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2. Process audit
Process audits are used to measure the process of care or
how
the care was carried out.
Process audit is task oriented and focuses on whether or not
practice standards are being fulfilled.
These audits assumed that a relationship exists between the
quality of the nurse and quality of care provided.
3. Structure audit
Structure audit monitors the structure or setting in which
patient
care occurs, such as the finances, nursing service, medical
records
and environment.
This audit assumes that a relationship exists between quality
care
and appropriate structure.
Advantages of Nursing Audit:
Can be used as a method of measurement in all areas ofnursing.
Scoring system is fairly simple Results easily understood Assesses
the work of all those involved in recording care. May be a useful
tool as part of a quality assurance
programme in areas where accurate records of care are
kept.
Disadvantages of the Nursing Audit:
Appraises the outcomes of the nursing process, so it isnot so
useful in areas where the nursing process has not
been implemented
many of the components overlap making analysis difficult is time
consuming requires a team of trained auditors deals with a large
amount of information only evaluates record keeping. It only serves
to improve
documentation, not nursing care.
Utilization Review
are used to evaluate the efficiency, appropriateness,necessity
and efficacy of health care services that
patients receive.
It is conducted by auditing medical charts and
relateddocumentation about a patient's care.
Function
1. Utilization review serves to provide a health
careorganization with information about how their medical
services are being utilized by patients.
2. Health care administrators use the data found inutilization
reviews to make projections about things like
funding and process improvement protocols.
ADVANTAGES:
By performing utilization reviews, health care administrators
can:
1. maintain patient safety
2. ensure patients are receiving appropriate services3. reduce
medical adverse reactions4. Eliminate unnecessary treatment and
deliver services
more efficiently.
Morbidity and Mortality Conference
Provide a safe venue for residents to identify areas
ofimprovement, and promote professionalism, ethical
integrity and transparency in assessing and improving
patient care. The M&M Conference also provides a forum to
teach
curriculum on quality improvement and medico legal
issues to residents and students and to foster a climate
of openness and discussion about medical errors.
Credentialing and Privileging
Is the first step in a patient safety program Reduces the risk
to patients for adverse outcomes by
completing the appropriate assessment of staff,
reducing the risk for liability
Allows for a systematic review that ensures practitionershave
kept abreast of new developments and have
competencies for approved privileges
Credentialing
o the systematic process of screening and
evaluatingqualifications and other credentials, including
licensure
required education, relevant training and experience, and
current competence and health status
Clinical Privileging
o the process by which a practitioner is permitted by lawand the
facility to practice independently, to provide
medical or other patient care services within the scope o
the individuals license, based on the individual's clinica
competence as determined by peer references
professional experience, health status, education
training, and licensure.
5S (methodology)
5S is the name of a workplace organization methodologythat uses
a list of five Japanese words which are seiri
seiton, seiso, seiketsu and shitsuke.
Translated into English, they all start with the letter "S". The
list describes how to organize a work space fo
efficiency and effectiveness by identifying and storing the
items used, maintaining the area and items, and
sustaining the new order.
Phases of 5S
There are 5 primary phases of 5S:
1. Sorting (Seiri)
2. Straightening (Seiton)
3. Systematic cleaning (Seiso)
4. Standardizing (Seiketsu)
5. Sustaining. (Shitsuke)
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1. Sorting (Seiri)
Eliminate all unnecessary tools, parts, and instructions. Go
through all tools, materials, and so forth in the plant
and work area.
Keep only essential items and eliminate what is notrequired,
prioritizing things per requirements and
keeping them in easily-accessible places.
Everything else is stored or discarded.
2. Straightening or setting in order / stabilize (Seiton) There
should be a place for everything and everything
should be in its place.
The place for each item should be clearly labeled ordemarcated.
Items should be arranged in a manner that
promotes efficient work flow, with equipment used most
often being the most easily accessible.
Workers should not have to bend repetitively to accessmaterials.
Each tool, part, supply, or piece of equipment
should be kept close to where it will be used in other
words, straightening the flow path.
This phase can also be referred to as Simplifying[1].3. Sweeping
or shining or cleanliness / systematic cleaning (Seiso)
Clean the workspace and all equipment, and keep itclean, tidy
and organized.
At the end of each shift, clean the work area and be
sureeverything is restored to its place. This makes it easy to
know what goes where and ensures that everything is
where it belongs.
Spills, leaks, and other messes also then become a visualsignal
for equipment or process steps that need
attention.
A key point is that maintaining cleanliness should be partof the
daily work not an occasional activity initiated
when things get too messy.
4. Standardizing (Seiketsu)
Work practices should be consistent and standardized. All work
stations for a particular job should be identical. All employees
doing the same job should be able to work
in any station with the same tools that are in the same
location in every station.
Everyone should know exactly what his or herresponsibilities are
for adhering to the first 3 S's.
5. Sustaining the discipline or self-discipline (Shitsuke)
Maintain and review standards.
Once the previous 4 S's have been established, theybecome the
new way to operate. Maintain focus on this
new way and do not allow a gradual decline back to the
old ways.
While thinking about the new way, also be thinkingabout yet
better ways. When an issue arises such as a
suggested improvement, a new way of working, a new
tool or a new output requirement, review the first 4 S's
and make changes as appropriate.
The Origin of 5S
o developed by Hiroyuki Hiranoo Japaneseo Hirano identified a
range of benefits from improved
housekeeping
o they are all based around the elimination of waste in oneform
or another.
The Objectives of 5S
1. Improved productivity
most obvious benefit from items being organized in sucha way
(i.e. that they are always readily available)
often-needed items are stored in the most accessiblelocation and
correct adoption of the standardisation
approach means that they are returned to the correct
location after use
2. Quality
Standard Operating Procedure for tool certification ismuch
easier to achieve if the tool to be certified is
always in a clearly-marked location
3. improved Health & Safety
Clear pathways between workbenches and storage rackscan minimise
accidents, as can properly-swept floors
The Objectives of 5S
The successful implementation of 5S requires that
everyoneunderstand why it is being used and what the expected
results
are.
The aim is improvement in business performance; the adoption
isnot an end in itself.
