Quality assurance

1. QUALITY ASSURANCE
QUALITY: DEGREE OF EXCELLANCE
ASSURANCE: MAKE SAFE

2. QUALITY ASSURANCE
STANDARD SETTING
NURSING / CLINICAL AUDIT
OBJECTIVES
AT THE END OF THE SESSION THE STUDENTS WILL BE ABLE TO:
• ACKNOWLEDGE THE IMPORTANCE OF QUALITY ASSURANCE
• ACQUIRE AN UNDERSTANDING THE DEFINITION OF QUALITY
• UNDERSTAND THE IMPORTANCE OF STANDARD SETTING
• ACQUIRE THE KNOWLEDGE ON THE IMPORTANCE OF NURSING
/ CLINICAL AUDIT AND ITS PROCESS

3. QUALITY ASSURANCE
PRIORITISING CLINICAL AUDIT TOPICS
• A review of the patient’s prospective on quality of care
• An area of high cost, volumes or risk
• Evidence of a serious quality e.g. : patient complaints,
infection rates
• The availability of systematic reviews of research or national
clinical guidelines

4. QUALITY ASSURANCE
CONCEPTS OF QUALITY ASSURANCE
PROVISION OF A PROFESSIONAL SERVICE CARRYING
WITH IT OBLIGATION ON THE PROFESSIONAL TO
SATISFY PATTIENTS’ / CLIENTS’ NEEDS AT ALL LEVEL
WHY QUALITY ASSURANCE
IT IMPLIES IDENTIFICATION OF AREAS FOR
IMPROVEMENT AND SELECTIVE ATTENTION TO THE
DEVELOPMENT OF NEW TECHNIQUES IN AREAS OF
GREATEST NEED

5. QUALITY ASSURANCE
STEPS TO QUALITY ASSURANCE
STANDARDS ARE SET
QUALITY ASSURANCE
PERFORMANCE OUTCOMES ARE CHECK
AGAINST THESE STANDARDS
IF THERE IS A SHORTFALL THIS IS USED AS A
FEEDBACK TO CRITICAL PARTS OF THE SYSTEM
ALTERNATIVELY THE STANDARD MAYBE MODIFIED TO
ONE THAT IS SCHIEVABLE

6. QUALITY ASSUARANCE
CONCERN FOR EXCELLENCE AND STANDARD
• FOCUSSING ON INDIVIDUALS CARE OR POPULATION SERVICE
• MUST REFLECT AN INTEREST IN THE PROVISION OF THE HIGHEST
POSSIBLE QUALITY CARE
• IT SHOULD EXTEND TO ALL ASPECTS OF CARE INCLUDING THE
TECHNICAL, THE INTERPERSONAL AND MORAL
SPECIFICITY AND EXPLICITNESS
THE ESSENCE OF HEALTH CARE
QUALITY ASSURANCE
STANDARD ARE SPECIFIED AND OPERATIONALISED AND MEASUREMENT
TOOLS ARE DEVELOPED FOR THEIR APPRAISAL
COMMITTMENT
• BOTH INDIVIDUALS AND ORGANISATIONS MUST BE POSITIVELY
MOTIVATED TO IMPLEMENT QUALITY ASSURANCE AT THE
ORGANISATIONAL LEVEL
• THERE MUST BE RECOGNITION THAT QUALITY ASSURANCE DOES NOT
JUST HAPPEN – IT MUST BE MANAGED

7. QUALITY ASSURANCE
SOCIAL VALUE
INDIVIDUAL
VALUE
PROFESSIONAL
VALUE
INSTITUTIONAL
VALUE
QUALITY

8. QUALITY ASSURANCE
APPROPRIATENESS
QUALITY IN HEALTH SERVICES / IN
INDIVIDUALS
EQUITY
EFFECTIVENESS
EFFICIENCY
ACCEPTABILITY
THE SERVICE OF PROCEDURE IS WHAT THE
POPULATION OR THE INDIVIDUAL ACTUALY
NEEDS
A FAIR SHARE FOR ALL THE POPULATION
ACHIEVING THE INTENDED BENEFIT FOR THE
INDIVIDUAL AND FOR THE POPULATION
RESOURCES ARE NOT WASTED ON ONE
SERVICE OR PATIENT TO DETRIMENT OF
ANOTHER
SERVICES ARE PROVIDED SUCH AS TO
SATISFY THE REAONABLE EXPECTATIONS OF
PATIENTS, PROVIDERS AND THE COMMUNITY

