2.quality assurance in nursing

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MASTER PLANON

QUALITY ASSURANCE IN NURSING

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QUALITY ASSURANCE IN NURSING

INTRODUCTION

One of the most pressing concerns of individual nurses and of professional nursing associations at present is to ensure that patients receivesafe and competent nursing care regardless of the setting or the circumstancesunder which the care is given. Health professionals have long been concernedabout the need to maintain high standards of practice.

QUALITY ASSURANCE

Quality assurance the term borrowed from business world, refers to aprogram designed to try to ensure that health care provided to patients isconsistently of good quality.The quality of care the patient receives is dependenton a number of variables. Four of the principle elements that can vary and affectcare are:

1. The providers, that is, the people who give care- the nurses, physicians,and all others who contribute to patient care.

2. The standards that are maintained in the agency providing care.3. The environment, or setting, in which the care is given.4. The recipient of care, that is, the patient himself.

THE PROVIDERS OF CARE

1. Accreditation/ Approval of Basic Nursing Education Programs. 2. National qualifying examinations. 3. Licensing/ Registration. 4. Disciplinary bodies. 5. Mandatory continuing education. 6. Certification. 7. Assessment of clinical competence.

Peer review Nursing audit The problem oriented medical record.

PROFESSIONAL STANDARDS REVIEW ORGANIZATIONS

Although professional standards review organizations were stronglyphysician oriented, Public Law 92-603 provided for participation of other health


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care personnel in these organizations, thereby encouraging nurse involvement inquality control programs.

The joint commissions quality assurance program.

American nurses association quality assurance program.

PRINCIPLES UNDERLYING QUALITY ASSURANCE EFFORTS

1) Since, both physicians and nurses contribute to patient care outcomes,neither physician nor nurses should unilaterally carry responsibility forquality assurance.

2) In planning a comprehensive quality assurance program for a healthinstitution coordination is needed to ensure that objectives and activitiesof each health profession enhance rather than cancel those of otherprofessions.

3) Care should be taken to ensure that resource expenditure for quqlityassurance activities is appropriate in amount.

4) In order to ensure that resources expended for quality assurance yieldsignificant findings or results, investigation should focus their attention ormonitoring only critical performance factors

5) The key to ensure quality in patient care is accurate evaluation of care,and the key to successful auditing of care is adequate documentation of care.

6) The ability achieve nursing objectives depends on optimal functioning of the entire nursing process, and effective monitoring of nursing systemoperation depends upon receiving feedback from all subsystems of thenursing suprasystem.

7) Evaluation of care will not by itself improve practice. Feedback topractitioners is required both to perpetuate good practice and to replaceunsatisfactory interventions with more effective methods.

8) Once quality of care has been assessed and needed improvements havebeen identified, peer pressure can provide the impetus required to effectprescribed changes in practice.

9) If assessment reveals need for a different pattern of care delivery,recognition of care at the unit level may require changes in formalorganizational structure.

10) For quality assurance efforts to be effective, collection and analysisof quality assessment data must be performed by a decision maker. Datarelated to structural inadequancies, process failure, and inadequateoutcomes are without value unless used by a change agent to motivateremedial action.


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STANDARDS OF CARE

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The collection of data about the health status of the client/patient issystematic and continuous. The data are accessible, communicated andrecorded.

II. Nursing diagnoses are derived from the health status data. III. The plan of nursing care includes goals derived from the nursing

diagnoses. IV. The plan of nursing care includes priorities and the prescribed nursing

approaches or measures to achieve the goals derived from thediagnoses.

V. Nursing process provide for clients/ patient participation in healthpromotion, maintenance and restoration.

VI. Nursing actions assist the client/ patient to maximize his healthcapabilities.

VII. The clients/ patients progress or lack of progress toward goalachievement is determined by the client/ patient and the nurse.

VIII. The clients/ patients progress or lack of progress toward goalachievement directs reassessment, reordering of priorities, new goalsetting, and revision of the care of nursing care.

QUALITY ASSURANCE METHODS

The primary purpose of a nursing quality assurance program shouldbe improvement of a patient care rather than disciplining of incompetentnursing practitioners. The thrust of a nursing quality assurance programshould be twofold:

1. To measure and2. To improve the quality of nursing care delivered in the

organization.

Developing Quality Assurance Criteria

There are several frames of reference for criteria development. Someexperts believe it is most practical to develop nursing criteria in relation todiagnostic categories, since diagnosis is major concern for patients andcaregivers and since medical records are catalogued according to diagnosis.


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Reliability and Validity of Measuring Tools

Reliability refers to the consistency with which a particular tool

measures whatever it measures. The means of determining reliability is tohave the same individual use the assessment tool to measure the same objector phenomenon at different times and compare the two measurements to seehow closely they agree.

Validity refers to the degree to which a tool measures what it purportto measure.

Testing quality assurance criteria

After criteria have been prepared for each topic to be studied, theyshould be on a trial basis to a small sample of the patient population for whichthey were designed in order to determine whether the criteria permit reliableand valid measurement of the quality.

Preparation of the measurement tool

As soon as the appropriate process and outcome criteria have been

established by nursing experts and approved by the quality assurance taskforce, the quality assurance ordinance should organize criteria measurementtools.

LEGAL ISSUES OF INTEREST TO THE NURSE

Torts and crimes Negligence and malpractice Common acts of negligence

Overlooked sponges Burns Falls Wrong medicine, wrong dosage, wrong patient, wrong concentration Defects in apparatus or supplies Abandonment Loss of or Damage to patients property Other negligent act Incident report Good Samaritan laws Assault and battery


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Informed consent An explanation of the condition. A fair explanation of the procedures to be used and the expected

consequences. A description of alternative treatments or procedures. A description of the benefits to be expected. An offer to answer the patients inquires.

An understanding that the patient is not being coerced to agree andmay withdraw if he changes his mind. False imprisonment Invasion of privacy Defamation of character Malpractice insurance

BIBLIOGRAPHY

Books Dugas , Introduction to patient care, 4 th edition, south India edition,

Delhi. Page no: 97-108. Lucille.A.Joel, Advanced Practice Nursing essentials for role

development, 2 nd edition, F.A.Davis company, Philadelphia.Page no:444-446.

Helen Harkreader, Mary Ann Hogan, Marshelle Thobaben,Fundamentals of Nursing caring and clinical judgement, 3 rd edition,Elsevier India Pvt Ltd, Missouri. Page no:296-297.

Journal

Nightingale Nursing times, vol:5, no:11, Feb 2010, page no:17-20.

Website

http://en.wikipedia.org/wiki/Madeleine_Leininger
http://en.wikipedia.org/wiki/Madeleine_Leiningerhttp://en.wikipedia.org/wiki/Madeleine_Leiningerhttp://en.wikipedia.org/wiki/Madeleine_Leininger


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2.quality assurance in nursing

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