1. QUALITY ASSURANCE IN NURSING

2. INTRODUCTION
Public concerns about availability of
effective services to all at reasonable
cost and demand for quality care,
increasing legal action in malpractice,
and consumer
placed a new
protection acts have
emphasis on quality
career and development of technique
for evaluating health care in recent
years.

3. DEFINITION:-
⚫Dictionary defines quality as a degree of
excellence.
⚫Quality assurance is a general term for all arrangements
and activities that are mean to safeguard, maintain and
promote
quality of care (Dr. Aveda’s Donabedian )
⚫The set of activities that are carried out to set standards
and to monitor and improve performance, so that the care
provided is as effective and as safe as possible.

4. • A systemic process for closing gap between actual performance
and desirable outcome
-Dr. Ruelas and frank
• Quality assurance is a systemic inquiry including those activities or
programme components designed to evaluate patient care and
identify,study and correct deficiencies in the patient care process.

5. PURPOSES OF QUALITY ASSURANCE
Increased
demand for
effective and
appropriate care
Need for
standardization
and variance
control
Meet patient
needs and
expectations
Necessity for cost
saving measures
Pressure of
competition and
enhance
marketing
Desire for
recognition and
strive for
excellence
Need for
improvement in
care and
services

6. PRINCIPLES:
 Focus on client’s need
Focus our systems and processes
Focus on data as basis for decision making
Focus on team approach to problem solving and
quality improvement.
hospital

7. QUALITYASSURANCE CYCLE
(a)
Standards
of care
(b)
Measurment
criteria
(c)
Assessment
(d)
Documented
problems
(e)
Recommendation
for change

8. TECHNIQUES OF QUALITYASSURANCE IN NURSING
1.professional standards system
identify
standards
criteria
structure process
outcomes secure
Choose
action
Take
action
Identify
values
Courses of
measurement
action

9. 2. COMPREHENSIVE REVIEW
SYSTEMS
• It provides guidelines for a process for
local standard setting on the assumption
that at some later date general standards
may grow from the local and specific ones.

10. 3.PROCESS APPRAISAL TECHNIQUES
• It contains methods which focus particularly
on appraisal of the quality of the processes of
care.
• The process of care comprises all the
procedures and activities through which the
health professionals
deploy their time,
and support workers
skills, knowledge and
resources in pursuit of improved patient health
and well being.
• It has technical, interpersonal and normal
components and includes access, diagnosis,
treatment, discharge, after care, and health
education and promotion.

11. QUALITYASSURANCE PROCESS
⚫Goal
⚫Focus
--- To improve quality
--- Discovery and correction of
errors.
-- Inspection of nursing
activities and chart audits.
⚫Major tasks
⚫Quality team --- quality assurance personnel
on department personnel.
---- Set by quality assurance team
with input from staff.
⚫ Outcome

12. FACTORS AFFECTING QUALITYASSURANCE IN NURSING CARE
• Lack of Resources
• Personal problems
• Unreasonable Patients and Attendants
• Improper Maintenance
• Absence of Well Informed Populaces
• Absence of Accreditation Laws
• Lack of Good Hospital Information System
• Absence of conducting patient satisfaction surveys
• Lack of Nursing Care Records

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

14. 2) Personnel problems:
Lack of trained, skilled and
motivated employees,staff
indiscipline affects the quality of
care.

15. 3) Improper maintenance:
Buildings and equipment 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.

16. 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.

17. 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.

18. 7.) 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

19. 7) Lack of incident review procedures :
During a patients hospitalizations reveal incidents may occur which have
a bearing on the may occur which have a bearing on the treatment and the
patient's 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

21. 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.

22. 9) Absence of patient satisfaction surveys
Ascertainment of patient satisfaction at
fixed points on an ongoing basis. Such
surveys carried out through ongoing
basis,questionnaires, interviews to by social
worker, consultant questionnaire, 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

23. 10) Lack of nursing care records
Nursing care records are perhaps the most
useful source of information on quality of
care rendered.
a) Detail the patient condition
b) Document all significant interaction
between
c) Contain information regarding
response to treatment
d) Have the dates in an easily accessible
form.

