MASTER PLAN ON 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 receive safe and competent nursing care regardless of the setting or the circumstances under which the care is given. Health professionals have long been concerned about the need to maintain high standards of practice. QUALITY ASSURANCE Quality assurance the term borrowed from business world, refers to a program designed to try to ensure that health care provided to patients is consistently of good quality.The quality of care the patient receives is dependent on a number of variables. Four of the principle elements that can vary and affect care 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. 2. 3. 4. 5. 6. 7.

Accreditation/ Approval of Basic Nursing Education Programs. National qualifying examinations. Licensing/ Registration. Disciplinary bodies. Mandatory continuing education. Certification. Assessment of clinical competence. Peer review Nursing audit The problem oriented medical record.

PROFESSIONAL STANDARDS REVIEW ORGANIZATIONS Although professional standards review organizations were strongly physician oriented, Public Law 92-603 provided for participation of other health

care personnel in these organizations, thereby encouraging nurse involvement in quality 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 for quality assurance. 2) In planning a comprehensive quality assurance program for a health institution coordination is needed to ensure that objectives and activities of each health profession enhance rather than cancel those of other professions. 3) Care should be taken to ensure that resource expenditure for quqlity assurance activities is appropriate in amount. 4) In order to ensure that resources expended for quality assurance yield significant findings or results, investigation should focus their attention or monitoring 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 system operation depends upon receiving feedback from all subsystems of the nursing suprasystem. 7) Evaluation of care will not by itself improve practice. Feedback to practitioners is required both to perpetuate good practice and to replace unsatisfactory interventions with more effective methods. 8) Once quality of care has been assessed and needed improvements have been identified, peer pressure can provide the impetus required to effect prescribed 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 formal organizational structure. 10) For quality assurance efforts to be effective, collection and analysis of quality assessment data must be performed by a decision maker. Data related to structural inadequancies, process failure, and inadequate outcomes are without value unless used by a change agent to motivate remedial action.

STANDARDS OF CARE I. The collection of data about the health status of the client/patient is systematic and continuous. The data are accessible, communicated and recorded. 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 the diagnoses. V. Nursing process provide for clients/ patient participation in health promotion, maintenance and restoration. VI. Nursing actions assist the client/ patient to maximize his health capabilities. VII. The clients/ patients progress or lack of progress toward goal achievement is determined by the client/ patient and the nurse. VIII. The clients/ patients progress or lack of progress toward goal achievement directs reassessment, reordering of priorities, new goal setting, and revision of the care of nursing care. QUALITY ASSURANCE METHODS The primary purpose of a nursing quality assurance program should be improvement of a patient care rather than disciplining of incompetent nursing practitioners. The thrust of a nursing quality assurance program should be twofold: 1. To measure and 2. To improve the quality of nursing care delivered in the organization. Developing Quality Assurance Criteria There are several frames of reference for criteria development. Some experts believe it is most practical to develop nursing criteria in relation to diagnostic categories, since diagnosis is major concern for patients and caregivers and since medical records are catalogued according to diagnosis.

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 to have the same individual use the assessment tool to measure the same object or phenomenon at different times and compare the two measurements to see how closely they agree. Validity refers to the degree to which a tool measures what it purport to measure. Testing quality assurance criteria After criteria have been prepared for each topic to be studied, they should be on a trial basis to a small sample of the patient population for which they were designed in order to determine whether the criteria permit reliable and 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 task force, the quality assurance ordinance should organize criteria measurement tools. 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

 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 and may withdraw if he changes his mind. False imprisonment Invasion of privacy Defamation of character Malpractice insurance BIBLIOGRAPHY Books Dugas , Introduction to patient care, 4th edition, south India edition, Delhi. Page no: 97-108. Lucille.A.Joel, Advanced Practice Nursing essentials for role development, 2nd 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