Quality assurance program began in hospitals in the 1960

 

INTRODUCTION

 

 

 

        Quality assurance program began in hospitals in the 1960, the tem quality assurance is of recent origin which has replaced the term “Medical Audit”.  Quality assurance is achievable through an ongoing evaluation of patient’s care when would assure the hospital that all that was done for the patient was done to justify diagnosis, treatment and outcome and to pinpoint inadequacies in medical care for rectification for Future cases.

 

 

A Review of The Process Content And Outcomes

 

          There are a number of different strategies for assessing the quality of medical care. Quality assessment methods differ, for example, in time frame for review (Prospective concurrent and retrospective), in date – gathering methods  (Record review, abstract, observation, and interview), and in the categories of criteria (Structure, process and outcome).  

          A review of medical records was expected to answer the following quest cone

1.   What did the patient have?

2.    What was done for him?

3.   Was something than was required to be done, not done? If not, why not?

4.   Was the treatment optimum? Is not, why not?

5.   Was the outcome satisfactory? Is not, why not?

 

Analysis of the above questions provides the means for judging whether whatever done for the patient was done to justify diagnosis, treatment & results, and whether it was done in the best interest of the patient.

    

Definition

          Quality assurance is a planned programme which objectively monitors and evaluates the clinical performance of all practitioners, which, identifies opportunities for improvement, and which provides a mechanism through which action is taken to make and sustain those improvements.

 

Purpose of quality assurance

        The purpose of the quality assurance programmed is to:

        i.        Help purpose and potential patients by improving quality of care

      ii.        Assess competence of medical staff, serve as an impetus to keep up to date and prevent future mistakes

     iii.        Bring to notice of hospital administration the deficiencies and in correcting the causative sectors

 

Quality assurance and costs

        It is important to note that physicals will open be most conscious of those instances where resources were too limited to meet patient’s needs. To proved better quality of care, but the cost will be higher.

 

          Quality assurance programmers to be successful will need to meet both sets of needs. Institution which are sensitive to these two sides of the cost quality. It will be able to achieve some of each of the desired goals.

 

Professional review for quality assurance

        Professional review eg :

Ø  Radiographic review

Ø  Tissue review

Ø  Periodic chart review

Ø  Death review

     These review are used to evaluate physicians and hospital performance.

 

Radiographic review

        The aim of the radiographic review is to ascertain whether screening of radiographic films could be avoided of reduced is a complete medical examination, history taking and analysis were carried out.

Tissue review

          It is done for whether surgery in certain cares was really necessary. In certain hospitals they have minimsed the rate of unnecessary appendectomies, tonsillectomies etc.

 

Periodic chart review

          This is another method to evaluate the performance of the medical staff in rendering efficient medical care.

 

Quality assurance committee

          The committee which should meet periodically to carry out the evaluation the committee should consist of the following.

·        Medical administrator

·        Two senior clinicians

·        Pathologist

·        Radiologist

·        Nurse administrator

·        Medical records officer- secretary

Additional personnel such as super specialists and consultants can be co–opted on the committee as and when required.

The major key to productive results is to assign specific functions to the quality assurance committee these functions of the QAC should include.

1.   Co – ordination

·        Collecting information

·        Consider activities that should be related

eg: quality appraisal and continuing education

·         Communicate across patient care disciplines

·        Coordinate actions of hospital authority groups  

2.   Information

·        Provide a centralized source of reports to the board

·        Suggest need for intervention to hospital authority groups

3.   Planning

·        Establish priority

4.   Prodding

·        In best on effective, productive quality appraisal effort form all hospital components   

5.   Consultation

·        Provide specific assistance, usually through the coordinator

 

 

6.   Response

·        Internally, acknowledge uses of importance to individuals and department when suggesting high – priority areas for immediate attention. 

7.   Search for expertise

·        Operate openly, not behind closed doors, seek out the specific clinical management expertise necessary to reach sound conclusions  

8.   Follow – up

To sum up, the work of the committee should be directed toward specific end products.

1)   The selection of the elements of the medical care delivery process that are to be audited

2)   The development of a reliable data collection process

3)   The development of an analytic system

4)   The development of a feed back system

American nurses association model

        The ANA has developed QA model in 1977 which has wide spread applicability in any healthcare setting and can be used as a guide to implement QA programmed.

 

          The basic components of ANA model can be summarized as follows

1.    Identify values

2.    Identify structure, process and outcome standards and criteria.

3.    Select measurement

4.    Make interpretation

5.    Identify course of action

6.    Choose action

7.    Take action

8.    Re-evaluate

 

1. Identify values

          In the ANA model value identification looks as such issues 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.

