NURS411 PROFESSIONL DEVELOPMENT

AND MANAGEMENT
COLLEGE OF SCIENCE, TECHNOLOGY & APPLIED
ARTS OF TRINIDAD & TOBAGO

PRESENTER: D. MC PHERSON

DATE: TUESDAY 17TH SEPTEMBER, 2024

GROUP: FINAL YEAR NURSING STUDENTS

SEMESTER: 1: 2024 - 2025

COURSE CREDITS: THREE (3)

FOCUS: UNDERSTANDING HEALTH CARE

SYSTEMS
Objectives
At the end of the lesson, students will be able
to:
1. Define quality assurance
2. Identify terms related to quality assurance
3. Explain the terms related to quality
assurance and give examples
4. Discuss the importance of accountability in
providing quality patient care
5. Discuss the relevance of effective clinical
policy to providing quality healthcare services
Quality Assurance

Definition:
Quality Assurance (QA) is an on-going comprehensive
process to prevent problems within organizations by
ensuring conformity to preset standards. It involves
detection and correction of errors.

TERMS RELATED TO QUALITY ASSURANCE:

Quality Improvement
Total Quality Management / Continuous Quality
Improvement
Quality Control
The Goal / Objective of Quality Assurance
To ensure the delivery of quality patient care

To improve the quality of patient care

To demonstrate the ability of health care

providers to provide the best possible
outcomes
Components of Quality Assurance
The components of a QA programme are often grouped
into three levels, variously labelled:
The strategic or organizational level (dealing with
the quality policy, objectives and management and
usually produced as the Quality Manual)

The tactical or functional level (dealing with

general practices such as training, facilities, operation
of QA)

The operational level (dealing with the Standard

Operating Procedures (SOPs) worksheets and other
aspects of day to day operations).
Evaluating the Components of Quality
Assurance
Structure Evaluation

Process Evaluation

Outcome Evaluation
 Factors Affecting Quality Assurance in Nursing
Practice
Lack of resources
Personality problem
Improper maintenance of systems and
equipment
Unreasonable patients and attendants
Absences of accreditation laws
Lack of incidence review procedure
Lack of good hospital information system
Absence of patient satisfaction survey
Lack of nursing care research
Question:
What are some things observed in the clinical
area that impact on patient safety and quality of
care? (Consider the physical environment as well
as the processes).
Quality Improvement

Definition:
Quality Improvement
Quality improvement (QI) involves a series of
activities undertaken to reduce the gap
between current practice and desired
practice.
Quality Improvement
Quality Improvement (QI) offers a way to
organize and harmonize the provision of care
by engaging service providers at point of
service delivery to reflect on and assess
programme performance to determine how
service can be improved

QI builds on the concept that improvement

will occur only when changes are made in the
system
Effective clinical and organizational leadership
contributes to quality improvement
Effective clinical and organizational leadership:
Prioritizes

Establishes partnership between healthcare and other

social care agencies to improve the quality of patient care

Establishes partnership between patients and the public

to improve the health of the population

Creates leadership development programmes to motivate

and develop staff – patient-centered, practical, needs-led

Creates a system for reviewing performance for

accountability
Quality Assurance: Quality Improvement In
Action
In order to create an active environment for
quality improvement, the following must be
put in place:
Clinical Audit
Risk Management
Complaints
Research effectiveness
Incident Reporting
Support from other agencies
Clinical Audit
Definition:
Clinical Audit
The systemic and critical analysis of the quality of
clinical care including the procedures used for
diagnosis, treatment and care, the associated use of
resources and the resulting outcome and quality of
life for the patient

Objectives of clinical audit

To improve patient care by informing the health
professionals’ understanding of their clinical
practices
Clinical Audit
A clinical audit should be led by the clinical
staff involved with the issue being reviewed
in collaboration with managers, audit staff
and patients

Benefits of Clinical Audits:

Promote a patient-focused approach to care
Encourage multi-professional team work
Enable open discussion and practice and
learning from mistakes
 Example of Clinical Audit
QUALITY ASSURANCE
TOPIC: Clinical Audit Of Pressure Sores at Hospital
(Royal Brompton Hospital 1991)

