rendered (provide) to
consumers.
6. QUALITY CARE - Right person doing:
• The right thing
• In the right way
• At the right time
• In the right place

8. 7. QUALITY IMPROVEMENT- Is concerned with
performance improvement and is ongoing, involved
with fixing problems now, costly mistakes in the
future and fostering breakthroughs.
8. STANDARD- Pre-determined level of excellence
that:-
• Serves as a guide for perfect practice and
• Comprises a Model to be followed and practiced.

9. 9. TOTAL QUALITY MANAGEMENT- Also
referred to as continuous quality improvement.
It focus on satisfying customer's expectation;
identifying problems, building commitment, and
promoting open decision-making among
workers.

10. INTRODUCTION

11. Quality assurance in health care is the burning issue
of the time. Throughout ages, the purpose of nursing
is to give services that are beneficial to mankind – to
care, to help and to heal. Over the years as nursing
practice has become a profession, its primary
purpose has been not only to provide care, but also
to improve its standards of practice.

12. Quality assurance is based on
planning ,
production ,
presentation,
distribution, and
staff training.

13. DEFINITION
• Quality assurance in nursing is about an on-
going, systematic comprehensive evaluation of
health care services and the impact of those
services on health. - Kozier
• Quality assurance is defined as all activities
undertaken to predate and prevent poor quality.
-Neetvert (1992).

14. NEED OF QUALITY ASSURANCE

15. Meet costumer’s needs and expectations.
Improve the health status of people.
Increased demand for effective and appropriate care.
Minimize waste of limited resources and reduce cost.
Standardize care and control variation.
Ensure safety and minimize risk.

16. OBJECTIVES OF QUALITY ASSURANCE:
According to Jonas (2000), the 2 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 results.

17. Other specific objectives are:
• NCP
• Attend the patient physical (air, water, food,
sleep, shelter, protection and security) and non
physical needs (self actualisation, esteem, and
acceptance).
• Evaluate achievement of nursing care
• Support delivery of nursing care with
administrative and managerial services.

18. PRINCIPLES OF QUALITY ASSURANCE

19. FOCUS ON
Clients
need
Data as
basis for
decision
System
and
processes
Team
approach
to problem
solving and
quality
improveme
nt

20. CONCEPT OF QUALITY ASSURANCE
• Quality is defined as the extent of resemblance
between the purpose of health care and the truly
granted care.
• Quality assurance is a dynamic process.
• It is a guarantee to the society that services
provided by nurses are being regulated by
members of profession.

21. • Quality assurance is a judgment concerning the
process of care, based on the extent to valued
outcomes.
• Quality assurance as the monitoring of the
activities of client care to determine the degree
of excellence attained to the implementation of
the activities.

22. QUALITY ASSURANCE PROCESS

23. QUALITY
ASSURANCE
PROCESS
1. Establishment of
standards or
criteria
2. Identify the
information relevant
to criteria
3. Determine ways
to collect
information
4. Collect and
analyze the
information
5. Compare
collected
information with
established criteria
6. Make a judgment
about quality
7. Provide
information and if
necessary, take
corrective action
regarding findings
of appropriate
sources.

24. EFFECT OF POOR QUALITY OF CARE

25. PATIENT FAMILY SOCIETY HOSPITAL
AND
INSTITUTION
CARE
PROVIDER
AND STAFF
Physical
discomfort
Inconvenient Increased
prevalence of
disease
Increased length
of stay
Reduced
motivation
Mental stress Loss of trust Increased risk of
certain infection
overcrowding Risk of infection
to staff
Increased length
of stay
Higher expenses Unhealthy
people is
medically more
demanding.
Higher rate of
complication
Burn out and
frustration
Complication
development
Family disputes Decreased
outcome
Loss of working
days

26. DIMENSION OF QUALITY ASSURANCE

27. Efficacy
Appropriateness
Availability
Timeliness
Effectiveness
Continuity
Safety
Efficiency
Respect and caring

28. STANDARDS
It is a pre-determined baseline condition or level of
excellence that:-
• Serves as a guide for perfect practice and
• Comprises a model to be followed and
practiced.

29. Standards as a Pre-requisite for Quality Care
• Historical Background
Nursing has come a long way as a profession since
the days when Florence Nightingale established
basic standards for education of nurses. The
standards she set emphasized the importance of
nurses’ understanding the rationale for their actions.
She designed a curriculum that included classroom
time and study as well as the practice.

30. Her innovations clearly indicated that she believed in
the value education for practicing nursing rather
than in the mere repetition of certain behaviours,
without supervision.
In 1893, Lystra E. Gretter led a committee of nurses
in the development of “The Florence Nightingale
Pledge”. This was an effort to identify a set of ethical
behaviour by which nurses could be judged.

31. One passage within it states, “I will do all within my
power to maintain and elevate the standard of my
profession.” However, the standard for the profession
was not defined at that time and a clear objective
establishment of standards was not attempted until
much later. It was not until 1960s and 1970s that the
American Nurses Association began developing
standards for nursing practice in general and for the
various specialities.

32. Standard as Important Part of Quality
Care
Standards for nursing practice help to fulfil the
profession’s obligations to provide quality
nursing services to clients. They focus on
nursing care needs of the patient and what the
patient can expect from nursing services. They
are essential to a professional nurse.

33. We need standards because these:
● provide guidelines and directions for nursing
performance;
● provide a baseline for evaluating quality of nursing
care;
● helps in improving quality nursing care;
● increase effectiveness of care;
● help in supervision and
● guide staff to improve their performance.
● decrease the cost of nursing care.

