seminar on quality assurence
TRANSCRIPT
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What is this? Why it stands for ? ,what means this ?
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SEMINAR ON QUALITYASSURENCE
GUIDE :- MADAMMrs. RAVEENADUTTE
READERSHRISHANKARACHARYACOLLEGEOF NURSING
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INTRODUCTION
Quality assessment is an examination of service
where as quality assurance implies that efforts
are made to evaluate are made to evaluate and
ensure and ensure quality health care
The field of quality assurance is as old as modern
nursing. Florence nightingale introduced the
concept of quality in nursing care in 1855 whileattending the soldiers in the hospital during the
Crimean war
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MEANING
QUALITYMEANS:-
DEGREE OF EXELLENCE
Assurance: -It implies a commitment to take corrective
action of care does not meet the criteria
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CONT
To a patient :Quality meansbeing treated with empathy,respect and concern.
To a professional: Qualitymeans delivering the mostadvanced knowledge andskills to help and savepatient .
For medical audit: Qualitymeans having the bestachievable outcome foreach patient.
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DEFINITION
Bull 1985 defined quality assurance as themonitoring of the activities of client care todetermine the degree of excellence attained
to the implementation of the activities Qualities assurance is the defining of nursing
practice through well written nursingstandards and the use of those standards as abasis for evaluation on improvement of clientcare ( Maker 1998
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Need for Quality Assurance in Health
Care :
It is an important managerial function which
assures confidence among customers.
It involves evaluation in order to secure
improvement and development on a condition
basis.
It is needed to indicate standard of agency
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GOALS OF QUALITYASSURANCE
The major goal of quality assurance is to
identity areas where standards have not
been met and correct them, or in other terms
quality assurance are:-
To ensure the delivery or quality care .
To evaluate the efforts of the health care
provider to provide best possible results .
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Purpose of Quality Assurance
Help patients and potential patients by
improving quality of care.
Assess competence of medical staff, sure as animpetus to keep up to date and prevent future
mistakes.
Being to notice of hospital administration the
deficiencies and in correcting the cases factors
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PHILOSOPHY OF QUALITYCIRCLE
1) Reduce errors
2) Encourage more effective team work
3) Promote job indolent and participation4) Increase employee motivation
5) Create problem solving capability
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CONT
6) Built an attitude of problem prevention
7) Improve communication in the organization
8) Improve harmonious relationship9) Promote cost reduction
10) Bringing about attitudinal changes for better
team work
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Need for Quality Assurance in Health
Care
It is an important managerial function which
assures confidence among customers.
It involves evaluation in order to secure
improvement and development on a condition
basis.
It is needed to indicate standard of agency.
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GOALS OF QUALITYASSURANCE
a) To ensure the delivery or quality care.
b) To evaluate the efforts of the health care
provider to provide best possible results.
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Purpose of Quality Assurance
Help patients and potential patients by
improving quality of care.
Assess competence of medical staff, sure as animpetus to keep up to date and prevent future
mistakes.
Being to notice of hospital administration the
deficiencies and in correcting the cases factors
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ELEMENTSTHATCONTRIBUTE
TOWARDS QUALITYASSURANCE
Commitment from top level management
Commitment from all personal of the
organization /institution.
Setting clear responsibility for quality activity
willingness to change.
Accurate documentation.
Effective communications at all levels.
Ongoing training program in quality improvement
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PRINCIPLESOF QUALITYASSURENCE
1) Customer focused
2) Identify key processes to improve quality
3) Use of quality tools and statistics4) Involve all people and department to find
solution
5) Leadership
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6) Commitment
7) Individual responsibility
8) Employee empowerment9) Data driven decision making
10) Education and retaining
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Barriers to the quality Improvement
Primary barrier in implementing effective
quality improvement is cost.
Tradition and failure to realize, the charger areneeded.
Authoritative leadership style, do not value
innovators.
Lack of evidence based practice.
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5)STRATEGIES OF QUALITY
ASSURANCE:
1) Setting standards.
2) Appraising actual achievements.
