Quality of Nursing Care & Patient Safety PDF

Quality of Nursing care & patient Safety Prof.Dr. Fathia Attia 1 Prof. / Fatia Attia El-bash  ‫مفهوم الجودة في االسالم‬ ‫ صنع هللا الذي أتقن كل شيء‬ ‫ الذي خلق الموت والحياة ليبلوكم أيّكم أح...

Quality of Nursing care & patient Safety Prof.Dr. Fathia Attia 1 Prof. / Fatia Attia El-bash  ‫مفهوم الجودة في االسالم‬ ‫ صنع هللا الذي أتقن كل شيء‬ ‫ الذي خلق الموت والحياة ليبلوكم أيّكم أحسن عملا‬ ‫ إ ّنا ال نضيع أجر من أحسن عمل‬ ‫وعن الرسول صلى هللا عليه وسلم قال‪:‬‬ ‫”إن هللا يحبّ إذا عمل أحدكم عمل أن يتقنه‬ ‫‪‬‬ ‫‪2‬‬ ‫‪Prof. / Fatia Attia El-bash‬‬ An introduction Quality of health care depends on human and financial resources, professional standards, institutional standards, available structural attributes, such as equipment, technology. Patient safety has become a key criterion for analyzing health system performance High quality care begins with ensuring safe care 3 Prof. / Fatia Attia El-bash  Quality Carrying out interventions correctly according to pre- established standards, with maximizing results without generating health risks or unnecessary costs (minimize cost & errors). Quality: means Doing the right things (what \ procedure ) To the right people (to whom Pt. \ customer ) At the right time (when \ time) Doing the right thinks for the right client at the right time in the right way to achieve the best possible results. 4 Prof. / Fatia Attia El-bash   A customer is one who receives goods or services.  Customers : they rely us a service or product.  "External customers" include the patient, family, and others outside the organization receiving health services.  "Internal customers" are those performing work, but dependent on others performing work, within the organization.  Employee may be an internal customer or a supplier. 5 Prof. / Fatia Attia El-bash  Quality goals are to : Reduce harm to patients Improve clinical effectiveness of the health services delivered Involve and empower patients, families and communities in descion Build systemic capacity for ongoing quality improvement activities Strengthen governance and accountability. 6 Prof. / Fatia Attia El-bash Quality health services should be:  Effective : degree to which the care/intervention is provided in the correct manner, based on the current state of knowledge and evidence-based guidelines  Safe: degree to which the risk of an intervention are reduced for the patient and others in institution (minimizes harm)  Patient-centered: Providing care that is respectful of and responsive to individual patients’ favorites, needs, and values. 7 Prof. / Fatia Attia El-bash  Timely:  Degree to which the needed test, procedure, treatment, or service is provided to the patient, as short as necessary time  Carrying out the procedure in a timely manner (keep delays in providing and receiving services to a minimum level)  Equitable : care would not vary according to personal characteristics such as gender, race, ethnicity, geographical location and socioeconomic status 8 Prof. / Fatia Attia El-bash Integrated : care receives across facilities and providers would be coordinated Appropriateness :  availability of a needed test, procedure, treatment, or service to the patient needs  the relationship between intervention and individual's medical needs according to the current state of knowledge 9 Prof. / Fatia Attia El-bash Technical competence : ability of the practitioner to provide health care to patients in the correct manner (continuous learning and training) Respectful : when Pt. finds the service providers treat him with respect, and the degree of involvement of in his care decisions Prevention : early detection of mistakes that may occur before they reach the patient, Prevention is better than care 10 Prof. / Fatia Attia El-bash Efficient : is the ratio of health care outputs to the costs related to providing this care and it means the optimal use of resources (human – financial) to provide the best health care (avoids waste of resources, including equipment, medicines, energy and ideas)  Quality of care plays an important role in describing relationships between quality, cost, and accessibility of health care within a community throughout iron triangle of health care. 11 Prof. / Fatia Attia El-bash  the health care iron triangle 12 Prof. / Fatia Attia El-bash  Six Crucial Domains Of Healthcare Quality 13 Prof. / Fatia Attia El-bash 14 Prof. / Fatia Attia El-bash  Quality For patients - A competent health care provider at their bedside - An environment that encourages, practical & analytical behaviors directed toward prioritizing patient care. Aspect quality in health care 1. Caring for the whole person What does this involve?  Taking a holistic, person-centered approach to care rather than a task-Focused approach  Seeing the person, not the need  Considering the person’s other health conditions, social issues and wider circumstances, not just a particular condition 15 Prof. / Fatia Attia El-bash  2.Continuity of care. What does this involve? The same nurse, or the same few nurses (who communicate information effectively) seeing each individual receiving care 3.Patient education and support for self- management What does this involve? Supporting and educating patients to self-manage their health and care needs Involving people in decisions about their own care 16 Prof. / Fatia Attia El-bash  Health system, patients and clinicians should work together to:  Ensure a high-quality health staff.  Ensure excellence across all health care facilities.  Ensure safe and effective use of medicines, devices and other technologies.  Ensure effective use of health information systems.  Develop financing mechanisms that support continuous quality improvement 17 Prof. / Fatia Attia El-bash 18 Prof. / Fatia Attia El-bash  The aims of measuring quality are to \ the measurement process helps: 1. Find out the gap between the expected and current level of performance: helps in identifying how quality will be improved. 