Accountability for nursing practice has significant roots in the history of nursing. FlorenceNightingale, the founder of modern nursing, was one of the first to document the need for asystematic approach for reviewing the quality of nursing care. She identified the need toincorporate health data and statistics in quality assurance activities. The quality assurance forPublic Health Nursing is to provide specific standards, measurement tools and processes forimproving the quality of public health nursing practice. The extent to which the standards areimplemented is determined by those who govern the day-to- day activities of public healthprogra

1. UNIT-VII
QUALITY ASSURANCE
DR.ANJALATCHI MUTHUKUMARAN
VICE PRINCIPAL
ERA COLLEGE OF NURSING

2. Introduction:
Accountability for nursing practice has significant roots in the
history of nursing.
Florence Nightingale, the founder of modern nursing, was one
of the first to document the need for a systematic approach
for reviewing the quality of nursing care.
She identified the need to incorporate health data and
statistics in quality assurance activities.
The quality assurance for Public Health Nursing is to provide
specific standards, measurement tools and processes for
improving the quality of public health nursing practice.
The extent to which the standards are implemented is
determined by those who govern the day-to- day activities
of public health programs

3. Quality assurance:
• Quality assurance can be defined as “the
promise or guarantee that certain standards
of excellence are being met in care delivered.

4. Principles for conducting Quality Assurance in
Community Health Nursing:
Expect Excellence.
Use a positive approach and expect to find
excellence. The site visit provides an
opportunity to identify, acknowledge and/or
share models of excellence, which may benefit
other public health practice settings.

5. Apply CQI Concepts.
• QualityAssurance/Quality Improvement is a
process and a journey. Where there are
opportunities for improvement, be
constructive when suggesting alternative
solutions

6. Respect the Environment.
• Site visitors do not normally work at the site
and need to be
• mindful of the site’s policies and procedures,
hours of operation, routines, wearing of
• proper identification and professional attire,
etc.

7. Focus on Established Standards.
• Site visits should be based on established
standards.

8. Build the Partnership.
• Site visitors need to work side by side with
staff from the site throughout the site visit.
This provides an opportunity to discuss and/or
clarify all findings in a collaborative manner

9. Clinical Record Documentation Standards for
community health nurses:
• 1. Contents of a clinical record must meet all regulatory, accrediting and
professional organization standards. Common requirements specific to
nursing documentation include, but are not limited to:
• a. The nursing assessment and care provided;
• b. Informed consent for any/all procedures;
• c. Teaching provided either to the client directly or to his/her family; and
d. Response and reaction to teaching.
• 2. Determine and assure adequate security measures for the entire
documentation system, electronic and/or paper.
• 3. Record the client's name on every page.
• 4. Record the date and time on all entries.
• 5. Sign every entry with full name and initials of professional and
educational titles (e.g., RN,
• APRN, FNP).

10. continued
• 6. Entries by students, interns, and residents should indicate title (e.g.,
SN: Student Nurse) and be countersigned by the licensed professional
supervising their training.
• 7. Make sequential entries, only on approved forms and in approved
locations on the client's record.
• 8. Make all entries permanent. For handwritten entries, use only blue
or black non-erasable ink. Do not alter the character of a record with
“white-out”, highlights, scratching or their markings. Any change in
character or altered look in any of the documentation should never
occur in a client’s medical record.
• 9. Do not attempt to erase, obliterate or “white-out” a handwritten
error. If errors are made, write "error" and initial/date the line.
• 10. Assure that entries are legible, with no blank spaces left on a line or
in any area of documentation. Draw a line through blank spaces to the
end of a line, or use diagonal lines to mark through an area. (In a
lawsuit, an effective case may be made for a sloppy record to suggest
sloppy care

11. Continued
• 11. Use only standard, approved or accepted list of abbreviations,
acronyms, symbols and dose designations as outlined in the current
policy on standard abbreviations (See copies of policy and
standardized list in the current Public Health Nursing Policies and
Practice Guidelines Manual).
12. Write entries specifically and completely, using objective data from
one's own observation, assessment and treatment of the client.
Avoid language that is ambiguous, vague or speculative.
13. Make all entries promptly and within appropriate time periods,
given the client's condition and diagnosis.
14. Late entries or entries made at a day/time other than when care
was provided should be clearly indicated.
15. Write objectively and with extreme care when making entries that
describe an adverse episode and subsequent interventions.
16. Specify the client's approval when family members or non-
healthcare professionals serve as translators or when documenting
informed consent (including signed consent forms).

12. • 17. Document all counselling and education given to the
client. Be specific, including client's reactions and responses.
• 18. Specify when a client fails to comply with recommended
self-care regimen or refuses to accept recommended
diagnostics and/or treatment.
• 19. Record the date, time and content of all telephone
communications. If messages are left for a client, document
the name/relationship of the person taking the message.
• 20. Assure that entries of verbal orders are signed by the
order-giver within the time frame established by
organizational policy.
• 21. To assure continuity of care for clients, all clinical health
information pertaining to anindividual client should be stored
in one clinical record, which includes clinical data from any
single service, encounter, and/or program.

13. Role of community health Nurse in
quality assurance
• Nurses should be the active participant of interdisciplinary quality
improvement team.
• Development mechanism for continually monitoring the
effectiveness of nursing care
• both a collaborative and an individual professional activity.
• Contribution in innovations and improvements of patient care.
• Participating in improvement projects and patient safety initiatives
• Participate in continuing educational programs and in-service
educational programs for
• continuing professional development
• Participate in research works related to quality assurance

14. Conclusion:
• The Community Health Nursing Quality
Assurance (QA) provides consultation services
to achieve an effective health care delivery
system for our County through conducting
clinics and programs. Community Health
Nursing Quality Assurance is found in home
health and health maintenance organizations

15. References:
• 1. Joseph, Eric D. and Webster, Nancy E, The Record that Serves and
Protects, 1st ed., Care Education Group, Inc., 1999.
• 2. Missouri State Health Department, "Documentation, General
Documentation
• Guidelines", www.health.state.mo.us/Publications/300-25.html.
• 3. Barry Herrin, J.D., telephone conversation, recorded by Argartha
Russell, RN, MSA, CPHQ,September 13, 2000.
• 4. ―Guidelines and Legal Principles for Clinical Record
Documentation in Public Health Nursing , Georgia Department of
Community Health, Division of Public Health, Office of Nursing,
(DVD), 2008.
• 5. ―Principles for Documentation, American Nursing Association,
Silver Spring, 2005.