2. Quality Assurance
A system for monitoring outcome of professional
intervention and departmental activities, which are
compared with established standards to evaluate
and document appropriateness of practies.
3. Need for Quality Assurance
Professional Factors
Code of Conduct
Autonomy
Accountability
Inter-professionalism
Moral issues
Social / Political Factor
Public awareness
Social expectation
Legislation
Accreditation
International pressure
Economical Factors
Demographic changes
Resource-distribution
5. Definition of Standards
A standard is a means of determining what
something should be in case of nursing
practice.
Standards are the establish criteria for the
practice of nursing.
Standards are statement for nursing practice.
Standards specifies what is necessary for
high quality practice (ANA1973)
6. Process of Quality Assurance
Setting Standards.
Apprising actual achievement.
Planning for improvement.
Taking action when required.
8. Need of Standards
Provides direction for nursing performance.
Provide systematic approach for nursing care.
Provides for evaluating nursing practice.
The patient’s right to have excellent nursing care
Helps in supervision and guide staff to improve.
Helps justify demands for resource allocation.
Help classify nurses area of accountability at different
levels
9. Need of a Standards
Nurses need to define and describe their
practice because of their statutory , legal and
social responsibility to give best possible
care to patient and client.
11. Purposes of Standards
Evaluating the quality of practice.
To coordinate and unify.
Identify the element of independent function of practice.
Provide a basis for planning and evaluating programs
Inform the society of our concern for the improvement of
nursing practice.
Assist public in understanding what to expect from nursing
practice.
Provide a means by which member of different health
profession can coordinate their efforts in the improvement of
health care.
Health employers to understand what expect from the
practitioner .
Stimulate and encourage nursing personnel to promote and
support education, studies and research
12. In general
Nursing care standard are important to :
Improve the quality of nursing care,
Decrease the cost of nursing care.
Promote a basis for determining
13. Types of Standards
Normative standards : These standards are
descriptive of practices which are considered
ideal by authority . These standards describe
higher quality of practices. e.g. standards set
by professional association.
14. Empirical standards : These standards
description of practices which are in actual
practice in large number of setting and which
agreed upon and achievable .e.g. standards
set by law enforcement bodies and
regulatory bodies- like health department and
licensures bodies.
16. Structure Standards ( Institution Oriented)
The structure standards related to…
Polices, goals, objectives
Staffing, number, type, training, qualification, job
responsibilities.
Recording system
Administrative set up – line of communication
Equipment and supplies
Budgeting
Physical facilities. Building etc.
17. Process Standards
Nursing activities .Identifies personal need ,
disease-related needs and therapy related
needs.
Identify framework
Technical skill
Evaluate the result.
19. STEPS IN STANDARD FORMATION
Organize small group of nurses who meet
periodically.
Decide on the area for work out standards
Review, revise philosophy, purposes, and
objective of patient care.
Review nursing theories / existing nursing care
practice, nursing process and identify your
client for service; client’s role, approaches and
strategies for nursing care services.
20. ……cont.
write the statement
Discuss that they are made feasible.
Devise a mechanism for determining the
achievement of the standards.
Determine the validity by giving to the expert.
Try out the standard to determine the feasibility
and validity.
The standards are put into practice and quality
care is audited.
21. Criteria of Standards
criteria specifies clearly and precisely the
level of performance which has to be
achieved to satisfy the standard. Criteria can
be based on the types of standard. i.e.
structure, process, and outcome .
22. AMOUR Principles of criteria (In Quality Assurance)
Achievable
Measurable
Observable
Understandable
Reasonable
23. EVALUATION OF NURSING CARE
Two major functions of evaluation of nursing
services are:
To ascertain the nature and effects of nursing
care.
To decide whether or not the observed effects
attain acceptable standards of nursing care.
25. TOOLS AND TECHNIQUE USED FOR
EVALUATING NURSING CARE
Patient care Centered tool /Methods
Nursing audit.
26. Patient care centered tool / technique
methods
Observation
By giving opinion : questionnaire to patient
relatives and or staff.
Interviewing patient and relatives.
