Quality Assurance PPT 1

UNIVERSITY OF MAIDUGURI TEACHING HOSPITAL
SCHOOL OF POST BASIC CRITICAL NURSING
(Principles and practice of critical care nursing)

CCN 413
LECTURE NOTE
QUALITY ASSURANCE
QUALITY
The degree to which nursing services for health care consumers,
patients and populations increase the likelihood of desired outcome.
Proper performance according to standard of intervention that is
known to safe to the population.
QUALITY ASSURANCE
Quality Assurance is defined as an activity to ensure that an
organization is providing the best possible product or service to
customers(patients). QA focuses on improving the processes to deliver
Quality Products(nursing services) to the customer . An organization
has to ensure, that processes are efficient and effective as per the
quality standards defined for patient care.
COMPONENTS OF QUALITY ASSURANCE
Structure evaluation
Structure evaluations are concerned with physical facilities,i.e, nature
of the building, equipment safety, staffing, emergency preparedness
planning and other characteristics of the facility or agency that have an
effect on the quality of care being provided. It evaluates whether the
environment in which health care is delivered is in compliance with
standards developed by licensing and accrediting organizations.
COMPONENT Cont.
Process evaluation
Process evaluations center on the activities of the provider and what
the provider has done to assess, plan, and implement nursing care. The
focus is on what was planned, what was done and what was
communicated or recorded. Therefore, the process evaluation assist
in measuring the degree of skill, with which technique or
procedure was carried out, or the nature of interaction between
nurse and client.(e.g. technique use while suctioning airway or wound
dressing.)
COMPONENT Cont.
Outcome evaluation
Outcome evaluations focus on patient and goals set forth in the care
plan and therefore are patient- and goal-oriented. Thus, outcome
evaluation is the measurement of a patient's progress or lack of
progress toward achievement of specified goals. This change may be
due to nursing care, medical care or as a result of variety of
services offered to the patient.(assessment of the patient after airway
suctioning and wound dressing)
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 state code of ethics and professional conduct for nurses.
• To appreciate importance of practicing standard safety measures.
• Plan and conduct patient teaching sessions.
• To identify appropriate management techniques to be used for managing
resources in given situation.
PRINCIPLES OF QUALITY
ASSURANCE
• Patient focus >Quality assurance relies on understanding the patient
and the family current and future needs and ensure that patient
treated with dignity and respect. The care tailored to suit their needs
and what you want to achieve.
• Leadership > Leaders should establish unity of purpose and
direction of the organization. They should create and maintain
conducive internal environment in which people can become fully
involved in achieving the organization’s objectives.
PRINCIPLE Cont.
• Involvement of people >(team work) it should involve maximum
multidisplinary approach so that standards can be maintained.
Involvement of people at all levels are the essence of an
organization and their full involvement enables their abilities to be
used for the organization’s benefit.
• Factual approach to decision making > there should be fact or
appropriate reason in taking certain decision. Factual approach to
decision making are based on the analysis of data and information.
PRINCIPLE Cont.
Continual improvement….To maintain quality assurance, it is
essential to provide nursing staff with the necessary tools and
knowledge for continual improvement. It focuses on care that
is safe, timely, effective and efficient, decreased number of
urinary catheter infections, development of pressure ulcer,
ventilation associated pneumonia and decreased medication
errors.
PRINCIPLE Cont.
Mutual relationships (interpersonal relationship between nurse-nurse,

nurse-patient and nurse - patient relative including other professions)It
encourages communication and sharing of knowledge among health
workers which reduces medication errors and other implications,
alleviate patient anxiety, imparting job satisfaction etc.
METHODS FOR MEASURING QUALITY ASSURANCE
Measuring actual performance

