QUALITY ASSURANCE IN

PERIOPERATIVE NURSING
Presented to Perioperative Nursing School students,
UCH,IBADAN
Adetule Olubunmi
 WHAT IS QUALITY ASSURANCE
Quality assurance is dynamic process through which nurses
assume accountability for quality of care they provide
It is a guarantee to society that service provided by nurses
are being regulated by members of profession
Quality assurance is a judgement concerning the process of
care
 WHAT DOES QUALITY ASSURANCE MEAN IN
NURSING
A quality assurance nurse evaluates nursing practices
within a department to help maximize efficiency and
optimize patient care. Their duties include suggesting
and implementing changes, training nurses on new
procedures, and ensuring state and hospital requirements
are consistently followed.
QUALITY ASSURANCE IN HEALTH CARE
Quality Assurance is the identification, assessment,
correction and monitoring of important aspects of
patient care designed to enhance the quality of Health
Maintenance Services consistent with achievable
goals and within available resources.
What is quality assurance
Quality assurance is an on-going, systematic,
comprehensive evaluation of health care services and
impact of those services on health care.
 Kozier

Quality assurance is defined as all activities

undertaking to predate and prevent poor quality
Objectives
To ensure the delivery of client care
To demonstrate efforts of health care providers to
provide good results
To formulate plan of care
To evaluate achievement of nursing care
Objectives
To support delivery of nursing care with administrative and
managerial services
To explain quality assurance models as prerequisite for
quality nursing care
To state code of ethics and professional conduct for nurses
in Nigeria
To appreciate importance of practicing standard safety
measures
Plan and conduct patient teaching sessions
To identify appropriate management techniques to be used
for managing resourses in given situation
Purposes
It is required to introduce code of ethics and
professional conduct for nurses.
To prepare nurses for implementation of quality
assurance model in nursing
To provide best care to patients by maintaining
standards
Principles
1.Customer focus:It focuses on patient’s care with
standard and recent medical knowledge
2.Leadership: It helps to inculcate qualities of
leadership in staff
3.Involvement of people: It should involve maximum
nursing staff so that standard can be maintained
Purpose
Process approach: There should be a system and
planned approach to provide quality care.
Factual approach to decision making: There should be
fact or appropriate reason in taking certain decision
for quality assurance of patient.
 Approaches to quality assurance
Methods for measuring perfomance
As nursing care is delivered within a framework of
independent relationships with physician and multiplicity
of other health care personnel. The most commonly used
methods of nursing care are task analysis and quality
control.
Measuring actual performance
It is an ongoing repetitive process with the actual
frequency dependant on the type of activity being
measured. It is better to clarify the purpose of the
measurement and to measure performance on continuous
basis
Approaches to quality assurance
Comparing results of performance with standards and
objectives and identifying strenghts and areas for
correction
The standards and objectives and methods of
measurement have been set, if performance matches
standards and objectives, managers may assume that
things are under control if performance is a contrary to
standards and objectives, action is necessary.
Approaches to quality assurance
Acting to reinforce strengths or success and taking
corrective action as necessary
Positive aspects need to be identified in order that
they may be translated into encouragement and
motivation for the nursing members involved in
achieving them
Development of quality assurance program
Foster commitment of quality
Conduct a preliminary review of quality related
activities
Develop the purpose and vision for the quality
assurance effort
Determine level and scope of initial quality assurance
activities
Assign responsibility for quality assurance
Allocate resourses for quality assurance
Development of quality assurance program
Develop a written quality assurance plan
Critical Management system
Disseminate quality assurance experience
Manage change
Approaches for quality assurance program
They are divided into 2 types
1.General approach
2.Specific approach
General approaches
It involves large governing of official body’s evaluation
of person’s or agency ability to meet standard at a
given time.
1.Credentialing-It is the process of determining and
maintaining nursing standards
Functional components of Credentialing process
Credentialing process has 4 functional components
 To produce a quality product
To confer a unique identity
To protect provider and public
To control the profession
Licensure
Individual licensure is a contract between profession
and state in which the profession is granted control
over entry into and exists from the profession and over
quality of professional practice.
The licensing process requires that regulations be
written to define the scopes and limits of the
professional’s practice. Licensure of nurses has been
mandated by law since 1903
Accreditation and Certification
Accreditation is the act of granting credit or
recognition especially to an educational institution
that maintains suitable standards.
Certification is usually a voluntary process within the
professions. A person’s educational achievement,
experience and performance on examination are used
to determine person’s qualification for functioning in
an identified specialty area.
 Specific approaches
Quality assurances are methods used to evaluate
identified instances of provider and client interaction
1.Peer review committee:
These are designed to monitor client specific aspects of
care appropriate for certain levels of care. The audit is
used by peer review committee to ascertain quality of
care.
2.Nursing Audit is evaluation of patient care through
analysis of written records maintained by nurses in
patient’s treatment profile.
NURSING AUDIT PROCESS
Goals of Nursing Audit
To improve quality of health care
To promote improved communication among nurses
and other health team members
To improve quality of nursing care
To detect and analyse problems and errors
Advantages of Nursing Audit
Provides quality of nursing
A patient is assured of good services
It will give valuable and pertinent information for the
staff
It will lead to cooperation and communication among
the nurse and health team.
It will help each professional nurse for self evaluation.
It will help the administration as better planning
It will reduce the incidence of medical legal
complication.
It will broaden and strengthen nursing service.
UTILIZATION REVIEW
Utilization review activities are directed towards
assuring that care actually needed and that the cost
appropriate for the levels of care provided.
TYPES OF UTILIZATION REVIEW
Prospective : It is an assessment of the necessity of care
before giving services.

