Quality assurance in community health nursing

2. QUALITY-
It is defined as the extent of resemblance between the purpose of
the health care and truly granted care.
QUALITY ASSURANCE-
Quality assurance is a system for evaluating performance
through well written nursing standards and use of those
standards as a basis for evaluation on improvement of client
care.
-Marker 1998

3. OBJECTIVES OF QUALITY ASSURANCE
 To ensure the delivery of the quality client care.
 To demonstrate the efforts of the health care providers
to provide the best possible results
 To provide the technical assistance in correcting the
systematic deficiencies.
 To refine adjusting method for ensuring optional
quality of health care
 To provide the best possible clinical outcome of care.

4. PRINCIPLES FOR CONDUCTING QUALITY
ASSURANCE IN COMMUNITY HEALTH NURSING
 EXPECT EXCELLANCE
 APPLY THE CONTINUE QUALITY IMPROVEMENT
CONCEPTS
 RESPECT THE ENVIRONMENT
 FOCUS ON ESTABLISHED STANDARDS
 BUILD THE PARTNERSHIP

5. According to Donabedian-
 STRUCTURE ELEMENT- The physical, financial and
organizational resources provided for health care
 PROCESS ELEMENT- Means how the work is going on.
 OUTCOME ELEMENT- these are the changes in the health
status of the patient.
METHODS OF QUALITY ASSURANCE-
 Concurrent
 Retrospective

6. APPROACHES FOR QUALITY ASSURANCE PROGRAM
A.GENERAL APPROACHES-
It involves the large governing of official body’s evaluation of
person’s or agency’s ability to meet standard at a given time.
1. Credentialing
2. Licensure
3. Accreditation
4. Certification
CREDENTIALING-
It is the process of determining and maintaining nursing
standards, a way in which professional competence is
maintained.

7. Functional components of the credentialing-
 To produce a quality product
 To confer a unique identity
 To protect provider and public
 To control the profession
LICENSURE-
Individual licensure is a contract between profession and state in
which profession is granted control over entry into and exists
from profession and over quality of professional practice.
ACCREDITATION-
Accreditation is the act of granting credit or recognition
especially to an educational institution that maintain suitable
standards.

8. CERTIFICATION-
It validates the speciality knowledge, experience and clinical
judgment. It is used to determine person’s qualification for
functioning in an identified area.
B. SPECIFIC APPROACH-
These methods used to evaluate identified instances of provider
and client interaction.
• Peer review
• Standards
• Audit
• Utilization review
• Evaluation studies
• Client satisfaction
• Incident review

9. PROCESS OF THE QUALITY ASSURANCE
Quality assurance process incorporate the following steps-
ACT SET
STANDARD
PLAN
APPRAISE

10. 1) SETTING STANDARD- Involve writing statements that
describes achievable and desirable levels of quality care.
2) APPRAISING ACTUAL ACHIVEMENT- Appraising
actual achievement involves comparing practice with define
standards through measurement criteria.
3) PLANNING FOR IMPROVEMENT- Is necessary when
after appraisal many gap between provision and expectation
is identified.
4) TAKING ACTION WHEN REQUIRED- If quality of a
care is below the stated accepted levels, the action is taken to
raise quality until standards.

11. CONSTRAINTS IN RENDERING QUALITY CARE
 Inadequate resources
 Poor maintenance
 Inadequate medical supplies
 Delays
 Poor work culture
 Attitude of patients and public

12. Nursing audit is an evaluation of patient care through analysis
of written records maintained by nurses in patients treatment
profile.
The concept of nursing audit is based on debit and credit system.
Debit system is negative in nature it emphasis on illness like
LAMA, hospital born disease where as credit system is
positive in nature and it emphasis on health like number of
patient recovered.
Goals of nursing audit-
 To improve quality of health care.
 To improve communication
 To detect and analyze the problems and error.

13. METHODS OF NURSING AUDIT
There are two methods-
1.RETROSPECTICE VIEW-
This refers to an in depth assessment of quality after the patient
has been discharged and the patient chart is the source of data.
2. COCURRENT VIEW-
This refers to the evaluation conducted on behalf of the patient
who are still underlying the care.
AUDIT CYCLE-
Implement
change
Set
standard
Observe
practice
Compare
with
standard