QUALITY ASSURANCE

QUALITY: DEGREE OF EXCELLANCE

ASSURANCE: MAKE SAFE

QUALITY ASSURANCE

STANDARD SETTINGNURSING / CLINICAL AUDIT

OBJECTIVES

AT THE END OF THE SESSION THE STUDENTS WILL BE ABLE TO:• ACKNOWLEDGE THE IMPORTANCE OF QUALITY ASSURANCE

• ACQUIRE AN UNDERSTANDING THE DEFINITION OF QUALITY

• UNDERSTAND THE IMPORTANCE OF STANDARD SETTING

• ACQUIRE THE KNOWLEDGE ON THE IMPORTANCE OF NURSING / CLINICAL AUDIT AND ITS PROCESS

QUALITY ASSURANCE

PRIORITISING CLINICAL AUDIT TOPICS

• A review of the patient’s prospective on quality of care

• An area of high cost, volumes or risk

• Evidence of a serious quality e.g. : patient complaints, infection rates

• The availability of systematic reviews of research or national clinical guidelines

QUALITY ASSURANCE

CONCEPTS OF QUALITY ASSURANCE PROVISION OF A PROFESSIONAL SERVICE CARRYING WITH IT OBLIGATION ON THE PROFESSIONAL TO SATISFY PATTIENTS’ / CLIENTS’ NEEDS AT ALL LEVEL

WHY QUALITY ASSURANCE IT IMPLIES IDENTIFICATION OF AREAS FOR IMPROVEMENT AND SELECTIVE ATTENTION TO THE DEVELOPMENT OF NEW TECHNIQUES IN AREAS OF GREATEST NEED

QUALITY ASSURANCE

STEPS TO QUALITY ASSURANCE

STANDARDS ARE SET

QUALITY ASSURANCE

PERFORMANCE OUTCOMES ARE CHECK AGAINST THESE STANDARDS

IF THERE IS A SHORTFALL THIS IS USED AS A FEEDBACK TO CRITICAL PARTS OF THE SYSTEM

ALTERNATIVELY THE STANDARD MAYBE MODIFIED TO ONE THAT IS SCHIEVABLE

QUALITY ASSUARANCE

CONCERN FOR EXCELLENCE AND STANDARD • FOCUSSING ON INDIVIDUALS CARE OR POPULATION SERVICE• MUST REFLECT AN INTEREST IN THE PROVISION OF THE HIGHEST POSSIBLE QUALITY CARE• IT SHOULD EXTEND TO ALL ASPECTS OF CARE INCLUDING THE TECHNICAL, THE INTERPERSONAL AND MORAL

SPECIFICITY AND EXPLICITNESS

THE ESSENCE OF HEALTH CARE QUALITY ASSURANCE

STANDARD ARE SPECIFIED AND OPERATIONALISED AND MEASUREMENT TOOLS ARE DEVELOPED FOR THEIR APPRAISAL

COMMITTMENT • BOTH INDIVIDUALS AND ORGANISATIONS MUST BE POSITIVELY MOTIVATED TO IMPLEMENT QUALITY ASSURANCE AT THE ORGANISATIONAL LEVEL• THERE MUST BE RECOGNITION THAT QUALITY ASSURANCE DOES NOT JUST HAPPEN – IT MUST BE MANAGED

QUALITY ASSURANCE

SOCIAL VALUE

INDIVIDUAL VALUE

PROFESSIONAL VALUE

INSTITUTIONAL VALUE

QUALITY

QUALITY ASSURANCE

APPROPRIATENESS

QUALITY IN HEALTH SERVICES / IN INDIVIDUALS

EQUITY

EFFECTIVENESS

EFFICIENCY

ACCEPTABILITY

THE SERVICE OF PROCEDURE IS WHAT THE POPULATION OR THE INDIVIDUAL ACTUALY NEEDS

A FAIR SHARE FOR ALL THE POPULATION

ACHIEVING THE INTENDED BENEFIT FOR THE INDIVIDUAL AND FOR THE POPULATION

RESOURCES ARE NOT WASTED ON ONE SERVICE OR PATIENT TO DETRIMENT OF ANOTHER

SERVICES ARE PROVIDED SUCH AS TO SATISFY THE REAONABLE EXPECTATIONS OF PATIENTS, PROVIDERS AND THE COMMUNITY

QUALITY ASSURANCE

STRUCTURE

THE QUALITY CARE CAN BE STUDIED FROM THESE ASPECTS

PROCESS

OUTCOME

A. CLINICAL (TREATMENT OF PATIENTS) CAREB. NON CLINICAL ( MEETING THE PATIENT PERSONAL,

SOCIAL, EMOTIONAL, SOCIAL NEEDS)