Concurrent: A review of the necessity of care while the

care is being given.

Retrospective: It is analysis of the necessity of the

services received by the client after the care has been
given.
Evaluation Studies
Donabedian’s Structure-Process-Outcome model.
Donabedian introduced 3 major method of evaluation
They are:
Structured Evaluation
Process Evaluation and
Outcome Evaluation
Structured Evaluation
This method evaluates setting and instruments used
to provide care such as facilities, equipments and
characteristics of administrative organization and
qualification of health provider. The data can be
obtained from existing document.
Process Evaluation
This method evaluates activities they relate to
standards and expectations of health providers in
management of client care.
Data is collected through direct observations, review
of records, audit e.t.c.
Outcome Evaluation
The net changes that occur as a result of health care or
net results of health care. The data of this method can
be collected from vital statistics records such as death
certification or telephone client interview, mailed
questionnaire and client records.
Models of Quality Assurance
System Model
System model is used for implementation of unit
based quality assurance program. It involves making
changes in organizational structure and individual
roles. In system model, task is broken down into
manageable components based on defined objectives.
Basic Components of system models
Input: The input can be compared to the present state
of systems
Throughput: It is developmental process.
Output: It is finished product or result
Feedback: It is essential component of system because
it maintains and nourishes growth.
ANA Quality Assurance Model
Factors affecting quality assurance in
nursing practice
Lack of resources
Personnel problem
Improper maintenance
Unreasonable patients and attendants
Absence of well-informed population
Absence of accreditation laws
Lack of incident review procedure
Lack of good hospital information system
Factors affecting quality assurance in
nursing practice
Absence of patient satisfaction survey
Lack of nursing care research
Miscellaneous factors
BARRIERS OF QUALITY IMPROVEMENT EFFORTS
The Nurse Manager might become preoccupied with
quality assessment
It is impossible to identify all factors that influence
nursing care quality
Difficulty in defining outcome criteria that result solely
from nursing intervention
Nurse’s documentation of care measures is at times vague,
incomplete and lacking in objectivity
There is still no single, all purpose, all site quality
assessment tool that is universally for all health agencies.
High cost.
ROLES OF NURSES IN QUALITY ASSURANCE
Nurses are the active participant of interdisciplinary
quality improvement team
Develop mechanism for continually monitoring the
effectiveness of nursing care both a collaborative and
an individual professional activity.
Contribute innovations and improvement of patient
care.
Participating in improvement projects and patient safe
initiative.
ROLES OF NURSES IN QUALITY ASSURANCE
Participate continuing educational programs and in-
service educational programs for continuing
professional development
Periodic and continuing appraisal of health care
situation of the patient.
Participate in research works related to quality
assurance
Identify any area of needed improvement in delivery
of care.
THANK YOU