Quality assurance is a way of preventing mistakes and defects in manufactured products and avoiding problems when delivering products or services to customers; which ISO 9000 defines as "part of quality management focused on providing confidence that quality requirements will be fulfilled".

1. DR. PALLAVI

2. Definition
 Quality
It is defined as a continual striving for
excellence and conforming to specific
approaches or guidelines.(Davis)
OR
It is the extent of resemblance between the
purpose of health care and the truly granted
care.(Donabedian)

3. Definition
 QUALITY ASSURANCE
It is the promise or guarantee that certain
standards of excellence are being met in
the delivery of care.
OR
Quality assurance is concerned with the
accountability of the provider and is only
one tool in achieving the best client
outcomes.

4. Quality Assurance program
 QAP includes –
Standards of practice.
Advances in Technology.
Changes in practical environment.
Continuing competences.
Continuous Quality Improvement

5. Goals of quality assurance
programme
 To ensure the delivery of quality client
care.
 To demonstrate the effects of the health
care provider to provide the best possible
results.

6. Principles of Quality
Assurance
Developing public support.
Stimulation of professional curiosity.
Training students.
Gaining the institutional administrators to
the side of quality assurance

7. FUNCTIONS OF QUALITY
ASSURANCE PROCESS

8. COMPONENTS OF QUALITY
ASSURANCE PROGRAMME

9. Approaches to quality
assurance programme
• Credentialing
• Licensure
• Accreditation
• Certification
• Recognition
GENERAL
APROACHES
• Nursing audit
• Utilization review
• Risk management committee
• Professional review organizations
• Client satisfaction
• Malpractice litigation
SPECIFIC
APPROACHES

10. General approaches
CREDENTIALITING
It is the formal recognition of a person as a
professional with high technical competence or
of an agency that met minimum standards of
performance.
LICENSURE
It is the contract between the profession and the
state.
ACCREDITATION
It is a voluntary approach to quality control used
for institutions

11. General approaches cont…
CERTIFICATION
Educational achievements ,experience and
performance on an examination determines a
person’s qualifications for functioning in an
identified specialized area.
RECOGNITION
It is a process whereby one agency accepts
the credentialing status of and the credentials
conferred by another.

12. Specific approaches
NURSING AUDIT
Definition :
Nursing audit refers to assessment of the
quality of clinical nursing(Elison)
or
Nursing Audit is an exercise to find out
whether good nursing practices are
followed.(Goster Wolfer)

13. Purposes of nursing audit
 Evaluating Nursing care given.
 Achieves deserved and feasible quality of
nursing care.
 Stimulant to better records.
Focuses on care provided and not on care
provider.
Contributes to research.

14. Types of nursing audit
 Retrospective view - this refers to an in-
depth assessment of the quality after the
patient has been discharged, have the
patients chart as the source of data.
 The concurrent review - this refers to
the evaluations conducted on behalf of
patients who are still undergoing care. It
includes assessing the patient at the
bedside in relation to pre-determined
criteria, interviewing the staff responsible
for this care and reviewing the patients
record and care plan.

16. Advantages of nursing audit
It can be used as a method of
measurement in all areas of nursing.
Scoring system is fairly simple.
Results easily understood.
Assesses the work of all those involved in
recording care.
May be a useful tool as part of a quality
assurance programme in areas where
accurate records of care are kept.

17. Disadvantages of nursing
audit
Appraises the outcomes of the nursing
process, so it is not so useful in areas
where the nursing process has not been
implemented.
Many of the components overlap making
analysis difficult.

18. Disadvantages of nursing
audit cont..
Time consuming.
Requires a team of trained auditors.
Deals with a large amount of information.
Only evaluates record keeping. It only
serves to improve documentation, not
nursing care.

19. Specific approaches cont.
UTILIZATION REVIEW
It is to ensure that care is needed and the
cost is appropriate.
3 TYPES
Prospective review
Concurrent review
Retrospective review

20. Advantages of Utilization
Review
It is designed to assist clients to avoid
unnecessary care.
It may serve to encourage the
consideration of care options by providers
such as home healthcare rather than
hospitalization.
It can provide guidelines for staff of
program development.
It provides a measure of agency
accountability to the customer.