3) Planning and improvement
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7)THE QUALITYASSURANCECYCLE:
Quality
care wheel
Measurement
criteria (b)
Assessment ( c)
Standards of
care (a)
Recommendationfor change (e)
Documented
problems (d)
Nursingcommittees
Nursing staff
development
Suspected
problem area
Hospital
quality
assurance
22
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APPROACHES FORA QUALITY
ASSURANCEPROGRAMME
1)General
2)Specific
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1)General
CREDENTIALING:
LICENSURE:
ACCREDITATION
CERTIFICATION
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SPECIFIC APPROACHES
Peer review committee
There are designed to monitor client specific aspects of care
appropriate for certain levels of care. The audit has been the
major tool used by peer review committee to ascertain quality
of care
The audit process (Stanhope-Han caster 2000)
Utilization review (UR)
Types of UR
Prospective Concurrent
Retrospective
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EVALUATIONSTUDIES
THREEMAJORMODELSHAVEBEEN USEDTO
EVALUATE QUALITYTHEYARE
DONABEDIANSSTRUCTURE PROCESS OUTCOME
MODEL
THETRACERMODEL
THESENTINELMODEL
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(1)DONABEDIANSSTRUCTURE
PROCESS OUTCOMEMODEL
introduced 3 major methods of evaluating
quality care
a) Structural evaluation
b) Process evaluation
c) outcome evaluation
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2) The Tracer Method
It is used to identify persons with certain
illness such as HT, Ulcers, UTI and to establish
criteria for good medical and nursing
management of the illness have used the
trace methods
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3) The Sentinel Method
It is an outcome measure cases of
unnecessary disease, disability death are
counted.
Client satisfaction: - it can be assessed using
person or telephone interventions and mailed
questionnaire. Data from client satisfaction
surveys are used to measure structuresprocess and outcome of care given
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PRINCIPLESANDCONDITIONS FOR
TOTAL QUALITYMANAGEMENT
Principles-
Continuous quality improvement
Knowledge of customers expectation needs.
Processes of customers supplies relationship.
Belief in people.
Statistical analysis.
Costs of poor quality
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Conditions
Employer involvement
Improvement
An environment that supports risk taking
Team work
Data collection and analysis skills
Group interaction skills
Structure and management to enableimprovement
Tools to facilitate the improvement
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framework for quality assurance
Quality in nursing practice:
The point commission on accreditation of health
care organization (JCAHO)1997 defines quality
improvement (QI) as an approach to the
continuous study and improvement of the process
of providing health care services to meet the
needs of client and others.
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STEPSIN QUALITYIMPROVEMENT
1)Professional standards:
2) Outcomes
.3)Developing quality improvement team:
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1)Professional standards:
They are authoritative statements used by the
professional in describing the responsibilities
for which its practitioners are accountable
(Peter 1995)
A)Policies
b)Job descriptions
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2) Outcomes
Outcomes are the conditions to be achieved
as a result of care delivery. An outcome tells
what interventions are effectiveness, whether
clients progress, how well standards are being
met. and whether changes are necessary.
a)Professional outcome
b)Client outcome:
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.3)Developing quality improvement
team:
This team composed of staff from alldepartments with in a hospital
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FACTORSCONTRIBUTING THE
SUCCESS OF THE QUALITY
ASSURANCEPROGRAM
Philosophy and commitment of management
Stability of the management and continuity
of leadership for the program
Clarity of organizational and operational goals
Establishment of targets, yardsticks
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Involvement of employees in respect
department and QAP
Motivation and commitment of employers
Documentation and reporting system
Feedback systems to management and
employers
Action plans, implementation, review systems
Incentives and recognition system
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10) QUALITYASSURANCE
COMMITTEE (QAC):
Medical administrator
Two senior clinicians
Pathologist Radiologist
Nurse administrator (Matron)
Medical records officer- Secretary
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SPECIFIC FUNCTIONS OF QAC:
1)Coordination:
Collecting information
Consider activates that should be related, eg.
quality appraisal or continuing education.
Communicate across patient care.
Coordinate the action with hospital authority
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2)Information:
Collect data reports about medical records.
Interaction between the patient and the care
provider.
Information regarding response to treatment
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3)Planning- Establish priorities.
4)Prodding- Insist on effective, productive,
efforts from all hospital components.
5)Consultation Provide specific assistance
usually through the coordinator. .
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6)Response:A) Internally provide importance to individual and
department.
B
)E
xternally provide organizational home for respondingto quality requirement of external agencies, e.g.medical companies.
7)Search for expertise: Operate openly notbehind closed doors.
