UALITY ASSURANCE IN NURSING

QUALITY ASSURANCE IN NURSING

INTRODUCTION:-Health care quality is in the eye of the beholder. In this, the primary goal is to secure the health care. It refers to the actual delivery of care from the point of patients first signaling a desire to be considered for potential treatment.

DEFINITION-

Quality assurance is a programme adopted by an institution that is designed to promte the best possible care. (Delaughery)

Qulity assurance is the process of achieving excellence in the service rendered to every client.

PRINCIPLES OF QUALITY ASSURANCE

managers need to be committed to quality management.All employees must be involved in quality improvement.The qoal of quality management is to provide a system in which workers can function effectively.The focus quality management is on improving the system.Every agency has internal and external customers.Customers define quality.Decision must be based on facts.

APPROACHES TO QUALITY ASSURANCE

Methods for measuring performance:

As nursing care is delivered within a frame work of independent relationships wth physicians and a multiplicity of other health care personnel. The most commonly used methods of nursing care are task analysis and quality control.

Measuring actual performance:

It is an ongoing repelitive process with the actual frequency dependant on the type of activity being measured. It is better to clarify the purpose of the measurement and to measure performance on a continuous basis.

Comparing results of performance wth standards and objectives and identifying strengths and areas for correction:

The standards and objectives and methods of measurement have been set ,if performance matches standards and objectives , managers may assume that things are under control if performance is a contrary to standards and objectives, action is necessary.

Acting to reinforce strengths or success and taking corrective action as necessary:

Positive aspects needed to be idebtified in order that they may e translated into encouragement and motivation for the nursing members involved in achieving them.

FACTORS AFFECTING QUALITY ASSURANCE IN NURSING CARE

Lack of resources: Insufficient resources, infrastructure, equipment, money for recurring expenses and staff make it impossible for output of a certain quality.

Personnel problem : Lack of trained, skilled and motivated employees, staff in disciplne etc. affects the quality of care.

Unreasonable patients and attendants:

Illness, anxiety absence of immediate response to treatment, unreasonable and unco-operative attitude which in turn affects the quality care.

4 .Improper maintenance: Building equipment requires proper ,aintenance for efficient use.

5. Absence of well-informed populance:

To improve quality nursing care, it is necessary that the people become knowledgeable and assert their rights to quality care.

6. Absence of accreditation laws: There is no organization strictly empowered legislation to lay down standards for nursing & medical care so as to requlate the quality of care.

7. Inspect hospitals and ensure that basic requirements are met: Enquire into major incidence of negligence and take action against health professional involved in malpractices.

8. Lack of incident review procedures:

During a patient’s hospitalization several incidents may occur which have a bearing on the treatment and the patient’s final recovery.

9. Delayed attendance by physician/nurse:

Incorrect medication, burns arising out of faulty procedures, death in a corridor with no nurse/physician accompanying the patient care.

10. Lack of good hospital information system:

A good management information system is essential for the appraisal of quality care.

11 Absence of conducting patient satisfaction surveys: Surveys to be carried out through questionnaires, interviews etc. by social worker, hospital management trainees and consultant groups.

12. Lack of nursing care records:

Nurses should use the problem oriented record system or use nursing process while recording the care given.

13. Miscellaneous: Lack of good supervision absence of knowledge about the philosophy of nursing care, lack of policy & administrative manual lack of procedure manual, substandard education and trining, inadequate quality and number of professionals, lack of evaluation techniques, lack of co-ordination between and within departmens, lack of written job descriptions and job specifications, lack of in service and continuing educational programmes.

DEVELOPMENT OF A QUALITY ASSURANCE PROGRAM

DEVELOPMENT OF A QUALITY ASSURANCE PROGRAM

This programme is a carefully planned, phased process, or it may be implemented in one step as part of a fundamental organizational change.

Foster Commitment o Quality:

This process must continue throughout the life of a project and at all levels of the organization. Commitment can be done through awareness- raising seminars, special planning meetings, or one-to- one discussion with an organizations leader

Conduct a Preliminary Review of Quality- Related Activities:-

It is important to conduct an initial review of the organization and to develop a general description of the existing system.

Develop the Purpose and Vision for the Quality Assurance Effort:

Purpose is to build consensus between managers and to set boundaries for the quality assurance effort. The vision will help the staff to understand how their day-to day wok relates to quality improvement.

*Determine level and scope of initial Quality Assurance Activities:

It depend on the resources available, the implementation time frame and the receptivity of managemet and program staff to the idea of quality assurance, The effort can be implemented at national, regional and district level or within a single health facility.

*Assign responsibility for Quality Assurance:

An Existing committee or management body will take on responsibility for quality assurance, integrating it into the general management structure.

