Quality Assuarance

QUALITY
ASSURANCE
IN
CRITICAL CARE
UNIT
Rupali samal
Msc nursing 2nd year
2
INTRODUCTION
Quality is rapidly becoming

concern to both the consumers
and the providers. In health
care, quality is being demanded
and expected and providers are
Judged by the quality of services.
3
MEANING OF QUALITY
“Quality is doing the right things, right the

first time and doing it better the next time’’.
4
DEFINITION OF QUALITY
“It is the degree to which health services for the

individuals and populations increase the
likelihood of the desired health outcomes and are
consistent with current professional knowledge”.
-Joint Commission on Accreditation of Healthcare
Organizations (2002).
5
CONCEPT OF QUALITY ASSURANCE
Quality assurance includes all activities related to
Assuring
Maintaining high quality
care for
Establishing patients.
• It is a process of establishing a target degree of

excellence.
• It is a dynamic process.
6
DEFINITION OF Q.A

“Quality assurance means delivery of efficient and

effective medical care in accordance with the
professional standards.”

DEFINITION OF Q.A IN NURSING
“Quality Assurance is the defining of nursing

practice through well written nursing standards
and the use of those standards as a basis for
evaluation on improvement of client care.”
(Maker 1998)
8
GOALS :
 · To ensure the delivery of quality client care.
 To demonstrate the efforts of the health

provider to provide the best possible results.
9
PURPOSE OF Q.A
 To sets standards for care.
 To help patients by improving quality of care.
 To assess competence of medical staff
 To bring to notice of hospital administration the

deficiencies and in correcting the causative factors.
10
IMPORTANCE
 Provide excellent patient care which will save

life, promote recovery and prevent complication
 Meet patient’s need and expectations
 Minimize waste of resources and reduce cost
 Meet the increasing demand for effective care.
11
PRINCIPLE OF Q.A
There are four principles
1.Focus on the client
2. Focus on systems and processes
3. Focus on measurement
4.Focus on teamwork
12
1.FOCUS ON THE CLIENT
 Gathering information about client’s
health condition.
 Designed and priorities the nursing
intervention to meet the need.
 Assess the improvement of
health status as an ongoing activity.

13
2. FOCUS ON PROCESSES AND SYSTEMS
Quality management views all work in the form of
processes and systems.
 Processes are the series of action that in order to
achieve a result.
 Systems are arrangement of organizations, people,
materials, and procedures that together are
associatiated with a particular function or outcome.
14
A SYSTEM MODEL FOR Q.A:
The basic components of the system are
• Input
• Process
• Output
• Feedback
15
A System Model for Quality
assurance
PROCESS OUTPUT
INPUT
A series of Outcomes are
Recourses interventions the resulting
needed to carried from the input
conduct critical out to and process of
care process transform the nursing
input into interventions.
output
16 FEEDBACK
Cont.......
3. FOCUS ON MEASUREMENT
In QA, data are used to analyze process , identify
problem , test solution and measure performance.
Data are important because they ensure objectivity.
Specially measurement and data are used in quality
assurance to:
 Identify opportunities for improvement in QA efforts.
 Detect and assess problems in the area of critical
care.
17
Cont....
 Verify possible causes of problems that were
measure.
 Monitor processes over the period to see if the

change or improvement is maintained.
18
Cont...
4.FOCUS ON TEAMWORK
A team is a high performance
task group whose members
are interdependent and share
a common performance
objective.
19
PROCESS OF Q.A
There are 3 steps are used for improvement of

quality assurance in CCU.
1. Identify quality indicators
2. Develop standards
3. Develop the plan
20
1.IDENTIFY QUALITY INDICATORS:
 It means what needs to be improved
 It can be done in two ways
• By asking the client about their expectation
• By asking the care provider about the care they
provide
EXAMPLE: A patient is discharging from CCU and he said ,

he was very much disturbed with noise and light in the unit
and he hardly slept while in CCU.
EXAMPLE:A patient get bedsore in ICU/CCU, it indicates that
21
nurses are not given careful lookout to prevent bedsore.
2. DEVELOP STANDARDS
 Standard means something set up and established by

authority as a rule for measurement of quality
 Once the indicators are identified the standards are
develop.
 In CCU nursing in-charge and nurses together develop
standard according to priority and resources available.
 It review periodically
 It can change according to the need of patient.
22
Cont…..
E.g: pressure sore and noise

Standard-1: All clients will received adequate care
to prevent bed sore/pressure sore.
Standard-2: All clients in CCU will experience
adequate rest and sleep/free from noise.
In order to meet the standard peer review and

nursing audit plays a vital role.
23
1)PEER REVIEW
It is the evaluation of
performance by the other
people in same field in order
to maintain or enhance the
quality of the work or
performance in that field .
24
2.NURSING AUDIT
Nursing audit refers to assessment of the quality

of clinical nursing’
(elision)
Nursing audit is an exercise to find out whether
good nursing practices are followed.
(Goster )
25
NURSING AUDIT PROCESS
Audit can be two types internal
external
Nursing audit process involves:
 Planning
 Preparation of tool and data collection
 Taking action and documentation
26
1. Planning
 Stating the objective.

