QUALITY ASSURANCE

IN NURSING
.
Neha Barari
Assistant
Professor SNSR
 INTRODUCTION
THE EXPENSE OF QUALITY IS AN
INTERACTIVE PROCESS BETWEEN
CUSTOMER & PROVIDER. QUALITY
ASSURANCE USUALLY FOCUSES ON
MATERIAL, GOOD WORK & SERVICE
PROVIDED EFFECTIVELY. ANY LACK IN
SERVICE PROVIDED CAUSES DECREASE IN

QUALITY.
 QUALITY

It is degree to which health services for

individuals & population increase the likelihood
of desired health outcomes & are consistent
with current professional knowledge.

-Joint Commission on
Accreditition of health care organization ,2002
(JCAHO)
 ASSURANCE

It is statement or indication that inspires

confidence.
 QUALITY ASSURANCE
• Quality assurance is an on-going, systematic,
comprehensive evaluation of health care services
& impact of those services on health.
-Kozier
• Quality assurance is defined as all activities
undertaken to predate & prevent poor quality.
-Neetvert
 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 support delivery of nursing care with
administrative & managerial services.

• To explain quality assurance models as pre-

requisite for quality nursing care.

• To state code of ethics & professional conduct for

nurses in India.
• To appreciate importance of practicing standard
safety measures.

• Plan & conduct patient teaching sessions.

• To identify appropriate management techniques

to be used for managing resources in given
situation.
 PURPOSES
• It is required to introduce code of ethics &
professional conduct for nurses in India.

• To prepare staff nurse for implementation

quality assurance model in nursing.

• To provide best care to patients by maintaining

standards.
 PRINCIPLES
1. Customer focus- It focuses on patient’s care with
standard & recent medical knowledge.

2. Leadership – It helps to inculcate qualities

of leadership in staff.

3. Involvement of People- It should involve

maximum nursing staff so that standards can be
maintained.
4)Process approach- There should be a systematic &
planned approach to provide quality care.

5)Factual approach to decision making- There

should be fact or appropriate reason in taking
certain decision for quality assurance of patient.
 APPROACHES FOR QUALITY
ASSURANCE PROGRAM
Approaches of quality assurance are divided
into 2 types:

1. General Approach
2. Specific Approach
 GENERAL APPROACHES

It involves large governing of official body’s

evaluation of person’s or agency’s ability to meet
standard at a given time.

1. CREDENTIALING - It is process of
determining & maintaining nursing
standards.
Functional Components Of Credentialing
Process

According to Hinsvark, credentialing process has

4 functional components:-

1. To produce a quality product.

2. To confer a unique identity.
3. To protect provider & public.
4. To control the profession
2. LICENSURE

Individual licensure is a contract between profession

& state in which profession is granted control over
entry into & exists from profession & over quality
of professional practice.
3. ACCREDITATION

Accreditation is the act of granting credit or

recognition especially to an educational
institution that maintains suitable
standards.
4. CERTIFICATION
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.
 SPECIFIC APPROACHES
Quality assurances are methods used to evaluate
identified instances of provider and client
interaction

1. Peer review committee- These are designed

to monitor client specific aspects of care
appropriate for certain levels of care. The audit
is used by peer review committee to ascertain
quality of care.
2. NURSING AUDIT –

Nursing audit is evaluation of patient care through

analysis of written records maintained by
nurses in patient’s treatment profile.
- Avtar Brar
3.Utilization Review

Utilization review activities are directed towards

assuring that care actually needed and that the
cost appropriate for the levels of care provided
 TYPES OF UTILIZATION REVIEW

• Prospective: It is an assessment of the

necessary of care before giving services.

• Concurrent: A review of the necessity of care

while the care is being given.

• Retrospective: It is analysis of the necessity of

the services received by the client after the care
has being given
4.Evaluation Studies

Donabedian’s Structure-Process-Outcome model

Donabedian introduced 3 major method of

evaluating quality care:-
1. Structural evaluation

This method evaluates setting & instruments used to

provide care such as facilities, equipments &
characteristics of administrative organization &
qualification of health provider. The data can be
obtained from existing documents.
2. Process Evaluation

This method evaluates activities as they relate to

standards & expectations of health providers in
management of client care. Data is collected through
direct observations, review of records, audit etc.
3.Outcome Evaluation

The net changes that occur as a result of health care

or net results of health care. The data of this
method can be collected from vital statistics
records such as death certificate or telephone client
interview, mailed questionnaire & client records.
 MODELS OF QUALITY
ASSURANCE
System Model
System model is used for implementation of
unit based quality assurance program. It
involves making changes in organizational
structure & individual roles. In system model,
task is broken down into manageable
components based on defined objectives.
 Basic Components of System
Models

• Input- The input can be compared to the

present state of systems.
• Throughput- It is developmental
process.
• Output- It is finished product or result.
• Feedback- It is essential component of system
because it maintains & nourishes growth.
ANA Quality Assurance Model
Identify
Reevaluation
values

Identify standards
Take action
& criteria

Choose action Secure measurement

Identify Make
course of measurement
action
 PDCA CYCLE

• PLAN
• DO
• CHECK
• ACT
 PDCA CYCLE
PLAN

ACT
PDCA DO
CYCLE

CHECK
FACTORS AFFECTING
QUALITY ASSURANCE
IN NURSING CARE
 QUALITY IMPROVEMENT
• Quality improvement is defined as an approach
to the continuous study & improvement of
process of providing health care services to
meet the needs of clients & others.
-Joint commission on accreditation of
health care organization (JCAHO)
 PRINCIPLES
• It requires continuous quality improvement.
• Knowledge of customer expectation needs.
• Processes of customer supplier relationship.
• Belief in people.
• Statistical analysis.
• Costs of poor quality.
 CONDITIONS IN WORK
ENVIRONMENT
• Employer’s involvement.
• Improvement.
• An environment that support taking risk.
• Team work.
• Data collection & analysis skills.
• Group interaction skills.
• Structure & management to enable
improvement.
• Tools to facilitate improvement.
 COMPONENTS OF QUALITY
IMPROVEMENT PROGRAMS
• Establish responsibility & accountability.

• Define scope of service for clinical area.

• Define key aspects of service for clinical area
• Develop quality indicators to monitor outcomes
& appropriateness of care delivered.
• Establish threshold for evaluation of indicators.
• Collect & analyze data from monitoring activity.
• Evaluate results of monitoring activities to
determine the need for change in practice.

• Resolve problems through development of

action plans.

• Reevaluate to determine if plan was

successful.

• Communicate quality improvement results to

organization.
 STANDARDS

Standard is an established rule as basis of

comparison in measuring or finding capacity,
quality context & value of objects in same
category.
 Classification of nursing care
standards
1) Structure standards

• It involves setup of institution.

• The philosophy, goals & objectives, structure of

organization, facilities, equipment, qualification
of employees are some of components of
structure of organization.
2) Process standard

• It describes behavior of nurse at desired

level of performance.

• It involves activities concerned with delivering

patient care.
3)Outcome standard

• An outcome standard measures changes in

patient health status.

• This change may be due to nursing care,

medical care or as a result of variety of services
offered to patient.
 ROLE OF A NURSE

• Role of nurse is to participate in quality

improvement team.

• Properly supervises & check whether patient is

receiving proper care or not.
• Contribute innovation & improvement of patient
care.

• Participating in improvement projects &patient

safety initiatives.
• Participating in CNE programs
& in-service education programs.

• Periodic & continuing appraisal

& evaluation of health care
situation of patient.

• Participate in research works

related to quality assurance.
• Nurse identifies area where
need improvement in delivery