*Allocate resources for quality assurance

Local resources must be allocated to quality assurance programme to become a permanent part of a health care organization. It may depend on outside technical and financial assistance.

*Develop a written quality Asurance plan

This plan is a written document that decribes the programme objectives and scope, defines lines of responsibility and authority, and puts forth implementation strategies. The plan help the staffs to relate quality, goals and objectives to their routine activities.

*Critical Management System:

Quality assurance efforts will focus three critical management system: Supervision, training and management information systems.

*Disseminate Quality Assurance Experience:

Dissemination strategy should be devised to share experience inside and outside the organization. Conferences which conduct at local, regional, national & international level will reinforce success encourage dialogue and creativity.

*Manage Change:

A careful, phased approach to change is required and an open and trusting environment must be cultivated.

ROLE OF A NURSE

A nursing administrator has to develop a formalized quality programme.

1. Review organizational, personnel and environment.

2. Focus on standards of nursing care and methods of delivering nursing care.

3. Focus on the outcome of care

TOTAL QUALITY MANAGEMENT

It focuses the production and service, ie; the environment must be customer responsive. It identifying and doing the right things, the right way, the first time and the prevention of problems.In this, customer needs and experiences with the end product are constantly evaluated.

The critical component in tota quality management is the empowerment of employees by providing positive feed back and reinforcing attitudes and behaviors that support quality and productivity. In total quality management, the employee to be knowledgeable, accountable and responsible and provides education and training for employees at all level.

NURSING AUDIT

DEFINITION

(i)“Nursing audit refers to assessment of the quality of clinical nursing”-Elison.

(ii) “ Nursing audit is an exercise to find-out whether good nursing practices are followed.”- Goster welfer

GOAL OF NURSING AUDIT:

Improve quality of health care.

Promote improved communication among nurses & other health team members.

Improve quality of nursing care.

Detect and analyze problems and errors

Ensure that nurses are accountable or answerable for the care.

Contribute to research

For the purpose of reimbursement.

STEPS IN AUDIT PROCESS:

*Selection of a topic

*Development of criteria

*Development of performance standards.

* Chart Preview

*Identification of variation

* Analysis of variation

* Development of solutions to correct poor performance.

* Implementation of corrective action

* Evaluation and reaudit

TYPES OF AUDIT

An audit can be retrospective or concurrent or prospective audit.

RETROSPECTIVE AUDIT

A retrospective nursing audit will identify the specific nurse who are responsible for patients care at various times during hospitalization and deficiencies in performance or charting will be reported back to the nurse.

CONCURRENT AUDIT

It reviews and evaluates records while persons are receiving care. The advantage is providing opportunities for making changes in the ongoing care programme.

PROSPECTIVE AUDIT

It identifies how future performance will be affected by current interventions.Most frequently used qualiy control are process audit, structure audit and outcome audit.

Prcess Audit: They are used to measure the process of care and how the care was carried out; and are task oriented and focus on whether or not standards of nursing practice are being met.

Structure Audit: These audits assume there is a relationship between setting, quality care, and appropriate structure.

Out Come Audits: They are end results of care. It determines what results occurred as a result of specific intervention by nurses for clients.

ADVANTAGES OF NURSING AUDIT

A biographical index of quality of nursing

A patient is assured of good services.

It will give a valuable and pertinent information for the staff.

It will lead to between co-operation and communication among the nurse & health team.

It will help each professional nurse for her self evaluation.

It helps the administration as better planning.

It will reduce the incidence of medical legal complication.

It will broaden and strengthen nursing service.

CONCLUSION

The concept of quality assurance refers to the accountability of the health professions to the society for the quality, quantity, appropriateness and costs of health services provided. In addition to the development of outcome indicators the agenda for change focus on continuous improvement. Total quality management may be one of the factors guaranteeing the survival of the fittest in the future. Fr the evaluation of care, an ongoing system of quality control was necessary in each hospital

Introduction

Standard is an acknowledged measure of comparison for quantitative or qualitative value, criterion, or norm. A standard is a practice that enjoys general recognition and conformity among professionals or an authoritative statement by which the quality of practice, service or education can be judged. It  is also defined as a  performance model that results from integrating criteria with norms and is used to judge quality of nursing objectives, orders and methods

A standard is a means of determining what something should be. In the case of nursing practice standards are the established criteria for the practice of nursing. Standards are statements that are widely recognised as describing nursing practice and are seem as having permanent value.

A nursing care standard is a descriptive statement of desired quality against which to evaluate nursing care. It is guideline. A guideline is a recommended path to safe conduct, an aid to professional performance.A nursing standard can be a target or a gauge. When used as a target, a standard is a planning tool. When used as a gauge against which to evaluate performance a standard is a control device.