Nursing round
27. NURSING AUDIT
Nursing audit is the nurse’s formal, systematic
written appraisal of the quality of nursing
services indicated in the care records of
discharged patient .
Structure audit : physical facilities, equipment and
supplies, the personnel.
Process audit : Focused on the order in which
events occur, i.e. procedure of giving care.
Outcome audit : Looks at the status of the patient
as a result of care provided.
28. Uses/ Advantages of Nursing Audit
biographical index
assured of good services
staff improvement in quality of nursing
cooperation
self evaluation.
better planning
reduce medico-legal complications
broaden and strengthen nursing service
29. Disadvantages
It is considered as a source of
punishment by professional group.
Medico-legal important-they feel that
these will be used in court of law as any
document can be called for in court of
law for clear, adequate and efficient
evidences.
30. Using Results of Nursing Audit
For Nursing care service.
Modifying nursing care plans and the nursing care
process
Implementing a program for improving
documentation
Focusing supervisory attention upon areas of
weakness identified
Focusing on nursing round and term conferences
Designing responsible orientation and in service
education program
31. Using Results of Nursing Audit
For Nursing Administration
Provide evaluation of particular program
Support requests for accreditation
Serves as basis for planning new
program
Serve to identify area of strength and
weakness
Determine the influence of varied
staffing pattern.
May be used as data
32. Using Results of Nursing Audit
For Nursing Supervisor and Head Nurse
Identify area of needed patient care
improvement
Provide basis for planning in-service education
program
Identify/ supervision needs of a staff member
who give direct care to the patient.
33. Using Results of Nursing Audit
For Staff Nursing
Provide a self examination of care in their
specific nursing unit or setting
Identify particular type of care in which
practice may be improved merely by
increase attention and conscientiousness.
Identify type of care in which improvement
will depends on the staffing acquiring
additional knowledge and skill.
34. STEPS IN DEVELOPING QUALITY ASSURANCE
Approval of the program
Taskforce or committee to be appointed
Orientation program to be agreed for the committee
member to familiarize with the purpose principles,
methods etc.
Examine their belief and behavior concerning
quality control through workshop.
Explore the difference in nursing values through
open confrontation
35. Two major categories of approaches
General Approach : It examines the
ability of the agency to meet criteria or
standards.
Specific Approaches : These are
methods used to evaluate provider and
client interaction
36. Beneficiaries of Quality Assurance Program
The recipients of care who receive safe
effective satisfying services.
The care providers because evaluating offers
opportunity to promote personal and
professional growth.
The agencies – which obtain data for planning
cost containment and legal protection.
The profession – quality assurance program
promotes development of standards and
protocol and generations of new knowledge.
37. Factor Affecting Quality Assurance
Lack of Resources- Infrastructure equipment.
Personal Problem
Improper Maintenance
Absence of well informed populace
Absence of Accreditation
Absence of conducting patient satisfaction
survey.
Lack of nursing care records.
Miscellaneous Factors
Indian publication nursing are very few
Lack of adequate nurse administrator
38. ROLE AND RESPONSIBLITES OF A NURSE
ADMINISTRATION IN DEVELOPING QUALITY
ASSURANCE SYSTEM
Deciding upon the philosophy .
Make certain that you as well as your nurses
know what you wish to evaluate and why
Formulate objectives
Set standards
Enlist expert guidance
plan carefully and select the evaluation tools
suitable to the unit
Work cooperatively
Publish the report of the result of evaluation of
care
39. NURSES ROLE IN QUALITY ASSURANCE
Planning
risk factor
identificatio
n, resource
mobilization
, goal
setting
Implement
ing
standards
monitoring
and
reporting
Evaluating
changes in
standards ,
policies ,
outcome ,
goal
attaintment
NURSES ROLE
IN
QUALITY
ASSURANCE
40. CONCLUSION
Sound evaluation tool alone will not be
sufficient to improve the quality. To attain the
goal of providing optimum quality care
nurses themselves make them to ready by
critical thinking and by developing and
implementation a quality assurance program
in their hospital so as to provide a scientific
care which is combined with humanitarian
approach.