4/3/2015
QUALITYASSURANCEINNURSING
QUALITYASSURANCEINNURSING
Byglobalpoint
QUALITYASSURANCEINNURSING
QUALITYASSURANCEINNURSING
INTRODUCTION:Healthcarequalityisintheeyeofthebeholder.Inthis,theprimarygoalistosecurethehealthcare.Itreferstothe
actualdeliveryofcarefromthepointofpatientsfirstsignalingadesiretobeconsideredforpotentialtreatment.
DEFINITION
Qualityassuranceisaprogrammeadoptedbyaninstitutionthatisdesignedtopromtethebestpossiblecare.(Delaughery)
Qulityassuranceistheprocessofachievingexcellenceintheservicerenderedtoeveryclient.
PRINCIPLESOFQUALITYASSURANCE
managersneedtobecommittedtoqualitymanagement.Allemployeesmustbeinvolvedinqualityimprovement.Theqoalofquality
managementistoprovideasysteminwhichworkerscanfunctioneffectively.Thefocusqualitymanagementisonimprovingthe
system.Everyagencyhasinternalandexternalcustomers.Customersdefinequality.Decisionmustbebasedonfacts.
APPROACHESTOQUALITYASSURANCE
Methodsformeasuringperformance:
Asnursingcareisdeliveredwithinaframeworkofindependentrelationshipswthphysiciansandamultiplicityofotherhealthcare
personnel.Themostcommonlyusedmethodsofnursingcarearetaskanalysisandqualitycontrol.
Measuringactualperformance:
Itisanongoingrepelitiveprocesswiththeactualfrequencydependantonthetypeofactivitybeingmeasured.Itisbettertoclarifythe
purposeofthemeasurementandtomeasureperformanceonacontinuousbasis.
Comparingresultsofperformancewthstandardsandobjectivesandidentifyingstrengthsandareasforcorrection:
Thestandardsandobjectivesandmethodsofmeasurementhavebeenset,ifperformancematchesstandardsandobjectives,managers
mayassumethatthingsareundercontrolifperformanceisacontrarytostandardsandobjectives,actionisnecessary.
Actingtoreinforcestrengthsorsuccessandtakingcorrectiveactionasnecessary:
Positiveaspectsneededtobeidebtifiedinorderthattheymayetranslatedintoencouragementandmotivationforthenursingmembers
involvedinachievingthem.
FACTORSAFFECTINGQUALITYASSURANCEINNURSINGCARE
Lackofresources:Insufficientresources,infrastructure,equipment,moneyforrecurringexpensesandstaffmakeitimpossibleforoutput
ofacertainquality.
Personnelproblem:Lackoftrained,skilledandmotivatedemployees,staffindisciplneetc.affectsthequalityofcare.
Unreasonablepatientsandattendants:
Illness,anxietyabsenceofimmediateresponsetotreatment,unreasonableanduncooperativeattitudewhichinturnaffectsthequality
care.
4.Impropermaintenance:Buildingequipmentrequiresproper,aintenanceforefficientuse.
5.Absenceofwellinformedpopulance:
Toimprovequalitynursingcare,itisnecessarythatthepeoplebecomeknowledgeableandasserttheirrightstoqualitycare.
6.Absenceofaccreditationlaws:Thereisnoorganizationstrictlyempoweredlegislationtolaydownstandardsfornursing&medicalcare
soastorequlatethequalityofcare.
7.Inspecthospitalsandensurethatbasicrequirementsaremet:Enquireintomajorincidenceofnegligenceandtakeactionagainsthealth
professionalinvolvedinmalpractices.
8.Lackofincidentreviewprocedures:
Duringapatientshospitalizationseveralincidentsmayoccurwhichhaveabearingonthetreatmentandthepatientsfinalrecovery.
9.Delayedattendancebyphysician/nurse:
Incorrectmedication,burnsarisingoutoffaultyprocedures,deathinacorridorwithnonurse/physicianaccompanyingthepatientcare.
