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PRESENTED BY:
AMIT NEWTON
MSC (N) FINAL YEAR
QUALITY ASSURANCE IN
NURSING(INC)
OBJECTIVES
 To introduce the topic quality assurance.
 To explain concept of quality assurance.
 To explain components of quality assurance.
 To enumerate the standards of quality
assurance in nursing.
 To describe the models associated with
QAN.
 To explain the format of QAN.
 Recorded observation of poor quality care
and made recommendations for
improvement.
Concept of Quality Assurance
 Quality assurance is a dynamic process through
which nurses assume accountability for quality care
they provide. It is a guarantee to the society that
members of profession are regulating services
provided by nurses. Quality assurance is a judgment
concerning the process of care, based on the extent
to which that cares contributes to valued outcomes.
DEFINITIONS
 “Quality assurance is a monitoring of the
activities of the client care, to determine the
degree of excellence attained to the
implementation of the activities”
-BULL
 “Quality is defined as the extent of
resemblance between the purposes of health
care and the truly granted care”.
- by donabedian
PHILOSOPHY OF QUALITY ASSURANCE
MODEL
Set of elements that are related to each
other and includes planning for quality,
development of objectives, setting and
communicating standards, collecting
data to monitor compliance with set
standards and to improve care.
1.Do good for person/receiver of care, do no
harm, maintain respect for life and human
dignity, believe in justice and fairness.
2.Be responsible and accountable for
providing quality care with set standards.
3.Be obliged to create public awareness.
4.Have moral obligation to provide services as per
the prescribed norms of regulatory body/health
care system.
5.Work in conjugation with legislation and
accreditation.
6.Be commited to advancement of profession.
COMPONENT OF QUALITY ASSURANCE
PROGRAMME
JACHO’S [ Joint Commission on Accreditation of
Health Care Organizations] 10 steps for Quality
Assurance
 Establish responsibility and accountability for a
quality assurance program.
 Define the scope of service for clinical area.
 Define the key aspects of service for the clinical
area.
 Develop quality indicators to monitor the
outcome and appropriateness of care delivered.
 Establish thresholds for evaluation of indicators.
 Collect and analyze data from monitoring
activities.
 Evaluate results of monitoring activities.
 Resolve problems through developments of action
plans.
 Re-evaluate to determine if the plan was
successful.
 Communicate Quality Assurance results to the
organization.
PROCESS OF QUALITY ASSURANCE
set standards
assess or appraise
planning
action
STANDARDS
 “Professionally developed expressions
of the range of acceptable variations
from a norm or criterion.”
(donabedian 1985)
 “level of performance required for obtaining
a specified desired outcome.”
(INC)
BENEFICIARIES OF QUALITY ASSURANCE
PROGRAMME
 1.Recipients of care
 2.Care provider
 3.Agencies
EVALUATION
 GENERAL APPROACH
1.Credentiality
 Formal recognition of professional or
technical competence and attainment
of minimum standards by a person or
agency.
 2.Licensure
 Contact between the profession and the
state in which the profession is granted
control over exit and entry from the
profession.
 Licensure of nurse(1903).
 3.Certification
 Educational achievements ,experiences
and performances on examination.
 Used to determine the person’s
qualification.
 4.Accreditation
 Accreditation process evaluated on
agency physical structure,
organizational structure and personal
qualification.
 Outcome of care and educational
qualification of person providing care.
 SPECIFIC APPROACH
1.Staff review committee
 AUDIT PROCESS
 UTILIZATION REVIEW
ANALYSING
 MAJOR MODELS HAVE BEEN USED FOR
QUALITY ASSURANCE ANALYSIS
1. ANA quality assurance model
2. Donabedian’s Structure-Process-Outcome Model
3. Tracer Method
4. The Sentinel Method
DONABEDIAN’S MODEL
 In this model it is being evaluated whether
the established structure, process and
outcome standards are achieved or not???
 Structure evaluation; data can be
obtained from existing documents of an
agency.
 Process evaluation: data can be obtained
via direct observations, review of records,
audit checklist.
 Outcome evaluation: data can be
collected from vital statistical records.
TRACER METHOD
 Measure of both process and outcome of care.
 One must identify a volume of client with
particular characteristics.
 Establishes a criteria for good care.
 Show outcome difference as a result of care.
SENTINEL METHOD
 Outcome measure for examining specific
instances of client care.
