Planning Quality Assurance in Nursing

PLANNING QUALITY ASSURANCE IN NURSING

By: Eu Salazar RN

OBJECTIVES:

• Understand the Quality Assurance Program in Nursing

• Familiarize with the Process in the Quality Assurance

Program

• Discuss and give pointers in Writing a QA Program Plan

REQUIREMENTS

Quality Assurance Activity must be PLANNED.

Monitoring process must include EVERY DEPARTMENT or UNIT within the division of nursing.

The process must be ORDERLY.

Must assure not only the quality of care but also the appropriateness of care

Quality – refers to the conformance to or variations from pre-established criteria, standards, policies or procedures

REQUIREMENTS

Appropriateness – refers to the fact that the standard being employed is relevant to the patients’ condition

When opportunities to improve care were being identified, nurses are required to take actions to improve care

SELECTING A NURSING QUALITY ASSURANCE MODEL

• Select or develop a structure that fits with the organizational structure and the style management practiced in the organization.

• Decide on the format that makes the best use of resources and manpower available.

• Keep the format simple and streamlined.

• Use a consistent model throughout the division of nursing

• In a skilled nursing facility, use a consistency model throughout the facility.

• It is a tool for assuring and improving quality of care.

• Used to monitor and evaluate the quality and appropriateness of care.

• It is the ongoing process to examine care, to find potential problems and opportunities for improvement and to do something about them

THE 10-STEP PROCESS IN A QUALITY ASSURANCE PROGRAM

Step 1 – Assign Responsibility

• Nursing departments and services must assign overall responsibility for their monitoring and evaluation activities.

• This person oversees all aspects of nursing monitoring and evaluating, assuring that the activities are comprehensive, effective, uniform, and coordinated.


Step 2 – Delineate scope of care and services.

Intended to assure that all nursing activities are considered in monitoring and evaluation.

• Types of patients served

• Condition and diagnosis treated

• Types of nursing staff providing care and service

• All existing standards of patient care


Step 3 - Identify Important Aspects of Care and Services.

• It is important for nursing staff to remember that important aspects of care are activities of the department that will be continually monitored and periodically evaluated to determine if care can be improved or if problems are present.


Nursing staff should identify those aspects of care and services that:

occur frequently or affect large numbers of patients

place patient at serious risk (high risk)

have intended in the past to produce problems (problem-prone)


Step 4 – Identify Indicators.

Indicators are measurable variables related to the structure, process or outcomes of care.

• Structures – elements that facilitate care (resources, equipment, numbers and qualification of staff)

• Process – functions carried out by practitioners (assessment, treatment, planning and medication administrations)


Outcomes – includes complications, adverse effects, short and long term results of treatment


Step 5 – Establish Threshold for Evaluation.

• Thresholds are accepted levels of compliance with any indicators being measured.

• Thresholds for evaluations are the level or point at which intensive evaluation is triggered.


Step 6 – Collect and Organize Data.

Some common date can be found in:

A) Patients records F) Laboratory report

B) Incident reports G) Meeting minute

C) Medication sheets H) Direct observation

D) Department logs I) Patient surveys

E) Infection Control J) Formal evaluation


Step 7 – Evaluate Care.

Once threshold for an indicator is reached, the critical step of evaluation is initiated. The most important purpose of monitoring and evaluation is to foster overall continuous improvement in the level of performance.


Examples:

• Lack of knowledge or skill

• Staff members knew what to do but did not do so

• Equipment deficiencies

• Deficiencies in medical record documentation

• Policy / procedure violation

• Lack of adequate staffing

• Infection control violation

• Inappropriate therapy, diagnostics


Evaluation must be designed to identify those opportunities for improvement by:

Objectively examining the possible causes for the level of performance

Recommending action pertinent to those causes to improve the performance


Step 8 – Take actions to solve problems or otherwise improve.

Staff should direct actions toward the root causes and should have an eye toward overall improvement in the quality of care and services


Some possible actions if the problem involves deficiencies in systems, include:

• Changing communication channels

• Changing organizational structure

• Adjusting staffing or redistributing staff

• Revising job descriptions

• Reallocating resources

• Adding or revising policies and procedures

• Altering the use of equipment

• Purchasing and repairing equipment


Some possible actions, if the problem involves deficiencies in staff knowledge, include:

• Modifying orientation procedures

• Providing focused in-service education

• Providing focused continuing education

• Circulating written policies and procedures or other informational material


Some possible actions, if the problem involves behavior or performance deficiencies, include:

• Revising job descriptions

• Informal counseling

• Formal counseling

• Changing assignments

• Disciplinary sanctions

• Limiting staff prerogatives relating to patient care

• Transferring to another unit/department


Step 9 – Assess the effectiveness of actions.

Monitoring and evaluation does not end when actions are taken. Staff continues to monitor the aspect of care for future opportunities for improvement, but they must determine whether actions are taken successful in improving care or service. If care does not improve within the expected time, staff should re-examine the aspect of care and take further action.


Step 10 – Communicate relevant information to the organization-wide quality assurance program.

It is essential that monitoring and evaluation information be communicated through established channels. Appropriate dissemination of information helps assure that quality assurance activities are coordinated and that knowledge regarding monitoring, evaluation and problem-solving methods is shared.


Step 1 – PURPOSE/GOAL

In stating the purpose, the following question should be answered: What is the purpose? An example of what could be stated in this: “the purpose of the QA program or the goal of the quality assurance program for nursing service is to establish a planned and systematic process for the monitoring and evaluation of the quality and appropriateness of patient care and for resolving identified problems”

Step 2 - OBJECTIVES

Objectives should define what is to be accomplished by carrying out a QA plan. Some plans include both long-term and short-term objectives. Long term objectives act as a guide to overall program while short-term objectives reflect the emphasis for the next one or two years.

Step 3 -

QA Coordinator: act as resource to staff nurses on QA issue; collates a quarterly summary of materials sent from all nursing areas; may be directly responsible for collecting data and creating quarterly reports, if the facility has a centralized QA program-creates & distributes the agenda for nursing QA meetings

DESCRIBE ROLE

RESPONSIBILITIES

Step 3 - DESCRIBE ROLE

RESPONSIBILITIES

Staff Nurse: identifies quality concerns on the unit or throughout the facility; helps collect data; participates in analysis QA data, suggest corrective action when indicated; performs corrective action when appropriate

Step 3 - DESCRIBE ROLE

RESPONSIBILITIES

Nurse Manager: is responsible for the quality of care his/her area of responsibility; can delegate QA activities to experienced clinical nurses, support the staff by providing time to carry out QA activities

Step 4 -

• The structure should indicate the manner in which the work of QA will be completed.

DESCRIBE A

STRUCTURE

Step 5 -

Responsibilities that might be considered include:

Monthly meeting Conducting annual QA evaluation

program Integrating nursing QA activities with

organizational wide activities Receiving and responding to reports

about various QA activities Providing ongoing education and training

for nurses unfamiliar with QA process

DESCRIBE QA

COMMITTEE FUNCTIONS

Step 6 -

• The information needs to be summarized

• Collect data and report findings at least 3 months before QA reporting program

• Make stagger reports

MONITORING &

EVALUATION

Planning Quality Assurance in Nursing

Documents

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