24. • 11) Miscellaneous Factors.
• Lack of good supervision
• Absence of knowledge about philosophy
of nursing care
• lack of policy and administrative manuals.
• Substandard education and training
• Lack of evaluation technique
• Lack of written job description and job
• Lack of in-service and continuing
educational

25. ROLE OF NURSING ADMINISTRATORS IN
QUALITY ASSURANCE PROGRAMME
Initiator Facilitator Leader
Coordinator Educator Evaluator

26. ROLE OFACLINICALNURSE IN QUALITY ASSURANCE
⚫Test sets of patient health/wellness outcome criteria for validity and
reliability.
⚫When outcomes are not at the desired level, search for activities
that will assist patients to realize the desired benefits.
⚫Teach the methods for developing and applying patient
health/wellness outcome criteria to staff and head nurses and to
students in educational programmes.
⚫Work with physicians and members of other disciplines to
initiate health review.

27. THE ROLE OF DIRECTOR OF NURSING SERVICE
• ⦿Make a commitment to the necessity, importance, and
urgency of implementing a quality assurance review
program.
• ⦿Create or guide the development of a protocol that enables
expert nurse peer panels to be organized and to proceed
productively.
• ⦿Teach staff nurses, head nurses and clinical nurse
specialists how to develop and apply sets of patient
health/wellness outcome criteria, and how to connect
nursing activities to specific outcomes, and how to evaluate
cost effectiveness

28. ⦿Create the nursing quality assurance review system and assemble the
resources.
⦿Monitor the reported results, support or direct implementation or
changes that will secure a higher degree of effectiveness or efficiency,
and make reports to appropriate internal bodies.
⦿Participate with other administrators and clinicians in decisions
about reports to external quality monitoring and control bodies, and
provide reports.
⦿Serve with other administrators and clinicians in evaluating
institutional effectiveness and efficiency in meeting the health needs of
the population in the service area.

29. CURRENT TRENDS, ISSUES AND CHALLENGES FOR QUALITY ASSURANCE
IN NURSING
ISSUES OF QUALITY ASSURANCE IN NURSING
1. A Continuum of Long-Term Care Options
⦿Persons with chronic conditions or illnesses often have a variety of health,
personal care, and social service needs.
⦿While consumer-centered care is growing in importance, factors such as access,
cost and quality - the three pillars of health policy - continue to influence the
availability and choice of care options. Often given less attention among the three
pillars, quality is receiving renewed and greater attention.

30. 2.The Movement toward More Consumer- Directed Care
–
• Under the traditional system for the delivery of Home- and
Community-Based Services (HCBS) services, states contract with
home care agencies to provide home care workers.
• Direct services, and monitoring the quality of care delivered to
clients. With the rise of the independent Living Movement in the
1970s, clients began to reject the agency-directed model in favor
of a more consumer directed model where the client could choose
the type and relative amount of services to be received.

31. 3.CREDENTIALING
• Credentialing is defined by Spanner (1995) as 'a process by which
individuals or institutions or one or more of their programs are
designated by a qualified agent as having met minimum standards
at a specified time.‘
• Credentialing criteria are commonly based own individual's current
license, education, training, experience, competence, and
professional judgment

32. TRENDS IN QUALITY ASSURANCE IN NURSING
1. QUALITY ASSURANCE OF
INTERNATIONALISATION
• The increasing international networking between
quality assurance agencies, including the exchange
of information and experiences, inclusion of
foreign experts in review panels, various forms of
cooperation, and international and European
networks, etc.

33. 2.RAPID CHANGES IN HEALTH CARE TECHNOLOGY AND
THERAPIES
⦿Driving forces include increasingly sophisticated surgical
technologies that are less invasive and promote quicker healing.
⦿Quality care can be assured by reducing sick time, hopefully in areas
such as cancer, HIV/AIDS and genetic disorders.
⦿However, as those technologies have prolonged the life span,
reduced mortality has changed fatal illness into more chronic
illness, which may still require care and control.

34. 3. DEMOGRAPHIC TRENDS, EPIDEMIOLOGICAL TRENDS
AND HEALTH CARE STATISTICS
⦿This help those quality care provider to recognize health care
needs for society and give information for future planning of
cost effective services.

