QUALITY INDICATOR IN NURSING.pptx

These indicators included: Falls, Falls with Injury, Nursing Care Hours per Patient Day, Skill Mix, Pressure Ulcer Prevalence, and Hospital-Acquired Pressure Ulcer Prevalence.

1. DR.ANJALATCHI MITHUKUMARAN VICE PRINCIPAL ERA COLLEGE OF NURSING ERA UNIVERSITY , LUCKNOW -226003 QUALITY INDICATOR IN NURSING

2. INTRODUCTION Quality indicators are the means to judge the real performance of certain clinical as well as managerial parameters selected for monitoring and evaluation. The Quality Indicators (QIs) are measures of health care quality that make use of readily available hospital inpatient administrative data.

3. Meaning of quality indicator in nursing Quality Indicators (QIs) are standardized, evidence-based measures of health care quality that can be used with readily available hospital inpatient administrative data to measure and track clinical performance and outcomes.

4. Meaning of quality indicators in NABH Quality Indicators are  the backbone on which quality assurance program of a hospital relies . NABH ( National Accreditation Board for Hospitals & Healthcare Providers) accreditation expects hospitals to calculate several quality indicators and use it for monitoring the quality of care . Checklist for quality indicator as per NABH

5. SUMMARY OF STANDARDS NQI.1 There is a structured quality improvement and continuous monitoring program for nursing service. NQI.2 The organization identifies key indicators to monitor the structures, processes and outcomes, which are used as tools for continual improvement for nursing services.

6. STANDARD CONTINUED NQI.3 The nursing quality improvement program is supported by the management NQI.4 There is an established system for nursing audit NQI.5 Incidents, complaints and feedback from nursing professionals are collected and analyzed to ensure continual quality improvement.

7. NQI.1 STRUCTURED QUALITY IMPROVEMENT AND CONTINUOUS MONITORING PROGRAMME Objective The quality improvement program is developed, implemented and maintained by a committee with a representative from nursing personnel E lements Interpretation There is need for a formal controlled documentation. This will be aligned with the organizations quality improvement program Remarks At minimum, a “nursing manual” shall be established. 

8. CONTINUED  Objective There is a designated individual for coordinating and implementing the nursing quality improvement program. E lements Interpretation Self explanatory Remarks This individual shall necessarily be a senior and experienced nursing professional preferably with exposure to NABH and quality standards 

9. CONTINUED Objective The quality improvement program shall be reviewed at periodic intervals. E lements Interpretation Self explanatory Remarks It should be reviewed and updated at least once every year.

10. NQI 2 IDENTIFICATION OF KEY INDICATORS  Objective The patient falls are monitored and the incident of patient falls is documented by the appropriate nursing professionals. E lements Interpretation The factors responsible for patient fall can be classified as under 1 ) Nursing related 2 ) Patient related unbalanced or unsteady gait, incorrect use of equipment . 3) Falls requiring medical intervention. Remarks Self explanatory 

11. CONTINUED Objective The hospital acquired decubitus/pressure ulcers in various departments are monitored and recorded as per laid down protocols by the HCO E lements Interpretation Self explanatory Remarks Self explanatory

12. CONTINUED Objective The medication errors during provisioning of care are monitored and recorded on occurrence by the concerned nursing staff in forms as laid down by the HCO E lements Interpretation Self explanatory Remarks Self explanatory 

13. CONTINUED   Objective Monitoring of accidental declining ( If applicable) Elements Interpretation Self explanatory Remarks Self explanatory

14. CONTINUED Objective All needle stick injuries are documented and monitored as per the policy laid down by the HCO that should be in consonance with the national and international guidelines. Elements Interpretation Self explanatory Remarks Self explanatory 

15. CONTINUED Objective All extravasations are recorded and monitored as per the laid down protocols. E lements Interpretation Self explanatory Remarks Self explanatory 

16. CONTINUED Objective The hand hygiene compliance is monitored and recorded by the nursing professional responsible for the same. E lements Interpretation Self explanatory. Remarks The monitoring should be as per the criteria identified by the WHO guidelines on hand hygiene. Self explanatory

17. CONTINUED Objective All restraint related incidents are monitored and documented E lements Interpretation Self explanatory Remarks Self explanatory

18. CONTINUED Objective The compliance with pain assessment and management is monitored by the senior nursing professional while undertaking their professional rounds and the same is documented. E lements Interpretation Self explanatory Remarks Self explanatory 

19. CONTINUED Objective The satisfaction of patients with the nursing care is monitored by the senior nursing professionals and the same is documented . E lements Interpretation Self explanatory Remarks Self explanatory

20. NQI 3 NURSING QUALITY IMPROVEMENT PROGRAMME Objective The management makes available adequate resources required for quality improvement program. E lements Interpretation This shall include the men, material, machine, money and method. Remarks These should be in steady supply so as to ensure that the program functions smoothly

21. CONTINUED Objective The management supports and implements use of appropriate quality improvement, statistical and management tools in its quality improvement program. E lements Interpretation Self explanatory Remarks For example, Root Cause Analysis, FMEA, Project Evaluation and Review Technique (PERT), Critical Path Method(CPM) control charts, etc. 

