1. QUALITY: DEGREE OF EXCELLANCE
QUALITY ASSURANCE
QUALITY: DEGREE OF EXCELLANCE
ASSURANCE: MAKE SAFE

2. STANDARD SETTING NURSING / CLINICAL AUDIT
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

3. PRIORITISING CLINICAL AUDIT TOPICS
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

4. 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

5. 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

6. CONCERN FOR EXCELLENCE AND STANDARD
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

7. QUALITY ASSURANCE SOCIAL VALUE PROFESSIONAL VALUE QUALITY
INDIVIDUAL VALUE
INSTITUTIONAL VALUE

8. QUALITY IN HEALTH SERVICES / IN INDIVIDUALS
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

9. THE QUALITY CARE CAN BE STUDIED FROM THESE ASPECTS
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?
PERCIEVED BY PATIENTS / CLIENTS
b) PERCIEVED BY PROFESSIONALS
CARE INCLUDES
CLINICAL (TREATMENT OF PATIENTS) CARE
NON CLINICAL ( MEETING THE PATIENT PERSONAL, SOCIAL, EMOTIONAL, SOCIAL NEEDS)

10. NON CLINICAL ( MEETING THE PATIENT) CARE
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

12. CRITERIA FOR STANDARDS
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

13. PRODUCTIVE LINE MODEL OF HEALTH SERVICES
QUALITY ASSUARANCE
PRODUCTIVE LINE MODEL OF HEALTH SERVICES
INPUT
PROCESS
OUTPUT
OUTCOME
RESOURCE
ACTIVITY
PRODUCTIVITY
HEALTH

14. 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

15. OBJECTIVE OF CLINICAL AUDIT
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

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

17. IDENTFYING AN AREA FOR CLINICAL AUDIT
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

18. 1. DEFINING BEST PRACTICES
QUALITY ASSURANCE
MAIN STAGES OF CLINICAL AUDIT
1. DEFINING BEST PRACTICES
2. IMPLEMENTING BEST PRACTICES
3. MONITORING AND COMPARING AGAINST BEST PRACTICE
4 TAKING ACTION TO IMPROVE

19. 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 £ TO TREAT

20. CLINICAL AUDIT OF PRESSURE SORES
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

21. An increased risk of costly litigation –health authorities were being sued anywhere between £ and £ 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.

22. 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%.

23. AN OVERVIEW OF THE ASPECT OF CARE UNDER REVIEW
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

24. 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

25. QUALITY ASSUARANCE
GROUP WORK