Quality of nursing

quality assurance, purpose, models , factors affecting quality of care in nursing

1. Seminar on: Quality A ssurance in Nursing PRESENTED BY: RAHUL GUSAIN M.SC (N) IST YEAR

2. Introduction Quality is rapidly becoming a concern to both consumes and the provides of the services. In the health care quality is being demanded and expected and providers are judged by the quality of services and hence there is a need to sensitize and train nursing personal to provide quality care. Expense of quality is an interactive process between customers & providers quality assurance usually focusses on material, good work and services provided effectively.

3. Quality It is the degree to which health services for individual & population increase the likelihood of desired health outcomes and are consistent with current professional knowledge. -Joint commission on accreditation of health care organization(2002, JCAHO)

4. Assurance It is statement or indication that inspires confidence. Q uality assurance Quality assurance is an on-going , systematic, comprehensive evaluation of health care services & the impaired of those services on health care services. - kozier Quality assurance is defines as all activities undertaken to predate and prevent poor quality. - Neetvert (1992)

5. Purposes To introduce code of ethics and professional conduct for nurses in I ndia. To prepare nursing personal for implementation of quality assurance model in nursing. To provide best care to patients by maintain standard.

6. Objectives To ensure the delivery of quality client care. To demonstrate efforts of health care provider to provide good results. To formulate plan of care. To evaluate achievement of nursing care. To support quality of nursing care with administrative and managerial services To explain quality assurance models as pre requisite quality nursing care.

7. Principles Customer focus Leadership Involvement of people Process approach System approach to management Continual improvement Factual approach to decision making Mutually beneficial supplier relationship

8. Contd.. Belief in people Statistical analysis Costs of poor quality Continuous quality improvement Knowledge of customer expectation needs

9. Approaches for a quality assurance program General approach Involves large approach governing of person agency ability to meet established criteria or standard at a given time. Specific approach Quality assurance are methods to evaluate identifies distances of providers and client interaction

10. Credentialing Credentialing refers to way in which professional competence ensure and maintained. There process are used for credentialing in nursing. They are accreditation , licensure certification.

11. Licensure licensure is a specialized form of credentialing based on laws passed by a state legislature. A license is a legal document that permits a person to offer to the public skills & knowledge .In a particular jurisdiction, where such practice would otherwise be unlawful without a license.

12. Accreditation State legislature bodies have authority to enact laws controlling occupational and professional groups. Nursing is one of the groups operating under state laws that promote the general welfare by determining minimum standard of education .

13. C ertification Licensure measures entry level competence, certification validates specialty knowledge, experience and clinical judgment. Nursing certification is offered by profession organizational .

14. Specific approach Peer review These are designed to monitor client specific aspects of care to monitor appropriate for certain levels of care. The audit is used by peer review committee to as certain quality of care. Nursing audit Nursing audit is evaluation of patient care through analysis of written records maintained by nurses in patients treatment.

15. Goals of nursing audit To improve quality of health care. To promote improve communication among nurses & other health team members. To improve quality of nursing care. To detect & analyze problem with errors.

16. Nursing audit process Provide quality of nursing A patient is assured of good services. It will give valuable and pertinent information for the staff. It will lead to between co operation and communication among the nurses & health team. It will help each professional nurses for her self evaluation It helps the administrative as better planning. It will broaden and strengthen nursing service.

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

18. 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.

19. Evaluation studies Donabedian structure –process outcome model Donabedian introduced 3 major method of evaluation quality care:- Structure evaluation Process evaluation Outcome evaluation

20. Structure evaluation It evaluates setting and instruments used to provide care such as facilities , equipment & characteristics of administrative organization & Qualification of health provider. The data can be obtained from existing documents.

21. Process evaluation This method evaluates activities as they relate to standard & expectation of health providers in management of client care . Data is collected through direct observation, review of records audit etc.

22. Outcome evaluation The net changes that occur as a result of health care or result of health care. The data of this method can be collected from vital statistics records such as death certification or telephone client interview mailed questionnaire & client records.

23. F ramework for quality T he joint commission on accreditation of health care organization (JACHO) 1997 defines quality improvement (QI) as an approach to the continuous study &improvement of the process of providing health care services to meet the needs of clients and others.

24. Components of Q.I (quality improvement)program Establish responding and accountability for a Q.I program. Define the scope of service for a clinical area. Define the key aspect of service for the clinical area. Develop quality indicators to monitor the outcome & appropriateness of care delivered. Establish thresholds for evaluation of indicators. Collect and analyze data from monitoring activities.