Characteristics of Standard

Standards statement must be broad enough to apply to a wide variety of settings.

Standards must be realistic, acceptable, attainable.

Standards of nursing care must be developed by members of the nursing profession; preferable

nurses practising at the direct care level with consultation of experts in the domain.

Standards should be phrased in positive terms and indicate acceptable performance good, excellence etc.

Standardsof nursing care must express what is desirable optional level.

Standards must be understandable and stated in unambiguous terms.

Standards  must be based on current knowledge and scientific practice.

Standards must be reviewed and revised periodically.

Standards may be directed towards an ideal ,ie,optional standards or may only specify the minimal care that must be attained,ie, minimum standard.

And one must remember that standards that work are objective, acceptable, achievable and flexible.

Purposes of Standards

Setting standard is the first step in structuring evaluation system. The following are some of the purposes of standards.

Standards give direction and provide guidelines for performance of nursing staff.

Standards provide a baseline for evaluating quality of nursing care

Standards help improve quality of nursing care, increase effectiveness of care and improve efficiency.

Standards may help to improve documentation of nursing care provided.

Standards may help to determine the degree to which standards of nursing care maintained and take necessary corrective action in time.

Standards help supervisors to guide nursing staff to improve performance.

Standards may help to improve basis for decision-making and devise alternative system for delivering nursing care.

Standards may help justify demands for resources association.

Standards my help clarify nurses area of accountability.

Standards may help nursing to define clearly different levels of care.

Major objectives of publishing, circulating and enforcing nursing care standards are to:

1. improve the quality of nursing care,

2. decrease the cost of nursing, and

3. determine the nursing negligence.

Sources of Nursing Care Standards

It is generally accepted that standards should be based on agreed up achievable level of performance considered proper and adequate for specific purposes. The standards can be established, developed, reviewed or enforced by variety of sources as follows:

Professional organisation, e.g. Associations, TNAI,

Licensing bodies, e.g. Statutory bodies, INC,

Institutions/health care agencies, e.g.  University Hospitals, Health Centres.

Department of institutions, e.g. Department of Nursing.

Patient care units, e.g. specific patients' unit.

Government units at National, State and Local Government units.

Individual e.g. personal standards

Classification of Standards

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

1. Normative and Empirical Standards

Standards can be normative or empirical. Normative standards describe practices considered 'good' or 'ideal' by some authoritative group. Empirical standards describe practices actually observed in a large number of patient care settings. Here the normative standards describe a higher quality of performance than empirical standards. Generally professional organisations (ANA/TNAI) promulgate normative standards where as low enforcement and regulatory bodies (INC/MCI) promulgate empirical standards.

2. Ends and Means Standards

Nursing care standards can be divided into ends and means standards. The endsstandards are patient-oriented; they describe the change as desired in a patient's physical status or behaviour. The means standards are nursing oriented, they describe the activities and behaviour designed to achieve the ends standards. Ends (or patient outcome) standards require information about the patients. A means standard calls for information about the nurses performance.

3. Structure,Process and Outcome Standards

Standards can be classified and formulated according to frames of references (used for setting and evaluating nursing care services) relating to nursing structure, process and outcome, because standard is a descriptive statement of desired level of performance against which to evaluate the quality of service structure, process or outcomes.

 a. Structure Standard

A structural standard involves the 'set-up' of the institution. The philosophy, goals and objectives, structure of the organisation, facilities and equipment, and qualifications of employees are some of the components of the structure of the organisation, e.g. recommended relationship between the nursing department and other departments in a health agency are structural standards, because they refer to the organisational structure in which nursing is implemented. It includes people money, equipment, staff and the evaluation of structure is designed to find out the effectiveness ,degree to which goals are achieved and efficiency in terms of the amount of effort needed  to achieve the goal.

The structure is related to the framework, that is care providing system and resources that  support for actual provision of care. Evaluation of care concerns nursing staff, setting and the care environment. The use of standards based on structure implies that if the structure is  adequate, reliable and desirable, standard will be met or quality care will be given.

b. Process Standard

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 standard involves the activities concerned with delivering patient care.These standards measure nursing actions or lack of actions involving patient care.The standards are stated in action-verbs, that is in observable and measurable terms.eg :the nurse assesses", "the patient demonstrates". The focus is on what was planned, what was done and what was communicated or recorded. Therefore, the process standards assist in measuring the degree of skill, with which technique or procedure was carried out, the degree of client participation or the nature of interaction between nurse and client.In process standard there is an element of professional judgement determining the quality or the degree of skill. It includes nursing care techniques, procedures, regimens and  processes.

c.Outcome Standards

Descriptive statements of desired patient care results are outcome standards because  patient's results are outcomes of nursing interventions. Here outcome as a frame of reference for setting of standards refers to description of the results of nursing activity in terms of the change that occurs in the patient. An outcome standard measures change in the patient health status. This change may be due to nursing care, medical care or as a result of variety of services offered to the patient. Outcome standards reflect the effectiveness and results rather than the process of giving care.

