Quality Assurance - Nursing Management QA programmes in long-term care do provide a mechanism for continuously evaluating & improving nursing practice skills that ultimately make a clinical difference at the bedside. So, the professionals must assume responsibility for their professional actions and be answerable to the recipients for their care. Quality assurance program is thus the need of the hour.

1. QUALITY
ASSURANCE

2. DEFINITION
• “Quality assurance is a judgement concerning
the process of care, based on extent to which
that cares contributes to valued outcomes.”
─DONABEDIAN 1982
• WHO (1992) defined Quality Assurance, as
making sure that the services provided by the
hospital are best possible in a given existing
resources and current medical knowledge

3. NEED FOR QA

4. • Ensures quality of nursing care in order to meet
the expectations of receiver, management and
regulatory body.
• Increases commitment of provider and
management
• Improves and maintain patient’s state of health.
• Improves and maintain patients’ functional
abilities
• Develops patient psychological condition or
wellbeing.
• Refines existing methods of ensuring optimal
quality healthcare.

5. PRINCIPLES OF QA

6. There are five basic principles of quality
assurance:
• Oriented towards meeting the needs and
expectations of our clients.
• Focuses on system and processes.
• Uses data to analyze service delivery.
• Encourages the use of teams in problem
solving and quality improvement.
• Uses effective communication to improve
service delivery

7. PROCESS OF QA

8. Quality assurance process is the systematic
process of evaluating the quality of care given
in a particular unit or institution. It includes:

9. 1. Setting standards: the nursing profession should
have design standards of nursing practice that
are specific to the patient population served.
2. Determining criteria: after standards of
performance are established, criteria must be
determined that will indicate if the standards
are being met and to what degree they are met.
3. Data collection: sufficient observations and
random samples are necessary for producing
reliable and valid information. The methods of
data collection are:
– Patient observation and interviews
– Nurse observation and interviews
– Review of chart.

10. 4. Evaluating performance: The methods for
evaluation are:
– Reviewing documented records
– Observing activities as they take place
– Examining patients
– Interviewing patients, families and staff.
5. Making plans for change based on evaluation:
it includes taking the actions for improving
quality care by changing the present scenario
and incorporates new policies for the same.

11. MODELS OF QA

12. Quality assurance model in nursing is the set of
elements personal beliefs and values.
Models of Quality Assurance:
• System model for quality assurance
• ANA quality assurance model
• The Donabedian Structure-Process-Outcome
Model

13. System model for Quality Assurance

14. The basic components of system are:
• INPUT: can be compared to present state of
system
• THROUGHPUT: To throughput to
developmental process
• OUTPUT: To the finished product.
• FEEDBACK: It is the essential component of
the system because it maintains and nourish
has growth.

15. ANA Quality Assurance model

16. The basic components of the ANA model
can be summarized as follows:
• Identify values
• Identify structure, process, outcome standards
and criteria
• Structure standards: Philosophy and objective
of organization serves to define structure
standards. Standards of structure are defined
by licensing and accrediting agency.
– Process standards: its evaluation is specific to
quality of care given by agency care providers.
– Outcome standards: it reveals the end results of
nursing care.

17. • Select measurement needed to determine
degree of attainment of criteria and standards
• Make interpretations
• Identify course of action
• Choose action
• Take action
• Re-evaluate

18. Donabedian Structure-Process-
Outcome Model

19. It is a conceptual model that provides a framework for
examining health services and evaluating quality of health
care. According to the model, information about quality
of care can be drawn from three categories:
• Structure: It describes the context in which care is
delivered, including hospital buildings, staff, financing
and equipment.
• Process: denotes the transactions between patients
and providers throughout the delivery of healthcare.
The measurement of process is nearly equivalent to
the measurement of quality of care because process
contains all acts of healthcare.
• Outcomes: refers to the effects of healthcare on the
health status of patients and populations.

20. SELECTING A NSG QA MODEL
• Select or develop structure that fits with the
organizational structure and the style
management practiced in the organization.
• Decide on format that makes the best use of
resources and manpower available.
• Keep the format simple and streamlined
• Use a consistent model throughout the
division of nursing.

21. CONT’D…
• In a skilled nursing facility, use a consistency
model throughout the facility.
• It is a tool for assuring and improving quality of
care.
• Used to monitor and evaluate the quality and
appropriateness of care.
• It is a ongoing process to examine care, to find
potential problems and opportunities for
improvement and to do something about them.

22. FACTORS AFFECTING QA IN NURSING
CARE
• Lack of resources
• Personnel problems
• Improper maintenance
• Unreasonable patients and attendants
• Absence of well-informed population
• Absence of accreditation laws
• Lack of good hospital information system

23. CONT’D…
• Absence of patient satisfaction surveys
• Lack of nursing care records
• Lack of good supervision
• Absence of knowledge about philosophy of nursing
care
• Lack of policy and administrative manuals
• Substandard education and training
• Lack of evaluation technique
• Lack of written job description and job specifications.
• Lack of in-service and continuing educational
programs.

24. FUNCTIONS OF NURSE IN QA
• Encourage team member to be actively involved in quality
process.
• Implement quality control and improvement
• Communicates standards of care too team members
• Assess appropriate source of information
• Evaluate quality and activity
• Assist in the planning and organization of quality assurance
program
• Assist in developing annual auditing scheduled
• Attend and participate in workshop and seminar
• Develop and implement plan and action to correct
deficiencies.

25. SUMMARY
• Definition Quality Assurance
• Need for Quality Assurance
• Principles of Quality Assurance
• Process of Quality Assurance
• Models of quality Assurance
• Steps of selecting a nursing quality assurance
model
• Factors affecting quality Assurance
• Functions of nurse in quality assurance

26. CONCLUSION
• Quality assurance refers to activities that
evaluate, monitor or regulate services
rendered to consumers in nursing, the goal of
quality care would be ensure quality while
meeting intended goals.
• The components of quality healthcare are:
high level of professionalism, efficient use of
resources, the lowest possible risk for patient,
patient satisfaction and positive influence on
his state of health.

27. BIBLIOGRAPHY
• Deepak .k, Sarath chandran.c, Mithun Kumar ;
comprehensive textbook of nursing management;
Emmess publications; 2nd edition 2019; Page no ;
quality assurance : 285-332
• Vati Jogindra, Principles and practice of nursing
management and administration, first edition,
Jaypee brothers’ publications, 2013, . Page no. 93-
125, 145-150
• Yoder wise. Leading and Managing in Nursing.
Elsevier publications. Page no. 144- 160