8) Follow up: Insert of report provideimplemented change
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Functions ofCommittee members
To coordinate, not to control
To inform, not to scold
To plan and suggest priorities, not to dostudies
To recommend and report, not to intervene
directly
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11) QUALITYASSURANCEMODEL
Nurses who are trained as per Indian NursingCouncil recreation and registered with statenursing registration councils are safe to providecare. Quality assurance model in nursing is the
set of elements that are related to each other andcomprise of planning for quality, development ofobjectives, setting and actively communicatingstandards, developing indicator, collecting data to
monitor compliance with set standards, fornursing practice and applying solutions toimprove care
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PURPOSE OF QUALITYASSURANCE
MODEL:
To ensure quality nursing care provided by
nurses in order to meet the expectations of
receiver, management and regulatory body, It
also intends to increase the commitment of
provider and the management
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GOALS OF QUALITYASSURANCE
MODEL:
Develop confidence of the receiver (s) thatquality care is being rendered as per assurance.
Develop commitment of the managementtowards quality care.
Increase commitment of providers to adhere toset standards for nursing practice and strive forexcellence.
Strengthen documentation of nursing care.
Promote optimum utilization of resources forproviding cost effective nursing care.
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12)MODELS OF QUALITY
ASSURANCE:
The basic components of the system are:
a)Input
b)Throughput
c) Out put
d) feed back
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SYSTEM MODEL
Input
Previous qualityassurance program
Output
Unit Based qualityassurance program
Through put
Structuralchange process
Feedback
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SYSTEM BASE FOR UNIT BASED
QUALITY ASSURENCE
American Nurses Association model
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H. REEVALUATE
G. TAKE ACTION
A. IDENTIFY VALUES
B . IDENTIFY
STANDARD & CRITERIA
F.
CHOOSEACTION
E . CAUSES OF
ACTION
C. SECURE
MEASUREMENT
D. MAKE INTERPRETATION
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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
prospective and value philosophy of the health careorganization and the provides of nursing sciences.
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Identify structure, process and
outcome standards and criteria:
The focus may be the staff, the clients, theorganization or all three or any combination ofthe three.
Standards and criteria: although the focus ofthe QA activity is decided, standards must beselected or formulated. Standards are definedas an agreed upon, level of practice. These
standards generally are broad statements thatreflect values and the level of care.
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Select measurement needs to
determine degree of attainment of
criteria and standards Measurement are those tools used to gather
information or data, determined by the selections ofstandards and criteria.
The approaches and techniques used to evaluatestructural standards and criteria are nursing audit,utilizations reviews, review of agency documents, selfstudies and review of physical facilities
approaches and techniques for the evaluation processstandards and criteria are peer review clientsatisfaction survey, direct observation, questionnaires,interviews, written audits and videotapes
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Make interpretations:
predetermined criteria are met is the basis for
interpolation about the strength and
weakness of the program. The late of
compliance is compared against the expected
level of criteria
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Identify course of action:
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
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Take action
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?
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Reevaluate:
final step of QA process involves an evaluation
of the results of the action. The reassessment
is accomplishment in the say same way as the
original assessment and begins the QA cycle
again
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. Maxwell six dimension model(1984)
Relevance in the needs.
Accessibility
Equality
Effectiveness
Acceptability
Efficiency and Economy
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Joint commission model:
1. Establish responsibility and accountability for a QI program.2. Define the scope of service for a clinical area.
3. Define the key aspects of service for the clinical area.
4. Develop quality indicators to monitor the outcomes and
appropriateness of care delivered.5. Establish threshold for evaluation of indicators.
6. Collect and analyze data from monitoring activities.
7. Evaluate results of monitoring activities to determine the
need for change in practice.8. Resolve problems through development of action plans.
9. evaluate to determine if the plan was successful.
10. communicate QI results to the agencies
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PROGRAMEVALUATIONMODEL
(PEM)
two major types of program evaluation:
Formative evaluation
Summative evaluation
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Program evaluation includes
Determine focus
Establish purpose
Define appropriate type of evaluation.
Formulate data gathering questions.
Gather data.
Make data based judgment. Formulate report.
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FACTORSAFFECTING QUALITY
ASSURANCEINNURSINGCARE
Lack of resources
Personnel problems.
Improper maintenance.
Unreasonable patients and attendants.
Absence of well informed population.
Absence of accreditation laws. Lack of incident review procedures
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Lack of good and hospital information system.
Absence of patient satisfaction surveys.
Lack of nursing care records.
Legal redness
Delay in attendance by doctors, nurses andhelpers.
