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2 quality assurance
Quality:,[object Object],Quality is defined as the extent of resemblance between the purpose of healthcare and the truly granted care (Donabedian1986).,[object Object]
Quality assurance,[object Object],"Quality assurance is the monitoring of the activities of client care to determine the degree of excellence attained to the implementation of the activities". (Bull, 1985),[object Object]
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).,[object Object]
APPROACHES FOR A QUALITY ASSURANCE PROGRAMME:,[object Object],Two major categories of approaches exist in quality assurance they are,[object Object],General,[object Object],Specific,[object Object]
General Approach:,[object Object],It involves large governing of official body's evaluation of a persons or agency's ability to meet established criteria or standards at a given time.,[object Object],1) Credentialing:,[object Object],	2) Licensure:,[object Object],	3) Accreditation:,[object Object],	4) Certification:,[object Object]
1) Credentialing:,[object Object],It is generally defined as the formal recognition of professional or technical competence and attainment of minimum standards by a person or agency According to Hinvasky (1981),[object Object]
credentialing process has four functional components,[object Object],      a) To produce a quality product,[object Object],	b) To confer a unique identity,[object Object],	c) To protect provider and public,[object Object],	d) To control the profession.,[object Object]
2) Licensure:,[object Object],Individual licensure is a contract between the profession and the state, in which the profession is granted control over entry into and exists from the profession and over quality of professional practice.,[object Object]
The licensing process requires that regulations be written to define the scopes and limits of the professional's practice. Licensure of nurses has been mandated by law since 1903,[object Object]
3) Accreditation:,[object Object],National league for nursing (NLN) a voluntary organization has established standards for inspecting nursing education's programs. In the part the accreditation process primarily evaluated on agency's physical structure, organizational structure and personal qualification,[object Object]
4) Certification:,[object Object],Certification is usually a voluntary process with in the profession. A person's educational achievements, experience and performance on examination are used to determine the person's qualifications for functioning in an identified specialty area.,[object Object]
Specific approaches:,[object Object],Quality assurances are methods used to evaluate identified instances of providers and client interaction.,[object Object],	1) Peer review:,[object Object],	2) Standard as a device for quality assurance:,[object Object],	3)Audit as a tool for quality assurance:,[object Object]
1) Peer review:,[object Object],To maintain high standards, peer review has been initiated to carefully review the quality of practice demonstrated by members of a professional group. Peer review is divided in to two types. One centers on the recipients of health services by means of auditing the quality of services rendered. The other centers on the health professional by evaluating the quality of individual performance.,[object Object]
2) Standard as a device for quality assurance:,[object Object],Standard is a pre-determined baseline condition or level of excellence that comprises a model to be followed and practiced. The ANA standard for practice include;,[object Object],Standard 1: The collection of data about health status of the patient is systematic and continuous. The data are accessible, communicative, and recorded.,[object Object]
Standard 2: Nursing diagnosis are derived from health status data.,[object Object],Standard 3: The plan of nursing care includes goals derived from the nursing diagnoses.,[object Object],Standard 4: The plan of nursing care includes priorities and the prescribed nursing approaches or measures to achieve the goals derived from the nursing diagnoses.,[object Object]
Standard 5: Nursing actions provide for patient participation in health promotion, maintenance, and restoration.,[object Object],Standard 6: Nursing actions assist the patient to maximize his health capabilities.,[object Object]
Standard 7: The patient's progress or lack of progress towards goal achievement is determined by the patient and the nurse.,[object Object],Standard 8: The patient's progress or lack of progress towards goal achievement directs re-assessment, re-ordering of priorities, new goal setting, and a revision of the plan of nursing care.,[object Object]
To evaluate quality nursing care regularly, many staff nurses do indeed welcome opportunity to develop criteria, to review nursing care retrospectively and concurrently, and to discover methods of achieving higher levels of quality nursing care.,[object Object]
3) Audit as a tool for quality assurance:,[object Object],Nursing audit may be defined as a detailed review and evaluation of selected clinical records in order to evaluate the quality of nursing care and performance by comparing it with accepted standards,[object Object]
To be effective a nursing audit must be based on established criteria and feedback mechanism that provide information to providers on the quality of care delivered.,[object Object]
QUALITY ASSURANCE MODEL IN NURSING,[object Object],Quality assurance model in nursing is the set of elements that are related to each other and comprise of planning for quality development of objectives setting and actively communicating standards developing indicators, setting thresholds, collecting data to monitor compliance with set standards for nursing practice and apply solutions to improve care ,[object Object]