It is an ongoing repetitive process with the actual frequency dependent
on the type of activity being measured. It is better to clarify the
purpose of the measurement and to measure performance on a
continues basis.
METHOD Cont.
Comparing results of performance with standards and objectives and
identifying strengths and areas for correction.
The standards and objectives and methods of measurements have
been set, if performance matches standards and objectives, managers
may assume that things are under control if performance is a contrary
to standards and objectives, action is necessary
METHOD Cont.
ACTING TO REINFORCE STRENGTHS OR SUCCESS AND TAKING
CORRECTIVE ACTION AS NECESSARY
Positive aspect needed to be identified in order that they be translated
in to encouragement and motivation for the nursing staff involved in
achieving them.
DEVELOPMENT OF A QUALITY
ASSURANCE PROGRAM
• Conduct a preliminary review of quality related activities

• Develop the purpose and vision for the quality assurance effort
• Assign responsibilities for quality assurance
• Allocate resources for quality assurance
• Develop a written quality assurance plan
• Disseminate quality assurance experience
APPROACHES FOR QUALITY ASSURANCE PROGRAM
Approaches of quality assurance are divided into 2 types
1 General approach
2 Specific approach
1 General approaches involves large governing of official body
evaluation of persons or agency, those include
GENERAL APPROACH Cont.
ACCREDITATION Accreditation is the act of granting recognition
especially to an educational institution that maintains suitable
standards. Nursing is one of group operating that promote general
welfare by determining standard of education through accreditation of
school of nursing.
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.
GENERAL APPROACH Cont.
LICENSURE :Licensure is the process by which boards of nursing grant
permission to an individual to engage in nursing practice after
determining that the applicant has attained the competency necessary
to perform a unique scope of practice. A license is a legal document
that permit a person to offer to the public skills and knowledge in a
particular jurisdiction, where such practice would otherwise be
unlawful without license.
SPECIFIC APPROACHES
Peer review : Is the process by which practicing registered nurses

systematically assess, monitor and make judgement about the quality
of care rendered by peers, as measured against professional standard
of practice. Peer review is divided to in two types; One centers on the
recipient of health care services by means of auditing the quality of
services rendered.
The other centers on the health professional by evaluating the quality
of individual performance.e.g staff skills and knowledge.
FACTORS AFFECTING QUALITY ASSURANCE IN NURSING
• Lack of resources (e.g. staff, machine and equipment, money for

recurring expenses, consumables)
• Personnel problems(e.g. Lack of trained, skilled and motivated
employees, staff indiscipline affects the quality of care)
• Improper maintenance(e.g. Buildings and equipment require proper
maintenance for efficient use. If not maintained properly the
equipment cannot be used in giving nursing care.)
• Absence of well informed population: it is necessary that the people
become knowledgeable and assert their rights to quality care. This
can be achieved through continuous educational program.
Cont.
• Lack of nursing care records: Nursing care records are perhaps the
most useful source of information on quality of care rendered. The
records include detail of the patient condition, information regarding
response to treatment.
• Absence of patient satisfaction surveys: Such surveys carried out
through questionnaires, interviews by quality assurance Unit and
social worker help to document patient satisfaction with respect to
variables that are delay in attendance by nurses and doctors,
incidents of incorrect treatment etc.
Cont
• Lack of adherence to accreditation laws-It requires a legislation that

provides for setting of a stationary accreditation vigilance authority
to inspect hospitals and ensures that basic requirements are met
through enquire into major incidence of negligence and take actions
against health professionals involved in malpractice
• Lack of incident review procedures- such as delayed attendance by
nurses, surgeon, physician ,incorrect medication, death in a corridor
with no nurse or physician accompanying the patient.

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UNIVERSITY OF MAIDUGURI TEACHING HOSPITAL

SCHOOL OF POST BASIC CRITICAL NURSING

(Principles and practice of critical care nursing)

• To ensure the delivery of quality client care.

Mutual relationships (interpersonal relationship between nurse-nurse,

Measuring actual performance

• Conduct a preliminary review of quality related activities

Approaches of quality assurance are divided into 2 types

Peer review : Is the process by which practicing registered nurses

• Lack of resources (e.g. staff, machine and equipment, money for

• Lack of adherence to accreditation laws-It requires a legislation that

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