Miscellaneous factors. Lack of good supervision
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Lack of policy and administrative manners.
Substandard education and training.
Lack of evaluation technique.
Lack of written job description and job
specifications.
L
ack of in service and continuing educationalprogram
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QUALITYASSURANCESETTING
STANDARDS
For more than 100 years, a authors have
written about the evaluation of nursing
practice as a process with minimal elements
of
Setting standards
Comparing nursing practice to such standards.
Instituting changer to increase the adherence tothe standards.
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Definition:
Standards is an established rule as basis of
comparison in measuring or finding capacity,
quality context and value of objects in the
some category. Standard is a broad statementof quality
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Professional nursing standards in
nursing practice
a standard in model of established practice
which has general recognition and acceptance
among registered professional nurses and its
commonly accepted as correct standards ofpractice are agreed n levels of competence as
determined by the ANA and specially nursing
ranizations (ANA-1996)
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Standards are defined as authoritative
statements that describe a common level of
care as performed by which the quality of
practice can be determined or measured.standard help define professional practice
(hubes -1996)
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IMPORTANCEINSTANDARDSIN
NURSING
It is the authoritative statement by which the
quality of nursing practice, service and
education can be judged
In nursing practice, standards are established
criteria for the practice of nursing
It is a guideline and a guideline far is a
recommended path to safe conduct an aid toprofessional performance
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It provides a baseline for evaluating quality of
nursing care, increase effectiveness of care andimprove efficiency
Standard helps supervisors to guide nursing staffsto improve performances
Standard may helps to clarify nurses area ofaccountability
Standards may helps nursing to clearly definedifferent levels of care
standard s a device of quality assurance andquality control
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Purpose:
Improve the quality of nursing.
Decrease the cost of nursing.
D
etermine the nursing negligence
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Characteristics of standard
statement must be board enough to apply a widevariety of settings
must be realistic, acceptable and attainable
nursing care must be developed by members ofnursing profession
must be understandable and stated correctknowledge and scientific practice
Must be based on current knowledge and scientific
practice must be reviewed and revised periodically
must be directed towards an optimal standard
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SOURCES OF NURSINGSTANDARDS
Professional organizations like TNAI
Licensing bodies IC, MCI and DCI etc.
D
epartments of the institution. Patient care unit.
Individual personal standard
Government unit at national, state and localgovernment unit
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Classification of standards
1)Physical standardWhich includes patients activity rating toestablish nursing care hours per patient per
day
2)Cost standard
Which includes cost per patient per day
3)Capital standard
Which include the review of monitoryinvestments as new program
4)Revenue standardsWhich includes the revenue per patient day of nursing care
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5)Program standards
Which guide the development and implementation ofprogram to meet clients need
6)Intangible standard
Which guide the development of personal orientationcost
7)Goal standard
Which outlines qualitative goal in short and long termplanning
8)Strategies plan standardThis outlines check point in developing andimplementing the organization strategic plan
ROLE OF NURSE IN QUALITY
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ROLE OF NURSEIN QUALITY
ASSURANCE
Professional nurses have an obligation to ensure that thecare they provided is evidence based.
Ensure services provided is consumer centered.
Provide quality care to the individual and to the public in
reality with the desired outcome. Care provided should be consistent with current
professional knowledge.
Functions as leader and managers in various health caresettings which provide quality care.
Responsible to promote standards, measurement andinvolve in continuous quality improvement.
Effective care to the clients should be the primary focus ofall nurses
R l f d i i t t i
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Role of nurse administrator in
implementing quality assurance
Initiator:-
Creates an awareness or sensitizes the nurses aboutthe importance of quality assurence
Facilitator:- She facilitates to develop, implement, monitor and
evaluate standard of nursing practice in all times
Coordinator
She coordinates the different units of qualityassurance programe and coordinates the activitieswith hospital quality assurance program
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Educator
She gives orientation to nursing personal regarding thenees
Leader
She communicate the quality message to all nursing staffs
Evaluators
She evaluates the implementation of nursing practice
Supervisor
She supervise the activities of the differentcommittees,she supervises the nurses firstand secnd levelof leadership positions
IN A NUTSHELL QUALITY ASSURANCE
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INANUTSHELL, QUALITYASSURANCE
PROMOTES
Comprehensive, cost effective and contractual
aspect.
Accessible, accredited, acceptable.
Relevant, reliable, resourced.
Efficient, equitable and effective care.