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Quality in Health Care:: Definition

The document discusses quality assurance and quality audits in nursing. It defines quality assurance and describes its purpose as systematically monitoring and evaluating aspects of a project or service to ensure standards are met. Quality audits examine quality systems to identify progress against goals and opportunities for improvement. The document outlines the steps nurse administrators should take to establish a quality assurance program and tools that can measure quality assurance, including standards, audits, surveys, and tracking outcomes.

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170 views

Quality in Health Care:: Definition

The document discusses quality assurance and quality audits in nursing. It defines quality assurance and describes its purpose as systematically monitoring and evaluating aspects of a project or service to ensure standards are met. Quality audits examine quality systems to identify progress against goals and opportunities for improvement. The document outlines the steps nurse administrators should take to establish a quality assurance program and tools that can measure quality assurance, including standards, audits, surveys, and tracking outcomes.

Uploaded by

REVATHI H K
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Quality in health care:

Lohr KN 1990 explains QA as the extent to which individual and


communities achieve desired health outcomes and are in accordance with
knowledge of health care profession

It started with Florence Nightingale identifying the role of nursing in


health care quality and began to measure patient care professionals

Definition:

As per Webster’s dictionary, QA is an activity or programme for monitoring


and evaluating the various aspects of a project, service, or facility,
systematically to ensure the desired standards of quality are begin met.

Purpose of QA

 To assess the product or service in a systematic and comprehensive


manner and find any fault and errors so as to rectify them
 To identify the areas which have not met the criteria or standards and to
correct them immediately
 To improve the efficiency and effectiveness of the service or product
 To motivate for research effort by finding the relationship of services
provided with expected outcomes
 To identify and address various problem
Objectives of QA in nursing:

According to Jonas 2000, the objectives are

 To ensure delivery of quality client care


 To demonstrate the efforts of health care providers to provide the best
possible outcomes
 To provide good quality of service to public
 To improve the efficiency and effectiveness of nursing services

Quality assurance in nursing:

Pre requisites for a QA programme, the nurse administrator should follow the
following steps:

 Set up a system for collecting and reporting data


 Write a clear definition of all activities
 Agree method for establishing current performance
 Identify the resource and list them
 Identify and list the possible source of benchmarks data
 Develop a calendar for reporting
 Define roles and responsibilities
 Identify the training needs requirement
 Plan for training personnel
 Establish a quality assurance committee in hospitals
QUALITY AUDIT:

Quality audit is the process of systematic examination of a quality system


carried out by an internal or external quality auditor or an audit team. It is an
important part of an organization’s quality management system.

Purposes:

 To identify and monitor the progress achieved against organizational


goals
 To find out chances for improvement
 To compare the performance of employee with internal and external
standards
 To ensure the programme to meet the requirements and needs of the
customers. To be able to set sensible objectives and comply with them
 To establish standards for establishing comparisons
 To ensure each employee is aware of their level of performance
 To identify and highlight quality-related issues and decide the areas for
priority action
 To provide feedback for the successful performance
 To make auditing as an integral part of regulatory requirements

Tools to measure quality assurance

 Standards set by Indian nursing council (INC), professional bodies


(TNAI), university ( Board of nursing studies).
 Nursing audit of patients record.
 Patient opinion on exit interview on discharge.
 Review of infection control records.
 Patient’s family’s opinion.
 Critical incident technique by nurses.
 Reports on nursing rounds.
 Adhering the unit philosophy and objectives.
 Effectiveness of team conferences and reports.
 Effectiveness of patient teaching program.
 Review of staffing pattern for each unit.
 Use of nursing care plans.
 Observation of nursing activities.

Measuring the outcome of quality care

 Hospital acquired infection, surgical site infection. Inpatient mortality,


neonatal mortality, peri-operative mortality.
 Unplanned re-admission, unplanned admission after outpatient
procedures.
 Patient’s falls.
 Incidence of health care associated pressure ulcers.
 Incidence of health care associated infections; Catheter associated urinary
tract infection (CAUTI).
 Patient’s experience of pain management.
 Patient’s experience of the provision of educational information.
 Health-care associated infection (HAI) rate: The number of individuals
who develop any infection while in an inpatient setting.
NURSING AUDIT.

“It is a detailed review and evaluation of selected clinical records by


qualified professional personnel for evaluating quality of nursing care”.

 It is the part of the cycle of QA.


 It incorporates the systematic and critical analysis of care given by
nurse.
 It appraises the use of available resources and the impact of it on
patient care outcome.

Purposes:

 To evaluate the nursing care given.


 To achieve the deserved and feasible quality of nursing care.
 To improve the quality of documentation.
 To focus on the care provided and not on the care provider.
 To contribute towards research.

Common approaches to nursing audit:

 Organizational audit.
 Peer review.
 Prospective review.
 Concurrent review.
 Retrospective review.
Nursing audit cycle:

According to FBA clinical governance and nursing audit workshop


(www.Quis.org.uk) the nursing audit cycle describes to start with deciding
selected area to measure, review against standards, identify the gap decide
action, implemented action and review standards.

 Defining standards: It is based on the Donabedian model of quality


assurance. The three dimensions measured are-

structure

process

outcome

 Structure : environmental elements required to deliver care.


Ex-all infrastructure facilities, policy, procedures, equipment, record
keeping system.
 Process: professional and technical elements required to deliver care.
 Outcome : measurable elements demonstrating results of care.
Ex- leg ulcer healing time, immunization levels, pressure ulcer
prevalence, falls, infection rate, mortality etc.

 Identify the problem regarding quality nursing care by conducting a


baseline survey.

 To read widely from available literature.


 Identify gaps in providing care by analyzing.
- What are the reasons for not meeting the standard?
- How can the services be implemented?

 Implement action.
- This is the hardest area to address and the involves the input from
whole team.
- An action plan needs to be developed.

 Review standards.
- To know whether the developed standards met the needs and to assess
the status of standards whether they are high or low level standard.

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