A brief presentation on Healthcare Quality&EBP.pptx

For nursing students

1. UNIT X HEALTHCARE QUALITY & EVIDENCE BASED PRACTICE

2. Evidence Based Practice Evidence based practice (EBP) is defined as a systematic method of evaluating the best available scientific evidence from studies and clinical experience, including patient interests, beliefs, expectations, and needs to make a clinical decision that will affect patient care in particular circumstances.

3. EVIDENCE-BASED QUALITY IMPROVEMENT The actual strategies for implementing evidence-based medicine require an evidence base of their own. Using implementation strategies that are evidence-based is called evidence-based quality improvement (EBQI).  Implementation strategies that are evidence-based include performance feedback, leadership support, external and internal facilitation, provider and patient education, tailoring to the local context, using a quality manager, and regular data collection to drive and evaluate change. EBQI is best when it is a true partnership between researchers, clinicians, and clinic leadership. Clinicians and administrators give specialized expertise required to adapt evidence-based practice for their organizational demands.

4. Competencies of Healthcare Professionals for EBQI All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics. To this end, the committee proposes a set of simple, core competencies that all health clinicians should possess to meet the needs of the 21st-century health care system: Provide patient-centered care —identify, respect, and care about patients’ differences, values, preferences, and expressed needs; relieve pain and suffering; coordinate continuous care; listen to, clearly inform, communicate with, and educate patients; share decision making and management; and continuously advocate disease prevention, wellness, and promotion of healthy lifestyles, including a focus on population health.

5. Work in interdisciplinary teams —cooperate, collaborate, communicate, and integrate care in teams to ensure that care is continuous and reliable. Employ evidence-based practice —integrate best research with clinical expertise and patient values for optimum care and participate in learning and research activities to the extent. Apply quality improvement— identify errors and hazards in care; understand and implement basic safety design principles, such as standardization and simplification; continually understand and measure quality of care in terms of structure, process, and outcomes in relation to patient and community needs; design and test interventions to change processes and systems of care, with the objective of improving quality. Utilize informatics— communicate, manage knowledge, mitigate error, and support decision making using information technology.

6. Six Domains of Health Care Quality Healthcare quality is critical for all providers, patients and their families.  The Institute of Medicine (IOM) has identified six crucial domains of healthcare quality:  Safe : Avoiding harm to patients from the care that is intended to help them. Effective : Healthcare providers must use the most appropriate treatments and procedures to achieve the desired results. Patient-centered : It involves working with patients to identify their needs and ensuring that their concerns are taken into account when planning and delivering health services. Patient-centered care promotes an individualized approach to healthcare and strives to ensure that patients have control over their healthcare decisions.  Timely : T imely care means providing health services as soon as possible. This is particularly important when it comes to emergency services, which must be available whenever and wherever they are needed. Efficient : Efficiency is a measure of how well an organization uses resources to produce output. Avoiding waste, including waste of equipment, supplies, ideas, and energy. Equitable : Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.

7. Dimensions in Health Care Quality There are four dimensions in healthcare quality. They are: Accreditation and Certification of Hospitals and Community-Based Services Clinical Quality Performance Measurement and Improvement Patient Safety Assurance and Harm Prevention Patient Experiences and Perceptions of Care

8. 1. Accreditation and Certification of Hospitals and Community-Based Services: Accreditation and Certification establish the basis for providing quality in healthcare. Institutions and unique special services such as laboratory centers and imaging services must be accredited and must comply with standards of performance and licensure to establish credibility. It is about how well an institution has performed in the past and how well the infrastructure for providing quality healthcare has been established.

9. 2. Clinical Quality Performance Measurement and Improvement: Clinical performance metrics are generally regarded as the measures of clinical quality. Process measures assess what and how care is provided and the appropriateness of care; outcomes measures demonstrate how well care is provided and, potentially, the cost-benefits or cost-efficiencies of those efforts.

