QUALITY ASSURANCE IN NURSING

INTRODUCTION Quality assurance is achievable through an ongoing evaluation of patient care which would assure the hospital that all that was done for the patient was done to justify diagnosis, treatment and outcome and to pinpoint inadequacies in medical care for rectification for the future cases. DEFINITION Quality assurance is defined as all actions taken to establish protect, promote and improve the quality of health care METHODS OF QUALITY ASSURANCE Quality assurance in nursing having various methods. They are as follows; CONCURRENT OR ON-THE-SPOT-REVIEW A hospital administrator uses this methods routinely so far as nonclinical aspects of hospital care are concerned, in the form of daily and periodical administrative rounds. -As the rounds progresses, the visiting clinician should look into the patients case records, enquire from each patient about his/ her progress, treatment and diet, peruse nurses report, book and treatment book, and even inspect the house keeping activities and sanitation of the ward and other aspects connected with patient care. -The analysis of records immediately after discharge in the ward itself can prove fruitful in obtaining the final diagnosis from the physician before the record arrives in the medical record department. -This can assist in providing accuracy of information in the medical record itself, the most frequently used data source in the hospital. RETROSPECTIVE REVIEW Pre requisites of retrospective audit There are 3 fundamental pre requisites that need to be fulfilled before the programme is instituted. Good medical records. Establishment of criteria for diagnosis, investigations and treatment and Co-operation and involvement of medical staff.

The medical record has to be sequentially filled and a face sheet affixed to each case record before it is presented to the evaluation committee. EXTERNAL OR INTERNAL External quality assurance is seen as being concerned with the setting by independent outside authorities of explicit standards of service over wide areas of health care system. Internal quality assurance is seen as essentially a local exercise, whereby the activities of physicians and surgeons are subjected to a confidential review by their peers designed to improve patient care and encourage professional selfevaluation. PROCESS OF QUALITY ASSURANCE Help patients and potential patients by improving quality of care. Assess competence of medical staff, serve as an impetus to keep up to date and prevent future mistakes. Bring to notice of hospital administration the deficiencies and in correcting the causative factors. The process can also help to exercise a regulatory function, restricting procedures. This cannot but help the medical staff to improve upon their clinical and professional judgment. By timely verification, it cannot but help provide assurance for future actions so that better methods could be used. NEED FOR QUALITY IMPROVEMENT Establish responsibility and accountability for a quality programme. Define the scope of service for a clinical area. Improvement of existing obsolete processes and procedures. Improved layout of office and working environment. Economy in human effort. Improved performance. Job satisfaction. Improved flow of work. Standardization of process and products.

RECORDS IN QUALITY IMPROVEMENT Records are an integral part of the communication structure of the health care organization. Records provide complete information about the client, indicate the extend and quality of service being rendered, resolve legal issues in malpractice suits and provide information from education

and research. Accurate and complete records are require by law and must be kept update by all governmental and non-governmental agencies. STEPS FOR QUALITY IMPROVEMENT -Define the key aspects of service for the clinical area. -Develop quality indicators to monitor the outcomes and appropriateness of care delivered. -Establish thresholds for evaluation of indicators. -Collect and analyses data from monitoring activities. -Evaluate results of monitoring activities to determine the need for change in practice. -Resolve problems through development of action plans. -Re evaluate to determine if the plan was successful. -Communicate results to the organization. APPROACHES FOR QUALITY ASSURANCE PROGRAMME There are mainly two categories. a) General approaches Credentialing: The formal recognition of a person as a professional with technical competence or of an agency that has met minimum standards of performance. Credentialing includes licensure for individuals accreditation for institution and certification with the features of both licensure and accreditation. b)Specific approaches: are implemented voluntary agencies and provider groups interested in the quality of interactions in their settings. They include,