 Cases of unnecessary diseases, disability
death are counted.
 Circumstances surrounding the unnecessary
events are examined in detail.
ANA QUALITY ASSURANCE MODEL
 This first proposed and accepted model of quality
assurance was given by Long & Black in 1975. This
helps in the self-destruction of patient and family.
Nursing health orientation, patient’s right to quality
and nursing contribution.
ANA quality assurance model
Identify
values
Identify
standard
criteria
Select
measurement
Make
interpretation
Course of
action
Choose
action
take
action
evaluation
FACTORS AFFECTING QUALITY
ASSURANCE
 1.Lack of Resources
 2.Personnel Problems
 3.Improper Maintenance
 4.Absence of Accreditation Law
 5.Lack of good Hospital Information System
 6.Absence of Conducting Patient Satisfactory Survey
 7.Lack of Nursing Care Records
FORMAT OF WRITING (LANG 1989)
 TOPIC: Treating side effects of chemotherapy
 Subtopic: control of vomiting
 Care group: patient receiving cytotoxic drugs
 Standard statements: patient receiving cytotoxic
drugs receive nursing care support to reduce
vomiting to an optimum level.
STRUCTURE PROCESS OUTCOME
1.Clean
environment for
each patient.
1.Encourage
protein sources
in diet.
1.Patient accepts
the fact that
vomiting is drug
induced.
2.Qualified staff
to give
confirmation
and advice.
2.Encourage
small frequent
meals as per
likes and
dislikes.
2.Patient takes
the food and
drink given.
STRUCTURE PROCESS OUTCOME
3.Avoid fried
food and advice
blend diet.
3.Patient feels
comfortable.
4.Frequent
mouthwash
5.Maintain
intake output.
6.Give
antiemetics if
prescribed.
SUMMARY
Today we discussed quality assurance in nursing.In
this we discussed the following aspects:
1.Introduction
2.Definitions
3.Purposes
4.Philosophy
5.Process of quality assurance
6.Standards
7.Evaluation
 8.Analysis
 9.Factors
 10.Format of writing QA.
Quality assurance in nursing
Quality assurance in nursing
Quality assurance in nursing
Quality assurance in nursing
Quality assurance in nursing
Quality assurance in nursing
Quality assurance in nursing
Quality assurance in nursing
Quality assurance in nursing
Quality assurance in nursing
Quality assurance in nursing
Quality assurance in nursing
Quality assurance in nursing

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Quality assurance in nursing

  • 1. PRESENTED BY: AMIT NEWTON MSC (N) FINAL YEAR QUALITY ASSURANCE IN NURSING(INC)
  • 2. OBJECTIVES  To introduce the topic quality assurance.  To explain concept of quality assurance.  To explain components of quality assurance.  To enumerate the standards of quality assurance in nursing.  To describe the models associated with QAN.  To explain the format of QAN.
  • 3.  Recorded observation of poor quality care and made recommendations for improvement.
  • 4. Concept of Quality Assurance  Quality assurance is a dynamic process through which nurses assume accountability for quality care they provide. It is a guarantee to the society that members of profession are regulating services provided by nurses. Quality assurance is a judgment concerning the process of care, based on the extent to which that cares contributes to valued outcomes.
  • 5. DEFINITIONS  “Quality assurance is a monitoring of the activities of the client care, to determine the degree of excellence attained to the implementation of the activities” -BULL
  • 6.  “Quality is defined as the extent of resemblance between the purposes of health care and the truly granted care”. - by donabedian
  • 7. PHILOSOPHY OF QUALITY ASSURANCE MODEL Set of elements that are related to each other and includes planning for quality, development of objectives, setting and communicating standards, collecting data to monitor compliance with set standards and to improve care.
  • 8. 1.Do good for person/receiver of care, do no harm, maintain respect for life and human dignity, believe in justice and fairness.
  • 9. 2.Be responsible and accountable for providing quality care with set standards. 3.Be obliged to create public awareness.
  • 10. 4.Have moral obligation to provide services as per the prescribed norms of regulatory body/health care system.
  • 11. 5.Work in conjugation with legislation and accreditation.
  • 12. 6.Be commited to advancement of profession.
