1. Copyright © 2006 Elsevier, Inc. All rights reserved Chapter 22 Quality Patient Care

2. Copyright © 2006 Elsevier, Inc. All rights reserved Quality Patient Care  Standards of quality health care management Standards of nursing care (ANA) Accrediting group standards (JCAHO) Clinical practice treatment guidelines (AHRQ) Standards of practice (each health care agency)

3. Copyright © 2006 Elsevier, Inc. All rights reserved Quality Patient Care  JCAHO Publishes a Sentinel event alert monthly  An unexpected occurrence involving death or loss of limb or function  Sounds a warning of the need for immediate investigation and response

4. Copyright © 2006 Elsevier, Inc. All rights reserved History and Evolution of Quality in Health Care (cont’d)  Who is Deming? Edward Deming—father of quality improvement Method to prevent defects evolved to a method to track and improve quality Quality is everyone’s responsibility

5. Copyright © 2006 Elsevier, Inc. All rights reserved History and Evolution of Quality in Health Care (cont’d)  Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Primary agency for hospital accreditation Must meet certain quality standards to pass inspection Mandated continuous quality improvement JCAHO mandates specific quality outcome measures for all hospitals

6. Copyright © 2006 Elsevier, Inc. All rights reserved Just What Is the JCAHO?  Accrediting body for health care institutions that are Medicare and Medicaid funded  Address patient safety issues  Require error reduction and design of safe patient care processes

7. Copyright © 2006 Elsevier, Inc. All rights reserved Just What Is the JCAHO?  What are patient safety goals? Improve accuracy of patient identification Improve the effectiveness of communication among caregivers Improve the safety of using medications Improve the safety of using infusion pumps Reduce the risk of health care–associated infections Accurately and completely reconcile medications across the continuum of care Reduce the risk of patient harm resulting from falls

8. Copyright © 2006 Elsevier, Inc. All rights reserved Monitoring Quality of Health Care  What is quality assurance? Used synonymously with quality improvement Process or activities used to monitor, evaluate, and control services providing some measure of quality to consumers Key Indicators

9. Copyright © 2006 Elsevier, Inc. All rights reserved Monitoring Quality of Health Care (cont’d)  What are key indicators? JCAHO mandates certain key indicators to monitor  Advance directives, autopsy rates, AMAs and elopement rates, blood product utilization rates, blood transfusion reaction rates, code blue rates, conscious sedation complication rates, fall rates, medication error rates, mortality rates, pain management effectiveness, restraint use, and surgical site infection rates

10. Copyright © 2006 Elsevier, Inc. All rights reserved Quality Improvement Methods  Institutional values  Commitment to CQI  Empowerment of nurses  Collect data systematically  Working groups with sense of collaboration