10.Lackofgoodhospitalinformationsystem:
Agoodmanagementinformationsystemisessentialfortheappraisalofqualitycare.
11Absenceofconductingpatientsatisfactionsurveys:Surveystobecarriedoutthroughquestionnaires,interviewsetc.bysocialworker,
hospitalmanagementtraineesandconsultantgroups.
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12.Lackofnursingcarerecords:
Nursesshouldusetheproblemorientedrecordsystemorusenursingprocesswhilerecordingthecaregiven.
13.Miscellaneous:Lackofgoodsupervisionabsenceofknowledgeaboutthephilosophyofnursingcare,lackofpolicy&administrative
manuallackofproceduremanual,substandardeducationandtrining,inadequatequalityandnumberofprofessionals,lackofevaluation
techniques,lackofcoordinationbetweenandwithindepartmens,lackofwrittenjobdescriptionsandjobspecifications,lackofinservice
andcontinuingeducationalprogrammes.
DEVELOPMENTOFAQUALITYASSURANCEPROGRAM
DEVELOPMENTOFAQUALITYASSURANCEPROGRAM
Thisprogrammeisacarefullyplanned,phasedprocess,oritmaybeimplementedinonestepaspartofafundamentalorganizational
change.
FosterCommitmentoQuality:
Thisprocessmustcontinuethroughoutthelifeofaprojectandatalllevelsoftheorganization.Commitmentcanbedonethrough
awarenessraisingseminars,specialplanningmeetings,oronetoonediscussionwithanorganizationsleader
ConductaPreliminaryReviewofQualityRelatedActivities:
Itisimportanttoconductaninitialreviewoftheorganizationandtodevelopageneraldescriptionoftheexistingsystem.
DevelopthePurposeandVisionfortheQualityAssuranceEffort:
Purposeistobuildconsensusbetweenmanagersandtosetboundariesforthequalityassuranceeffort.Thevisionwillhelpthestaffto
understandhowtheirdaytodaywokrelatestoqualityimprovement.
*DeterminelevelandscopeofinitialQualityAssuranceActivities:
Itdependontheresourcesavailable,theimplementationtimeframeandthereceptivityofmanagemetandprogramstafftotheideaof
qualityassurance,Theeffortcanbeimplementedatnational,regionalanddistrictlevelorwithinasinglehealthfacility.
*AssignresponsibilityforQualityAssurance:
AnExistingcommitteeormanagementbodywilltakeonresponsibilityforqualityassurance,integratingitintothegeneralmanagement
structure.
*Allocateresourcesforqualityassurance
Localresourcesmustbeallocatedtoqualityassuranceprogrammetobecomeapermanentpartofahealthcareorganization.Itmay
dependonoutsidetechnicalandfinancialassistance.
*DevelopawrittenqualityAsuranceplan
Thisplanisawrittendocumentthatdecribestheprogrammeobjectivesandscope,defineslinesofresponsibilityandauthority,andputs
forthimplementationstrategies.Theplanhelpthestaffstorelatequality,goalsandobjectivestotheirroutineactivities.
*CriticalManagementSystem:
Qualityassuranceeffortswillfocusthreecriticalmanagementsystem:Supervision,trainingandmanagementinformationsystems.
*DisseminateQualityAssuranceExperience:
Disseminationstrategyshouldbedevisedtoshareexperienceinsideandoutsidetheorganization.Conferenceswhichconductatlocal,
regional,national&internationallevelwillreinforcesuccessencouragedialogueandcreativity.
*ManageChange:
Acareful,phasedapproachtochangeisrequiredandanopenandtrustingenvironmentmustbecultivated.
ROLEOFANURSE
Anursingadministratorhastodevelopaformalizedqualityprogramme.
1.Revieworganizational,personnelandenvironment.
2.Focusonstandardsofnursingcareandmethodsofdeliveringnursingcare.
