QUALITY ASSURANCE

QUALITY
It is degree to which health services for individuals & population increase the likelihood of desired health outcomes & are consistent with current professional knowledge.
-Joint Commission on Accreditation of health care organization ,2002 (JCAHO)

ASSURANCE-
It is statement or indication that inspires confidence.

QUALITY ASSURANCE

Quality assurance is an on-going, systematic, comprehensive evaluation of health care services & impact of those services on health care services. -Kozier
Quality assurance is defined as all activities undertaken to predate & prevent poor quality. –Neetvert
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. -Maker1998

NURSING
The unique function of nurse is to assist in individual sick or well in performance of those activities contributing to health or its recovery or to a peaceful death that he would perform unaided if he had necessary strength will or knowledge & to do this in such a way as to help him to gain independence as rapidly as possible.” - Virginia Henderson

OBJECTIVES

To ensure the delivery of quality client care.
To demonstrate efforts of health care providers to provide good results.
To formulate plan of care.
To evaluate achievement of nursing care.
To support delivery of nursing care with administrative & managerial services.
To explain quality assurance models as pre- requisite for quality nursing care.
To state code of ethics & professional conduct for nurses in India.
To appreciate importance of practicing standard safety measures.
Plan & conduct patient teaching sessions.
To identify appropriate management techniques to be used for managing resources in given situation.

PURPOSES

It is required to introduce code of ethics & professional conduct for nurses in India.
To prepare staff nurse for implementation quality assurance model in nursing.
To provide best care to patients by maintaining standards.

PRINCIPLES

Customer focus- It focuses on patient’s care with standard & recent medical knowledge.
Leadership – It helps to inculcate qualities of leadership in staff.
Involvement of People- It should involve maximum nursing staff so that standards can be maintained.
Process approach- There should be a systematic & planned approach to provide quality care.
Factual approach to decision making- There should be fact or appropriate reason in taking certain decision for quality assurance of patient.

APPROACHES FOR QUALITY ASSURANCE PROGRAM
Approaches of quality assurance are divided into 2 types-

General Approach
Specific Approach

A. GENERAL APPROACHES
It involves large governing of official body’s evaluation of person’s or agency’s ability to meet standard at a given time.

1. CREDENTIALING - It is process of determining & maintaining nursing standards.
Functional Components Of Credentialing Process According to Hinsvark (1981)

To produce a quality product.
To confer a unique identity.
To protect provider & public.
To control the profession

2.LICENSURE

dividual licensure is a contract between profession & state in which profession is granted control over entry into & exists from profession & over quality of professional practice.

3. ACCREDITATION
Accreditation is the act of granting credit or recognition especially to an educational institution that maintains suitable standards.

4. CERTIFICATION
Certification is usually a voluntary process within the professions. A person’s educational achievement, experience & performance on examination are used to determine person’s qualification for functioning in an identified specialty area.

B. SPECIFIC APPROACHES
Quality assurances are methods used to evaluate identified instances of provider and client interaction

1. Peer review committee- These are designed to monitor client specific aspects of care appropriate for certain levels of care. The audit is used by peer review committee to ascertain quality of care.

2. NURSING AUDIT – Nursing audit is evaluation of patient care through analysis of written records maintained by nurses in patient’s treatment profile. - Avtar Brar

GOALS OF NURSING AUDIT

To improve quality of health care.
To promote improved communication among nurses & other health team members.
To improve quality of nursing care.
To detect & analyze problems & errors.

3. Utilization Review
Utilization review activities are directed towards assuring that care actually needed and that the cost appropriate for the levels of care provided

TYPES OF UTILIZATION REVIEW

Prospective: It is an assessment of the necessary of care before giving services.
Concurrent: A review of the necessity of care while the care is being given.
Retrospective: It is analysis of the necessity of the services received by the client after the care has being given

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 health care rather than hospitalization
It can provide guidelines for staff of program development.
It provides a measure of agency accountability to the consumer. The major disadvantage to UR is that not all clients are fit for the classic picture presented by the explicit criteria that serves as the basis for approval or denial of care.

4. Evaluation Studies
Three major models have been used to evaluate Quality

Donabedian’s Structure-Process-Outcome model
The tracer model
The sentinel model

a. Donabedian
introduced 3 major method of evaluating quality care:-

1. Structural evaluation- This method evaluates setting & instruments used to provide care such as facilities, equipment's & characteristics of administrative organization & qualification of health provider. The data can be obtained from existing documents.

2. Process Evaluation- This method evaluates activities as they relate to standards & expectations of health providers in management of client care. Data is collected through direct observations, review of records, audit etc.

3. Outcome Evaluation- The net changes that occur as a result of health care or net results of health care. The data of this method can be collected from vital statistics records such as death certificate or telephone client interview, mailed questionnaire & client records.

b . The Tracer method
It is a measure of both process and outcome of care To use the tracer method, one must identity a volume of client with a particular characteristic resuming specific health care management. Physicians and nurse practitioners, to identity persons with certain illness such as HTN, ulcers, UTI and to establish criteria for good medical and nursing management of the illnesses have used the tracer method.

c. The Sentinel Method
It is an outcome measure for examining specific instances of client care

Cases of unnecessary disease, disability death are counted.
The circumstances surrounding the unnecessary event.
In review of morbidity and mortality are used as an index.
Health status indicator such as changes in social, economic, political and environmental factors Diasaster

Factors affecting Quality Assurance in Nursing Care

Lack of Resources'
Personnel problems
Improper maintenance
Unreasonable patient and Attendants
Absence of well informed population
Absence of accreditation laws
Lack of incident review procedures
Lack of good hospital information system
Absence of patient satisfaction surveys
Lack of nursing care records 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 specifications.
Lack of in-service and continuing educational program.