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PLANNING QUALITY

ASSURANCE IN NURSING
By: Eu Salazar RN
OBJECTIVES:
• Understand the Quality Assurance Program in Nursing

• Familiarize with the Process in the Quality Assurance


Program

• Discuss and give pointers in Writing a QA Program Plan


REQUIREMENTS
 Quality Assurance Activity must be PLANNED.
 Monitoring process must include EVERY
DEPARTMENT or UNIT within the division of nursing.
 The process must be ORDERLY.
 Must assure not only the quality of care but also the
appropriateness of care
Quality – refers to the conformance to or variations
from pre-established criteria, standards, policies or
procedures
REQUIREMENTS
Appropriateness – refers to the fact that the standard
being employed is relevant to the patients’ condition

 When opportunities to improve care were being


identified, nurses are required to take actions to
improve care
SELECTING A NURSING QUALITY
ASSURANCE MODEL
• Select or develop a structure that fits with the
organizational structure and the style management
practiced in the organization.
• Decide on the format that makes the best use of
resources and manpower available.
• Keep the format simple and streamlined.
• Use a consistent model throughout the division of
nursing
• In a skilled nursing facility, use a consistency model
throughout the facility.
THE 10-STEP PROCESS IN A QUALITY
ASSURANCE PROGRAM
• It is a tool for assuring and improving quality
of care.
• Used to monitor and evaluate the quality and
appropriateness of care.
• It is the ongoing process to examine care, to
find potential problems and opportunities for
improvement and to do something about
them
THE 10-STEP PROCESS IN A QUALITY
ASSURANCE PROGRAM
Step 1 – Assign Responsibility
• Nursing departments and services must assign
overall responsibility for their monitoring and
evaluation activities.
• This person oversees all aspects of nursing
monitoring and evaluating, assuring that the
activities are comprehensive, effective,
uniform, and coordinated.
THE 10-STEP PROCESS IN A QUALITY
ASSURANCE PROGRAM
Step 2 – Delineate scope of care and services.
Intended to assure that all nursing activities are
considered in monitoring and evaluation.

• Types of patients served


• Condition and diagnosis treated
• Types of nursing staff providing care and service
• All existing standards of patient care
THE 10-STEP PROCESS IN A QUALITY
ASSURANCE PROGRAM
Step 3 - Identify Important Aspects of Care and
Services.

• It is important for nursing staff to remember that


important aspects of care are activities of the
department that will be continually monitored and
periodically evaluated to determine if care can be
improved or if problems are present.
THE 10-STEP PROCESS IN A QUALITY
ASSURANCE PROGRAM
Nursing staff should identify those aspects of
care and services that:
occur frequently or affect large numbers of
patients
place patient at serious risk (high risk)
have intended in the past to produce
problems (problem-prone)
THE 10-STEP PROCESS IN A QUALITY
ASSURANCE PROGRAM
Step 4 – Identify Indicators.
Indicators are measurable variables related to the
structure, process or outcomes of care.

• Structures – elements that facilitate care (resources,


equipment, numbers and qualification of staff)
• Process – functions carried out by practitioners
(assessment, treatment, planning and medication
administrations)
THE 10-STEP PROCESS IN A QUALITY
ASSURANCE PROGRAM
Outcomes – includes complications, adverse effects,
short and long term results of treatment
THE 10-STEP PROCESS IN A QUALITY
ASSURANCE PROGRAM
Step 5 – Establish Threshold for Evaluation.
• Thresholds are accepted levels of compliance
with any indicators being measured.
• Thresholds for evaluations are the level or
point at which intensive evaluation is
triggered.
THE 10-STEP PROCESS IN A QUALITY
ASSURANCE PROGRAM
Step 6 – Collect and Organize Data.
Some common date can be found in:

A) Patients records F) Laboratory report


B) Incident reports G) Meeting minute
C) Medication sheets H) Direct observation
D) Department logs I) Patient surveys
E) Infection Control J) Formal evaluation
THE 10-STEP PROCESS IN A QUALITY
ASSURANCE PROGRAM
Step 7 – Evaluate Care.