35. 4.SUPPLY OF MANPOWER AND COMPETITION
• Manpower shortages in health care professions affect
the utilization of nurses and advanced practice nurses.
• This is a particularly important area in times of nursing
shortage to be sure that less qualified health care
workers are not used to substitute for the sake of
expedience and reduced costs

36. 5.THE ERA OF ALTERNATIVE THERAPIES, GENOMICS AND
PALIATIVE CARE
• The nursing practice must expand to include the
implications of emerging therapies fromgenetic research
,palliative and end of life care, hospice care,councelling
are now likely to be part of well developed health care
systems opportunities for working to achieve this goals
and to ensure safe,quality,health care services

37. 6. EVIDENCE-BASED PRACTICE AND INNOVATION
⦿Evidence-based practices would promote more
appropriate and effective health care.
⦿Health care research, including basic, clinical, prevention, and health services
research calls for substantially more collaboration among private and public
organizations and researchers, both for funding and in conducting health care
technology assessments.
⦿ The report also recommends targeting research to' areas where the greatest
improvements in health and functional status of the population can occur and
where gaps in knowledge exist, using the proposed entity for Sources that
supplement evidence attained from the research:

38. ⦿Quality Improvement and Risk Data
⦿International, National and Local Standards
⦿Benchmarking Data
⦿Cost Effective Analysis
⦿Clinical expertise
⦿Patient's preferences
⦿Infection Control Data
⦿When the research base is insufficient to guide practice,
these sources provide the best 'available evidence.

39. CHALLENGES IN QUALITY ASSURANCE
FACTORS DIRECTLY IMPACTING ON THE
SHORTAGE OF NURSES AND MIDWIVES-
• The main factors are unstable funding of the health sector and
inadequate planning, management and deployment of human
resources. Low salaries and poor working conditions continue to
be identified as the main reasons for persistent problems in
recruitment, retention and attrition.

40. KNOWLEDGE EXPLOSION AND ACCESS TO
TECHNOLOGY SOLUTIONS
⦿Although ongoing developments in communication
technology are facilitating global communications and
the rapid dissemination of results, the systems, tools
and training are often not made accessible to health
providers
⦿If developing countries continuously have difficulty to
develop, assess and transfer health technology, the
North-South gap could continue to widen, Advances in
health informatics, including tele-health and distance
education, are having an impact on our concept of
health services and training and are raising public and
provider expectations.

41. EPIDEMIOLOGICAL CHANGES AND
SERVICE RESPONSE
• Communicable and non-communicable diseases
continue to be a global challenge although improvements
differ between developed and developing countries.
• the re-emergence of infectious diseases and increases in
chronic health conditions broaden the demand in the
health system.
• The aging and disabled populations are shifting service
needs to communities where people live and work. It is
estimated that mental health will be the leading cause of
burden in the world by the year 2020.

42.  RESOURCES
⦿The toughest challenge in this century is the
Management of Resources be it Men, Money or
Material. Hospital Administration shall be able to
make the judicious use 'of these resources so as to
provide the best of 'services to the community.
⦿As the employees are the hospital's most important
resource, Hospital Administration has to revise
innovative application of various strategies, new
organizational structure and advanced technologies to
keep human resource update enhancing their
productivity and qality of service rendered.
⦿ Other challenge is funds. Expenditure on health care
is increasing, but the resource are shrinking. So in
order to keep the balance between the demands and
resources, hospital administration has to adopt the
innovative ways and means.

43.  PRODUCTIVITY
• Productivity is the relationship between
organizational outputs and inputs.
Hospital Administration should focus on
this relationship to increase outputs
relative to inputs consumed.

44. LEGAL CHALLENGES-
• The public is fast becoming conscious of its
rights in every walk of life, so same is also true
for the medical care.
• Consumer protection Act is there to give
protection to the consumers, so every Hospital
Administrator is duty-bound to know the lawful
rights and responsibilities with respect to
members of hospital staff, patients and visitors.

45. TELECOMMUNICATION
REVOLUTION-
• Focusing on transfer of clinical and management
information, sharing of patient records,
diagnostic information and data base across
hospitals using Tele-medicine can open up
entirely new vistas and horizons.
• The call of the day is Hospital Administrators to
be computer literate and share views and ideas
for better management of hospitals.