Quality assurance
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QUALITY ASSURANCE. QUALITY: DEGREE OF EXCELLANCE. ASSURANCE: MAKE SAFE. QUALITY ASSURANCE. OBJECTIVES. AT THE END OF THE SESSION THE STUDENTS WILL BE ABLE TO: ACKNOWLEDGE THE IMPORTANCE OF QUALITY ASSURANCE ACQUIRE AN UNDERSTANDING THE DEFINITION OF QUALITY

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QUALITY ASSURANCE

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Quality assurance

QUALITY ASSURANCE

QUALITY: DEGREE OF EXCELLANCE

ASSURANCE: MAKE SAFE


Quality assurance1

QUALITY ASSURANCE

OBJECTIVES

  • AT THE END OF THE SESSION THE STUDENTS WILL BE ABLE TO:

  • ACKNOWLEDGE THE IMPORTANCE OF QUALITY ASSURANCE

  • ACQUIRE AN UNDERSTANDING THE DEFINITION OF QUALITY

  • UNDERSTAND THE IMPORTANCE OF STANDARD SETTING

  • ACQUIRE THE KNOWLEDGE ON THE IMPORTANCE OF NURSING / CLINICAL AUDIT AND ITS PROCESS

STANDARD SETTING

NURSING / CLINICAL AUDIT


Quality assurance2

QUALITY ASSURANCE

  • A review of the patient’s prospective on quality of care

  • An area of high cost, volumes or risk

  • Evidence of a serious quality e.g. : patient complaints, infection rates

  • The availability of systematic reviews of research or national clinical guidelines

PRIORITISING CLINICAL AUDIT TOPICS


Quality assurance3

QUALITY ASSURANCE

PROVISION OF A PROFESSIONAL SERVICE CARRYING WITH IT OBLIGATION ON THE PROFESSIONAL TO SATISFY PATTIENTS’ / CLIENTS’ NEEDS AT ALL LEVEL

WHY QUALITY ASSURANCE

CONCEPTS OF QUALITY ASSURANCE

IT IMPLIES IDENTIFICATION OF AREAS FOR IMPROVEMENT AND SELECTIVE ATTENTION TO THE DEVELOPMENT OF NEW TECHNIQUES IN AREAS OF GREATEST NEED


Quality assurance4

QUALITY ASSURANCE

STANDARDS ARE SET

PERFORMANCE OUTCOMES ARE CHECK AGAINST THESE STANDARDS

STEPS TO QUALITY ASSURANCE

IF THERE IS A SHORTFALL THIS IS USED AS A FEEDBACK TO CRITICAL PARTS OF THE SYSTEM

ALTERNATIVELY THE STANDARD MAYBE MODIFIED TO ONE THAT IS SCHIEVABLE

QUALITY ASSURANCE


Quality assuarance

THE ESSENCE OF HEALTH CARE QUALITY ASSURANCE

QUALITY ASSUARANCE

  • FOCUSSING ON INDIVIDUALS CARE OR POPULATION SERVICE

  • MUST REFLECT AN INTEREST IN THE PROVISION OF THE HIGHEST POSSIBLE QUALITY CARE

  • IT SHOULD EXTEND TO ALL ASPECTS OF CARE INCLUDING THE TECHNICAL, THE INTERPERSONAL AND MORAL

CONCERN FOR EXCELLENCE AND STANDARD

SPECIFICITY AND EXPLICITNESS

STANDARD ARE SPECIFIED AND OPERATIONALISED AND MEASUREMENT TOOLS ARE DEVELOPED FOR THEIR APPRAISAL

COMMITTMENT

  • BOTH INDIVIDUALS AND ORGANISATIONS MUST BE POSITIVELY MOTIVATED TO IMPLEMENT QUALITY ASSURANCE AT THE ORGANISATIONAL LEVEL

