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Standards for Evaluating Health Standards for Evaluating Health CareCare
Types of standards
– Structural standards
– Process standards
– Outcome standards
Structural StandardsStructural Standards
establish guidelines for the facility’s patterns and supports for providing client care
i.e. The nurse patient ratio in ICU is 1:2 All home health nurses will have at
least 1 year of acute care experienceCan you think of an example of a
structural standard???
Process StandardsProcess Standards
deal with the methods or the process used in providing client care or services
i.e. The initial nursing care plan will be established within 24 hours of admission.
The patient meal trays will be passed out within 30 minutes of arrival to the unit
Can you think of an example of a process standard???
Outcome standardsOutcome standards
used to evaluate patient outcomes or the desired result of care
i.e. Post op hip replacement patients will be ambulatory by Day 2.
The incidence of nosocomial infections will be less than 10%.
Can you think of an example of an outcome standard???
QuestionQuestion
Each nursing unit will have a fire extinguisher on each side of the hallway. This is an example of a:
a) structural standard b) process standard c) outcome standard
Nursing specific standards
Regulatory agency standards
Accrediting agency standards
Clinical practice guidelines as standards
Health facility established standards
Sources of Standards for CareSources of Standards for Care
QuestionQuestionIs the following statement true or false?
A type of standard to which a nurse is held accountable is called a process standard.
AnswerAnswerTrue.
Rationale: process standards describe methods of providing services. Process standards are also referred to as performance standards. Protocols and procedures are examples of process standards.
BenchmarkingBenchmarking
Benchmark – a specific quantitative standard (expressed as a number or percent) to which you compare to your own facility to a similar facility or standards established by JCAHO or another entity.
i.e. 3 falls per 100 patient care days 8% nosocomial infection rate 75 medication errors per year 5% surgical site infection rate
Cost StandardsCost Standards
Outcomes related to costCost-effectivenessCost- benefit ratioDoesn’t take into consideration quality of
life or satisfaction
Collecting Data for Evaluation- Collecting Data for Evaluation- Key IndicatorsKey Indicators
Selected data that reveal the need for more extensive data collection
i.e. Number of Falls per year evaluates Safety
Number of Nosocomial Infections per year evaluates Infection Control
Number of Medication Errors per year evaluates Safety
Length of stay for Hip Replacement evaluates Cost
Collecting Data for Evaluation- cont.Collecting Data for Evaluation- cont. Quality assurance reports- “Incident
report”
Audit-
– Retrospective-i.e. Going back to medical records for chart review to see if all medications were signed off.
– , concurrent- i.e. Looking at a chart which is currently in use to see if I.V. restarts were charted
Collecting Data for Evaluation- Collecting Data for Evaluation- contcont
Direct Observationi.e. Going in patient rooms to see if I.V.
tubing is labeled Interviewi.e. Interviewing a patient to see if pain
is less than 5 on a scale of 1-10
QuestionQuestionWhat is the term used for a systematic
data collection process that commonly focuses on documentation?
A. Cost-analysis report
B. Benchmarking
C. Audit
D. Survey
AnswerAnswerC. Audit
Rationale: an audit is a systematic data collection process that commonly focuses on documentation.
Analyzing Data and Developing Action Analyzing Data and Developing Action PlansPlans
Types of reports– Simple descriptive reports– Percentage and numerical reports– Sophisticated statistics
Analysis of data– Identify discrepancies– Opportunities for improvement
Action plans
– Detailed approaches to change
– Specific
– Identify responsible person
– Set time frame
Analyzing Data and Analyzing Data and Developing Action Plans (cont'd)Developing Action Plans (cont'd)
Using Goals and Objectives in the Using Goals and Objectives in the Evaluation ProcessEvaluation Process
Goals– Broad statements of
overall intent of an organization, department, unit, or individual
– Usually stated in general terms
Objectives– Specific
accomplishments that help achieve a goal
– Usually have a related time deadline
Strengths of Using Goals and Strengths of Using Goals and ObjectivesObjectives
Everyone knows what is expected
Facilitates change in individual behavior
Evaluation is clear
Limitations of Using Goals and Limitations of Using Goals and ObjectivesObjectives
Cannot be done in isolation
Related to standards of care
Impossible to address all the areas of function
Conflict over goals can occur
Quality Assurance and ImprovementQuality Assurance and ImprovementQuality assurance
– Refers to activities that are used to monitor, evaluate, and control services provided to consumers
– Goal is to identify areas where standards are not met and improve them
Sentinel events
– Defined by the Joint Commission (2007c) as “unexpected occurrences involving death or serious physical or psychological injury, or risk thereof.”
Quality Assurance and Improvement Quality Assurance and Improvement (cont'd)(cont'd)
Both errors and near misses
– Death from medication error
– Suicide of a patient receiving 24/7 care
– Surgery on wrong patient or body part
– Hemolytic transfusion reaction
– Near miss
Quality Assurance and Improvement Quality Assurance and Improvement (cont'd)(cont'd)
Root cause analysis– Comprehensive, often complex, process that seeks to
identify all the contributory factors to an error and identify their share of causation
– What happened– Why it happened– How do you keep it from happening again– Tool for prevention strategies
Quality Assurance and Improvement Quality Assurance and Improvement (cont'd)(cont'd)
Acting to prevent error
– Addressing system problems
– Patient safety goals
Quality Assurance and Improvement Quality Assurance and Improvement (cont'd)(cont'd)
QuestionQuestionIs the following statement true or false?
A medication error that results in the death of the patient is a sentinel event.
AnswerAnswerTrue.
Rationale: sentinel events include both errors and what are commonly referred to as near misses. An example of a sentinel event is a death resulting from a medication error or other treatment-related error.
Quality Improvement MovementQuality Improvement MovementIncorporates all aspects of quality assurance
Aimed at improving quality of health care
JCAHO: “Quality assessment and improvement”
Efforts toward evidence-based practice
Continuous Quality ImprovementContinuous Quality ImprovementA process in which ongoing analysis and
improvement lay the foundation for change Includes:
– Collecting data– Analyzing data– Forming a task force– Planning change– Implementing change– Collecting data again
Key Aspects of Quality Key Aspects of Quality ImprovementImprovement
Culture of empowerment
Blame-free environment
Effective data collection systems
Use of teams for problem solving
Focus on the customer
Eliminating waste
Barriers to Quality ImprovementBarriers to Quality ImprovementCosts
– Staff time
– Computer programming
– Documentation
Improvement may not defray costs
Risk ManagementRisk Management
Minimizing the risk to the institution or agency from an error or problem that could result in legal action or liability
Think ahead about defense when a legal action is contemplated or actually occurs
Attempts to be proactive in identifying and eliminating areas of risk for the institution
Response of those in the health care system when an adverse event occurs
QuestionQuestionWhat is one purpose of risk management?
A. Change in time when vital signs are done at night
B. Improvement of quality of meals served to patients
C. Defense when legal action occurs
D. Planning of community emergency drills
AnswerAnswerC. Defense when legal action occurs
Rationale: another focus of risk management is to think ahead about defense when a legal action is contemplated or actually occurs.
Evaluating Nursing Care You ManageEvaluating Nursing Care You Manage
Identify specific standards of care that you will strive to meet and determine ways of improving care
Goals and objectives may be established informally with a team even when the setting does not have a formal process in place
A philosophy of continuous improvement