10. 3. Patient Safety Assurance and Harm Prevention: Providing safe care and avoiding harm may be considered components of clinical performance measurement, but the huge challenges that exist in harm-avoidance raise this to the level of special consideration. Communication factors seem to be consistently at the forefront of correctable causal factors of safety incidents. Processes to standardize important elements of complex care management, including the use of evidence-based guidelines such as the WHO safe surgery checklist, have worked their ways into our practice.

11. 4. Patient Experiences and Perceptions of Care: Patients view quality in ways very different from clinicians. Patients deserve to receive compassionate care in a timely fashion, in comfortable settings, via convenient processes. Unfortunately, some patients may confuse “wants” and “needs” and may compliment and even revere the physician who prescribes inappropriate and ineffective medications for illnesses or who orders imaging studies with no focus on appropriateness and little regard to hazards. For example, nearly 75% of adults diagnosed with upper respiratory tract infections receive antibiotics despite the fact that the overwhelming majority of such infections are caused by viruses.

12. Components of Quality Management in Healthcare In healthcare, quality management refers to the administration of systems design, policies, and processes that minimize or eliminate, harm while optimizing patient care and outcomes. It has four main components Quality Planning, Quality Assurance, Quality Control and Continuous Improvement. Quality management is focused not only on product and service quality, but also on the means to achieve it. Quality Planning: Quality planning is determining the activities required for developing the products, systems, and processes needed to meet customer expectations. Quality Control: A system of maintaining standards in manufactured products or services by testing a sample of the output against the specification. Quality Improvement: after completing the quality control process, you need to thoroughly review your findings and come up with a way to improve your methods going forward. Quality Assurance: It is a way of preventing mistakes and defects in manufactured products and services to customers.

13. ROLE OF NURSE IN QUALITY IMPROVEMENT THROUGH EBP

14. HEALTHCARE DATA STANDARDS Healthcare organizations communicate information in accordance with a set of standards. Standards are accepted techniques for linking systems. Data standards are created to ensure that all parties use the same language and the same approach to sharing, storing, and interpreting information. The key to facilitating information sharing and communication between departments, health agencies, and health workers is standards. Standards are required for interoperability(regardless of domain or software provider).

15. PURPOSES OF HEALTH INFORMATICS STANDARDS promote interoperability between independent systems, to enable compatibility and consistency for health information and data, as well as to reduce duplication of effort and redundancies. Semantic interoperability is the ability to interpret, and, therefore, to make effective use of the information so exchanged In order to successfully transmit information and analyze and apply it, interoperability is required in all healthcare settings around the world. Easier manufacturing, supply, and trade are other significant objectives, as are reducing duplication of effort and redundancy. The secure, efficient incorporation of ICT and information management into clinical practice. The fundamental goals of HI standards are to facilitate interoperability and to direct safe, efficient HI activity.

16. DEVELOPMENT OF HEALTHCARE STANDARDS Step1- Determine the needs of the firm: Stakeholders identify business needs and submit specifications to a standard development organization(SDO) such as healthcare providers, hospitals, health insurance, or software suppliers. Step2- Workgroup collaboration: A team with clinicians, healthcare administrators, health information professionals, software developers, and specialists in regulatory requirements is tasked with creating a standard. The standard draft and the implementation plan are both created by this workgroup. Step3- First balloting: Stakeholder provide comments on the draft which are then taken into consideration by the workgroup while creating the standards. All participants then cast their votes for the pilot-ready draft criteria.

17. Step4- Piloting: Vendors of software and/or healthcare systems test the standards’ draft version and offer input. Step5- Second balloting: The workgroup incorporates feedback from piloting and sends the draft for the second balloting. Upon receiving comments, the workgroup makes all necessary improvements. Finally, workgroup members and stakeholders vote to approve the draft as a normative standard for use. Step6- Implementation and maintenance: The Standard Development Organization(SDO) implements standards, fixes issues and collects feedback to make improvements.