QUALITY ASSURANCE

by: Jesah Maria S. Palmes

DEFINITIONAssurance- means achieving a sense of accomplishment and implies a guarantee of excellence.

Quality- is the degree of excellence and assurance means formal guarantee of a degree of excellence.

Quality of Care- is the degree to which health services for individuals and population increase the likelihood of desired health outcomes and are consistent with the current professional knowledge.

Quality Assurance- is a process of evaluation that is applied to the health care system and the provision of health care services by health workers.

Quality Improvement Program- is the umbrella program that extends the many areas for the purpose of accountability to the consumer and the payor.

Indicators- are valid and reliable quantitative measures of structure, process and outcome that are related to one or more dimensions of performance.

Sentinel Event Indicators- measures a low-volume but serious, undesirable and often avoidable process or outcome such as falls and medication errors.

Benchmarking- is a tool to assist in quality of care decision making. It is a continuous process of measuring what exists against the best in search for industry best practices.

Best Practice- is a service, function or process that has been fine-tuned, improved and implemented to produce superior outcomes.

Total Quality Management (TQM)- is a way to ensure customer satisfaction by involving all employees in the improvement of the quality of every product or service.

Continuous Quality Improvement (CQI)- is a process of continuously improving a system by gathering data or performance and using multi-disciplinary team to analyze the system, collect measurements, and propose changes.

PRINCIPLES UNDERLYING QUALITY ASSURANCE EFFORTS

All health professionals should collaborate in the effort to measure and improve care.

Coordination is essential in planning a comprehensive quality assurance program.

Resource expenditure for quality assurance activities is appropriate.

There should be focus on critical factors such as functions and activities that promise to yield the greatest health and financial benefit to reveal significant findings.

Quality patient care is accurately evaluated through adequate documentation.

The ability to achieve nursing objectives depends upon the optimal functioning of the entire nursing process and its effective monitoring.

Feedback to practitioners is essential to improve practice. It perpetuates good performance and replaces unsatisfactory interventions with more effective methods.

Peer pressure provides the impetus or effect prescribed changes based on results of assessment and needed improvements on quality of care.

Reorganization in the formal organizational structure may be required if assessment reveals the need for a different pattern of health care.

Collection and analysis of data should be utilized to motivate remedial action.

QUALITY ASSURANCE AND PERFORMANCE

EVALUATION

Performance evaluation focuses on the worker. It asks questions about how the worker satisfies the requirements of his or her job within the organization.

On the other hand, quality assurance focuses on the care and service the patient receives than how well the professional performs the duties that the position requires.

QUALITY ASSURANACE

METHODS

Several methods used are:

Concurrent and retrospective patient care audits

Patient care profile analysisPeer reviewQuality circles

DEVELOPINGQUALITY ASSURANCE

CRITERIA

Structure Approach- includes physical setting, instrumentalities and conditions through which nursing care is given such as the philosophy and objectives, the building, organizational structure, financial resources, and equipment.

Process Approach- includes the steps in the nursing process in compliance with established standards of nursing practice.

Outcome Approach- identifies desirable changes in the patient’s health status as modification of symptoms, signs, knowledge, attitudes, satisfaction, skill level, and compliance with the treatment regimen.

NURSING AUDIT COMMITTEE

This is composed of a representative from all levels of the nursing staff, a member of the Training Staff, Supervising Nurse, Head/ Senior Nurse, and a Staff Nurse. The composition may vary in other hospitals. In smaller hospitals, the Chief Nurse or her Assistant may be a member of this committee.

The audit team usually designates a day within the week to be the audit day. However, the nurses do not know which unit will be audited. The audit team utilizes the developed process or outcome criteria to evaluate nursing care.The Staff Nurse or Senior Nurse participates during the audit and are shown the findings- both strong and weak points. They sign the audit form to confirm the authenticity of the findings of the audit team.

PATIENTCARE AUDITS

Concurrent Audit- is one in which patient care is observed and evaluated. It is given through;

A review of the patients’ charts while the patients are still confined in the hospital

Observation of the staff as patient care is given

Inspection of patients and/ or observation of the effects of patient care where the focus is on the patient.

Retrospective Audit- is one in which which patient care is evaluated through;

A review of discharged patients’ charts

Questionnaires sent or interviews conducted on discharged patients.

PEER REVIEW

Patient care audits may be done by peers (employees of the same profession, rank and setting) evaluating another’s job performance against accepted standards.

QUALITTY CIRCLESThe quality circle may be defined as a group of workers doing a similar work who meet regularly, voluntarily, on normal working time, under the leadership of their supervisor, to identify , analyze, and solve work-related problems and recommended solutions to management.

UTILIZATION OF RESULTS

The Nursing staff in the unit is given a feedback on the results on the quality assurance study. Positive feedback reinforces desirable performance. Consistent positive findings deserve a commendation from the nursing service.

Negative feedbacks should tactfully conveyed in a face-to-face situation so that assessment result may easily clarified. Negative findings have implications for review of existing standards in the unit regarding closer supervision and designing systems to remedy identified problems and staff development.

CONTROL OF RESOURCES

Part of the control process is the periodic review of the utilization of materials and supplies in the various nursing units.

Requisitions of and/or stocking a large number of supplies and materials should be avoided to prevent pilferage, misuse, or spoilage.

A high turnover inventory is desired.

An equipment utilization report should be made including frequency breakdown.

Preventive maintenance requires the regular inspection of equipment to prevent breakdown and/or detect needed repairs.

Likewise, end-users of supplies, materials and equipment should be given the opportunity to evaluate their quality.

Absences due to leaves, whether scheduled or not, should be analyzed as these may have implications for staffing.

DISCIPLINE

Part of controlling process in management is discipline. In the past, discipline meant rigid obedience to rules and regulations, the violation of which resulted in punitive actions.

Today, discipline is regarded as a constructive and effective means by which employees take personal responsibility for their own performance and behavior. This is termed as self-discipline.

SOME FACTORSTHAT INFLUENCE SELF-

DISCIPLINEARE:

A strong commitment to the vision, philosophy, goals and objectives of the institution.

Laws that govern the practice of all professionals and their Codes of Conduct.

Understanding the rules and regulations of the agency.

An atmosphere of mutual trust and confidence.

Reference:

Lydia M. Venzon 2006. Nursing Management Towards Quality Care. 3rd edition

Bessie L. marquis 2000. Leadership and Management Functions in Nursing. Theory and Application. 3rd edition