25. Contd.. Evaluate results of monitoring activities to determine for change in practice. Resolve problems through development of actions plans. Reevaluate to determine if the plan was successful. Communicate results to the organization.

26. Models of quality assurance Basic components of system models Input – T he input can be compared to the present state of systems. Through put- It is development process. Output :- It is finished product or result. Feedback - It is essential components of system because it maintains & nourishes.

27. Incident review Incidents in the hospital bear on the quality of treatment & patients final recovery. Incidents like – delayed attendance by physician /nurse. Lack of cleanness Incorrect medication Asepsis leading to infection Carelessness in carrying nursing procedure- hot and cold application Reports are legal and should be written carefully.

28. Quality assurance model (American nurses association quality assurance model)

29. Model of quality assurance

30. Development of a quality assurance program Foster commitment of quality Preliminary review of quality Develop the purpose & vision for the quality presence effort Assign responsibility for quality assurance Develop a written quality assurance plan Critical management system Manage change

31. Developing quality indicators Quantitative measure of an important aspect of service that the determine whether the service conforms to established standards or requirement Focus for the quality improvement program and staff monitoring criteria

32. Three types of indicators Structure indicators- Evaluate the structure or systems for delivering care. Process indicators- evaluate the manner in which care is delivered ( e.g – process of pain assessment, recovery of clients from sedation) Outcome indicators- evaluate the end result of care delivered ( e.g incidence of nosocomial infection )

33. Factors affecting quality assurance in nursing care Lack of resources Personal problems Improper maintenance Unreasonable patients and attendants Absence of accreditation laws Lack of incident review procedures Lack of good hospital information system

34. Contd.. Absence of patient satisfaction Lack of nursing care records Lack of supervision Sub-standards education & training Lack of written job description & job satisfaction

35. Quality assurance model in I ndia Nurses who are registered to INC and state nursing council are safe provide care Program is expected to develop mechanism for ensuring quality of nursing practice.

36. Quality assurance model in nursing Set of elements that are related to each other and comprise of planning for quality development of objectives setting & actively communicating standards developing indicators.

37. Philosophy of quality assurance model in nursing Indian nursing council believes that nurse will- Do good for person /receiver of care , do no harm, Be responsible and accountable for providing quality care in the line with set standards Be committed to understanding of dynamic nature of her/his role in interdisciplinary health team Create public awareness

38. Contd.. Work in conjugation with legislation, accreditation & political system Have obligation to promote education of self & others . Be committed to advancement of profession

39. Purpose of quality assurance model Ensure quality nursing care provided by nurses in order to meet the expectation of the receiver , management and regulatory body Also intends to increase the commitment of the provider and the management

40. Goals of quality assurance model Develop confidence of the receiver that quality care is being rendered as per assurance. Develop commitment of the management towards quality care. Commitment to set standards for nursing practice and strive for excellence. Strengthen documentation of nursing care. Promote optimum utilization of resources in providing cost effective nursing care.

41. Research article

42. Development of an instructional quality assurance model in nursing science Abstract Purpose of the study was to develop an instructional quality assurance model in nursing science. It is divided in 3 phase Study the information for instructional quality assurance model in nursing science To develop an instructional quality assurance model in nursing science Audit and the assessment of the development model.

43. Results Factors which affected the instructional quality of nursing science more the instructional quality assurance model the developed by the institutions There were 3 models of instructional quality assurance Instructional quality assurance model in nursing service was systematic consisting of input, process & output. The operation based on 3 domains Principles Concepts practice

44. Role of nurse in quality assurance Active participants of interdisciplinary quality improvement team. Develop mechanism for continuity monitoring the effectiveness of nursing care both a collaborative and an individual professional activity. Contribute innovation and improvements projects and patient safety initiatives.

45. Contd.. Periodic research works related to quality assurance Identify any area of needed improvement in delivery of care. Participate continuing educational program & insurance educational program for continuing professional development

46. Summary

47. Conclusion Quality assurance program will helps to improve the quality of nursing care & professional development. Individual with the profession must assume responsibility for their professional actions & be answerable to the recipients for their care.

48. Bibliography Kozier , fundamental of nursing, Dorling kindersky put second edition, 2006 p.no 360-361 F.A Davis legal ethics and political issues in nursing. Davis company , second edition 1994, p.no. 231-244 Potter and perry , fundamental of nursing , M osby publications, fourth edition , 1997, p.no-173-176 Shabeer . P. basheer , advanced nursing practice, E mmess Ist edition , 2016, p.no 50-60

49. Internet refrences http://currentnursing.com/nursing management /tool quality management healthcare.html www.indiannursing council.com/quality assurance in nursing standards