3.Focusontheoutcomeofcare
TOTALQUALITYMANAGEMENT
Itfocusestheproductionandservice,ietheenvironmentmustbecustomerresponsive.Itidentifyinganddoingtherightthings,theright
way,thefirsttimeandthepreventionofproblems.Inthis,customerneedsandexperienceswiththeendproductareconstantlyevaluated.
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Thecriticalcomponentintotaqualitymanagementistheempowermentofemployeesbyprovidingpositivefeedbackandreinforcing
attitudesandbehaviorsthatsupportqualityandproductivity.Intotalqualitymanagement,theemployeetobeknowledgeable,accountable
andresponsibleandprovideseducationandtrainingforemployeesatalllevel.
NURSINGAUDIT
DEFINITION
(i)NursingauditreferstoassessmentofthequalityofclinicalnursingElison.
(ii)Nursingauditisanexercisetofindoutwhethergoodnursingpracticesarefollowed.Gosterwelfer
GOALOFNURSINGAUDIT:
Improvequalityofhealthcare.
Promoteimprovedcommunicationamongnurses&otherhealthteammembers.
Improvequalityofnursingcare.
Detectandanalyzeproblemsanderrors
Ensurethatnursesareaccountableoranswerableforthecare.
Contributetoresearch
Forthepurposeofreimbursement.
STEPSINAUDITPROCESS:
*Selectionofatopic
*Developmentofcriteria
*Developmentofperformancestandards.
*ChartPreview
*Identificationofvariation
*Analysisofvariation
*Developmentofsolutionstocorrectpoorperformance.
*Implementationofcorrectiveaction
*Evaluationandreaudit
TYPESOFAUDIT
Anauditcanberetrospectiveorconcurrentorprospectiveaudit.
RETROSPECTIVEAUDIT
Aretrospectivenursingauditwillidentifythespecificnursewhoareresponsibleforpatientscareatvarioustimesduringhospitalization
anddeficienciesinperformanceorchartingwillbereportedbacktothenurse.
CONCURRENTAUDIT
Itreviewsandevaluatesrecordswhilepersonsarereceivingcare.Theadvantageisprovidingopportunitiesformakingchangesinthe
ongoingcareprogramme.
PROSPECTIVEAUDIT
Itidentifieshowfutureperformancewillbeaffectedbycurrentinterventions.Mostfrequentlyusedqualiycontrolareprocessaudit,
structureauditandoutcomeaudit.
PrcessAudit:Theyareusedtomeasuretheprocessofcareandhowthecarewascarriedoutandaretaskorientedandfocuson
whetherornotstandardsofnursingpracticearebeingmet.
StructureAudit:Theseauditsassumethereisarelationshipbetweensetting,qualitycare,andappropriatestructure.
OutComeAudits:Theyareendresultsofcare.Itdetermineswhatresultsoccurredasaresultofspecificinterventionbynursesforclients.
ADVANTAGESOFNURSINGAUDIT
Abiographicalindexofqualityofnursing
Apatientisassuredofgoodservices.
Itwillgiveavaluableandpertinentinformationforthestaff.
Itwillleadtobetweencooperationandcommunicationamongthenurse&healthteam.
Itwillhelpeachprofessionalnurseforherselfevaluation.
Ithelpstheadministrationasbetterplanning.
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Itwillreducetheincidenceofmedicallegalcomplication.
Itwillbroadenandstrengthennursingservice.
CONCLUSION
Theconceptofqualityassurancereferstotheaccountabilityofthehealthprofessionstothesocietyforthequality,quantity,
appropriatenessandcostsofhealthservicesprovided.Inadditiontothedevelopmentofoutcomeindicatorstheagendaforchangefocus
oncontinuousimprovement.Totalqualitymanagementmaybeoneofthefactorsguaranteeingthesurvivalofthefittestinthefuture.Fr
theevaluationofcare,anongoingsystemofqualitycontrolwasnecessaryineachhospital
LastupdatedonMarch29,2012
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