Once threshold for an indicator is reached, the


critical step of evaluation is initiated. The most
important purpose of monitoring and
evaluation is to foster overall continuous
improvement in the level of performance.
THE 10-STEP PROCESS IN A QUALITY
ASSURANCE PROGRAM
Examples:
• Lack of knowledge or skill
• Staff members knew what to do but did not do so
• Equipment deficiencies
• Deficiencies in medical record documentation
• Policy / procedure violation
• Lack of adequate staffing
• Infection control violation
• Inappropriate therapy, diagnostics
THE 10-STEP PROCESS IN A QUALITY
ASSURANCE PROGRAM
Evaluation must be designed to identify those
opportunities for improvement by:

Objectively examining the possible causes for


the level of performance
Recommending action pertinent to those
causes to improve the performance
THE 10-STEP PROCESS IN A QUALITY
ASSURANCE PROGRAM
Step 8 – Take actions to solve problems or
otherwise improve.

Staff should direct actions toward the root


causes and should have an eye toward overall
improvement in the quality of care and
services
THE 10-STEP PROCESS IN A QUALITY
ASSURANCE PROGRAM
Some possible actions if the problem involves
deficiencies in systems, include:
• Changing communication channels
• Changing organizational structure
• Adjusting staffing or redistributing staff
• Revising job descriptions
• Reallocating resources
• Adding or revising policies and procedures
• Altering the use of equipment
• Purchasing and repairing equipment
THE 10-STEP PROCESS IN A QUALITY
ASSURANCE PROGRAM
Some possible actions, if the problem involves
deficiencies in staff knowledge, include:
• Modifying orientation procedures
• Providing focused in-service education
• Providing focused continuing education
• Circulating written policies and procedures or
other informational material
THE 10-STEP PROCESS IN A QUALITY
ASSURANCE PROGRAM
Some possible actions, if the problem involves behavior
or performance deficiencies, include:
• Revising job descriptions
• Informal counseling
• Formal counseling
• Changing assignments
• Disciplinary sanctions
• Limiting staff prerogatives relating to patient care
• Transferring to another unit/department
THE 10-STEP PROCESS IN A QUALITY
ASSURANCE PROGRAM
Step 9 – Assess the effectiveness of actions.

Monitoring and evaluation does not end when actions


are taken. Staff continues to monitor the aspect of
care for future opportunities for improvement, but
they must determine whether actions are taken
successful in improving care or service. If care does
not improve within the expected time, staff should
re-examine the aspect of care and take further
action.
THE 10-STEP PROCESS IN A QUALITY
ASSURANCE PROGRAM
Step 10 – Communicate relevant information to the
organization-wide quality assurance program.

It is essential that monitoring and evaluation


information be communicated through established
channels. Appropriate dissemination of information
helps assure that quality assurance activities are
coordinated and that knowledge regarding
monitoring, evaluation and problem-solving methods
is shared.
Step 1 – PURPOSE/GOAL
In stating the purpose, the following
question should be answered: What
is the purpose? An example of what
could be stated in this: “the purpose
of the QA program or the goal of the
quality assurance program for nursing
service is to establish a planned and
systematic process for the monitoring
and evaluation of the quality and
appropriateness of patient care and
for resolving identified problems”
Step 2 - OBJECTIVES
Objectives should define what is to
be accomplished by carrying out a
QA plan. Some plans include both
long-term and short-term
objectives. Long term objectives
act as a guide to overall program
while short-term objectives reflect
the emphasis for the next one or
two years.
Step 3 - DESCRIBE ROLE
RESPONSIBILITIES
QA Coordinator: act as resource to
staff nurses on QA issue; collates a
quarterly summary of materials
sent from all nursing areas; may be
directly responsible for collecting
data and creating quarterly
reports, if the facility has a
centralized QA program-creates &
distributes the agenda for nursing
QA meetings
Step 3 - DESCRIBE ROLE
RESPONSIBILITIES
Staff Nurse: identifies quality
concerns on the unit or throughout
the facility; helps collect data;
participates in analysis QA data,
suggest corrective action when
indicated; performs corrective
action when appropriate
Step 3 - DESCRIBE ROLE
RESPONSIBILITIES
Nurse Manager: is responsible for the
quality of care his/her area of
responsibility; can delegate QA
activities to experienced clinical
nurses, support the staff by
providing time to carry out QA
activities
Step 4 - DESCRIBE A
STRUCTURE
• The structure should indicate the
manner in which the work of QA
will be completed.
DESCRIBE QA
Step 5 - COMMITTEE FUNCTIONS

Responsibilities that might be considered


include:
 Monthly meeting
 Conducting annual QA evaluation
program
 Integrating nursing QA activities with
organizational wide activities
 Receiving and responding to reports
about various QA activities
 Providing ongoing education and training
for nurses unfamiliar with QA process
Step 6 - MONITORING &
EVALUATION
• The information needs to be
summarized
• Collect data and report findings at
least 3 months before QA reporting
program
• Make stagger reports

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