quality assua

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A.QUALITY ASSURANCE:-Quality assurance defines theperformance measurement and compares actual process

and outcomes to clinical and satisfaction indicators.

B.QUALITY CONTOL:-It involves performance managementand maintain and includes systemic methods ofensuring

conformance to a desired standard or norm.

C.QUALITY IMPROVEMENT:-It is concerned withdevelopment and is ongoing,involvd with fixing problems

now,costly mistakes in the future and fostering

breaktrough.

CHARACTERSTICS OR FEATURES OF QUALITY ASSURANCE:

I. Direction oriented.II. Reactive

III. Narrow focusIV. Getting byV. Tradition and safety

VI. BusynessVII. Leadership not vested

VIII. Employee as expendibleIX. Responisibility of fewX. Problem solving by authority

XI. We-they thinkingXII. Cypniasm


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THE DEVELOPMENT OF STANDARD FOR QUALITY ASSURANCE:-A standard is a

baseline level of excellence. It is not an evalution in itself but provides the

yardstick for measuring the quality of service provided.Duke university

hospitals nursing service list four qualities necsessory for development of

standards

I. The standard must be explicit in terms of what is measured,at what level ofperformance and at what times.

II. It must distinguish various differences in quality of care.III. The organization must posses the technology necessary for the

measurement of the criteria.

IV. The measurement of standard must be cost-effective.ANA STANDRAD OF NURSING PRATICE(1973):-

I. The collection of data about the health status of client is systematic andcontinous the data are accessible,communicative and recorded.

II. Nursing diagnosis are derived from health status data.III. The nursing care includes goals derived from the nursing diagnosis.IV. Nursing actions provide for client participation in health

promotion,maintenance and restoration.

V. Nursing actions assist clients to maximize their health capabilities.VI. The plan of nursing care includes priorties the prescribed nursing

approaches or measures to achieve the goals derived from the nursing

diagnosis.

VII. The clients progress or lack of progress toward goal achievement isdetermined by client and nurse.

Standards of practice allow the organization to

more objectively measure unit and individual performance and

KOONTZ&WEIHRICH identified eight types of standards:-

a. PHYSICAL STANDARDS:-IT INCLUDES PATIENTacuity ratings toestablish nursing care hours per patient day.

b. COST STANDARDS:-The cost per patient day for nursing carewould be an example.


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3.CAPITAL STANDARDS:-By which monetory investments or new

program would be reviewed.

c. REVENUE STANDARDS:-The revenue per patient day for nursingcare would be an example.

d. PROGRAMM STANDARDS:-Guide the development andimplementationof new program to meet client needs.

e. INTANGIBLE STANDARDS:-COULD INCLUDE STAFF DEVELOPMENTOR orientation cost for personnel.

f. GOAL STANDARDS:-Outline qualitative goals in short and longterm planning.

g. STRATEGIC PLAN STANDARDS:-Outline checkpoints in thedevelopment and implementation of the organisations strategicplan.

The ANA and national league for nursing both

publish manual in 1959 to help establish standards for health

care.during 1960s the ANA STARTED FOR NURSING practice to

deveop standard for nursing practices which become the basis for

quality assusance program.

JACHO 10 STEP MONITORING AND EVALUATION PROCESS:-

a. ASSIGN RESPONSIBILITY AND ACCOUNTABLITY:-A director ofquality improvement can be found within each organization

that is responsible and accountable for an activity during

program.in nursing care area,clinics a nurse manager is often

responsible and accountable for proper implementation of

program to assure quality of care and work co-ordinately and

co-operatively with other and individual staff is responsible for

monitoring quality,decision making and ensuring high quality

care.

b. DELNATE,SCOPE OF CARE OR SERVICES:- Each nursing unitarea involved in the care of selected group of clients provides

a well-defined set of services. An analysis of a units scope of


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services reveals the types of client who recive care and type of

process involved in delivering care and how much or either

they are beneficial for client and its understanding allow staff

to focus on quality issue related typical group.

c. IDENTIFY IMPORTANT ASPECT OF CARE:-In this committeeasses activities or services considered most important to

providing high-quality services to clients.e.g,-key aspects of

service in the medicine unit migt include client,education,

diagnostic monitoring and admission of I.V therapy.

d. IDENTIFY INDICATOR:-QUALITY INDICATOR IS A QUantativemearsures of an important aspect of care that determine

whether quality of service conform to requirement.e.g,-

incidence of wound infection,self administration of insulin

these are of three types:-

1.STURCTURE INDICATORS:-Evaluate structure or system for

delivering care.

