king saud universityNursing collage

Quality of care management

Supervision by: DR\Ofat Salem

- Al ِ�Ms\Mona Al-Aseeri

Done by: Afaf hakami

Nashmiah al shammariBedor al harthyFaizah al anzi

Roqayah al jeade

Out line:

Quality

Quality management:

Total quality management:

Six sigma:

Risk management:

Nursing role in risk management

•

•Quality

Having high degree of excellenceDoing right things right first time

It is a cost – reduction

•Quality management: *It is a preventive approach designed to

admass problem before they become crisis .

Quality management moved health care from a mode of identifying failed standards, problem people to proactive organization in which problems are prevented and ways to improve care and quality of care are sought.

This paradigm shift involves all in the organization

and promotes problem solving and experimentation.

•Total quality management:

TQM is a management philosophy that emphasizes a commitment to excellence throughout the organization.

•TQM believes in the values of :

•Customers:Needs, Expectations ,Opinions

Staff:Willingness & desire ,Abilities & desire ,Opinions ,Access to Top Management

Involvement in:decision making ,Problem solving ,Goal sitting ,planning

Management:Commitment & Visibility ,Active Leadership ,Participation ,Empowerment of Employee ,Accountability

Teamwork: Unity ,Ownership ,More & better ideas ,Openness ,Encouragement ,Mutual respect

Continuous quality improvement:

TQM is the overall philosophy, whereas continuous quality improvement (CQI) is the process used to improve quality and

performance.TQM and CQI often are used synonymously.

components of quality management:

Comprehensive ِquality ِmanagement ِprogram ِincludes:

*A comprehensive quality management plan. A quality management plan is a systematic method to design, measure , assess, and improve organizational performance.

*set standards for benchmarking .standards are written statements that define a level of performance or a set of conditions determined to be acceptable by some authorities.

•standard relate to three major dimensions of quality care:

structureprocessoutcome

• Structure standards relate to the physical environment , organization , and management of an organization .

Process standard are those connected with the actual delivery of care.

Outcome standards involve the end results of care that has been given.

Indicator:

A tool used to measure the performance of structure, process, and outcome standards.

Benchmarking:

The process of comparing data with reliable internal and external sources.

•Six sigma:

Is another quality management program that uses, primarily, quantitative data to monitor progress . six sigma is a measure , a goal , and a

system of management

•as a measure

The system has six themes:

customer focusdata driven process emphasisproactive management boundary less collaborationaim for perfection

Allowing for variance, fostering innovation

•Risk management:

•Risk management is a program directed toward identifying, evaluating, and taking corrective action against potential risks that could lead to the injury of patients, staff, or visitors.

Risk management program:

1 \Identify potential risk for injury or accident.

2 \Review current organization wide monitoring system as incident report, audits, committee minutes.

3 \analyzes the frequency, severity, and causes.

4\reveiw and appraises safety and aspects of patient care procedure.

5 \monitors laws and code related to patient safety and care.

6 \reduce risk as possible.

7\identefy need of patient and family.

8 \evaluation the result of risk management.

9 \provide periodic reports to admenstration.medical staff, and board of directors.

Nursing role in risk management:

In the organizational setting, nursing is the one department involved in patient care 24 hours a day; nursing personal are there force critical to the success of a risk management program.

The chief nursing a administrator must be committed to the program.

Her or his attitude will influence the staff and their participation.

After all, it is the staff, with their daily patient contact, who actually implements a risk management program.

Role of the nurse manager:

The nurse manager plays a key role in the success of any risk management program.

Nurse managers can reduce risk by helping their staff view health and illness from the patient's perspective.

Usually, the staff's understanding of quality differs from the patient's expectations and perceptions.

By understanding the meaning of the course of illness to the patient and the family, the nurse will manage risk better because that understanding can enable the nurse to individualize patient care.

This individualized attention produces respect and, in turn, reduces risk.

In the example given, prompt attention and care by the nurse manger protected the patients involved and may have averted a potential liability claim. once an incident as occurred, the important factors in successful risk management are

-Recognition of the incident.

- Quick follow-up and action.

- Personal contact.

Immediate restitution (where appropriate)-

•High-risk areas in health care fall into five general categories:

•*Medication errors*Complications from diagnostic or treatment procedures*Falls*Patient or family dissatisfaction with care*Refusal of treatment or refusal to sign consent for treatment

• -Nursing is involved in all areas, but the medical staff may be primarily responsible in cases involving refusal of treatment or consent to treatment.

• -Medical records and incident reports serve to document organization, nurse, and physician accountability.

• Incident reports are used to analyze the severity, frequency, and causes of occurrences within the five risk categories. Such analysis serves as a basis for intervention.

A reportable incident should include any unexpected or unplanned occurrence that affects or could potentially affect a patient, family member, or staff.

•Reporting incidents involves the following steps:

•Discovery: nurses, physicians, patients, families, or any employee or volunteer may report actual or potential risk.

Notification: the risk manger receives the completed incident form within 24 hours after the

incident.

Investigation: the risk manager or representative investigates the incident immediately.

•Consultation: the risk manager consults with the referring physician, risk management committee member, or both to obtain additional information and guidance.

Action: the risk manager should clarify any misinformation to the patient or family, explaining exactly what happened.

Recording: the risk manager should be sure that all record, including incident reports, follow-up, and actions taken, if any, are filed in a central depository

Example of risk management:

Weight transcribed incorrectly form emergency room sheet. medication dose was calculated on incorrect weight; therefore, patient was given double the dose required .error discovered after first dose and corrected .second dose omitted.

Standers:Written statements that define a level of performance or a set of conditions determined to be acceptable by some authority.

Structure standers:Standers that relate to the physical environment, organization, and management of an organization.

Process standers:Standers connected with the actual delivery of care.

Outcome standers:Standers that reflect the desired result or outcome of care.

Example:

1-philosophy and structure:Organized nursing services have a philosophy and structure that ensure the delivery of effective nursing care.

Rationale:The philosophy provides the statement of beliefs and values that gives direction to the delivery of nursing services. the structure of organized nursing services is developed to make the philosophy operational. It is necessary to have a philosophy and structure to ensure a framework for the provision of nursing care and provide a means for resolving nursing practice problems.

Criteria:The philosophy and structure are compatible with established professional standards, nursing: A Social policy statement and code for nurses with interpretive statements, standards of regulatory agencies, and the mission of the organization within which nursing services are provided

2 -Nurse administratorOrganized nursing services are administered by qualified and competent nurse administrators.

Rationale:The complex demands of the health care environment require the leadership and direction of qualified and competent nurse administrators (nurse executives and nurse mangers) for the provision of effective nursing care.

Criteria:The nurse executive is a registered nurse who holds a baccalaureate degree in nursing and a graduate degree in nursing or a related field from a program that includes organizational science and management concepts. certification in nursing administration by a nationally recognized nursing organization is recommended.

Reference:

Effective leadership management nursing

ELEANOR J.SULLIVAN

PHILLIP J.DECKER