You are on page 1of 74

Quality:

 Quality is defined as the extent of


resemblance between the purpose of
healthcare and the truly granted care
(Donabedian 1986).
Quality assurance

 "Quality assurance is the monitoring


of the activities of client care to
determine the degree of excellence
attained to the implementation of the
activities". (Bull, 1985)
 Quality assurance is the defining of
nursing practice through well written
nursing standards and the use of
those standards as a basis for
evaluation on improvement of client
care (Maker 1998).
APPROACHES FOR A QUALITY
ASSURANCE PROGRAMME:
 Two major categories of approaches
exist in quality assurance they are
 General
 Specific
General Approach:

It involves large governing of official


body's evaluation of a persons or
agency's ability to meet established
criteria or standards at a given time.
1) Credentialing:
2) Licensure:
3) Accreditation:
4) Certification:
1) Credentialing:

 It is generally defined as the formal


recognition of professional or
technical competence and attainment
of minimum standards by a person or
agency According to Hinvasky (1981)
credentialing process has four functional
components
a) To produce a quality product
b) To confer a unique identity
c) To protect provider and public
d) To control the profession.
2) Licensure:

 Individual licensure is a contract


between the profession and the state,
in which the profession is granted
control over entry into and exists
from the profession and over quality
of professional practice.
 The licensing process requires that
regulations be written to define the
scopes and limits of the professional's
practice. Licensure of nurses has been
mandated by law since 1903
3) Accreditation:

 National league for nursing (NLN) a


voluntary organization has
established standards for inspecting
nursing education's programs. In the
part the accreditation process
primarily evaluated on agency's
physical structure, organizational
structure and personal qualification
4) Certification:

 Certification is usually a voluntary


process with in the profession. A
person's educational achievements,
experience and performance on
examination are used to determine
the person's qualifications for
functioning in an identified specialty
area.
Specific approaches:

Quality assurances are methods used


to evaluate identified instances of
providers and client interaction.
1) Peer review:
2) Standard as a device for quality
assurance:
3)Audit as a tool for quality
assurance:
1) Peer review:

 To maintain high standards, peer review


has been initiated to carefully review the
quality of practice demonstrated by
members of a professional group. Peer
review is divided in to two types. One
centers on the recipients of health
services by means of auditing the quality
of services rendered. The other centers
on the health professional by evaluating
the quality of individual performance.
2) Standard as a device for
quality assurance:
 Standard is a pre-determined baseline
condition or level of excellence that
comprises a model to be followed and
practiced. The ANA standard for practice
include;
 Standard 1: The collection of data about
health status of the patient is systematic
and continuous. The data are accessible,
communicative, and recorded.
 Standard 2: Nursing diagnosis are derived
from health status data.
 Standard 3: The plan of nursing care
includes goals derived from the nursing
diagnoses.
 Standard 4: The plan of nursing care
includes priorities and the prescribed
nursing approaches or measures to
achieve the goals derived from the
nursing diagnoses.
 Standard 5: Nursing actions provide
for patient participation in health
promotion, maintenance, and
restoration.
 Standard 6: Nursing actions assist the
patient to maximize his health
capabilities.
 Standard 7: The patient's progress or lack
of progress towards goal achievement is
determined by the patient and the nurse.
 Standard 8: The patient's progress or lack
of progress towards goal achievement
directs re-assessment, re-ordering of
priorities, new goal setting, and a revision
of the plan of nursing care.
 To evaluate quality nursing care
regularly, many staff nurses do indeed
welcome opportunity to develop
criteria, to review nursing care
retrospectively and concurrently, and
to discover methods of achieving
higher levels of quality nursing care.
3) Audit as a tool for
quality assurance:
 Nursing audit may be defined as a
detailed review and evaluation of
selected clinical records in order to
evaluate the quality of nursing care
and performance by comparing it
with accepted standards
 To be effective a nursing audit must
be based on established criteria and
feedback mechanism that provide
information to providers on the
quality of care delivered.
QUALITY ASSURANCE MODEL IN
NURSING
Quality assurance model in nursing is the set
of elements that are related to each other
and comprise of planning for quality
development of objectives setting and
actively communicating standards
developing indicators, setting thresholds,
collecting data to monitor compliance with
set standards for nursing practice and
apply solutions to improve care
PHILOSOPHY OF QUALITY
ASSURANCE MODEL IN NURSING
Indian nursing council believes that
nurse will
 Do good for person /receiver of care,
do no harm, maintain respect for life
and human dignity, believe in human
justice and fairness to individuals in
terms of access to resources and care
and protect the vulnerable
 Have moral obligation to provide services
as per the prescribed of the regulatory
body / health care system/ organization
/institution even if it is in conflict with her
personal beliefs and values
 Be responsible and accountable for
providing quality care in line with set
standards
 Be committed to understanding of
dynamic nature of his / her role in
interdisciplinary health team
 Be obliged to create public awareness
and consider social expectations before
making decisions for providing nursing
care
 Be obliged to include receiver in making
choices in planning and implementation
of care
 Work in conjugation with legislation,
accreditation and political system
 Have obligation to promote
education of self and others
 Be committed to advancement of
profession
PURPOSE OF QUALITY ASSURANCE
MODEL
 To ensure quality nursing care
provided by nurses in order to meet
the expectations of the receiver,
management and regulatory body
 It also intends to increase the
commitment of the provider and the
management
GOALS OF QUALITY ASSURANCE
MODEL
 Develop confidence of the receiver
that quality care is being rendered as
per assurance
 Develop commitment of the
management towards quality care
 Increase commitment of providers to
adhere to set standards for nursing
practice and strive for excellence
MODELS OF QUALITY ASSURANCE

