RESEARCH BASED QUALITY ASSURANCE

The key to excellence in Nursing

INTRDUCTIN
Quality assurance has unfortunately to often been conceptualized as
something to be done to meet hospital accreditation standards or to satisfy
nursing administration. To most staff nurses, quality assurance assurances are
viewed as more unnecessary paper work which farther removes them from the
bedside or as an activity which only nursing administration need be concerned. In
actuality, the assurance of quality to patients should be the center focus of all
nurses everyday of their working lives.
De!initions o! "u#lity #ssur#nce$
Quality assurance is the promise on guarantee that certain standards of
excellence and being met in delivery of care.
!alonde, "#$$$%
Quality assurance is concerned with the accountability of the providers
and is only one tool in achieving optimum client out comes.
&avis
Quality assurance is the ongoing systematic monitoring or evaluation of
nursing practice, or practice of other discipline.
'otter ( 'erry
Co%&onents o! "u#lity c#re$
Quality assurance requires evaluation of three components of care)
'( Structure e)#lu#tion$
*ocuses on the setting in which care in given structural standards
describe desirable environmental or organization characteristics that influence
care, such as equipment and staffing.
1
*( +rocess e)#lu#tion$
*ocuses on how the care was given process standards focus on the
manner in which the nurses use the nursing process.
,( utco%e e)#lu#tion
*ocuses on demonstrable changes in the client+s health status as a result
of nursing care outcome criteria are written in terms of client responses or health
states ,ust as they are for evaluation with in the nursing process.
Deter%in#nts o! "u#lity client c#re$
-ccording to ./-01 ",oint commission on the -ccording of health care
organizations%
-ccessibility
2ffectiveness
-ppropriateness
2fficiency
/ontinuity
'rimary
/onfidentiality
'articipation of client and family.
2nvironmental safety.
-o#ls o! "u#lity #ssur#nce$
'( Accor.ing to /on#s(
To ensure the delivery of quality client care.
To demonstrate the efforts of the health provider to provide the best
possible results.
*( Accor.ing to B(0( S#kh#r#l(
To help patient and potential patients by improving quality of care.
2
To assess competence of medical staff, serve as an impetus to keep up to
date and prevent future mistakes.
3ring to notice of hospital administration deficiencies and in the correcting
the causative factors.
+ers&ecti)e o! "u#lity #ssur#nce$
It has two perspectives)
#% Quality assurance has to be the dynamic force that develops and maintains
standards of care.
4% Quality assurance studies must be conducted in a climate of scientific inquiry.
5hen quality assurance is seen as a top priority, quality assurance studies will
become the force that will create for nurses high level of ,ob satisfaction and a
feeling of having control over their practice.
+rinci&les o! "u#lity #ssur#nce$
#. 6anagers need to be committed to quality management.
4. -ll employees must be involved in quality improvement.
7. The goal of quality management is to provide a system in which workers
can function effectively.
8. The focus of quality management is on improving the system, not on
assigning blame.
9. 2very agency has internal and external customers.
:. /ustomers define quality.
;. &ecisions must be based on facts.
Ste&s in the "u#lity i%&ro)e%ent &rocess$
#. <elect a nursing activity for improvement
4. -ssemble a multidisciplinary team to review and revise the nursing activity.
7. &elineate all components of the activity using a flow chart.
8. collect data to measure the current status of the activity
9. <et a measurable standard for the activity.
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:. discuss various plans to meet the standard
;. <elect and implement one plan to meet the standard.
=. collect data to evaluate the implementation of the plan and revise an
needed
Techni"ue !or o1t#ining "u#lity o! c#re in!or%#tion !ro% clients$
#. 6ail surveys to discharged clients.
4. /onduct telephone surreys of discharged patients.
7. Interview active patients.
8. interview family members of active clients
9. /onduct focus group discussions with inpatient > discharged patients.
:. -nalyze unsolicited comments > letter from clients.
;. systematically observe the behaviors of clients and family in unit > agency
Qu#lity #ssur#nce in nursing$
2valuation is the most overlooked step in the nursing process. 2valuation of
the effectiveness of the effectiveness of interventions has not systematically
followed.
*ederal regulations surrounding 6edicare, and 6edicaid funds and the .oint
/ommission on -ccreditation of 0ospitals "./1-0% requirements for
midsized the structure of evaluation of nursing care with the institutional
organization.
0ech#nis%s o! # "u#lity #ssur#nce &rogr#%$
5ritten standards of care are essential to a quality assurance program.
<tandards contain the criteria by which the effectiveness of nursing care can be
evaluated. It determines the acceptable level of ,ob performance and the scope
nursing practice. <tandards and essential in guiding the delivery of care and in
providing a baseline for patient care evaluation by the nurse manager.
4
<tandards of care
'osition, <tandard patient audit competition
&escription, of practice assignment based
'erformance system orientation
-ppraisals inservice
Quality -ssurance
<tudies
Quality patient care is best done by implementing a research based
quality assurance programs beginning at the unit level to systematically evaluate
the effectiveness of patients care management. The nursing staff can be use