  • THERE MUST BE RECOGNITION THAT QUALITY ASSURANCE DOES NOT JUST HAPPEN – IT MUST BE MANAGED


Quality assurance5

PROFESSIONAL VALUE

QUALITY ASSURANCE

SOCIAL VALUE

QUALITY

INDIVIDUAL VALUE

INSTITUTIONAL VALUE


Quality assurance6

QUALITY IN HEALTH SERVICES / IN INDIVIDUALS

THE SERVICE OF PROCEDURE IS WHAT THE POPULATION OR THE INDIVIDUAL ACTUALY NEEDS

QUALITY ASSURANCE

EQUITY

A FAIR SHARE FOR ALL THE POPULATION

EFFECTIVENESS

ACHIEVING THE INTENDED BENEFIT FOR THE INDIVIDUAL AND FOR THE POPULATION

APPROPRIATENESS

ACCEPTABILITY

SERVICES ARE PROVIDED SUCH AS TO SATISFY THE REAONABLE EXPECTATIONS OF PATIENTS, PROVIDERS AND THE COMMUNITY

EFFICIENCY

RESOURCES ARE NOT WASTED ON ONE SERVICE OR PATIENT TO DETRIMENT OF ANOTHER


Quality assurance7

THE QUALITY CARE CAN BE STUDIED FROM THESE ASPECTS

WHERE IS CARE CARRIED OUT

WHAT EQUIPMENT IS USED

QUALITY ASSURANCE

PROCESS

WHO CARRIES OUT THE CARE

HOW IS IT CARRIED OUT

STRUCTURE

OUTCOME

  • WHAT IS THE END RESULTS?

  • PERCIEVED BY PATIENTS / CLIENTS

  • b) PERCIEVED BY PROFESSIONALS

CARE INCLUDES

  • CLINICAL (TREATMENT OF PATIENTS) CARE

  • NON CLINICAL ( MEETING THE PATIENT PERSONAL, SOCIAL, EMOTIONAL, SOCIAL NEEDS)


Quality assurance8

NON CLINICAL ( MEETING THE PATIENT) CARE

QUALITY ASSURANCE

BSURROUDINGS THAT SUGGEST COMPETENT HELPS IS AT HAND

CREADY ACCES TO THE SUPPORT OF FAMILY AND FRIENDS

A COURTESY

DBEING TOLD WHAT WILL HAPPENED AND WHEN

ELACK OF DELAYS


Quality assurance9

A STANDARD IS A MEANS OF MEASURE

QUALITY ASSURANCE

  • RELEVANT

  • UNDERSTANDABLE

  • MEASUREBLE

  • BEHAVIORAL

  • ACCEPTABLE

CRITERIA FOR STANDARDS

EXAMPLE OF A STANDARD

“ ALL OUT PATIENTS SHOULD BE SEEN BY A DOCTOR WITHIN 30 MINUTS

OF THEIR APPOINTMENTS OR TOLD THE REASON FOR ANY DELAY


Quality assuarance1

PRODUCTIVE LINE MODEL OF HEALTH SERVICES

QUALITY ASSUARANCE

PROCESS

OUTPUT

OUTCOME

INPUT

RESOURCE

ACTIVITY

PRODUCTIVITY

HEALTH


Quality assurance10

CLINICAL AUDIT

QUALITY ASSURANCE

IS THE SYSTEMATIC AND CRITICAL ANALYSIS OF THE QUALTY OF CLINICAL CARE INCLUDING THE PROCEDURES USED FOR DIAGNOSIS, TREATMENT AND CARE, THE ASSOCIATED USE OF RESOURCES AND THE RESULTNG OUTCOME AND QUALITY OF LIFE FOR PATIENT

FUNDAMENTAL PRINCIPLES ASSOCIATED WITH CLINICAL AUDIT

  • IT SHOULD BE

  • BE PROFESSIONALLY LED

  • BE SEEN AS EDUCATIONAL PROCESS

  • FORM A PART OF A ROUTINE CLINICAL PRACTICE

  • BE BASED ON THE SETTING OF STANDARS

  • GENERATE RESULTS THAT CAN BE USED TO IMPROVE OUTCOME OF QUALITY CARE

  • INVOLVE MANAGEMENT IN BOTH THE PROCESS AND OUTCOME OF THE AUDIT

  • BE CONFIDENTIAL AT THE INDIVIDUAL PATIENT / CLINICAL LEVEL

  • BE INFORMED BY THE VIEWS OF PATIENTS / CLIENTS

DEFINITION


Quality assurance11

CLINICAL AUDIT

QUALITY ASSURANCE

TO IMPROVE PATIENT CARE BY INFORMING THE HEALTH CARE PROFESIONALS’ UNDERSTANDING OF THEIR CLINICAL PRACTICES

BENEFIT OF CLINICAL AUDIT

  • PROMOTE A PATIENT-FOCUS APPROACH TO CARE

  • ENCOURAGE MULTI-PROFESSIONAL TEAMWORK

  • ENABLES OPEN DISCUSSION ABOUT PRACTICE AND LEARNING FROM MISTAKE

OBJECTIVE OF CLINICAL AUDIT


Quality assurance12

  • CLINICAL AUDIT

QUALITY ASSURANCE

IT MUST BE LED BY THE CLINICAL STAFF INVOLVED WITH THE ISSUE REVIEWED, IN COLLABORATION WITH MANAGERS, AUDIT STAFF AND PATIENTS

WHO DO THE AUDIT?