1) System Model for Quality


assurance.
2) ANA Quality Assurance Model
3) JCAHO Quality Assurance Model
4) ISO Quality Assurance Model
A System Model for Quality
assurance.

The basic components of the system are


 Input
 Throughput
 Output
 Feedback
i) Input:- Can be compared to the present state of
the system.

ii) Through put:- The through put to the


developmental process.

iii) Out put:- To the finished product.

iv) Feed Back:- It is the essential component of the


system because it maintains and nourish
growth.
AMERICAN NURSES ASSOCIATION
MODEL FOR QUALITY ASSURENCE
 Identify values

 Identify structure, process and


outcome standards and criteria

 Select measurement

 Make interpretation
 Identify course of action

 Choose action

 Take action

 Reevaluate
1) Identify Value:

 In the ANA value identification looks


as such issue as patient/client,
philosophy, needs and rights from an
economic, social, psychology and
spiritual perspective and values,
philosophy of the health care
organization and the providers of
nursing services.
2) Identify structure,
process and outcome
standards and criteria:
 Identification of standards and criteria
for quality assurance begins with
writing of philosophy and objective of
organization. The philosophy and
objectives of an agency serves to
define the structural standards of the
agency.
 Standards of structure are defined by
licensing or accrediting agency.
Another standard of structure
includes the organizational chart,
which shows supervisory methods,
communication patterns, staff
patterns and sometimes staff
assignments. Evaluation of the
standards of structure is done by a
group internal or external to the
agency.
3) Select measurement needed
to determine degree of
attainment of criteria and
standards:
 Measurements are those tools used to gather
information or data, determined by the
selections of standards and criteria. The
approaches and techniques used to evaluate
structural standards and criteria are, nursing
audit, utilization's reviews, review of agency
documents, self studies and review of
physicals facilities.
 The approaches and techniques for
the evaluation of process standards
and criteria are peer review, client
satisfactions surveys, direct
observations, questionnaires,
interviews, written audits and
videotapes.
4) Make interpretations

 The degree to which the


predetermined criteria are met is the
basis for interpretation about the
strengths and weaknesses of the
program. The rate of compliance is
compared against the expected level
of criteria accomplishment.
5) Identify Course of Action

 If the compliance level is above the


normal or the expected level, there is
great value in conveying positive
feedback and reinforcement. If the
compliance level is below the expected
level, it is essential to improve the
situations. It is necessary to identify the
cause of deficiency. Then, it is important
to identify various solutions to the
problems.
6) Choose action