9. QUALITY ASSURANCE
STRUCTURE
THE QUALITY CARE CAN BE STUDIED FROM
THESE ASPECTS
PROCESS
OUTCOME
A. CLINICAL (TREATMENT OF PATIENTS) CARE
B. NON CLINICAL ( MEETING THE PATIENT PERSONAL,
SOCIAL, EMOTIONAL, SOCIAL NEEDS)
CARE INCLUDES
WHERE IS CARE CARRIED OUT
WHAT EQUIPMENT IS USED
WHO CARRIES OUT THE CARE
HOW IS IT CARRIED OUT
WHAT IS THE END RESULTS?
a) PERCIEVED BY PATIENTS / CLIENTS
b) PERCIEVED BY PROFESSIONALS

10. QUALITY ASSURANCE
• A COURTESY
NON CLINICAL ( MEETING THE PATIENT) CARE
B SURROUDINGS THAT SUGGEST COMPETENT HELPS IS AT HAND
C READY ACCES TO THE SUPPORT OF FAMILY AND FRIENDS
D BEING TOLD WHAT WILL HAPPENED AND WHEN
E LACK OF DELAYS

12. QUALITY ASSURANCE
CRITERIA FOR STANDARDS
A STANDARD IS A MEANS OF MEASURE
 RELEVANT
 UNDERSTANDABLE
 MEASUREBLE
 BEHAVIORAL
 ACCEPTABLE
EXAMPLE OF A STANDARD
“ ALL OUT PATIENTS SHOULD BE SEEN BY A DOCTOR WITHIN 30 MINUTS
OF THEIR APPOINTMENTS OR TOLD THE REASON FOR ANY DELAY

13. QUALITY ASSUARANCE
INPUT
PRODUCTIVE LINE MODEL OF HEALTH SERVICES
PROCESS OUTPUT OUTCOME
ACTIVITY
RESOURCE PRODUCTIVITY HEALTH

14. QUALITY ASSURANCE
DEFINITION
IS THE SYSTEMATIC AND CRITICAL ANALYSIS OF THE QUALTY OF
CLINICAL CARE INCLUDING THE PROCEDURES USED FOR DIAGNOSIS,
TREATMENT AND CARE, THE ASSOCIATED USE OF RESOURCES AND THE
RESULTNG OUTCOME AND QUALITY OF LIFE FOR PATIENT
FUNDAMENTAL PRINCIPLES ASSOCIATED WITH CLINICAL AUDIT
CLINICAL AUDIT
IT SHOULD BE
• BE PROFESSIONALLY LED
• BE SEEN AS EDUCATIONAL PROCESS
• FORM A PART OF A ROUTINE CLINICAL PRACTICE
• BE BASED ON THE SETTING OF STANDARS
• GENERATE RESULTS THAT CAN BE USED TO IMPROVE OUTCOME OF QUALITY CARE
• INVOLVE MANAGEMENT IN BOTH THE PROCESS AND OUTCOME OF THE AUDIT
• BE CONFIDENTIAL AT THE INDIVIDUAL PATIENT / CLINICAL LEVEL
• BE INFORMED BY THE VIEWS OF PATIENTS / CLIENTS

15. QUALITY ASSURANCE
OBJECTIVE OF CLINICAL AUDIT
TO IMPROVE PATIENT CARE BY INFORMING THE HEALTH CARE
PROFESIONALS’ UNDERSTANDING OF THEIR CLINICAL PRACTICES
BENEFIT OF CLINICAL AUDIT
CLINICAL AUDIT
• PROMOTE A PATIENT-FOCUS APPROACH TO CARE
• ENCOURAGE MULTI-PROFESSIONAL TEAMWORK
• ENABLES OPEN DISCUSSION ABOUT PRACTICE AND LEARNING FROM MISTAKE

16. QUALITY ASSURANCE
WHO DO THE AUDIT?
IT MUST BE LED BY THE CLINICAL STAFF INVOLVED WITH THE ISSUE
REVIEWED, IN COLLABORATION WITH MANAGERS, AUDIT STAFF AND
PATIENTS
CLINICAL AUDIT

17. QUALITY ASSURANCE
IDENTFYING AN AREA FOR CLINICAL AUDIT
• REQUIRES CAREFUL THOUGHT IN THE SELECTION OF TOPICS
• THE AREA IDENTIFIED MUST ADDRESS THE IMPORTANT ASPECTS OF CONCERNS ABOUT
QUALITY
CLINICAL AUDIT

18. QUALITY ASSURANCE
1. DEFINING
BEST PRACTICES
4 TAKING ACTION
TO IMPROVE
2. IMPLEMENTING
BEST PRACTICES
3. MONITORING AND
COMPARING AGAINST
BEST PRACTICE
MAIN STAGES OF CLINICAL AUDIT