CARE INCLUDES

WHERE IS CARE CARRIED OUT

WHAT EQUIPMENT IS USED

WHO CARRIES OUT THE CARE

HOW IS IT CARRIED OUT

WHAT IS THE END RESULTS?a) PERCIEVED BY PATIENTS / CLIENTSb) PERCIEVED BY PROFESSIONALS

QUALITY ASSURANCE

• A COURTESY

NON CLINICAL ( MEETING THE PATIENT) CARE

B SURROUDINGS THAT SUGGEST COMPETENT HELPS IS AT HAND

C READY ACCES TO THE SUPPORT OF FAMILY AND FRIENDS

D BEING TOLD WHAT WILL HAPPENED AND WHEN

E LACK OF DELAYS

QUALITY ASSURANCE

CRITERIA FOR STANDARDS

A STANDARD IS A MEANS OF MEASURE

RELEVANT UNDERSTANDABLE MEASUREBLE BEHAVIORAL ACCEPTABLE

EXAMPLE OF A STANDARD

“ ALL OUT PATIENTS SHOULD BE SEEN BY A DOCTOR WITHIN 30 MINUTSOF THEIR APPOINTMENTS OR TOLD THE REASON FOR ANY DELAY

QUALITY ASSUARANCE

INPUT

PRODUCTIVE LINE MODEL OF HEALTH SERVICES

PROCESS OUTPUT OUTCOME

ACTIVITYRESOURCE PRODUCTIVITY HEALTH

QUALITY ASSURANCE

DEFINITION IS THE SYSTEMATIC AND CRITICAL ANALYSIS OF THE QUALTY OF CLINICAL CARE INCLUDING THE PROCEDURES USED FOR DIAGNOSIS, TREATMENT AND CARE, THE ASSOCIATED USE OF RESOURCES AND THE RESULTNG OUTCOME AND QUALITY OF LIFE FOR PATIENT

FUNDAMENTAL PRINCIPLES ASSOCIATED WITH CLINICAL AUDIT

CLINICAL AUDIT

IT SHOULD BE• BE PROFESSIONALLY LED• BE SEEN AS EDUCATIONAL PROCESS• FORM A PART OF A ROUTINE CLINICAL PRACTICE• BE BASED ON THE SETTING OF STANDARS• GENERATE RESULTS THAT CAN BE USED TO IMPROVE OUTCOME OF QUALITY CARE• INVOLVE MANAGEMENT IN BOTH THE PROCESS AND OUTCOME OF THE AUDIT• BE CONFIDENTIAL AT THE INDIVIDUAL PATIENT / CLINICAL LEVEL• BE INFORMED BY THE VIEWS OF PATIENTS / CLIENTS

QUALITY ASSURANCE

OBJECTIVE OF CLINICAL AUDITTO IMPROVE PATIENT CARE BY INFORMING THE HEALTH CARE PROFESIONALS’ UNDERSTANDING OF THEIR CLINICAL PRACTICES

BENEFIT OF CLINICAL AUDIT

CLINICAL AUDIT

• PROMOTE A PATIENT-FOCUS APPROACH TO CARE

• ENCOURAGE MULTI-PROFESSIONAL TEAMWORK

• ENABLES OPEN DISCUSSION ABOUT PRACTICE AND LEARNING FROM MISTAKE

QUALITY ASSURANCE

WHO DO THE AUDIT?IT MUST BE LED BY THE CLINICAL STAFF INVOLVED WITH THE ISSUE REVIEWED, IN COLLABORATION WITH MANAGERS, AUDIT STAFF AND PATIENTS

CLINICAL AUDIT

QUALITY ASSURANCE

IDENTFYING AN AREA FOR CLINICAL AUDIT

• REQUIRES CAREFUL THOUGHT IN THE SELECTION OF TOPICS

• THE AREA IDENTIFIED MUST ADDRESS THE IMPORTANT ASPECTS OF CONCERNS ABOUT QUALITY

CLINICAL AUDIT

QUALITY ASSURANCE

1. DEFINING BEST PRACTICES

4 TAKING ACTION TO IMPROVE

2. IMPLEMENTING BEST PRACTICES

3. MONITORING AND COMPARING AGAINST BEST PRACTICE

MAIN STAGES OF CLINICAL AUDIT

QUALITY ASSURANCE

CONCERN ABOUT THE PROVISION OF PRESSURE-RELEIVING

DEVICES FOR THOSE IDENTIFIED AS HIGH RISK PATIENTS

DEVELOPMENT OF PRESSURE SORES

CLINICAL AUDIT OF PRESSURE SORES

(ROYAL BROMPTON HOSPITAL 1991)