 Usually various alternative course of action


are available to remedy a deficiency. Thus it
is vital to weigh the pros and cons of each
alternative while considering the
environmental context and the availability
of resources. In the recent that more than
one cause of the deficiency has been
identified; action may be needed to deal
with each contributing factor.
7) Take Action:

 It is important to firmly establish


accountability for the action to be
taken. It is essential to answer the
questions of who will do? What? By
when?. This step then concludes with
the actual implementation of the
proposed courses of action.
8) Reevaluate:

 The final step of QA process involves


an evaluation of the results of the
action. The reassessment is
accomplished in the same way as the
original assessment and begins the
QA cycle again.
 Careful interpretation is essential to
determine whether the course of
action has improves the deficiency,
positive reinforcement is offered to
those who participated and the
decision is made about when to again
evaluate that aspect of care.
JCAHO
JCAHO QUALITY ASSURENCE MODEL
ISO QUALITY ASSURENCE MODEL
QUALITY ASSURANCE PROCESS:

 Establishment of standards or criteria


 Identify the information relevant to criteria
 Determine ways to collect information
 Collect and analyze the information
 Compare collected information with established
criteria
 Make a judgment about quality
 Provide information and if necessary, take
corrective action regarding findings of
appropriate sources
 Determine ways to collect the information
FACTORS AFFECTING QUALITY
ASSURANCE IN NURSING CARE
1) Lack of Resources:
2) Personnel problems:
3) Improper maintenance:
4) Unreasonable Patients and
Attendants
5) Absence of well informed
population.
6) Absence of accreditation laws
7) Lack of incident review procedures
8) Lack of good and hospital
information system
9 Absence of patient satisfaction
surveys
10) Lack of nursing care records
1) Lack of Resources:

 Insufficient resources, infrastructures,


equipment, consumables, money for
recurring expenses and staff make it
possible for output of a certain quality
to be turned out under the prevailing
circumstances.
2) Personnel problems:

 Lack of trained, skilled and motivated


employees, staff indiscipline affects
the quality of care.
3) Improper maintenance:

 Buildings and equipments require


proper maintenance for efficient use.
If not maintained properly the
equipments cannot be used in giving
nursing care. To minimize equipment
down time it is necessary to ensure
adequate after sale service and
service manuals.
4) Unreasonable Patients and
Attendants
 Illness, anxiety, absence of immediate
response to treatment, unreasonable
and un co-operative attitude that in
turn affects the quality of care in
nursing.
5) Absence of well informed
population.
 To improve quality of nursing care, it
is necessary that the people become
knowledgeable and assert their rights
to quality care. This can be achieved
through continuous educational
program.
6) Absence of accreditation
laws
 There is no organization
empowered by legislation to lay
down standards in nursing and
medical care so as to regulate the
quality of care. It requires a
legislation that provides for setting
of a stationary accreditation /
vigilance authority to
a) Inspect hospitals and ensures
that basic requirements are met.
b) Enquire into major incidence of
negligence
c) Take actions against health
professionals involved in
malpractice
7) Lack of incident review
procedures
 During a patients hospitalizations
reveal incidents may occur which
have a bearing on the treatment and
the patients final recovery. These
critical incidents may be
a) Delayed attendance by nurses,
surgeon, physician
b) Incorrect medication
c) Burns arising out of faulty
procedures
8) Lack of good and hospital
information system
 A good management information
system is essential for the appraisal of
quality of care.
a) Workload, admissions, procedures
and length of stay
b) Activity audit and scheduling of
procedures.
9 Absence of patient
satisfaction surveys
 Ascertainment of patient satisfaction
at fixed points on an ongoing basis.
Such surveys carried out through
questionnaires, interviews to by social
worker, consultant groups, and help
to document patient satisfaction with
respect to variables that are
a) Delay in attendance by nurses and
doctors.
b) Incidents of incorrect treatment
10) Lack of nursing care
records
 Nursing care records are perhaps the
most useful source of information on
quality of care rendered. The records.
a) Detail the patient condition
b) Document all significant interaction
between patient and the nursing
personnel.
c) Contain information regarding
response to treatment
d) Have the dates in an easily accessible
form.
Thank you for your patient listening

You might also like