LEGAL SIGNIFICANCE OF STANDARDS

Standards of care are guidelines by which nurses should practice.If nurses do not perform duties within accepted standards of care,they may place themselves in jeopardy of legal action.Malpractice suit against nurses are based on the charge that the patient was injured as a consequence of the nurses failure to meet the appropriate standards of care.

To recover losses from a charge of malpractice, a patient must prove that:

1. a patient-nurse relationship existed such that the nurse owed to the patient a duty of due care,

2. the nurse deviated from the appropriate standard of care,

3. the patient suffered damages,

4. the patient's damages resulted from the nurses deviations from the standard of care.

CONCLUSION

Quality assurance is to provide a higher quality of care. It is necessary that nurses develop standards of patient care and appropriate evaluation tools, so that professional aspects of nursing involving intellectual and interpersonal activities. Quality will be ensured and attention will be given to the individual needs and responses to patients.The formulation of standards is the first step towards evaluating the nursing care delivery. The. standards serve as a base by which the quality of care can be judged. This judgement may be according to a rating or other data that reflect the conformity of existing practice with the established standards. The standards must be written, regularly reviewed and well-known by the nursing staff.

REFERENCES

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2. Johnson M and Closkey J.C. The Delivery Of Quality Health Care Series On Nursing Administration. London: Mosby 1992

3. Koch M.W And Fairly T.M. Integrated Quality Management: The Key To Improving Nursing Care Quality. st Edition.St.Louis,Missouri:MosbyPublications;1993.

4. Ward MJ, Price SA .Issues in nursing administration. St.Louis: Mosby;1991.

5. Marquis B.L. ,Hutson C.J . Leadership roles and management functions in nursing– Theory and application. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2006.

6. Douglass L M. The effective nurse- leader and manager. 5th ed. Mosby: St. Louis; 1996.

7. Morrison M. Professional skills for leadership. Mosby: US; 1993.

8. Ellis J R, Hartley C L. Managing and Co-ordinating nursing care. 3rd ed. Lippincott: Philadelphia;1995.

9. Anthony, Mary K., Theresa; Hertz, Judith .Factors Influencing Outcomes After Delegation to Unlicensed Assistive Personnel. JONA.  30(10):474-481, October 2000.

10. Cheryl L. Plasters, Seagull F J, Xiao Y. Coordination challenges in operating-room management: an in-depth field study. Amia annu  symp  proc; 2003.

INTRODUCTION

Quality refers to excellence of a product or a service, including its attractiveness, lack of defects, reliability, and long-term durability.

Quality assurance provides the mechanisms to effectively monitor patient care provided by health care professionals using cost-effective resources.

Nursing programmes of quality assurance are concerned with the quantitative assessment of nursing care as measured by proven standards of nursing practice.

Quality assurance system motivates nurses to strive for excellence in delivering quality care and to be more open and flexible in experimenting with innovative ways to change outmoded systems.

Florence Nightingale introduced the concept of quality in nursing care in 1855 while attending the soldiers in the hospital during the Crimean war.

CONCEPT OF QUALITY IN HEALTH CARE

Quality is defined as the extent of resemblance between the purpose of healthcare and the truly granted care (Donabedian 1986).

Quality assurance originated in manufacturing industry “to ensure that the product consistently achieved customer satisfaction”.

Quality assurance is a dynamic process through which nurses assume accountability for quality of care they provide.

It is a guarantee to the society that services provided by nurses are being regulated by members of profession.

“Quality assurance is a judgment concerning the process of care, based on the extent to which that cares contributes to valued outcomes”. (Donabedian 1982).

 “Quality assurance as the monitoring of the activities of client care to determine the degree of excellence attained to the implementation of the activities”. (Bull, 1985) 

Quality assurance is the defining of nursing practice through well written nursing standards and the use of those standards as a basis for evaluation on improvement of client care (Maker 1998).

APPROACHES FOR A QUALITY ASSURANCE PROGRAMME

Two major categories of approaches exist in quality assurance they are

1. General

2. Specific

A. General Approach

It involves large governing of official body’s evaluation of a persons or agency’s ability to meet established criteria or standards at a given time.

1) Credentialing

formal recognition of professional or technical competence and attainment of minimum standards by a person or agency

Credentialing process has four functional components

a) To produce a quality product

b) To confer a unique identity

c) To protect provider and public

d) To control the profession.