21. Specific approaches cont..
RISK MANAGEMENT COMMITTEE
It reviews client and personnel safety
policies and procedures and determine
whether personnel are following rules.
PROFESSIONAL REVIEW
ORGANIZATIONS
They monitor access to care and cost
of care.

22. Specific approaches cont..
CLIENT SATISFACTION
It is used to measure quality of care.
MALPRACTICE LITIGATION
In this quality assurance imposed on the
health care delivery system by the legal
system.

23. The Eight elements of QAM
Ethics
It is a discipline concerned with good or bad
in any situation. These can be
organizational or individual ethics
Integrity
 Integrity implies honesty, morals, values,
fairness, & adherence to the facts &
sincerity.

24. The Eight elements of QAM
cont..
Trust
 It is the by- product of integrity & ethical
conduct. Trust allows decision – making at
appropriate levels in the organization
Training
 Training of the employees includes
interpersonal skills, the ability to function
within teams, problem solving, decision
making, job management performance
analysis.

25. The Eight elements of QAM
cont..
 Teamwork
Teams provides more permanent
improvement in processes & operations.
 Leadership
Leadership in total quality management
(TQM) provides an inspiring vision; make
strategic directions that are understood by
all and to instill values that guide
subordinates

26. The Eight elements of QAM
cont..
 Communication
It acts as a vital link between all elements of
the TQM.It can be upward communication,
downward communication, or sideways
communication
 Recognition
It should be provided for both suggestions
and achievements for teams as well as
individuals

27. Community health nursing
standards
 Promoting health: incorporates practice
strategies in health promotion, prevention,
protection and maintenance, restoration
and palliation.
 Building individual/community
capacity: reflects the integral role of work
with individuals, groups, organizations and
communities in developing skills,
knowledge and readiness to take action in
support of health.

28. Community health nursing
standards cont..
 Building relationships: emphasizes
development of caring relationships,
networks and supportive environments

29. Community health nursing
standards cont..
 Facilitating access and equity:
integrates application of the principles of
primary health care in working with others
to facilitate universal and equitable access
to services and addressing determinants of
health.

30. Community health nursing
standards cont..
 Demonstrating professional
responsibility and accountability:
acknowledges the autonomy of community
health nursing practice and the
practitioner's responsibility in providing
competent care within a complex
environment.

31. Quality Evaluation model
Donabedian’s model

32. Donabedian’s model
STRUCTURE
• Vision
• Philosophy
• Values
• Objectives
PROCESS
•Standard of
care
OUTCOME
•Change in
health
status of
client

33. Framework according to
JCAHO
 Professional Standards
• Policies
• Position Descriptions
• Performance Skill
 Outcome
• Professional Outcome
• Client `s Outcome

34. Framework according to
JCAHO cont..
 Care Guidelines
• Procedures
• Clinical Protocol
• Critical pathways
• Care plans

35. Factors affecting quality
assurance
Lack of resources
Personnel problem
Improper maintenance
Unreasonable patients and attendants
Absence of well informed populace

36. Factors affecting quality
assurance cont..
Absence of accreditation laws
Lack of incident review procedures
Absence of conducting patient satisfaction
Lack of nursing care records
Miscellaneous factors

37. References cont..
 Kozier Barbara,Erb Glenora,Blais Kathleen,Wilkson
Judith M , “ Fundaments of nursing – Concepts, process &
Practice”,5th ed.,California:Addison_ WeselyPublishing
Company,1995.
 Potter Patricia A., Perry Anne Griffin,” Fundamentals of
Nursing”,5th Ed. New Delhi:Harcout( India) Private
Ltd.,2002,p-78-83
 C.Sanz,R.Sunol,C.Abello,A.Blank, “ Design & Results of
Nursing Quality Assurance Program in hospital de la
Santa Creu I sant Pau , Spain “, International Journal for
Quality in Health Care, vol.5, No. 3, p- 267-273.

38. References cont..
 Brooten Dorothy,et al, “ Quality & the Nursing
Workforce : APNs, Patient Outcomes & Heath care
costs “ Nursing Outlook, Vol.52, Issue 1 , Feb 2004, p
– 45-52
 Basvanthappa BT, “Nursing Administration,” New
Delhi, Jaypee Brothers Medical Publishers Ltd., 2003,
p-443.
 Available from URL-www.google .com
 Available from URL-www.science direct.com

39. Thank you