2. Realize the presence and the degree of the problem. 3. Identify the differences between a specific and a general reason: Performance in general, ranges between the best and the worst level. 4. be aware of the success or failure of the experimental intervention 5. Monitor progress. 6. Learning by patient & employee satisfaction 7. Monitor the productivity of the teamwork 8. Ensure the continuity of the performance improvement. 19 Prof. / Fatia Attia El-bash  The Beginning of evaluating the quality of nursing practice when Florence Nightingale began to measure patient outcomes. Reflection for today: used statistical methods to generate reports correlating patient outcomes to environmental conditions How to evaluate the quality of care?  Right and Appropriate Quality Indicators Appropriate & Relevant E.g.: Initiation of Breast feeding Simple to Complex – E.g.. Pressure Injury (PI) to Healing pattern Common / Routine to uncommon / Rare What are Quality Indicators? “A qualitative & quantitative measures used in determining the quality of care” “If you can’t measure it you can’t manage it” 20 Prof. / Fatia Attia El-bash  Do you need a Quality Indicator? Burden of illness Is this an important problem? Opportunity for improvement What is the current quality of care? Better care & better health Improving quality of care improves patient health Gaps in existing quality indicators what are the existing quality indicators? What is the supporting evidence base? What indicators are currently used in practice? 21 Prof. / Fatia Attia El-bash  Current Nursing-Sensitive Quality Indicators Pain Assessment, Intervention, Nursing Turnover Nosocomial Infections Nursing Hours per Patient Day Patient Falls With Injury Pressure Ulcer Rate Peripheral Intravenous Infiltration 22 Prof. / Fatia Attia El-bash 23 Prof. / Fatia Attia El-bash  Elements of indicators 1. Indicator statement \ Title 2. Definition of terms 3. Quality aspects used for evaluation 4. Type of indicator) input-process and procedure-output) 5. Availability of all information 6. Source of information 24 Prof. / Fatia Attia El-bash 25 Prof. / Fatia Attia El-bash Quality Indicator Development Develop a measurement framework Determine if quality indicators are needed Establish quality indicator criteria Select a development approach Evaluate the indicators developed Develop a maintenance plan Develop an implementation plan Quality Indicator Criteria Important –audiences will find the information useful for a purpose Scientifically sound –measure will produce consistent & reliable results Feasible–can be implemented Usable–target audience can understand the results & use for 26 decision making Prof. / Fatia Attia El-bash  Example in Medication Error indicators Incidence of Medication Error Incidence of prescription error Incidence of transcription error List Other Example Incidence of dispensing error Incidence of administration error Percentage of admissions with ADR Percentage of medication charts with error prone abbreviations Compliance rate to Medication Prescription in capitals Percentage of patients receiving high risk medications developing adverse drug event. Percentage of contrast allergic reaction No specified size and limit for the number of QI that can be monitored. 27 Prof. / Fatia Attia El-bash  Types of Indicators 28 Prof. / Fatia Attia El-bash  Nursing Sensitive Indicators- Structure Process & Outcome Model Structural Indicators \ input: Includes the supply of nursing staff, the skill level of nursing staff, equipment, education and certification levels of nursing staff. Process Indicators: Measure methods of patient assessment and nursing interventions and competency assessment. Nurse's job satisfaction is also considered a process indicator. Outcome Indicators: Reflect patient outcomes that are determined to be nursing sensitive because they depend on the quantity or quality of nursing care outcome. These include pressure ulcers and falls. 29 Prof. / Fatia Attia El-bash  Structure Processes Outcomes of Care Input Steps Outcome Patients Inventory Physiologic Equipment Methods parameters Supplies Coordination Functional status Training Physician orders Satisfaction Environment Nursing Care Cost Additional staff Housekeeping Transport 30 Prof. / Fatia Attia El-bash Structure Process Outcome Model 31 Prof. / Fatia Attia El-bash Prevention Quality Indicators (PQI): Identify issues of access to outpatient care, including appropriate follow-up care after hospital discharge. Inpatient Quality Indicators (IQI): Provide a perspective on quality of care inside hospitals, including inpatient mortality and utilization of procedures where there are questions of overuse, underuse, and misuse. Patient Safety Indicators (PSI): Provide information on potentially avoidable safety events that represent opportunities for improvement in the delivery of care. Pediatric Quality Indicators (PDI): Focus on potentially preventable complications events for pediatric patients treated in hospitals and taking into account the special characteristics of the pediatric population. 32 Prof. / Fatia Attia El-bash  Factors Related to health care Quality  Competent nurses  Independent and self-sufficient practice  Management support (team building, and other activities)  Patient-centered culture (patients over income)  Collaborative working environment (particularly between nurses and doctors)  Availability of continuing education and training options ( engagement of team & newer approaches ) Nurses directly affect the quality of hospital care - All efforts to train and maintain their value should be addressed. 33 Prof. / Fatia Attia El-bash The difficulties encountered by Nurses while implementing Quality Lack of time Inadequate number of professionals Lack of knowledge Lack of understanding of how to use instruments \ training 34 Prof. / Fatia Attia El-bash Relationship between Quality of care and Staff Empowerment 35 Prof. / Fatia Attia El-bash