 

2. Identify structure, process and outcome standards and criteria

          Identification of standards and criteria for quality assurance begins with writing of philosophy and objectives of organization.  Standards of structure are defined by licensing or accrediting agency.  Another standard of structure includes the organizational chart, which shows supervisory methods, communication patterns, staffing patterns and sometimes staff assignments.

          The evaluation of process standards is more specific appraisal of the quality of care being given by agency providers.  The primary approaches for process evaluation include the peer review committee and the client satisfaction survey.  The techniques involved are direct observation, questionnaire, interview, written audit, and video tape of client and provider encounter.

3) Select Measurement

          Select measurable needed to determine degree of attainment of criteria and standards measurements are those tools used to gather information or data, determined by the selections of standards and criteria.

          The approaches and techniques for the evaluation of process standards and criteria are peer review, client satisfaction surveys, direct observations, questionnaires, interviews, written audits and video tapes.

 

 

4)  Make interpretation

          The degree to which the predetermined criteria are met is the basis for interpretation about the strengths and weakness of the programme.  The rate of compliance is compared against the expected level of criteria accomplishment.

 

5) Course of Action

          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 situation.  It is necessary to identify the cause of deficiency.

 

6) Choose Action

          Usually various alternative course of action are available to remedy a deficiency.  In the event that more than one come of the deficiency has been identified action may be needed to deal with each contributing course.

 

7) Take action

          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 course of action.

 

8) Re-evaluate

          The final step of the QA process involves an evaluation of the results of the action.  If the deficiency was remedial, positive reinforcement is offered to those who participated and the decision is made about when to again evaluate that aspect of care.

 

FACTORS AFFECTING QUALITY ASSURANCE IN NURSING CARE

          There are some factors that affect the quality assurance in nursing care.

          They are as follows:-

1.  Lack of resources:

          In sufficient resources infrastructure, equipment, consumables, money fare recurring expenses and staff make if impossible for output of a certain quality to be turned out under the prevailing circumstances.

 

2. Personnel Problems:

          Lack of trained, skilled and motivated employees, skilled and motivated employees, staff indiscipline etc, affects the quality of care.

 

3. Improper Maintenance

          Buildings and equipments require proper maintenance for efficient use.  If not maintained properly the equipments cannot be used in giving nursing care.

 

4. Unreasonable patients and Attendants

          Illness, anxiety, absence of immediate response to treatment, unreasonable and un-co-operative attitude which in turn affects the quality care in nursing.

 

5. Absence of well informed populance

          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 programmes.

 

6. Absence of accreditation laws

          There is no organization enpowered by legislation to lay down standards for 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 (a) Inspect hospitals and ensures that basic requirements are met (b) Enquires into major incidents of negligence (c) Take action against health professionals involved in malpractices.

7) Lack of incident review procedures

          During a patients hospitalization several may occur which have a bearing on the treatment and the patients final recovery.  There critical incidents may be

(a)      Delayed attendance by nurses, surgeon, physicians 

(b)      Incorrect medication

(c)      Burns arising out of faulty procedures.

(d)      Death in a corridor with no nurse / physician accompanying the patient etc

8) Lack of good hospital information system

          A good management information system is essential for the appraisal of quality care.

(a)      Work load, admissions, procedures and length of stay

(b)      Activity audit scheduling of procedures.

 

9) Absence of conducting patient satisfaction

Survey

          Ascertainment of patient satisfaction at fixed points on an ongoing basis such surveys carried out through questionnaires, interview etc by social worker, consultant groups, help document patients satisfaction with respect to variable that are,

(a)    Delay in attendance by nurses, elector etc

(b)    Incidents of incorrect treatment

 

10)    Lack of Nursing care records

          Nursing care records are perhaps the most useful source of information on quality of nursing care rendered.  The records

(a)    Detail the patients condition

(b)    Document all significant interaction between the patients and the nursing personnel

(c)    Contain information regarding response to treatment

(d)    Have the dates in an easily accessible form.

 

11) Miscellaneous factors

(a)    Lack of good supervision

(b)    Absence of knowledge about philosophy of nursing care.

(c)    Lack of policy and administrative manuals.

(d)    Sub standard education and training.

(e)    Lack of evaluation technique

(f)      Lack of written job description and job specifications.

(g)    Lack of in-service and continuing educational programmes.

 

          All these factors affect quality assurance in nursing care, which is to be rendered to patients.

 

 

 

 

 

 

  

  

 

CONCLUSION

 

          Quality assurance defines performance measurements and compares actual process and outcomes to clinical and satisfaction indicators.  Being ever watchful of client satisfaction of services provided is essential in all quality assurance not only encorporates evaluating but also involves its use to secure improvement.