  • 13. COMPONENT OF QUALITY ASSURANCE PROGRAMME JACHO’S [ Joint Commission on Accreditation of Health Care Organizations] 10 steps for Quality Assurance  Establish responsibility and accountability for a quality assurance program.  Define the scope of service for clinical area.  Define the key aspects of service for the clinical area.  Develop quality indicators to monitor the outcome and appropriateness of care delivered.
  • 14.  Establish thresholds for evaluation of indicators.  Collect and analyze data from monitoring activities.  Evaluate results of monitoring activities.  Resolve problems through developments of action plans.  Re-evaluate to determine if the plan was successful.  Communicate Quality Assurance results to the organization.
  • 15. PROCESS OF QUALITY ASSURANCE set standards assess or appraise planning action
  • 16. STANDARDS  “Professionally developed expressions of the range of acceptable variations from a norm or criterion.” (donabedian 1985)
  • 17.  “level of performance required for obtaining a specified desired outcome.” (INC)
  • 18. BENEFICIARIES OF QUALITY ASSURANCE PROGRAMME  1.Recipients of care  2.Care provider  3.Agencies
  • 20.  Formal recognition of professional or technical competence and attainment of minimum standards by a person or agency.
  • 22.  Contact between the profession and the state in which the profession is granted control over exit and entry from the profession.  Licensure of nurse(1903).
  • 24.  Educational achievements ,experiences and performances on examination.  Used to determine the person’s qualification.
  • 26.  Accreditation process evaluated on agency physical structure, organizational structure and personal qualification.  Outcome of care and educational qualification of person providing care.
  • 27.  SPECIFIC APPROACH 1.Staff review committee
  • 30. ANALYSING  MAJOR MODELS HAVE BEEN USED FOR QUALITY ASSURANCE ANALYSIS 1. ANA quality assurance model 2. Donabedian’s Structure-Process-Outcome Model 3. Tracer Method 4. The Sentinel Method
  • 31. DONABEDIAN’S MODEL  In this model it is being evaluated whether the established structure, process and outcome standards are achieved or not???  Structure evaluation; data can be obtained from existing documents of an agency.
  • 32.  Process evaluation: data can be obtained via direct observations, review of records, audit checklist.  Outcome evaluation: data can be collected from vital statistical records.
  • 33.
  • 34. TRACER METHOD  Measure of both process and outcome of care.  One must identify a volume of client with particular characteristics.  Establishes a criteria for good care.  Show outcome difference as a result of care.
  • 35. SENTINEL METHOD  Outcome measure for examining specific instances of client care.  Cases of unnecessary diseases, disability death are counted.  Circumstances surrounding the unnecessary events are examined in detail.
  • 36. ANA QUALITY ASSURANCE MODEL  This first proposed and accepted model of quality assurance was given by Long & Black in 1975. This helps in the self-destruction of patient and family. Nursing health orientation, patient’s right to quality and nursing contribution.
  • 37. ANA quality assurance model Identify values Identify standard criteria Select measurement Make interpretation Course of action Choose action take action evaluation
  • 40.  3.Improper Maintenance  4.Absence of Accreditation Law
  • 41.
  • 42.  5.Lack of good Hospital Information System  6.Absence of Conducting Patient Satisfactory Survey
  • 43.  7.Lack of Nursing Care Records
  • 44. FORMAT OF WRITING (LANG 1989)  TOPIC: Treating side effects of chemotherapy  Subtopic: control of vomiting  Care group: patient receiving cytotoxic drugs  Standard statements: patient receiving cytotoxic drugs receive nursing care support to reduce vomiting to an optimum level.
  • 45. STRUCTURE PROCESS OUTCOME 1.Clean environment for each patient. 1.Encourage protein sources in diet. 1.Patient accepts the fact that vomiting is drug induced. 2.Qualified staff to give confirmation and advice. 2.Encourage small frequent meals as per likes and dislikes. 2.Patient takes the food and drink given.
  • 46. STRUCTURE PROCESS OUTCOME 3.Avoid fried food and advice blend diet. 3.Patient feels comfortable. 4.Frequent mouthwash 5.Maintain intake output. 6.Give antiemetics if prescribed.
  • 47. SUMMARY Today we discussed quality assurance in nursing.In this we discussed the following aspects: 1.Introduction 2.Definitions 3.Purposes 4.Philosophy 5.Process of quality assurance 6.Standards 7.Evaluation
  • 48.  8.Analysis  9.Factors  10.Format of writing QA.

Editor's Notes

  1. Death certificates or telephone client interviews.