Quality assurance13

CLINICAL AUDIT

QUALITY ASSURANCE

  • REQUIRES CAREFUL THOUGHT IN THE SELECTION OF TOPICS

  • THE AREA IDENTIFIED MUST ADDRESS THE IMPORTANT ASPECTS OF CONCERNS ABOUT QUALITY

IDENTFYING AN AREA FOR CLINICAL AUDIT


Quality assurance14

MAIN STAGES OF CLINICAL AUDIT

QUALITY ASSURANCE

2. IMPLEMENTING BEST PRACTICES

1. DEFINING BEST PRACTICES

3. MONITORING AND COMPARING AGAINST BEST PRACTICE

4 TAKING ACTION TO IMPROVE


Quality assurance15

CLINICAL AUDIT OF PRESSURE SORES

(ROYAL BROMPTON HOSPITAL 1991)

QUALITY ASSURANCE

DEVELOPMENT OF PRESSURE SORES

CONCERN ABOUT THE PROVISION OF PRESSURE-RELEIVING DEVICES FOR THOSE IDENTIFIED AS HIGH RISK PATIENTS

  • HAS INCREASED HOSPITAL STAY

  • INCREASED DISCOMFORT

  • THE COST IMPLICATIONS WERE EXTREMELY HIGH – WITH A GRADE 4 PRESURE SORE ESTIMATING COST £25 000 TO TREAT


Quality assurance16

CLINICAL AUDIT OF PRESSURE SORES

QUALITY ASSURANCE

MAIN FINDINGS

50% OF THE PATIENTS POPULATION WERE AT RISK OF DEVELOPING PRESSURE SORE

A NUMBER OF MATTRESSES WERE IN POOR CONDITION

THERE WAS LACK OF KNOWLEDGE AMONGST WARD NURSES ON AREAS RELATED TO PRESSURE-RELEVING EQUIPMENT

LACK OF LIFTING AIDS ON THE WARDS – DISCOURAGING NURSES FROM LIFTING AND TURNING PATIENTS

PAIN WAS LIKELY TO BE A CONTRIBUTING FACTOR AS PATIENTS WERE PREVENTED FROM MOVING IN BED


Quality assurance

  • An increased risk of costly litigation –health authorities were being sued anywhere between £100 000 and £1 0000 000 by patients who had developed sores during their hospital stay .

  • All of the above reasons including that 95% of pressure sores are preventable, led to a clinical audit group for pressure area care being formed. Representatives of the multi-professional teams comprised of nurses, occupational therapists, physiotherapists and dietician.

  • PILOT AUDIT (1992) 8 mths from the raising of the first concerns through to completion of the objectives and criteria.

  • - A small convenience sample of 4 patients and 4 nurses were audited from each ward.


Quality assurance17

OUTCOME MEASURE

  • Each year, the standard and the point prevalence study have been reviewed, re audited and local and hospital – widw action plan devised to address new issues:

  • A matress replacement programme and the writing of a policy to maintain this.

  • Identifying a nuerse rto coordinate both in-house

  • Hold regular meetings with the link nurses to encourage information sharing

  • The initial audit 1992 identified the prevalence of pressure sores as being 19% of the patient population. Dropped dramaticcally over subsequent years, 1997 results are just 3% of the patient population, within the DoH guidelines (1993) stating a commitment to reduce the incidence of pressure sores in NHS by 5%.

QUALITY ASSURANCE


Quality assuarance2

AN OVERVIEW OF THE ASPECT OF CARE UNDER REVIEW

QUALITY ASSUARANCE

LETTERS FROM PATIENTS, COMLPLAINT OR COMMENTS FROM EXTERNAL AGENCIES

CRITICAL ACCIDENTS REPORTS – WHERE NUMBERS OF STAFF HAVE DESCRIBED AND ANALYSED IMPORTANT CONCERNS FOLLOWING ONE INCIDENT

SUMMARIES OF TEAM MEEINGS OR GOOD ROUND WHERE ISSUE HAS BEEN DISCUSSED

INFORMATION FROM ROUTINE DATA SOURCES INCLUDING OF PATIENTS INVOLVED

PATIENTS STORIES OF FEEDBACK FROM FOCUS GROUP

DIRECT OBSERVATION OF CARE


Quality assuarance3

GROUP WORK

QUALITY ASSUARANCE

LIST SOME TOPICS FOR CLINICAL AUDIT WHICH YOU THINK WOULD BE APPROPRIATE FOR YOUR CLINICAL AREA

CHOOSE A TOPIC FOR A CLINICAL AUDIT PROTECT IN A SPECIFIC CLINICAL AREA AND DEVELOP YOUR MONITORING TOOL

BRIEFLY WRITE REPORT ON THE AUDIT PROCESS AND RESULT OF THE AUDIT, AND RECOMMENDATION


Quality assuarance4

GROUP WORK

QUALITY ASSUARANCE


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