2) Licensure

Individual licensure is a contract between the profession and the state, in which the profession is granted control over entry into and exists from the profession and over quality of professional practice.

The licensing process requires that regulations be written to define the scopes and limits of the professional’s practice.

Licensure of nurses has been mandated throuhout the world by laws and regulations..

3) Accreditation

ISO

JCI

NABH

Accrediation Canada

NAAC

4) Certification

Certification is usually a voluntary process with in the profession.

A person’s educational achievements, experience and performance on examination are used to determine the person’s qualifications for functioning in an identified specialty area.

B. Specific approaches

1) Peer review

Peer review is divided in to two types.

1. The recipients of health services by means of auditing the quality of services rendered.

2. The health professional evaluating the quality of individual performance.

2) Standard as a device for quality assurance

Standard is a pre-determined baseline condition or level of excellence that comprises a model to be followed and practiced. The ANA standard for practice include:

Standard 1: The collection of data about health status of the patient is systematic and continuous. The data are accessible, communicative, and recorded.

Standard 2: Nursing diagnosis are derived from health status data.

Standard 3: The plan of nursing care includes goals derived from the nursing diagnoses.

Standard 4: The plan of nursing care includes priorities and the prescribed nursing approaches or measures to achieve the goals derived from the nursing diagnoses.

Standard 5: Nursing actions provide for patient participation in health promotion, maintenance, and restoration.

Standard 6: Nursing actions assist the patient to maximize his health capabilities.

Standard 7: The patient’s progress or lack of progress towards goal achievement is determined by the patient and the nurse.

Standard 8: The patient’s progress or lack of progress towards goal achievement directs re-assessment, re-ordering of priorities, new goal setting, and a revision of the plan of nursing care.

3) Audit as a tool for quality assurance

Nursing audit may be defined as a detailed review and evaluation of selected clinical records in order to evaluate the quality of nursing care and performance by comparing it with accepted standards.

MODELS OF QUALITY ASSURANCE

1. System Model

Tasks are broken down into manageable components based on defined objectives.

The basic components of the system are

1. Input

2. Throughput

3. Output

4. Feedback

The input can be compared to the present state of systems, the throughput to the developmental process and output to the finished product. The feedback is the essential component of the system because it maintains and nourishes the growth.

2) ANA Quality Assurance Model

The basic components of the ANA model are:

1. Identify values

2. Identify structure, process and outcome standards and criteria

3. Select measurement

4. Make interpretation

5. Identify course of action

6. Choose action

7. Take action

8. Reevaluate

1) 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 perspective and values, philosophy of the health care organization and the providres of nursing services.

2) Identify structure, process and outcome standards and criteria:

 Identification of standards and criteria for quality assurance begins with writing of philosophy and objective of organization.

The philosophy and objectives of an agency serves to define the structural standards of the agency.

Standards of structure are defined by licensing or accrediting agency.

Evaluation of the standards of structure is done by a group internal or external to the agency.

The evaluation of process standards is a more specific appraisal of the quality of care being given by agency care providers.

3) Select measurement needed to determine degree of attainment of criteria and standards

Measurements are those tools used to gather information or data, determined by the selections of standards and criteria.

The approaches and techniques used to evaluate structural standards and criteria are, nursing audit, utilization’s reviews, review of agency documents, self studies and review of physicals facilities.

The approaches and techniques for the evaluation of process standards and criteria are peer review, client satisfactions surveys, direct observations, questionnaires, interviews, written audits and videotapes.

The evaluation approaches for outcome standards and criteria include research studies, client satisfaction surveys, client classification, admission, readmission, discharge data and morbidity data.

4) Make interpretations

The degree to which the predetermined criteria are met is the basis for interpretation about the strengths and weaknesses of the program.

The rate of compliance is compared against the expected level of criteria accomplishment.

5) Identify Course of Action

If 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. Then, it is important to identify various solutions to the problems.

6) Choose action

Usually various alternative course of action are available to remedy a deficiency.

Thus it is vital to weigh the pros and cons of each alternative while considering the environmental context and the availability of resources.

7) Take Action

It is important to firmly establish accountability for the action to be taken.

This step then concludes with the actual implementation of the proposed courses of action.

8) Reevaluate

The final step of QA process involves an evaluation of the results of the action.

The reassessment is accomplished in the same way as the original assessment and begins the QA cycle again.

Careful interpretation is essential to determine whether the course of action has improves the deficiency, positive reinforcement is offered to those who participated and the decision is made about when to again evaluate that aspect of care.

