QUALITY ASSURANCE

QUALITY: DEGREE OF EXCELLANCE

ASSURANCE: MAKE SAFE

 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
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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
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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
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STEPS TO QUALITY ASSURANCE

STANDARDS ARE SET

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

QUALITY ASSURANCE
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THE ESSENCE OF HEALTH CARE
QUALITY ASSURANCE
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

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
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SOCIAL VALUE PROFESSIONAL

VALUE

QUALITY

INDIVIDUAL INSTITUTIONAL
VALUE VALUE
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QUALITY IN HEALTH SERVICES / IN
INDIVIDUALS
APPROPRIATENESS THE SERVICE OF PROCEDURE IS WHAT THE
POPULATION OR THE INDIVIDUAL ACTUALY
NEEDS

EQUITY A FAIR SHARE FOR ALL THE POPULATION

EFFECTIVENESS ACHIEVING THE INTENDED BENEFIT FOR THE

INDIVIDUAL AND FOR THE POPULATION

ACCEPTABILITY SERVICES ARE PROVIDED SUCH AS TO

SATISFY THE REAONABLE EXPECTATIONS OF
PATIENTS, PROVIDERS AND THE COMMUNITY

EFFICIENCY RESOURCES ARE NOT WASTED ON ONE

SERVICE OR PATIENT TO DETRIMENT OF
ANOTHER
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THE QUALITY CARE CAN BE STUDIED FROM
THESE ASPECTS
STRUCTURE WHERE IS CARE CARRIED OUT

WHAT EQUIPMENT IS USED

PROCESS WHO CARRIES OUT THE CARE

HOW IS IT CARRIED OUT

OUTCOME WHAT IS THE END RESULTS?

a) PERCIEVED BY PATIENTS / CLIENTS
b) PERCIEVED BY PROFESSIONALS
CARE INCLUDES
A. CLINICAL (TREATMENT OF PATIENTS) CARE
B. NON CLINICAL ( MEETING THE PATIENT PERSONAL,
SOCIAL, EMOTIONAL, SOCIAL NEEDS)
 QUALITY ASSURANCE
NON CLINICAL ( MEETING THE PATIENT) CARE

• A COURTESY

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
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A STANDARD IS A MEANS OF MEASURE

CRITERIA FOR STANDARDS

 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
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PRODUCTIVE LINE MODEL OF HEALTH SERVICES

INPUT PROCESS OUTPUT OUTCOME

RESOURCE ACTIVITY PRODUCTIVITY HEALTH

 QUALITY ASSURANCE
CLINICAL AUDIT
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

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
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CLINICAL AUDIT

OBJECTIVE OF CLINICAL AUDIT

TO IMPROVE PATIENT CARE BY INFORMING THE HEALTH CARE
PROFESIONALS’ UNDERSTANDING OF THEIR CLINICAL PRACTICES

BENEFIT OF CLINICAL AUDIT

• PROMOTE A PATIENT-FOCUS APPROACH TO CARE

• ENCOURAGE MULTI-PROFESSIONAL TEAMWORK

• ENABLES OPEN DISCUSSION ABOUT PRACTICE AND LEARNING FROM MISTAKE

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CLINICAL AUDIT

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
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CLINICAL AUDIT

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
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MAIN STAGES OF CLINICAL AUDIT

1. DEFINING 2. IMPLEMENTING
BEST PRACTICES BEST PRACTICES

3. MONITORING AND
4 TAKING ACTION COMPARING AGAINST
TO IMPROVE BEST PRACTICE
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CLINICAL AUDIT OF PRESSURE SORES
(ROYAL BROMPTON HOSPITAL 1991)

CONCERN ABOUT THE PROVISION OF PRESSURE-RELEIVING

DEVICES FOR THOSE IDENTIFIED AS HIGH RISK PATIENTS

DEVELOPMENT OF PRESSURE SORES

HAS INCREASED HOSPITAL STAY
•INCREASED DISCOMFORT
•THE COST IMPLICATIONS WERE EXTREMELY HIGH – WITH A GRADE 4 PRESURE SORE
ESTIMATING COST £25 000 TO TREAT
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CLINICAL AUDIT OF PRESSURE SORES

MAIN FINDINGS
• 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
• 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.
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OUTCOME MEASURE
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:

••this.
A matress replacement programme and the writing of a policy to maintain

•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%.
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AN OVERVIEW OF THE ASPECT OF
CARE UNDER REVIEW

• 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

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GROUP WORK

• 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
 QUALITY ASSUARANCE
GROUP WORK
HAND WASHING
NAME OF AUDITEE
AUDITOR

PROCEDURE COMPLIANCE REMARKS STRUCTURE COMPLIANCE REMARKS SIGNATURE

STATUS STATUS
YES NO YES NO AUDITOR AUDITEE
1 Roll up sleeves 1 Antiseptic
Soap
2 Remove rings / wrist watch 2 Elbow
bracelet operated
tape
3 Use continuously running 3 Paper hand
water towel or
Hand dryer
4 Position hand to avoid 4 Tap water
contaminating arms
5 Avoid splashing cloth or 5 Written
floor 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