34. Types of Standards
i) Normative Standards: These standards describe
higher quality of practices, e.g. standards set by
professional association.
ii) Empirical Standards: These standard set by law
enforcement bodies and regulatory bodies – like
health departments.

35. STEPS OF STANDARDS FORMATION

36. Organize
into a
small
group of
nurses
Decide
out
standar
ds
Review,
revise
philosop
hy
Review
nursing
theories,
nursing care
practices
identify
the client
for
nursing
service
Write the
statement
s
Discuss
them with
the nursing
services
providers
checklist
for making
observatio
n of care
given
Determine
the validity by
giving to the
expert
Try out of
the
standard to
determine
the validity
The
standard
s are not
put into
practice
and
quality
care is
audited
Assist
public in
understan
ding what
to expect
from
nursing
practice.

37. QUALITY ASSURANCE MODEL IN
NURSING
Set of elements
Related to each other

38. comprise of:
1. planning for quality,
2. development of objectives, setting and
3. actively communicating standard,
4. developing indicators,
5. setting thresholds,
6. collecting data to monitor compliance with set
standard for nursing practice and
7. applying solution to improve care.

39. PURPOSE
• Develop confidence of receivers
• Ensure quality nursing care
• To meet the expectation of receiver,
management and regulatory body

40. CYCLE OF QUALITY ASSURANCE

41. It define
acceptable
standard of
service
Compare
services of
standard
Implement
development
and changes
as needed
Monitor the
effects of
changes and
development

42. MODELS OF QUALITY ASSURANCE

43. 1. System model for quality
assurance
2. ANA quality assurance model
3. JCAHO quality assurance model
4. ISO (International Organisation for
Standardization) quality assurance model
5. PDCA (Plan, Do, Check, Act) CYCLE
6. Six sigma
7. DMAIC (Define, Measure process
performance, Analyze the process, Improve
process, Control the improved process)
8. DMADDV (Define, Measure of quality,
Analyze, Design, Detail, Verify the definition)

44. System Model
Tasks are broken down into manageable
components based on defined objectives.
Basic components of the system are -

45. 1. Input
(structure) -
2. Throughout
(process)-
3. Output (outcome)
Geographical
location of facility
Treatment process Death rate
Nurse to patient
ratio
Appropriateness Adverse event
Equipments and
supplies
Use of diagnostic
test Re-admission
Rules and
procedures
Use of procedure Length of hospital
stay
Technology IPR Cost of service
Documentation Patient's of
satisfaction

46. Planning
Implementation
Evaluation
Review
ISO Quality Assurance Model

47. FACTORS AFFECTING QUALITY
ASSURANCE IN NURSING CARE

48. • Lack of resources
• Personnel problems
• Improper maintenance
• Absence of well informed population
• Lack of good and hospital information systems
• Lack of nursing care records
• Lack of good supervision
• Absence of knowledge about philosophy of nursing care
• Lack of evaluating technique
• Lack of in-service and continuing education and staff development
program.

49. STEPS IN DEVELOPING QUALITY
ASSURANCE IN HOSPITALS
Quality assurance is a cyclic process of
1. setting standards of care;
2. measuring care according to these standards,
3. evaluating data from chart review,
4. observations, and interview and
5. making recommendations for improvement.

50. APPROACHES TO QUALITY
ASSURANCE
A quality assurance programme consists of
different methodologies which focus on:
A) Planning of action to be developed.
B) Communicating these standards to those who
will use them.
C) Developing indicators and thresholds to
continuously monitor these standards.
D) Problem-solving and process improvement.

51. Two major categories of approaches
exist in quality assurance.
1) general approach: it examines the ability of the
agency to meet criteria or standards.
2) specific approaches: these are methods used
to evaluate provider and client interaction.

52. BENEFICIARIES OF QUALITY
ASSURANCE PROGRAMME
1) The recipients of care who receive safe effective satisfying
services.
2) The care providers because evaluation offers opportunity to
promote personal and professional growth.
3) The agencies – which obtain data for planning, cost containment
and legal protection.
4) The profession – quality assurance programme promotes
development of standards and protocol and generations of new
knowledge.

53. ROLE OF NURSE IN QUALITY
ASSURANCE
1. Maintenance of a current knowledge base and
competencies.
2. Interpersonal skills.
3. Caring and compassion.
4. Mutual and decision making with client and
nurse.
5. Individualized treatment.

54. CONCLUSION
Quality assurance in nursing is about assuring
quality in nursing by ensuring that practices are
compliant with quality standards. This is a full-
fledged profession with its own educational and
experience requirements. Quality assurance in
nursing has to be understood from the
standpoint of quality assurance and compliance.

55. BIBLIOGRAPHY
Books
• Brar N. K., Rawat H.C.( First Edition 2015) Textbook Of Advanced Nursing
Practice, Quality Of Assurance In Nursing
• Soni S., Forwarded By Bobby Kj, Nair P., Sunita Ks (2014)Textbook Of
Advance Nursing Practice
• Khan, Yasmeen, ‘Factors Affecting Quality Assurance In Nursing’, Nursing
Journal Of India, 90 (8); 173-175.
• Sridhar, S.S. (1998), ‘Quality Assurance in Nursing’, Indian Journal of
Nursing and Midwifery, 1 (2), 5.7.

56. Websites
• Www.Slideshare.Net/Quality_Assurance_26354281
• Http://Currentnursing.Com/Nursing_Managment/Quality_Standards_Nursin
g.Html

57. THANKYOU