QUALITY ASSURANCE PROCESS

1. Establishment of standards or criteria

2. Identify the information relevant to criteria

3. Determine ways to collect information

4. Collect and analyze the information

5. Compare collected information with established criteria

6. Make a judgment about quality

7. Provide information and if necessary, take corrective action regarding findings of appropriate sources

8. Determine ways to collect the information

FACTORS AFFECTING QUALITY ASSURANCE IN NURSING CARE

1) Lack of Resources

Insufficient resources, infrastructures, equipment, consumables, money for recurring expenses and staff make it possible for output of a certain quality to be turned out under the prevailing circumstances.

2) Personnel problems

Lack of trained, skilled and motivated employees, staff indiscipline affects the quality of care.

3) Improper maintenance

Buildings and equipments require proper maintenance for efficient use. If not maintained properly the equipments cannot be used in giving nursing care.

To minimize equipment down time it is necessary to ensure adequate after sale service and service manuals.

4) Unreasonable Patients and Attendants

Illness, anxiety, absence of immediate response to treatment, unreasonable and unco-operative attitude that in turn affects the quality of care in nursing.

5) Absence of well informed population

To improve quality of nursing care, it is necessary that the people become knowledgeable and assert their rights to quality care.

This can be achieved through continuous educational program.

6) Absence of accreditation laws

There is no organization empowered by legislation to lay down standards in nursing and medical care so as to regulate the quality of care. It requires a legislation that provides for setting of a stationary accreditation / vigilance authority to:

a) Inspect hospitals and ensures that basic requirements are met.

b) Enquire into major incidence of negligence

c) Take actions against health professionals involved in malpractice

7) Lack of incident review procedures

During a patients hospitalizations reveal incidents may occur which have a bearing on the treatment and the patients final recovery. These critical incidents may be:

a) Delayed attendance by nurses, surgeon, physician

b) Incorrect medication

c) Burns arising out of faulty procedures

d) Death in a corridor with no nurse / physician accompanying the patient etc.

8) Lack of good and hospital information system

A good management information system is essential for the appraisal of quality of care.

a) Workload, admissions, procedures and length of stay

b) Activity audit and scheduling of procedures.

9) Absence of patient satisfaction surveys

Ascertainment of patient satisfaction at fixed points on an ongoing basis. Such surveys carried out through questionnaires, interviews to by social worker, consultant groups, and help to document patient satisfaction with respect to variables that are

a) Delay in attendance by nurses and doctors.

b) Incidents of incorrect treatment

10) Lack of nursing care records

Nursing care records are perhaps the most useful source of information on quality of care rendered. The records.

a) Detail the patient condition

b) Document all significant interaction between patient and the nursing personnel.

c) Contain information regarding response to treatment

d) Have the dates in an easily accessible form.

11) Miscellaneous factors

a. Lack of good supervision

b. Absence of knowledge about philosophy of nursing care

c. Lack of policy and administrative manuals.

d. Substandard education and training

e. Lack of evaluation technique

f.  Lack of written job description and job specifications

g. Lack of in-service and continuing educational program

FRAMEWORKS FOR QUALITY ASSURANCE:

1. Maxwell (1984)

Maxwell recognized that, in a society where resources are limited, self assessment by health care professionals is not satisfactory in demonstrating the efficiency or effectiveness of a service. The dimensions of quality he proposed are:

Access to service

Relevance to need

Effectiveness

Equity

Social acceptance

Efficiency and economy

2. Wilson (1987)

Wilson considers there to  be four essential components to a QA programme. These are:

Setting objectives

Quality promotion

Activity monitoring

Performance assessment

3. Lang (1976)

This framework has subsequently been adopted and developed by the ANA. The stages includes;

Identify and agree values

Review literature, Known QAP

Analyze available programmes

Determine most appropriate QAP

Establish structure, plans, outcome criteria and standards

Ratify standards and criteria

Evaluate current levels of nursing practice against ratified structures

Identify and analyze factors contributing to results

Select appropriate actions to maintain or improve care

Implement selected actions

Evaluate QAO

STAGES OF THE DEVELOPMENT OF INTERNATIONAL STANDARDS

An International Standard is the result of an agreement between the member bodies of ISO. It may be used as such, or may be implemented through incorporation in national standards of different countries.

International Standards are developed by ISO technical committees (TC) and subcommittees (SC) by a six-step process:

Stage 1: Proposal stage

Stage 2: Preparatory stage

Stage 3: Committee stage

Stage 4: Enquiry stage

Stage 5: Approval stage

Stage 6: Publication stage

The following is a summary of each of the six stages:

Stage 1: Proposal stage

The first step in the development of an International Standard is to confirm that a particular International Standard is needed. A new work item proposal (NP) is submitted for vote by the members of the relevant TC or SC to determine the inclusion of the work item in the programme of work.