2.PROCESS INDICATORS:-EVALUATE the manner in which care

is delivered.

3.OUTCOMES INDICATOR:-Evaluate the end results of care

delivered.

e. ESTABLISHING THRESHOLDS OR EVALUATION:-After selection

of quality indicator and form a threshold is a standard for

determining whether a problem with quality exist and measure

ment that fall below the threshold indicates problem.e.g,-staff may set a standard

that states 90% of clients who receive instruction will correctly self-administration

of insulin and after test only 80% of client are able to administer insulin.when QI

is an ongoing process, staff continuously work to improve outcome or

performance by raising threshold.

f.COLLECTION AND ANALYSIS OF DATA:-staff must collect

meaningful information on a sufficient no. of clients to allow for accurate analysis

of the appropriateness of care.e.g,-diabetic instruction and insulin


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A. Develop confidence of the reciver that quality care is being renderedas per assurance.

B. Develop commitment of the management towards quality care.C. Increase commitment of providers to adhere to set standards for

nursing practice and strive for excellence.

D. Strengthen documentation of nursing care.E. Promote optimum utilization of resources in providing cost-effective

nursing care.

TRAINING PROGRAMME FOR QUALITY ASSURANCE IN NURSING IN

NURSING:-

INTRODUCTION:-Quality is rapidly becoming a concern to both the

consumers and the providers of the services. In health care quality is

being demanded and expected and the provider we judged by the

quality of services.nurses play a vital role in delivery of health care

services and hence there is need to sensitize and train nursing

personnel to provide quality care.

The purpose,objective and the suggested training

programme for nursing personnel enable them to provide qualitycare is given below:-

PURPSOE:-

a. To introduce code of ethics and professional conduct fornurses in Indian to the nursing personnel

b. To prepare nursing personnel for implementation of qualityassurance model in nursing.

OBJECTIVES:-At the end of training programme, the participants

will be able to:-

I. State the code of ethics and professional conduct for nursesin india.

II. Recongnize the significance of following code of ethics andprofessional conduct in nursing practice.


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III. Explain QAM as a pre-requisite for quality nursing care.IV. Describe standards for nurses and their rationale.V. Identify the legal boundaries for nursing practices.

VI. Prepare a nursing care plan following the nursing processapproach.

VII. Appreciate the important ofpracticing standard safetymeasures

VIII. Identify appropriate communication techniques to be usedin given interpersonal situations.

IX. Plan and conduct patient teaching session.X. Identify appropriate management techniques to be used for

managing resources in given situations.

XI. Appreciate the importance of continuing education andresearch for development of self others and of the use

XII. Describe the institutional disaster preparedness plan andnurse role.

QUALITY ASSURANCE IN NURSING:-

Quality assurance is a program for formal guarantee for

provision of quality nursing care against set standards.

QUALITY ASSURANCE MEMOS:-Incident report are called

quality assurance memos an incident is any unsual

happening such as fall, medication error,malfunction in

equipment or injury to client or victim. Each agency has a

standardized form on which the witnessing.nurse can

record client or visitor incidents.nurses oftenly avoid

sounding judgemental when documenting incidents.some

facilties use incident report related to nursing procedure asaway to evaluate the quality of care and these may be

collect quality assurance memos.

QUALITY ASSURANCE ACTIVITIES IN A HOSPITAL:-

a. CLIENT CARE AUDITS:-client care audits are of two types-


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1.CONCURRENT AUDIT:-It is one in which the client

care is observed and evaluated as it provided.

2.RETROSPECTIVE AUDIT:- It is one in which client

care is evaluated after the client discharge from

hospital.

The accuracy of retrospective or concurrent

audit depends upon its accuracy and completeness

of records by all care giver.

b. PEER REVIEW:-It is the evaluation and judgement of anurses performance by other nurses with equal status

and ability who can expected to assess accurately the

appropriateness of an assiociates responses to a

particular nursing care needs.

c. CLIENTS SATIAFACTION STUDIES:-Client are interviewedin which the clients state how the experienced the

hospital stay.

d. CONTROL CCOMMITTEES:-Committees may be set up inhospital to evaluate a particular problem and to take

corrective measures e.g,-infection control committee.

e. REVIEW OF ACCIDENT REPORTS:-There are so manytypes of accidents can occur in hospital situation. A goodaccident report guides us for taking the steps for their

prevention. The report should contain detail of patients

and also the accident.

