QUALITY ASSURANCE

QUALITY: DEGREE OF EXCELLANCE

ASSURANCE: MAKE SAFE

QUALITY ASSURANCE
STANDARD SETTING
NURSING / 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 patients 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
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 ASSURANCE

QUALITY ASSUARANCE
THE ESSENCE OF HEALTH CARE
QUALITY ASSURANCE
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

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
PROFESSIONAL
VALUE

SOCIAL VALUE

QUALITY

INDIVIDUAL
VALUE

INSTITUTIONAL
VALUE

QUALITY ASSURANCE
QUALITY IN HEALTH SERVICES / IN
INDIVIDUALS
APPROPRIATENESS

THE SERVICE OF PROCEDURE IS WHAT THE

POPULATION OR THE INDIVIDUAL ACTUALY
NEEDS

EQUITY

A FAIR SHARE FOR ALL THE POPULATION

EFFECTIVENESS

ACHIEVING THE INTENDED BENEFIT FOR THE

INDIVIDUAL AND FOR THE POPULATION

ACCEPTABILITY

SERVICES ARE PROVIDED SUCH AS TO

SATISFY THE REAONABLE EXPECTATIONS OF
PATIENTS, PROVIDERS AND THE COMMUNITY

EFFICIENCY

RESOURCES ARE NOT WASTED ON ONE

SERVICE OR PATIENT TO DETRIMENT OF
ANOTHER

QUALITY ASSURANCE
THE QUALITY CARE CAN BE STUDIED FROM
THESE ASPECTS
STRUCTURE

WHERE IS CARE CARRIED OUT

WHAT EQUIPMENT IS USED

PROCESS

WHO CARRIES OUT THE CARE

HOW IS IT CARRIED OUT

OUTCOME

WHAT IS THE END RESULTS?

a)
PERCIEVED BY PATIENTS / CLIENTS
b)
PERCIEVED BY PROFESSIONALS

CARE INCLUDES
A.
B.

CLINICAL (TREATMENT OF PATIENTS) CARE

NON CLINICAL ( MEETING THE PATIENT PERSONAL,
SOCIAL, EMOTIONAL, SOCIAL NEEDS)

QUALITY ASSURANCE
NON CLINICAL ( MEETING THE PATIENT) CARE

COURTESY

SURROUDINGS THAT SUGGEST COMPETENT HELPS IS AT HAND

READY ACCES TO THE SUPPORT OF FAMILY AND FRIENDS

BEING TOLD WHAT WILL HAPPENED AND WHEN

LACK OF DELAYS

QUALITY ASSURANCE
A STANDARD IS A MEANS OF MEASURE
CRITERIA FOR STANDARDS

RELEVANT
UNDERSTANDABLE
MEASUREBLE
BEHAVIORAL
ACCEPTABLE

EXAMPLE OF A STANDARD
ALL OUT PATIENTS SHOULD BE SEEN BY A DOCTOR WITHIN 30 MINUTS
OF THEIR APPOINTMENTS OR TOLD THE REASON FOR ANY DELAY

QUALITY ASSUARANCE
PRODUCTIVE LINE MODEL OF HEALTH SERVICES

INPUT

PROCESS

OUTPUT

OUTCOME

RESOURCE

ACTIVITY

PRODUCTIVITY

HEALTH

QUALITY ASSURANCE
CLINICAL AUDIT
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

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
CLINICAL AUDIT
OBJECTIVE OF CLINICAL AUDIT

TO IMPROVE PATIENT CARE BY INFORMING THE HEALTH CARE

PROFESIONALS UNDERSTANDING OF THEIR CLINICAL PRACTICES

BENEFIT OF CLINICAL AUDIT

PROMOTE A PATIENT-FOCUS APPROACH TO CARE
ENCOURAGE MULTI-PROFESSIONAL TEAMWORK
ENABLES OPEN DISCUSSION ABOUT PRACTICE AND LEARNING FROM MISTAKE

QUALITY ASSURANCE
CLINICAL AUDIT

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

QUALITY ASSURANCE
CLINICAL AUDIT
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

QUALITY ASSURANCE
MAIN STAGES OF CLINICAL AUDIT

1. DEFINING
BEST PRACTICES

4 TAKING ACTION
TO IMPROVE

2. IMPLEMENTING
BEST PRACTICES

3. MONITORING AND
COMPARING AGAINST
BEST PRACTICE

QUALITY ASSURANCE
CLINICAL AUDIT OF PRESSURE SORES
(ROYAL BROMPTON HOSPITAL 1991)
CONCERN ABOUT THE PROVISION OF PRESSURE-RELEIVING
DEVICES FOR THOSE IDENTIFIED AS HIGH RISK PATIENTS

DEVELOPMENT OF PRESSURE SORES

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
CLINICAL AUDIT OF PRESSURE SORES
MAIN FINDINGS

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

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
OUTCOME MEASURE
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%.

QUALITY ASSUARANCE
AN OVERVIEW OF THE ASPECT OF
CARE UNDER REVIEW
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

QUALITY ASSUARANCE
GROUP WORK
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

QUALITY ASSUARANCE
GROUP WORK