Transcript Quality care

Chapter 22
Quality Patient Care
Copyright © 2006 Elsevier, Inc. All rights reserved
Quality Patient Care
 Standards of quality health care
management
 Standards of nursing care (ANA)
 Accrediting group standards (JCAHO)
 Clinical practice treatment guidelines
(AHRQ)
 Standards of practice (each health care
agency)
Copyright © 2006 Elsevier, Inc. All rights reserved
Quality Patient Care
 JCAHO
 Publishes a Sentinel event alert monthly
 An unexpected occurrence involving death
or loss of limb or function
 Sounds a warning of the need for
immediate investigation and response
Copyright © 2006 Elsevier, Inc. All rights reserved
History and Evolution
of Quality in Health Care
(cont’d)
 Who is Deming?
 Edward Deming—father of quality
improvement
 Method to prevent defects evolved to a
method
to track and improve quality
 Quality is everyone’s responsibility
Copyright © 2006 Elsevier, Inc. All rights reserved
History and Evolution
of Quality in Health Care
(cont’d)
 Joint Commission on Accreditation of
Healthcare Organizations (JCAHO)
 Primary agency for hospital accreditation
 Must meet certain quality standards to
pass inspection
 Mandated continuous quality
improvement
 JCAHO mandates specific quality
outcome measures for all hospitals
Copyright © 2006 Elsevier, Inc. All rights reserved
Just What Is the JCAHO?
 Accrediting body for health care
institutions that are Medicare and
Medicaid funded
 Address patient safety issues
 Require error reduction and design of
safe patient care processes
Copyright © 2006 Elsevier, Inc. All rights reserved
Just What Is the JCAHO?
 What are patient safety goals?
 Improve accuracy of patient identification
 Improve the effectiveness of communication
among caregivers
 Improve the safety of using medications
 Improve the safety of using infusion pumps
 Reduce the risk of health care–associated
infections
 Accurately and completely reconcile
medications across the continuum of care
 Reduce the risk of patient harm resulting
from falls
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Monitoring Quality of Health Care
 What is quality assurance?
 Used synonymously with quality
improvement
 Process or activities used to monitor,
evaluate, and control services providing
some measure of quality to consumers
 Key Indicators
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Monitoring Quality
of Health Care (cont’d)
 What are key indicators?
 JCAHO mandates certain key indicators
to monitor
 Advance directives, autopsy rates, AMAs
and elopement rates, blood product
utilization rates, blood transfusion reaction
rates, code blue rates, conscious sedation
complication rates, fall rates, medication
error rates, mortality rates, pain
management effectiveness, restraint use,
and surgical site infection rates
Copyright © 2006 Elsevier, Inc. All rights reserved
Quality Improvement Methods
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Institutional values
Commitment to CQI
Empowerment of nurses
Collect data systematically
Working groups with sense of
collaboration
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