COMMITTEE SELECTION AND FUNCTIONS:-

Quality assurance committee to established criteria and a process for

quality assurance and to evaluate care make recommendations and dofollow-up work.

A chairperson with enthusiasm and attention to detail helps

ensure a successful programme. member also needs to be interested in

quality assurance and knowledge about channels of communication

,hospital resources, patient population and nursing needs. representation


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oproces of staff nurses, head nurses, clinical specialists and units helps

produce a wide variety of ideas preset meeting time allow for staffing to

accommodate attendance and committee membership supplies personal to

do the work.

TOOLS USED IN MEASUREMENT OF QUALITY ASSURANCE:- For the

measurement of quality care is done by audit .an audit is a systematic and

official examination of a record,process or account to evaluate

performance. There are so many audit are used to ensure quality.

I. PROCESS AUDIT:-These audit are used to how the care wascarried out. Process audit are taskoriented and focus on

whether or not standards of nursing practice are being met.

Process standards may be documented in patient care plans,

procedure manuals or nursing protocol statements

II. STRUCTURE AUDIT:-This audit monitor the structure orsetting in which the patient care occurs. e.g, -nursing services

structure ,medical records and accrediating bodies ensure a

safe and effective environment.

III. OUTCOME AUDIT:-By this audit the end results of care , thechanges in the patientss health status that can be attributedto the delivering of health care services. Outcome audits

determine what results occurred as aresult of specific

intervention by nurses for the clients.

QUALITY ASSURANCE /IMPROVEMENT PROGRAMME:-

It is an ongoing process designed to evaluate and promote

excellence in health care provided to clients. Evaluation can also

focus on the quality of nursing care provided to groups of clientswith similar problems nursing diagnosis. Quality improvement

programmes are mechanical called quality assurance monitor,

total quality management , total quality improvent. These

programs ensure that quality client care is provided and standard

are upheld.


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Quality improvent is the combined result of consumers

demands for high-caliber health services and soaring health care

csots.also governmental agencies, accreditation groups and

regulatory bodies have preesured the nursing profession to

respond to quality improvent issues. Description of objectives of

these assiociations are:-

AMERICAN NURSES ASSIOCIATION:-

ANA established the standards of nursing practice in 1973 and updated in

1998 with 2nd edition of standards of clinical nursing practice which included

standards of care and standards of professionalperformance standards

of care are composed of seven nursing and behavior and roles of

professional nurses are described in eight standards of professional

performance. Both standards are used as criteria for evaluating nursing care

and performance.

JOINT COMMISSION ON ACCREDIATION OF HEALTH CARE

ORGANIGATIONS:-

The JCHAO(1996) is an external review board that establishes standards for

institutions to ensure that the institution fuctions with specialized guidelines.The hospital standards for nursing care are applicable to all the clients in

every settings. Evaluation of the quality of nursing care provided to the

department of nursing.

ORGANISATION STRUCTURE OF QUALITY ASSURANCE PROGRAMME:

Organisational structure of a quality assurance programme is defined

by organizational policy encompassing every department and medical staff.

It is large organization a full or part-time persons is assigned to oversee theprogram.quality assurance committee often function at the level of both

organization and nursing department.

CONTINUOUS QUALITY IMPROVENT IN NURSING:-


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INTRODUCTION:-Quality improvent and evaluation in nursing professional

practice at any hospital facilitates and support the excellence in patient care

through evidence based practice in a safe,caring and collaborative environment.

every employee is responsible for quality, by participating in continuous quality

improvement activities nurse and other staff improve quality of care.

The nursing quality improvement co-ordinators provide

quality improvement expertise to clinical teams,co-ordinate,monitor and evaluate

the continuous quality improvement program for nursing. Clinical nurses

collaborates on the identification of quality indicators and participates in

continuous improvement activities and work groups.

PURPOSE:-

1.To enhance patient care through systematic assessment and improvement of

quality and appropriateness of care rendered.