22. CONTINUED Objective The senior nursing professionals as delineated by the HCO also monitor the nursing satisfaction based on pre determined criteria in consultation with human resource department of the HCO E lements Interpretation Self explanatory Remarks Self explanatory 

23. CONTINUED Objective The attrition rate and frequency of attrition of the nursing professional is monitored and documented by the head of the nursing in consultation with the human resource department of the HCO E lements Interpretation Self explanatory Remarks Self explanatory

24. NQI 4 ESTABLISHED SYSTEM FOR NURSING AUDIT  Objective The parameters to be audited are defined by the organization As these audits are retrospective/ concurrent in nature. It is imperative that this be done using predefined parameters so that there is no bias. E lements Interpretation The parameters could be disease based, nursing protocol based, nursing documentation based, cost based, community based or based on morbidity ( length of stay) It shall lay down the objectives, the parameters that are going to be captured, develop a checklist where required, sampling and data collection guidelines and preparation of report . Remarks The audit shall encompass all aspects of care including clinical and nursing 

25. CONTINUED Objective Patient and staff anonymity is maintained. This means that the names of the patients and the hospital staff who may figure in the audit documents must not be disclosed or any reference be made to them in public discussion/ conferences. E lements Interpretation This is at the stage of report preparation and dissemination. Remarks The staff participating in the audit shall maintain patient and staff anonymity and not reveal names

26. CONTINUED Objective All audits are recorded and reviewed E lements Interpretation Self explanatory Remarks The organization could use a checklist with the predefined parameters and the audit findings could be recorded on this sheet.

27. CONTINUED Objective Implementation is recorded and reviewed. E lements Interpretation All remedial measures as ascertained should be documented and implemented and improvements there of recorded to complete the audit cycle. Remarks This should preferably be done based on root cause analysis.

28. NQI.5 COLLECTION & ANALYSIS OF INCIDENTS, COMPLAINTS AND FEEDBACK Objective The organization has an incident reporting system The incident reporting system includes :- Elements Interpretation a ) Identification b ) Reporting c ) Review d ) Action on incidents. Remarks These could be members of the core committee/ nursing quality assurance committee, etc.

29. CONTINUED Objective Corrective and preventive action are taken based on the findings of such analysis . E lements Interpretation The objective of this is to continually improve the quality of patient-care services. Remarks All such action shall be documented.

30. CONTINUED Objective The organization has a process to collect feedback and receive complaints E lements Interpretation Self explanatory REMARKS This shall be communicated to the patients using displays or brochures

31. CONTINUED  Objective The organization has established processes for analysis of incidents, feedbacks and complaints. E lements Interpretation The quality improvement committee shall be responsible for this activity Remarks This could preferably be done by identifying the root cause where possible; it is preferable that patients be included in analyzing the feedback and complaint. 

32. NQI.5 COLLECTION & ANALYSIS OF INCIDENTS, COMPLAINTS AND FEEDBACK  Objective Feedback about care and service is communicated to staff . elements Interpretation At a minimum, patient satisfaction levels shall be communicated on a monthly basis. Remarks This could be done using internal communication. It is equally important that positive feedback about care and services is communicated to staff.

33. Examples of Hospital Quality Measures for Consumers Patient safety measure Effectiveness measure Patient center measure Timelines measure Efficiency measure Equity measure

34. SUMMARY Till now we have discussed about quality indicators of nursing and its significance in nursing care like introduction, meaning, checklist for NABH, standard of NQI 1-5 , example of quality measure etc. I hope you all understand the quality indicator of nursing measure. If you all get chance to work quality standard will you able to apply this knowledge confidently.

35. CONCLUSION System for monitoring and measurement of nursing quality standards shall be established Statistical review and analysis of trends shall be reviewed by the organization. These act as tools for excellence in nursing care delivery and satisfaction with nursing care amongst patients. Contributes to overall improvement in quality of care

36. References NABH standard 5 th edition from QCI , India. NABH standard 4 th edition from QCI , India Licenses ,documents for establishment hospital Quality indicator of hospital measure