The proposal is accepted if a majority of the P-members of the TC/SC votes in favour and if at least five P-members declare their commitment to participate actively in the project. At this stage a project leader responsible for the work item is normally appointed.

Stage 2: Preparatory stage

Usually, a working group of experts, the chairman (convener) of which is the project leader, is set up by the TC/SC for the preparation of a working draft. Successive working drafts may be considered until the working group is satisfied that it has developed the best technical solution to the problem being addressed. At this stage, the draft is forwarded to the working group's parent committee for the consensus-building phase.

Stage 3: Committee stage

As soon as a first committee draft is available, it is registered by the ISO Central Secretariat. It is distributed for comment and, if required, voting, by the P-members of the TC/SC. Successive committee drafts may be considered until consensus is reached on the technical content. Once consensus has been attained, the text is finalized for submission as a draft International Standard (DIS).

Stage 4: Enquiry stage

The draft International Standard (DIS) is circulated to all ISO member bodies by the ISO Central Secretariat for voting and comment within a period of five months. It is approved for submission as a final draft International Standard (FDIS) if a two-thirds majority of the P-members of the TC/SC are in 

favour and not more than one-quarter of the total number of votes cast are negative. If the approval criteria are not met, the text is returned to the originating TC/SC for further study and a revised document will again be circulated for voting and comment as a draft International Standard.

Stage 5: Approval stage

The final draft International Standard (FDIS) is circulated to all ISO member bodies by the ISO Central Secretariat for a final Yes/No vote within a period of two months. If technical comments are received during this period, they are no longer considered at this stage, but registered for consideration during a future revision of the International Standard. The text is approved as an International Standard if a two-thirds majority of the P-members of the TC/SC is in favour and not more than one-quarter of the total number of votes cast are negative. If these approval criteria are not met, the standard is referred back to the originating TC/SC for reconsideration in light of the technical reasons submitted in support of the negative votes received.

Stage 6: Publication stage

Once a final draft International Standard has been approved, only minor editorial changes, if and where necessary, are introduced into the final text. The final text is sent to the ISO Central Secretariat which publishes the International Standard.

IMPACT OF ISO IN A LOCAL HOSPITAL:

Positive impacts:

1. Nurses are accountable for their actions and, professionally, we have responsibility to evaluate the effectiveness of our care

2. Nurses can deliver a high standard of care, and being empowered to identify and resolve problems can add to personal satisfaction with work

3. Documents state clearly how the health service should perform and what the patient can expect

4. Guaranteeing standards of care to the public must be a duty of all those who work within the health service

5. Nurses are actively involve in audit, service reviews, standard-setting and customer relations

6. Improves the overall quality of nursing care

7. Improves all types of documentation and communication

8. Helps in professional growth

Negative impacts:

1. Lack of adequate resources

2. Lack of trained, skilled and motivated employees, staff indiscipline affects the quality of care.

3. ISO activities may overburden the nursing personnel

4. Nurses will not get adequate time to spent with the patient, most of the time may be spending for recording and reporting

5. The hospital will be restricted only to ISO standards

6. Hospital has to provide special training for all the staffs those who are involved in ISO inspection

7. All types of services will be under the control of ISO

IMPACT OF ISO IN A LOCAL NURSING EDUCATIONAL INSTITUTIONS:

Positive impacts:

1. Improves the quality of nursing education

2. improves the quality of nursing practice

3. Helps to maintain international standard

4. Helps to compare the standard with another institution

5. Helps in personnel development of teachers

6. Helps to maintain all the records in time

7. Avoids malpractice and bias

8. Encourages extra-curricular activities also

9. Act as a control for all the activities

10. Improves professional growth

Negative impacts:

1. Gives more importance to documentation

2. Over-burden for the teachers

3. Teachers need to take special training in maintaining the standards

4. Not observing the actual practice

5. Organizational philosophy and policies has to be modified according to the ISO standards

CRITICAL ANALYSIS:

Strengths:    ISO helps to improve and maintain the quality of educational institutions and hospitals

Weakness   : Standards are set by the institution itself, it may be biased

Opportunities:    Helps in professional growth

Threats:    Organizational philosophy and policies may not be considered

CONCLUSION

To ensure quality nursing care within the contemporary health care system, mechanisms for monitoring and evaluating care are under scrutiny. As the level of knowledge increases for a profession, the demand for accountability for its services likewise increases. Individuals within the profession must assume responsibility for their professional actions and be answerable to the recipients for their care. As profession become more interdependent, it appears that the power base will become more balanced, allowing individual practitioners to demonstrate their competence and expertise. Quality assurance programme will helps to improve the quality of nursing care and professional development.