2. To improve the standards or techniques thorugh which nursing is provides.

3. To deliver patient care which is optimal,customer focused and achieves

improved patient health outcome.

4.To improve the patient care through evaluation of clinical and operationalperformance measures.

GOALS AND OBJECTIVES:-

1.To improve the delivery,quality and efficiency and outcome of patient care and

services.

2.To ensure that all the activities are done in accordance with standards of

professional health care practices or regulatory bodies.

AUTHORITY:-The chief nursing officer.officer has the authority and direct

responsibility for continous assessment and improvement of the quality of

services provided. The director will incorporate these qualities measures into

daily department operations and management decision and will report

significance. Outcome or unresolved issue to their administrative officer.


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SCPOE:-The nursing services quality improvement program encompasses relavant

dimensions of performance including those that are high volume ,high risk

orproblem prone.nursing care is provided on a 24-hour bases to patient from

infancy to old age encompassing health care needs. Nursing care is provided in

an organized and systematic process under registered professional nurse. Nursing

process begins with assessment and recongnition of patient priorty

,development and implementation of a plan of care and finally evaluate plan.

discharge planning ,patient teaching, implementation of current nursing

standards and collaboration with the interdisciplinary team are key improtants.

TOTAL QUALITY MANAGEMENT

It is based on the premise that the individual is the focal element on which

production and services depends. Quality is built into the service or product ,

rather than assuming that inspection of and removal of errors lead to quality.

Identify and doing the right things, right way, first-time and problem-prevention

planningnot only inspection and reactive problems solving lead to quality

outcomes.

TQM is a never ending process. Everything and everyone in the

organization are subject to continuous improvement efforts. TQM philosophy

says there is always room for improvement. Customer needs and experience with

the end-product are constantly evaluated.

PRINCIPLES OF TOTAL QUALITY MANAGEMENT:-

ACCORDING TO DEMINGS:-

a. Create a constancy of purpose for the improvement of products andservices.

b. Adopt a philosophy of continual improvement.c. Focus on improving process, not on inspection of [roduct.d. End the practice of awarding business on price alone, instead, minimize

total cost by working with a single a supplier.

e. Improve constantly every process for planning,production and servicesf. Institute job training and retraining.


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g. ,Develop the leadership in the organization.h. Drive out fear by encouraging. Employees, to participate actively in the

process.

i. Foster interdepartment co-operation,and breakdown barriers betweendepartments.

j. Eliminate slogans, exhortations and targets for the work force.k. Focus on quality and not just quanity eliminate quota system if they are in

place.

l. Promote team work rather than individual accomplishments eliminatethe annual ratting or merit system.

m.Educate/train employees to maximize personal development.n. Charge all employees with carrying out the total quality management

package.

DEFINITION OE NURSING STANDARDS:-

Defines a standard as the desireable and achievable level of performance

against which a practice is compred.the standards must meet the needs of

the patient.

CLASSIFICATION OF STANDARDS:-

There are different types of standards used to direct and control nursing

actions. Standard can be normative or empirical. standards can be classified

and formulated according to frames of references relating to nursing

structure, process and outcome ,because standard is a descpritive statement

of desired level of performance against which to evaluate the quality of

service structure, process oroutcomes.

STRUCTURE STANDARD:-A standard involves the setup the institution. The

philosophy ,goals and objectives ,structure of the organization, facilities and

equipment, and qualifications of employees are some of the components of

the structure of the organization,e.g. recommended relationship between

the nursing the nursing department and other departments in a health

agency are structural standards .


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PROCESS STANDARDS:

Process standards describe the behaviours of the nurse at the desired level

of performance. The criteria that specify desired method for specific nursing

intervention are process standards. A process standards involves theactivities concerned with delivering patient care. In process standard there is

an element of professional judgement , i.e. determining ,the quality or the

degree of skill. It includes nursing care techniques, procedures , regimens,

processes.

OUTCOME STANDARDS:-

Descriptive statements of desired patient care results are outcome

standards , because patients results are outcomes of nursing interventions.

An outcome standard measures change in the patient health status. Out

comes standards reflect the effectiveness and results rather than the process

of giving care. In quality assurance outcomes are stated in positive terms as

the nursing goal is to improve the health status of client.

NURSING AUDIT:-

1.According to elison nursing audit refers to assessment of the

quality assua

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