Fundamentals of Quality & Safety in Healthcare PDF

Fundamentals of Quality & Safety in Healthcare 1 List of Contents Topics 1 Quality introduction, definition, goals 2 Quality indicators 3 Quality assessment 4 Quality improvement 5 Quality control and management 6 International Patient Safety Goals...

Fundamentals of Quality & Safety in Healthcare 1 List of Contents Topics 1 Quality introduction, definition, goals 2 Quality indicators 3 Quality assessment 4 Quality improvement 5 Quality control and management 6 International Patient Safety Goals “IPSGs” 7 Safety medication 8 Fall and pressure ulcer 9 Health care associated infection 10 Safety of chemo-radiotherapy 11 Safety technology 12 Blood transfusion safety 13 Occupational hazards 14 Prevention of surgical wound infection 15 References 2 Introduction Quality of health care Objectives  Define quality, and quality of health care.  Mention the domains of healthcare.  Recognize the quality indicators. 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 Definition of Quality: Carrying out interventions correctly according to pre-established standards, with maximizing results without generating health risks or unnecessary costs (minimize cost & errors). Quality: In general quality means:  Doing the right things (what)  To the right people (to whom)  At the right time (when)  Doing things right from the first time Doing the right thinks for the right client at the right time in the right way to achieve the best possible results.  A customer is one who receives goods or services.  Customers are our "dependents"; they rely on us for a service or product.  "External customers" include the patient, family, and others outside the organization receiving services from the organization.  "Internal customers" are those performing work, but dependent on others performing work, within the organization.  Employee may be an internal customer or a supplier. Quality of health care goals are to : Reduce harm to patients Improve clinical effectiveness of the health services delivered Engage and empower patients, families and communities 3  Build systemic capacity for ongoing quality improvement activities Strengthen governance and accountability 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. 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 Integrated – care receives across facilities and providers would be coordinated Appropriateness : o availability of a needed test, procedure, treatment, or service to the patient needs o the relationship between intervention and individual's medical needs according to the current state of knowledge 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) 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 Quality of care plays an important role in describing the iron triangle of health care relationships between quality, cost, and accessibility of health care within a community. 4  The Institute of Medicine (IOM) has identified six crucial domains of healthcare quality: patient safety, effectiveness, patient- centered, timeliness, efficiency, and equity., Each domain has a vital role in the overall quality of care. 5 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 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 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 6 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. 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 Eg: Initiation of Breast feeding Simple to Complex – Eg. Pressure Injury (PI) to PI 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” Do you need a Quality Indicator? quality of care improves patient health? isting quality indicators? Current Nursing-Sensitive Quality Indicators Pain Assessment, Intervention, Nursing Turnover Nosocomial Infections 7  Nursing Hours per Patient Day Patient Falls With Injury Pressure Ulcer Rate Peripheral Intravenous Infiltration Elements of indicators 1. Indicator statement 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 8  Quality Indicator Development Quality Indicator Criteria Important –audiences will find the information useful for a purpose Scientifically sound –measure will produce consistent & credible results Feasible–can be implemented Usable–target audience can understand the results & use for decision making E.g.: Medication Error indicators Incidence of Medication Error Incidence of prescription error Incidence of transcription error 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. Nursing Sensitive Indicators- Structure Process & Outcome Model Structural Indicators: 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. 9  Structure Processes Outcomes of Care Input Steps Outcome Patients Inventory Methods Physiologic parameters Equipment Coordination Functional status Supplies Physician orders Satisfaction Training Nursing Care Cost Environment Additional staff Housekeeping Transport Structure Process Outcome Model Organizational- Focused Nursing Focused Nurse Focused outcome Structural Indicators Process/Intervention Indicators Indicators *Nurse Staffing Treatment and Nurses Job satisfaction Characteristics Procedures Nurse reported quality of care Number of Nursing Staff Pain Management Nurse burnout Number Staffing Ratio Maintenance of skin Nurse turnover Nurse Staffing Levels integrity Nurse Staffing Qualifications Patient Education Patient Focused Nurse Experience Outcome Indicators Nurse Education Nosocomial Infection *Hospital Characteristics  Quality indicators were Mortality Work Schedule comprised of the 5Ds Pressure ulcer Patient Safety Death, disease, disability, Patient Satisfaction Patient turnover discomfort, and Patient falls Work environment Dissatisfaction Patient injury Nurse autonomy DVT/Pulmonary Embolism Case Mix Shock/Cardiac arrest 10  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. Factors Related to 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. 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 11 Relationship between Quality of care and Staff Empowerment  Staff Empowerment  Increased Job Satisfaction, Lower Job Turnover  Increased Patient satisfaction & Perception of care  Higher Quality of care  Nursing Quality of Care- Measured through NQI What Builds Staff Empowerment? 1. Leader support and teams. 2. Communication and information sharing. 3. Positive reinforcement. 4. Confidence. 5. Just Culture Barriers for Staff Empowerment: 1. Lack of senior leader support. 2. Lack of resources. 3. Poor teamwork and support. 4. Stagnation and loss of momentum for change. 5. Staff turnover. 6. Corrective response to error. 12  Quality Improvement Objectives By the end of the lecture the student will be able to: 1. Define the related terms. 2. List the goals of Pt. safety & quality improvement. 3. Describe the basic principles of quality improvement. 4. List area‘s where nurses can significantly improve Pt. Safety 5. Understand fundamental concepts in quality improvement. 6. Identify the environment and key steps for a successful quality improvement project. 7. Become familiar with several quality improvement tools and their use. 8. Demonstrate quality indicators. 9. Know how to use a range of quality improvement activities. Change drive to improvement depends on  Workplace Culture: personnel must be receptive to change.  Awareness: administrative and medical staffs must care about performance and support its improvement through change  Evidence: local experts must identify which research to translate into practice  Experience: a skilled team must choose, implement, and follow up. 1. Quality control in health care organization refers to activities that evaluate, monitor, or regulate services rendered to consumers. Quality Control Process:  It is an eight-step process for monitoring and evaluating performance:  Establish control criteria.  Identify the information relevant to the criteria.  Determine ways to collect the information.  Collect and analyze the information.  Compare collected information with the established criteria.  Make a judgment about quality.  Provide information and if necessary, take corrective action regarding finding to appropriate source. 13   Determine when there is a need for re-evaluation. Total Quality Management (TQM ) A way to continuously improve performance at every level of operation in every functional area of on organization using all available human and capital resources, aim to reduce the waste and cost of poor quality. The main elements of TQM are:  The customer, whose needs are paramount to the determination of quality.  The teamwork as a mean of achieving quality.  The scientific approach to decision-making based on data collection and analysis. During the control phase, determine what needs to be measured (what forms of data and from which processes?), and set a goal for performance. Obtain feedback by measuring actual performance, and act on the gap between performance and the goal. Through regulatory process measure the actual performance, compare it with standards and act on the difference. There are different ways in which quality can be measured.  Development of quality indicators  The audit that takes place in institutions (financial and administrative audit)  Using the accreditation method for health institutions. Accreditation is a method used to measure quality, and it is a process in which an external institution evaluates the performance in the health institution and evaluates the quality based on the standards of best practices. Quality control, measuring quality and developing indicators.  Why do we measure quality?  What we measure?  Measurement tools  Indicators development  Data collection (questionnaire) Quality Control in Nursing Patient Assessments: Thorough and accurate assessments of patients to identify their needs and establish a baseline for care. 14