HAS INCREASED HOSPITAL STAY•INCREASED DISCOMFORT•THE COST IMPLICATIONS WERE EXTREMELY HIGH – WITH A GRADE 4 PRESURE SORE ESTIMATING COST £25 000 TO TREAT

QUALITY ASSURANCE

• 50% OF THE PATIENTS POPULATION WERE AT RISK OF DEVELOPING PRESSURE SORE

• A NUMBER OF MATTRESSES WERE IN POOR CONDITION

• THERE WAS LACK OF KNOWLEDGE AMONGST WARD NURSES ON AREAS RELATED TO PRESSURE-RELEVING EQUIPMENT

• LACK OF LIFTING AIDS ON THE WARDS – DISCOURAGING NURSES FROM LIFTING AND TURNING PATIENTS

• PAIN WAS LIKELY TO BE A CONTRIBUTING FACTOR AS PATIENTS WERE PREVENTED FROM MOVING IN BED

MAIN FINDINGS

CLINICAL AUDIT OF PRESSURE SORES

• An increased risk of costly litigation –health authorities were being sued anywhere between £100 000 and £1 0000 000 by patients who had developed sores during their hospital stay .

• All of the above reasons including that 95% of pressure sores are preventable, led to a clinical audit group for pressure area care being formed. Representatives of the multi-professional teams comprised of nurses, occupational therapists, physiotherapists and dietician.

• PILOT AUDIT (1992) 8 mths from the raising of the first concerns through to completion of the objectives and criteria.

• - A small convenience sample of 4 patients and 4 nurses were audited from each ward.

QUALITY ASSURANCE

•

Each year, the standard and the point prevalence study have been reviewed, re audited and local and hospital – widw action plan devised to address new issues:

•A matress replacement programme and the writing of a policy to maintain this.•Identifying a nuerse rto coordinate both in-house•Hold regular meetings with the link nurses to encourage information sharing•The initial audit 1992 identified the prevalence of pressure sores as being 19% of the patient population. Dropped dramaticcally over subsequent years, 1997 results are just 3% of the patient population, within the DoH guidelines (1993) stating a commitment to reduce the incidence of pressure sores in NHS by 5%.

OUTCOME MEASURE

QUALITY ASSUARANCE

• LETTERS FROM PATIENTS, COMLPLAINT OR COMMENTS FROM EXTERNAL AGENCIES

• CRITICAL ACCIDENTS REPORTS – WHERE NUMBERS OF STAFF HAVE DESCRIBED AND ANALYSED IMPORTANT CONCERNS FOLLOWING ONE INCIDENT

• SUMMARIES OF TEAM MEEINGS OR GOOD ROUND WHERE ISSUE HAS BEEN DISCUSSED

• INFORMATION FROM ROUTINE DATA SOURCES INCLUDING OF PATIENTS INVOLVED

• PATIENTS STORIES OF FEEDBACK FROM FOCUS GROUP

• DIRECT OBSERVATION OF CARE

AN OVERVIEW OF THE ASPECT OF CARE UNDER REVIEW

QUALITY ASSUARANCE

• LIST SOME TOPICS FOR CLINICAL AUDIT WHICH YOU THINK WOULD BE APPROPRIATE FOR YOUR CLINICAL AREA

• CHOOSE A TOPIC FOR A CLINICAL AUDIT PROTECT IN A SPECIFIC CLINICAL AREA AND DEVELOP YOUR MONITORING TOOL

• BRIEFLY WRITE REPORT ON THE AUDIT PROCESS AND RESULT OF THE AUDIT, AND RECOMMENDATION

GROUP WORK

QUALITY ASSUARANCEGROUP WORK

HAND WASHING NAME OF AUDITEE AUDITOR

COMPLIANCE STATUS

STRUCTURE COMPLIANCE STATUS

REMARKS SIGNATURE PROCEDURE

YES NO

REMARKS

YES NO AUDITOR AUDITEE

1 Roll up sleeves 1 Antiseptic Soap

2 Remove rings / wrist watch bracelet

2 Elbow operated tape

3 Use continuously running water

3 Paper hand towel or Hand dryer

4 Position hand to avoid contaminating arms

4 Tap water

5 Avoid splashing cloth or floor

5 Written procedure

6 Apply ample amount of antiseptic soup

7 Rubs hands vigorously together

8 Use friction on all surfaces 9 Rinse hands thoroughly

with hand held down to rinse

10 Dry hands thoroughly using paper hand towel / hand dry