PHILOSOPHY OF QUALITY ASSURANCE MODEL IN NURSING ,[object Object],Indian nursing council believes that nurse will ,[object Object],Do good for person /receiver of care, do no harm, maintain respect for life and human dignity, believe in human justice and fairness to individuals in terms of access to resources and care and protect the vulnerable  ,[object Object]
Have moral obligation to provide services as per the prescribed of the regulatory body / health care system/ organization /institution even if it is in conflict with her personal beliefs and values ,[object Object],Be responsible and accountable for providing quality care in line with set standards ,[object Object]
Be committed to understanding of dynamic nature of his / her role in interdisciplinary health team,[object Object],Be obliged to create public awareness and consider social expectations before making decisions for providing nursing care ,[object Object],Be obliged to include receiver in making choices in planning and implementation of care ,[object Object]
Work in conjugation with legislation, accreditation and political system ,[object Object],Have obligation to promote education of self and others,[object Object],Be committed to advancement of profession ,[object Object]
PURPOSE OF QUALITY ASSURANCE MODEL,[object Object],To ensure quality nursing care provided by nurses in order to meet the expectations of the receiver, management and regulatory body ,[object Object],It also intends to increase the commitment of the provider and the management  ,[object Object]
GOALS OF QUALITY ASSURANCE MODEL,[object Object],Develop confidence of the receiver that quality care is being rendered as per assurance ,[object Object],Develop commitment of the management  towards quality care,[object Object],Increase commitment of providers to adhere to set standards for nursing practice and strive  for excellence ,[object Object]
MODELS OF QUALITY ASSURANCE,[object Object],System Model for Quality assurance.,[object Object],ANA Quality Assurance Model,[object Object],JCAHO Quality Assurance Model,[object Object],ISO Quality Assurance Model,[object Object]
A System Model for Quality assurance.,[object Object],The basic components of the system are,[object Object],Input,[object Object],Throughput,[object Object],Output,[object Object],Feedback,[object Object]
i) Input:- Can  be compared to the present state of the system.,[object Object], ,[object Object],ii) Through put:- The through put to the developmental process.,[object Object], ,[object Object],iii) Out put:- To the finished product.,[object Object], ,[object Object],iv) Feed Back:- It is the essential component of the system because it   maintains and nourish growth.,[object Object]
2 quality assurance
2 quality assurance
AMERICAN NURSES ASSOCIATION MODEL FOR QUALITY ASSURENCE,[object Object],Identify values,[object Object],Identify structure, process and outcome standards and criteria,[object Object],Select measurement,[object Object],Make interpretation,[object Object], ,[object Object]
Identify course of action,[object Object],Choose action,[object Object],Take action,[object Object],Reevaluate,[object Object]
1) Identify Value:,[object Object],In the ANA value identification looks as such issue as patient/client, philosophy, needs and rights from an economic, social, psychology and spiritual perspective and values, philosophy of the health care organization and the providers of nursing services.,[object Object]
2) Identify structure, process and outcome standards and criteria:,[object Object],Identification of standards and criteria for quality assurance begins with writing of philosophy and objective of organization. The philosophy and objectives of an agency serves to define the structural standards of the agency. ,[object Object]
Standards of structure are defined by licensing or accrediting agency. Another standard of structure includes the organizational chart, which shows supervisory methods, communication patterns, staff patterns and sometimes staff assignments. Evaluation of the standards of structure is done by a group internal or external to the agency.,[object Object]
3) Select measurement needed to determine degree of attainment of criteria and standards:,[object Object],Measurements are those tools used to gather information or data, determined by the selections of standards and criteria. The approaches and techniques used to evaluate structural standards and criteria are, nursing audit, utilization's reviews, review of agency documents, self studies and review of physicals facilities. ,[object Object]
The approaches and techniques for the evaluation of process standards and criteria are peer review, client satisfactions surveys, direct observations, questionnaires, interviews, written audits and videotapes.,[object Object]
4) Make interpretations,[object Object],The degree to which the predetermined criteria are met is the basis for interpretation about the strengths and weaknesses of the program. The rate of compliance is compared against the expected level of criteria accomplishment.,[object Object]
5) Identify Course of Action,[object Object],If the compliance level is above the normal or the expected level, there is great value in conveying positive feedback and reinforcement. If the compliance level is below the expected level, it is essential to improve the situations. It is necessary to identify the cause of deficiency. Then, it is important to identify various solutions to the problems.,[object Object]
6) Choose action,[object Object],Usually various alternative course of action are available to remedy a deficiency. Thus it is vital to weigh the pros and cons of each alternative while considering the environmental context and the availability of resources. In the recent that more than one cause of the deficiency has been identified; action may be needed to deal with each contributing factor.,[object Object]