REFERANCE

1. Margaret MM. Professionalization of nursing; current issues and trends. JB Lippincott company; Philadelphia: 1992

2. Karen P, Corrigan P. Quality improvement in nursing and health care. Chapman& Hall; Newyork: 1995

3. Patrica& Cerrell. Nursing leadership and management; A practical guide. Thomson Delmar; Canada: 2005

4. Roger E. Professional competence and quality assurance in the caring professions. Chapman& Hall; USA: 1993

5. Basavanthappa BT. Nursing administration. Jaypee brothers; New Delhi: 2000

6. Srinivasan AV. Managing a modern hospital. Sage publishers; New Delhi: 2000

7. Barbara C. Contemporary nursing issues trends and management, Mosby publication; St Louis: 2001

8. Ganong J.M and Ganong W.L, “Nursing Management”. Aspin Publication: 1980.

9. Stanhope. Community Health Nursing Process and Practice for promoting health. Mosby publication; St Louis: 1988

Quality Assurance Nurse

Location: Pell City, AL (7054 Veterans Parkway)

Location Details

HMR Veterans Services Inc. 7054 Veterans ParkwayPell City, AL  35125

P: 

864-224-3898

» See all jobs at this location

Job Description

Purpose:

To assist in the coordination of daily operation in the Quality Assurance Department.  The  Quality Assurance Nurse will perform the duties of the department in accordance with current applicable federal, state and local standards/regulations and as may be directed by the Director of Quality Assurance and CHVH Administration.

Qualifications:

Must possess a current, unencumbered, active license to practice as a LPN/RN in this state.

Must have sufficient previous experience in clinical health care including direct experience in quality assurance.

Must be able to read, write, speak, and understand the English language.

Must possess the ability to make independent decisions when circumstances warrant.

Must possess the ability to deal tactfully with personnel, residents, family members, visitors, government agencies/personnel, and the general public.

Must be knowledgeable of quality assessment and assurance procedures.

Must possess leadership and supervisory ability and the willingness to work harmoniously with and supervise other personnel.

Must be able to relate information concerning a resident's condition.

Must be willing to seek out new methods and principles and incorporate them into existing nursing practices.

Essential Functions:

Assist in the planning, organization and direction of Quality Assurance programs and related activities.

Assist Department Heads and staff in the evaluation of programs and effect changes as necessary to improve programs and assure compliance with regulatory requirements.

Assist in the coordination of studies performed within the Quality Assurance program and prepare reports as required.

Establish and maintain tracking systems for identified problems/indicators.

Develop and implement appropriate plans of action to correct identified deficiencies as needed.

Perform administrative requirements such as completing forms, writing reports, etc., and submit to the Director of Quality Assurance, Administrator or appropriate agency as directed.

Participate in meetings as directed.

Schedule committee meetings and notify members of such meetings.

Assist Departments in developing indicators and follow-up procedures for identified problems.

Assist in developing a reference library of written quality assessment and assurance material, laws, etc., necessary for complying with current standards and regulations, and that will provide assistance in maintaining quality resident care.

Make written and oral reports/recommendations to the Director, as necessary/required, concerning the operation of the Quality Assessment and Assurance program.

Assume the authority, responsibility and accountability of directing the Quality Assurance Department in the absence of the Quality Assurance Director.

Participate in the Nursing Administration “On Call” schedule as directed by the Director of Nursing.

Assist in developing annual auditing schedules for all Departments as well as audit development when identified.

Assist in the maintenance of tracking logs, incident and accidents, medication errors etc. and monitor for trends requiring corrective actions.

Assist in the investigation of incidents, injuries, sentinel events, abuse and misappropriation of resident property.  Summarize findings and file reports to appropriate staff and agencies.

Assist in the development and delivery of educational programs revolving around all components of Quality Assurance, including orientation for new employees and programs to address the Quality Assurance process and Regulatory guidelines.

Participate and assist in departmental studies and projects as assigned.

Attend and participate in workshops, seminars, etc., to keep abreast of current changes in the health care field, as well as quality related topics.

Assist in reeducation of staff when developing corrective action plans from completed audits or chart reviews.  Insure documentation of remediation and report to Department Head.

Maintain the confidentiality of all resident care information.

Knowledge of resident rights and responsibilities, including the right of refusal.

Ensure resident rights to fair and equitable treatment, self determination, individuality, privacy, property and civil rights, including the right to wage a complaint, are well

established and maintained at all times.

Serve as chairperson of the Quality Assessment and Assurance Committee in the absence of the Quality Assurance Director.

Attend the Quality Assessment and Assurance Committee monthly to report on all data collection results from monthly audits and the selected plans of correction.  Plans of correction will be written by the Department involved or in conjunction with Quality Assurance and reported to the Committee.