 Deciding on the structure, process and
outcome.
 Deciding the audit criteria
 Deciding the tool and techninique
 Deciding the sample and it’s size
27
2.Preparation of tool and the method
for data collection
This involves
 Preparation of criteria for audit and checklist of
care given.
 The audit sample should be representing the
population covered by the standard
 Minimum of twenty sample are used for an
audit.
28
A SAMPLE NURSING AUDIT CHECKLIST
Audit criteria yes no
Objective: to audit the 1. Used six steps while giving √
steps and process of
back massage
care used in
preventing pressure 2. Turned position every two √
sores.
hours
Place: CCU
Sample :ten CCU 3. Patient on alphabed/air √

nurses
mattress
Tool: checklist
4.Used clean and dry bed √
29
Sl VAP BUNDLE performed Not
no Performed
1 Hand hygiene
2 Head end of the patient to be

raised≥30.
3 Stress ulcer and DVT

prophylaxis
4 Sedation vacation/early
extubation
5 Mouth care/aseptic suction
30
Sl No CAUTI BUNDLE performed Non
performed
1 Hand hygiene
2 Proper secure of the catheter
3 Urine bag should be below the bladder

level
4 Aseptic perinea/mental dressing
5 Follow the closed bladder drainage

system
6 Make sure there no kinking

31
3.TAKING ACTION
This phase includes:

 Analyze and summarize the collected data.
 Noted the finding compliance and non
compliance
 Draw the conclusion.
 Prepare the nursing report for review and
discussion.
32
Cont...
 Analyze the possible cause.
 Take the corrective action.
 Remedial action should be taken for correcting.
 Re-auditing should be done after a period of

time to see the change if any.
33
3.DEVELOP THE PLAN
In this step the plan are developed on the basis of Q.A

model- structure, process and outcome.
Develop structure ( input)
It includes:
 Back care material are required at bedside for back
care.
 Bedsore risk scale
 Air matters/ water bed
 Adequate number of staff
34
• Develop the process:
 Nurses should access bedsore every morning and

evening and it should be recorded.
 All high risk patient should put on airbed/water bed.
 Nurses should change the patient position every 2nd

hourly.
 To avoid the friction, the patient’s bed sheet should be

dry and wrinkle free.
35
Outcome:
• All nurses in CCU learn the steps of back massage
• All nurses in CCU are able to assess clients for

pressure sores.
• All patients are free of pressure sores.
36
Q.A COMMITTEE IN NURSING
 Supervisors
 Head nurses
 Clinical specialists
 Nurse clinicians
 Licensed practical nurses
 Nursing assistants
 Medical records administrator
37
FACTORS AFFECTING Q.A IN
NURSING CARE
1.Lack of resources
2.Personnel problem
3.Improper maintenance
4.Unreasonable patients and attendants
5.Absence of well-informed population
38
Cont......
6. Lack of incident review procedure
7.Lack of nursing care record
9.Miscellaneous factors
39
ROLE OF NURSES IN Q. A
 Nurses are the active participant of interdisciplinary quality
improvement team .
 Develop mechanism for continually monitoring the effectiveness
of nursing care both a collaborative and an individual
professional activity.
 Contribute innovations and improvement of patient care.
 Participating in improvement projects and patient safety

initiatives.
40
Cont….
 Participate continuing educational programs and in-

service educational programs for continuing
professional development.
 Periodic and continuing appraisal and evaluation of
health care situation of the patient.
 Participate research works related to quality assurance.
 Identify any area of needed improvement in delivery of
care.
41
Thank you

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QUALITY

Quality is rapidly becoming

“Quality is doing the right things, right the

“It is the degree to which health services for the

Quality assurance includes all activities related to

• It is a process of establishing a target degree of

“Quality assurance means delivery of efficient and

“Quality Assurance is the defining of nursing

 · To ensure the delivery of quality client care.

 To demonstrate the efforts of the health

 To help patients by improving quality of care.

 To assess competence of medical staff

 To bring to notice of hospital administration the

 Provide excellent patient care which will save

 Meet patient’s need and expectations

 Minimize waste of resources and reduce cost

 Meet the increasing demand for effective care.

 Designed and priorities the nursing

intervention to meet the need.

 Assess the improvement of

health status as an ongoing activity.

 Monitor processes over the period to see if the

There are 3 steps are used for improvement of

EXAMPLE: A patient is discharging from CCU and he said ,

 Standard means something set up and established by

E.g: pressure sore and noise

In order to meet the standard peer review and

Nursing audit refers to assessment of the quality

 Stating the objective.

Sample :ten CCU 3. Patient on alphabed/air √

2 Head end of the patient to be

3 Stress ulcer and DVT

2 Proper secure of the catheter

3 Urine bag should be below the bladder

4 Aseptic perinea/mental dressing

5 Follow the closed bladder drainage

6 Make sure there no kinking

This phase includes:

 Take the corrective action.

 Remedial action should be taken for correcting.

 Re-auditing should be done after a period of

In this step the plan are developed on the basis of Q.A

 Nurses should access bedsore every morning and

 All high risk patient should put on airbed/water bed.

 Nurses should change the patient position every 2nd

 To avoid the friction, the patient’s bed sheet should be

• All nurses in CCU learn the steps of back massage

• All nurses in CCU are able to assess clients for

• All patients are free of pressure sores.

7.Lack of nursing care record

 Develop mechanism for continually monitoring the effectiveness

of nursing care both a collaborative and an individual

 Participating in improvement projects and patient safety

 Participate continuing educational programs and in-

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