 Staff review committee ( audit process) This is a method of evaluation quality of care through appraisal of nursing process. Utilization review The process of utilization review is to assure that if care actually is needed and that the cost is appropriate. Client satisfaction survey. It is yet another method for measuring quality of care. Client satisfaction is been assessed using in person or telephone interview and mailed questionnaires. This survey measures the intervention of client care, attitudes about the care received and the providers of care. Risk management The goal of risk management is to reduce the liability on the part of the agency and the no: of grievances brought against the agency. Malpractice litigation Is typically results from client dis satisfaction with the provider and with the content of care provider. CRITERIA FOR EVALUATION OF QUALITY OF SERVICE -Patients satisfaction levels as assessed from the satisfaction survey program and the complaints received from the patients / relatives. -Complaints received from the doctors about incompetence negligence / or bad behaviour on the part of nurse. -Instances of sampling errors by nurse leading to enoneous reports / results. -Instance of nosocomial infections attributable to unsafe nursing practice. -Instance of unexpected complications / death due to negligent performance by the nurse. EVALUATION OF QUALITY OF NURSING SERVICE The way to judge the quality of nursing services is from the quality of outcome of nursing care, which means, a)satisfaction of patient / relatives. (external client)

b)satisfaction of physicians (internal clients) Expectation of patients / relatives -To have someone to take care of them continuously during the period of sickness, sympathetically, willingly and smilingly. -Someone to attend their basic needs with patience, understanding and efficiency. -Someone to provide all the right nursing care and medication at the right time in the right manner as prescribed by the doctors, relieve the pain and suffering and quickly restore them back to health without any complications or ill effects. Expectations of the physicians -The nurses monitor the patients condition with efficiency and alertness and inform them immediately any change requiring the physicians intervention. -Nurses carryout the physicians instructions strictly regarding the investigations, medications, nutrition, and specialized nursing / other procedures as per prescribed schedule. -Nurses take care of the basic needs of the patients provide a safe and comfortable environment conducive to early healing and nurse them back to normal health. -There are no complications / harm to the patients due to any mistakes on the part of nurses in the performance of above functions. QUALITY HEALTH OUTCOME MODEL STRUCTURE Facility resource personal mix and skills, philosophy, policies and client mix. PROCESS Standards,attitudesnursing care plan effectiveness client satisfaction. OUTCOME Clients health goals effectiveness services. care met of

ROLE OF NURSES IN QUALITY ASSURANCE. As an assistant to the treating physician By assisting the physicians in various procedure as well as carrying out their instructions for medical management of patients. In provision of nursing care

A very skilled role requiring continuous responsibility of nursing care of the patients under their charge. Hospitality role Taking care of all the routine needs (food, clothing, cleanliness, hygiene, sanitation , accommodation ) and psychological support to reassure the patient and relatives anxiety. Nurses are responsible for managing the caseload of client with needs of varying degrees of urgency. Using the resources available , the must priority services that will promote the highest possible level of person and group functioning and health. Some quality improvement activities for nurses include daily prioritizing care needs, seeking supervision or skills development for a difficult case, systematizing charting so that needed documentation is effectly completed, proposing better ways to organize care of chronically ill client or establishing new agency procedures. All these actions demonstrate that nurses are evaluating their work and looking for ways to improve care. Staff meetings, quality circle meetings, peer review and case conferences are common settings for nurses to brings the lessons of their practice to the large group for examination and potential adoption. CONCLUSION The role of nurse in the treatment and recovery of patients can never be exaggerated, it is multifold. Not only do the minister the treatment advised, but carry out the nursing procedure, take care of the day to day needs of the patient and also provide the much needed psychological support in addition to the general activities related to ward management. BIBLIOGRAPHY S.K Joshi, Quality management in hospitals, Jaypee brothers medical Publishers PLtd. pp no:257-263. Potter perry, Fundamentals of nursing, Elsevier publications, volume 1 Pp no: 78-81. Helen Harkreader, Mary Ann Hogan, Fundamentals of nursing ,2 nd Edition,pp no: 277-278. Nightingale nursing times, Safe staffing saves lives,12 th may, vol 2 Pp no: 9-12.

 Lawrence F.Wolper, Health care administration, 3 rd edition, Jones And Bartlett publishers, ppno:554.

B.M Sanharkar, principles of hospital administration and planning Published by Jaypee brothers, pp no: 302-304