QUALITY ASSURANCE QUALITY DEGREE OF EXCELLANCE ASSURANCE MAKE

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 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 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 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 • A COURTESY 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 A STANDARD IS A MEANS OF MEASURE CRITERIA FOR STANDARDS ü ü ü 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 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 Do. H 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 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