patient care standards in actual practice as a reference guide for developing
patient care plans. 2stablishing standards facilities the development of autonomy
in nursing because the professional practice of the staff nurse is clearly
delineated. <tandards "quality of care% can be done by implementing a multilevel
research based quality assurance program to maintain standards that reflect
general practice.
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rg#ni2#tion o! "u#lity #ssur#nce &rogr#%$
The director is in a unique position to determine the quality of the nursing
care in institution by establishing and maintain standards.
-t the department level, a quality assurance committee should be
established determine and monitor quality assurance program.
2very division or unit of the nursing department should be quality
assurance committee to monitor patient care at the appropriate level.
3unctions o! "u#lity #ssur#nce &rogr#%$
2stablishes the desired standards of care and services that the health
care facility expects to pride to clients.
?athers data systematically and regularly by chart audit, client survey or
computer statistics and ,udges data against previously established
standards.
6
&irector of nursing
&epartment quality assurance committee
&ivision quality -ssurance committee
@nit quality assurance committee
<trengthens and reinforces quality outcome, inadequate or deficiencies
can be recognized and changed.
Qu#lity #ssur#nce )ersus nursing rese#rch$
Quality assurance studies are defined as those which,
#. &o not with hold an intervention from the group of patients.
4. &o not in traduce an intervention that is not commonly accepted in
practice.
7. -re necessary for patient care management in the institution.
Rese#rch stu.ies #re .e!ine. #s stu.ies 4hich$5
#. 6ay manipulate variables.
4. Introduce new nursing procedures
7. 6ay not have an immediate application to practice.
Accor.ing to L#rsons .e!inition$5
Quality assurance as having the intended as the caregivers and
administrators in the particular institution while nursing research has an audience
of the larger profession as in nursing.
If quality assurance can be conceptualized as a form of nursing research
that contributes to better patient care and better practice for the profession of
nursing, advanced in nursing practice will be dramatic.
+ro1le% i.enti!ic#tion$5
The problem identification phase should be an integral function of the
quality assurance committees.
It can be done by periodically quarter to annually reviewing patient care
problems.
A&&ro#ches to i.enti!y the &ro1le%$5
#. /ommittee members meet to identify problem at the designated times.
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4. 'roblems are listed by collecting through source of information. 2g,
incidental report, audit, nursing rounds etc.
7. Aank the problem so that the problems of greatest concern and magnitude
receive priority for investigation.
8. -nalysis of the problem.
9. 'atient problem investigation can than be implemented using a research
based approach.
Qu#lity #ssur#nce Rese#rch %etho.ologies #n. ethic#l .ile%%#s$5
Quality assurance studies provide the opportunity to conduct clinically
based examinations of patient care management strategies.
In order to systematically study quality assurance problem, sound
methodological principles must be used. This allows nurses to identify
more precisely the underlying causes of patient care problems and the
most effective nursing management strategy
Quality assurance research does raise, however, some specific ethical
questions.
<hould patient be told about their participation in investigational studies
and their written consent obtainedB It is the question of informed consent.
I%&lic#tion o! "u#lity #ssur#nce on nursing$5
Qu#lity #ssur#nce &rogr#%s6
2nable nursing to be accountable to society for the quality of nursing
care.
-re responses to the public mandate for professional accountabilityB
2nsure survival of the profession
2ncourage nursing fidelity to its moral and ethical responsibility.
Su%%#ry$5
8
<o far we have discussed about definition goals of quality assurance,
perspective of quality assurance, quality assurance and nursing research, ethical
dilemma, problem identification and research methodologies.
Conclusion$
Aesearch based quality assurance program is the key providing
excellence nursing care. It provides the basis for establishing and reassessing
standards and maintains staff compliance with patient care protocols and will be
the determining factors.
Bi1iliogr#&hy$
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<tandhop and lacaotcs $#$$:% Ccommunity health nursingD 8
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6argaret walsh+ CQuality assurance system must balance functioning with
securityD computer in Gursing .an>*eb. #$$#, vol. 8 'p) 4;4=.
/arl taylor, carol lillis and 'riscilla lemone+s Cfundamentals of nursing
"4EE#% theory and science of nursing care) 8
th
edition lippincott,
phicalphia, 'p) 7#4 F 7#8.







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S(No Content +(No
#. Introduction #
4. definition #
7. /omponents of Quality care #
8. ?oals of quality assurance 4
9. 'erspective of quality assurance 7
:. principal of quality assurance 7
;. quality assurance in nursing 8
=. 1rganization of quality assurance programme :
$ quality assurance verses nursing research ;
#E Quality assurance Aesearch methodologies and
ethical dilemmas
=
## Implication of quality assurance on nursing =
#4. <ummary =
#7 /onclusion $
#8 3ibliography $
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