Transcript Mod 5 Powerpoint - Austin Community College

Supporting Quality Care
Chapter 4
Standards for Evaluating Health
Care
 Types of standards
– Structural
standards
– Process standards
– Outcome standards
Structural Standards
establish guidelines for the facility’s
patterns and supports for providing
client care
 i.e. The nurse patient ratio in ICU is 1:2
 All home health nurses will have at
least 1 year of acute care experience
 Can you think of an example of a
structural standard???

Process Standards

deal with the methods or the process used in
providing client care or services
 i.e. The initial nursing care plan will be
established within 24 hours of admission.
 The patient meal trays will be passed out
within 30 minutes of arrival to the unit
 Can you think of an example of a process
standard???
Outcome standards
used to evaluate patient outcomes or
the desired result of care
 i.e. Post op hip replacement patients
will be ambulatory by Day 2.
 The incidence of nosocomial infections
will be less than 10%.
 Can you think of an example of an
outcome standard???

Question
Each nursing unit will have a fire
extinguisher on each side of the
hallway. This is an example of a:

a) structural standard

b) process standard

c) outcome standard

Answer
Structural.
 Rationale
– Structural standards include the physical
plant and equipment.
Sources of Standards for Care
 Nursing specific standards
 Regulatory agency standards
 Accrediting agency standards
 Clinical practice guidelines as standards
 Health facility established standards

Question
Is the following statement true or
false?
A type of standard to which a nurse
is held accountable is called a
process standard.
Answer
True.
Rationale: process standards describe
methods of providing services. Process
standards are also referred to as performance
standards. Protocols and procedures are
examples of process standards.
Benchmarking

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Benchmark – a specific quantitative
standard (expressed as a number or
percent) to which you compare to your
own facility to a similar facility or
standards established by JCAHO or
another entity.
i.e. 3 falls per 100 patient care days
8% nosocomial infection rate
75 medication errors per year
5% surgical site infection rate
Cost Standards
Outcomes related to cost
 Cost-effectiveness
 Cost- benefit ratio
 Doesn’t take into consideration quality of
life or satisfaction

Collecting Data for EvaluationKey Indicators

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Selected data that reveal the need for
more extensive data collection
i.e. Number of Falls per year evaluates
Safety
Number of Nosocomial Infections
per year evaluates Infection Control
Number of Medication Errors per
year evaluates Safety
Length of stay for Hip Replacement
evaluates Cost
Collecting Data for Evaluation- cont.

Quality assurance reports- “Incident
report”

Audit– Retrospective-i.e. Going back to
medical records for chart review to
see if all medications were signed
off.
– , concurrent- i.e. Looking at a chart
which is currently in use to see if I.V.
restarts were charted
Collecting Data for Evaluationcont
Direct Observation
 i.e. Going in patient rooms to see if I.V.
tubing is labeled
 Interview
 i.e. Interviewing a patient to see if pain
is less than 5 on a scale of 1-10

Question

What is the term used for a systematic
data collection process that commonly
focuses on documentation?
A. Cost-analysis report
B. Benchmarking
C. Audit
D. Survey
Answer
C. Audit
Rationale: an audit is a
systematic data collection
process that commonly focuses
on documentation.
Analyzing Data and Developing Action
Plans
 Types of reports
– Simple descriptive reports
– Percentage and numerical
reports
– Sophisticated statistics
 Analysis of data
– Identify discrepancies
– Opportunities for improvement
Analyzing Data and
Developing Action Plans (cont'd)
 Action plans
– Detailed approaches to change
– Specific
– Identify responsible person
– Set time frame
Using Goals and Objectives in the
Evaluation Process
 Goals
 Objectives
– Broad statements of
– Specific
overall intent of an
organization,
department, unit, or
individual
– Usually stated in
general terms
accomplishments
that help achieve a
goal
– Usually have a
related time
deadline
Strengths of Using Goals and
Objectives

Everyone knows what is expected

Facilitates change in individual
behavior

Evaluation is clear
Limitations of Using Goals and
Objectives

Cannot be done in isolation

Related to standards of care

Impossible to address all the areas of
function

Conflict over goals can occur
Quality Assurance and Improvement
 Quality assurance
– Refers to activities that are used to
monitor, evaluate, and control services
provided to consumers
– Goal is to identify areas where standards
are not met and improve them
Quality Assurance and Improvement
(cont'd)

Sentinel events
– Defined by the Joint Commission (2007c) as
“unexpected occurrences involving death or
serious physical or psychological injury, or
risk thereof.”
Quality Assurance and Improvement
(cont'd)
 Both errors and near misses
– Death from medication error
– Suicide of a patient receiving 24/7 care
– Surgery on wrong patient or body part
– Hemolytic transfusion reaction
– Near miss
Quality Assurance and Improvement
(cont'd)
 Root cause analysis
– Comprehensive, often complex, process that seeks to
–
–
–
–
identify all the contributory factors to an error and
identify their share of causation
What happened
Why it happened
How do you keep it from happening again
Tool for prevention strategies
Quality Assurance and Improvement
(cont'd)

Acting to prevent error
– Addressing system
problems
– Patient safety goals
Question
 Is the following statement true or
false?
A medication error that results in
the death of the patient is a sentinel
event.
Answer
True.
Rationale: sentinel events include
both errors and what are commonly
referred to as near misses. An
example of a sentinel event is a
death resulting from a medication
error or other treatment-related
error.
Quality Improvement Movement

Incorporates all aspects of quality
assurance

Aimed at improving quality of health
care

JCAHO: “Quality assessment and
improvement”
Continuous Quality Improvement
 A process in which ongoing analysis and
improvement lay the foundation for change
 Includes:
– Collecting data
– Analyzing data
– Forming a task force
– Planning change
– Implementing change
– Collecting data again
Key Aspects of Quality
Improvement
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Culture of
empowerment
Blame-free
environment
Effective data
collection
systems
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Use of teams
for problem
solving
Focus on the
customer
Eliminating
waste
Barriers to Quality Improvement

Costs
– Staff time
– Computer programming
– Documentation

Improvement may not defray
costs
Risk Management

Minimizing the risk to the institution or agency
from an error or problem that could result in
legal action or liability

Think ahead about defense when a legal action is
contemplated or actually occurs

Attempts to be proactive in identifying and
eliminating areas of risk for the institution

Response of those in the health care system when
an adverse event occurs
Question

What is one purpose of risk management?
A. Change in time when vital signs are done
at night
B. Improvement of quality of meals served
to patients
C. Defense when legal action occurs
D. Planning of community emergency drills
Answer
C. Defense when legal action occurs
Rationale: another focus of risk
management is to think ahead about
defense when a legal action is
contemplated or actually occurs.
Evaluating Nursing Care You Manage

Identify specific standards of care that
you will strive to meet and determine
ways of improving care

Goals and objectives may be established
informally with a team even when the
setting does not have a formal process in
place

A philosophy of continuous