19. QUALITY ASSURANCE
CONCERN ABOUT THE PROVISION OF PRESSURE-RELEIVING
DEVICES FOR THOSE IDENTIFIED AS HIGH RISK PATIENTS
DEVELOPMENT OF PRESSURE SORES
CLINICAL AUDIT OF PRESSURE SORES
(ROYAL BROMPTON HOSPITAL 1991)
HAS INCREASED HOSPITAL STAY
•INCREASED DISCOMFORT
•THE COST IMPLICATIONS WERE EXTREMELY HIGH – WITH A GRADE 4 PRESURE SORE
ESTIMATING COST £25 000 TO TREAT

20. QUALITY ASSURANCE
• 50% OF THE PATIENTS POPULATION WERE AT RISK OF DEVELOPING
PRESSURE SORE
• A NUMBER OF MATTRESSES WERE IN POOR CONDITION
• THERE WAS LACK OF KNOWLEDGE AMONGST WARD NURSES ON AREAS
RELATED TO PRESSURE-RELEVING EQUIPMENT
• LACK OF LIFTING AIDS ON THE WARDS – DISCOURAGING NURSES FROM
LIFTING AND TURNING PATIENTS
• PAIN WAS LIKELY TO BE A CONTRIBUTING FACTOR AS PATIENTS WERE
PREVENTED FROM MOVING IN BED
MAIN FINDINGS
CLINICAL AUDIT OF PRESSURE SORES

21. • An increased risk of costly litigation –health authorities were being sued
anywhere between £100 000 and £1 0000 000 by patients who had
developed sores during their hospital stay .
• All of the above reasons including that 95% of pressure sores are
preventable, led to a clinical audit group for pressure area care being
formed. Representatives of the multi-professional teams comprised of
nurses, occupational therapists, physiotherapists and dietician.
• PILOT AUDIT (1992) 8 mths from the raising of the first concerns through to
completion of the objectives and criteria.
• - A small convenience sample of 4 patients and 4 nurses were audited from
each ward.

22. QUALITY ASSURANCE
•
Each year, the standard and the point prevalence study have been reviewed,
re audited and local and hospital – widw action plan devised to address new
issues:
•A matress replacement programme and the writing of a policy to maintain
this.
•Identifying a nuerse rto coordinate both in-house
•Hold regular meetings with the link nurses to encourage information sharing
•The initial audit 1992 identified the prevalence of pressure sores as being
19% of the patient population. Dropped dramaticcally over subsequent years,
1997 results are just 3% of the patient population, within the DoH guidelines
(1993) stating a commitment to reduce the incidence of pressure sores in
NHS by 5%.
OUTCOME MEASURE

23. QUALITY ASSUARANCE
• LETTERS FROM PATIENTS, COMLPLAINT OR COMMENTS FROM EXTERNAL AGENCIES
• CRITICAL ACCIDENTS REPORTS – WHERE NUMBERS OF STAFF HAVE DESCRIBED AND
ANALYSED IMPORTANT CONCERNS FOLLOWING ONE INCIDENT
• SUMMARIES OF TEAM MEEINGS OR GOOD ROUND WHERE ISSUE HAS BEEN DISCUSSED
• INFORMATION FROM ROUTINE DATA SOURCES INCLUDING OF PATIENTS INVOLVED
• PATIENTS STORIES OF FEEDBACK FROM FOCUS GROUP
• DIRECT OBSERVATION OF CARE
AN OVERVIEW OF THE ASPECT OF
CARE UNDER REVIEW

24. QUALITY ASSUARANCE
• LIST SOME TOPICS FOR CLINICAL AUDIT WHICH YOU THINK
WOULD BE APPROPRIATE FOR YOUR CLINICAL AREA
• CHOOSE A TOPIC FOR A CLINICAL AUDIT PROTECT IN A
SPECIFIC CLINICAL AREA AND DEVELOP YOUR MONITORING
TOOL
• BRIEFLY WRITE REPORT ON THE AUDIT PROCESS AND RESULT
OF THE AUDIT, AND RECOMMENDATION
GROUP WORK

25. QUALITY ASSUARANCE
GROUP WORK
HAND WASHING
NAME OF AUDITEE
AUDITOR
COMPLIANCE
STATUS
STRUCTURE COMPLIANCE
STATUS
REMARKS SIGNATURE
PROCEDURE
YES NO
REMARKS
YES NO AUDITOR AUDITEE
1 Roll up sleeves 1 Antiseptic
Soap
2 Remove rings / wrist watch
bracelet
2 Elbow
operated
tape
3 Use continuously running
water
3 Paper hand
towel or
Hand dryer
4 Position hand to avoid
contaminating arms
4 Tap water
5 Avoid splashing cloth or
floor
5 Written
procedure
6 Apply ample amount of
antiseptic soup
7 Rubs hands vigorously
together
8 Use friction on all surfaces
9 Rinse hands thoroughly
with hand held down to
rinse
10 Dry hands thoroughly
using paper hand towel /
hand dry