7) Take Action:,[object Object],It is important to firmly establish accountability for the action to be taken. It is essential to answer the questions of who will do? What? By when?. This step then concludes with the actual implementation of the proposed courses of action.,[object Object]
8) Reevaluate:,[object Object],The final step of QA process involves an evaluation of the results of the action. The reassessment is accomplished in the same way as the original assessment and begins the QA cycle again. ,[object Object]
Careful interpretation is essential to determine whether the course of action has improves the deficiency, positive reinforcement is offered to those who participated and the decision is made about when to again evaluate that aspect of care.,[object Object]
JCAHO,[object Object]
2 quality assurance
2 quality assurance
JCAHO QUALITY ASSURENCE MODEL,[object Object]
ISO QUALITY ASSURENCE MODEL,[object Object]
2 quality assurance
2 quality assurance
QUALITY ASSURANCE PROCESS:,[object Object],Establishment of standards or criteria,[object Object],Identify the information relevant to criteria,[object Object],Determine ways to collect information,[object Object],Collect and analyze the information,[object Object],Compare collected information with established criteria,[object Object],Make a judgment about quality,[object Object],Provide information and if necessary, take corrective action regarding findings of appropriate sources,[object Object],Determine ways to collect the information,[object Object]
2 quality assurance
FACTORS AFFECTING QUALITY ASSURANCE IN NURSING CARE,[object Object],1) Lack of Resources:,[object Object],2) Personnel problems:,[object Object],3) Improper maintenance:,[object Object],4) Unreasonable Patients and Attendants,[object Object],5) Absence of well informed population.,[object Object],6) Absence of accreditation laws,[object Object], ,[object Object]
7) Lack of incident review procedures,[object Object],8) Lack of good and hospital information system,[object Object],9 Absence of patient satisfaction surveys,[object Object],10) Lack of nursing care records,[object Object]
1) Lack of Resources:,[object Object],Insufficient resources, infrastructures, equipment, consumables, money for recurring expenses and staff make it possible for output of a certain quality to be turned out under the prevailing circumstances.,[object Object]
2) Personnel problems:,[object Object],Lack of trained, skilled and motivated employees, staff indiscipline affects the quality of care.,[object Object]
3) Improper maintenance:,[object Object],Buildings and equipments require proper maintenance for efficient use. If not maintained properly the equipments cannot be used in giving nursing care. To minimize equipment down time it is necessary to ensure adequate after sale service and service manuals.,[object Object]
4) Unreasonable Patients and Attendants,[object Object],Illness, anxiety, absence of immediate response to treatment, unreasonable and un co-operative attitude that in turn affects the quality of care in nursing.,[object Object]
5) Absence of well informed population.,[object Object],To improve quality of nursing care, it is necessary that the people become knowledgeable and assert their rights to quality care. This can be achieved through continuous educational program.,[object Object]
6) Absence of accreditation laws,[object Object],There is no organization empowered by legislation to lay down standards in nursing and medical care so as to regulate the quality of care. It requires a legislation that provides for setting of a stationary accreditation / vigilance authority to,[object Object]
a) Inspect hospitals and ensures that basic requirements are met.,[object Object],b) Enquire into major incidence of negligence,[object Object],c) Take actions against health professionals involved in malpractice,[object Object]
7) Lack of incident review procedures,[object Object],During a patients hospitalizations reveal incidents may occur which have a bearing on the treatment and the patients final recovery. These critical incidents may be,[object Object],a) Delayed attendance by nurses, surgeon, physician,[object Object]
b) Incorrect medication,[object Object],c) Burns arising out of faulty procedures,[object Object]
8) Lack of good and hospital information system,[object Object],A good management information system is essential for the appraisal of quality of care.,[object Object],a) Workload, admissions, procedures and length of stay,[object Object],b) Activity audit and scheduling of procedures.,[object Object]
9 Absence of patient satisfaction surveys,[object Object],Ascertainment of patient satisfaction at fixed points on an ongoing basis. Such surveys carried out through questionnaires, interviews to by social worker, consultant groups, and help to document patient satisfaction with respect to variables that are,[object Object]
a) Delay in attendance by nurses and doctors.,[object Object],b) Incidents of incorrect treatment,[object Object]
10) Lack of nursing care records,[object Object],Nursing care records are perhaps the most useful source of information on quality of care rendered. The records.,[object Object],a) Detail the patient condition,[object Object],b) Document all significant interaction between patient and the nursing personnel.,[object Object]
c) Contain information regarding response to treatment,[object Object],d) Have the dates in an easily accessible form.,[object Object]
2 quality assurance
Thank you for your patient listening,[object Object]

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