Background: There is concern about the provision

of Pressure-relieving devices for those identified as
high risk patients for pressure sores

Development of pressure sores:

 Has increased hospital stay
 Has increased discomfort
 The cost implications were extremely high with a
Grade 4 pressure sore estimating cost £25,000 or
approximately $225,000 to treat
 QUALITY ASSURANCE
TOPIC: Clinical Audit Of Pressure Sores
Main Findings:
50% of the patient population were at risk of
developing pressure sores

A number of mattresses were in poor condition

There was lack of knowledge amongst ward

nurses on areas related to pressure-relieving
equipment

Lack of lifting aids on the wards – discouraging

Main Findings (cont’d):
Pain was likely to be a contributing factor as
patients were prevented from moving in bed

An increased risk of costly litigation – health

authorities were being sued any where between
£100,000 and £10,000,000 by patients who had
developed sores during their hospital stay
Methodology:
All of the above reasons including that 95% of
pressure sores are preventable, led to a pressure
audit group for pressure area care being formed.
Representatives of the multi-professional teams
comprised of nurses, occupational therapists,
physiotherapists and dietitians

Pilot Audit (1992) 8 months from the raising of the

first concerns through to completion of the
objectives and criteria

A small convenience sample of 4 patients and 4

nurses were audited from each ward
Outcome Measure
Every year, the standard and point prevalence
study have been reviewed, re-audited and local
and hospital action plan devised to address
new issues:
A mattress replacement programme and the
writing of a policy to maintain this

Identifying a nurse to coordinate both in-house

and external programmes

Hold regular meetings with the link nurses to

encourage information sharing
Outcome Measure (cont’d)
Local and hospital action plan devised to
address new issues (cont’d):
The initial Audit (1992) identified the
prevalence of pressure sores to be 19% of the
patient population. This figure dropped
dramatically over subsequent years.

1997 results was just 3% of the patient

population which is within the 1993 guidelines
that stated a commitment to reduce pressure
sores in the National Health Service (NHS) by
5%.
An overview of the aspect of care under
review:
Letters from patients’ complaints or comments
from external agencies
Critical accidents reports – where numbers of
staff have described and analyzed important
concerns following one incident
Summaries of team meetings or good round
where issue has been discussed
Information from routine data sources including
patients involved
Patients’ stories or feedback from focus group
Direct observation of care
Risk Management

Definition:
Risk management
The identification, assessment and
prioritization of risks, followed by
coordinated and economical application of
resources to minimize, monitor, and
control the probability and/or impact of
unfortunate events, or to maximize the
realization of opportunities.
Incident Reporting

Definition:
Incident Reporting:
A nursing intervention defined as written and
verbal reporting of any event in the process
of patient care that is inconsistent with
desired patient outcomes or routine
operations of the health care facility.
Accountability and Responsibility
DEFINITIONS:
 Accountability: This refers to the ability to answer for
your actions. Potter & Perry (2003)

 Responsibility: This refers to the execution of duties

associated with a nurse’s particular role. Potter & Perry
(2003)

 The nurse demonstrates professional commitment to

accountability when he/she takes actions to prevent
injury to the client by adhering to externally agreed
standards for practice.
Accountability at All Levels

1. Professional Level
Accountability is an integral part of professional
practice
Associated with individuals recognizing that they
are members of a profession and therefore
accepting the status, rights and responsibilities
that attend this
Dependent on certain preconditions:
That the nurse has the ability (appropriate knowledge,
skills, values)
That the nurse has appropriate responsibility and
authority
 Accountability at All Levels:
Professional level (cont’d)
Two interrelated concepts – ability and competence

Ability – is understood as the relevant knowledge skills

and values to make decisions and act upon them (the
requirement to update knowledge and skills is enshrined in
professional codes of practice)

Competence – is described as the ability to perform a

responsibility with appropriate knowledge and skill, and
to perform that responsibility in terms of appropriate
scope and quality.
Accountability at All Levels

2. Contractual level (ethical)

Accountability related to conditions of
employment since there is an agreement
between two or more parties

This is derived from the relationship of implicit

trust as a result of the informal contract between
the client and the nurse

There is a moral obligation to be answerable for

the care rendered to clients
Accountability at All Levels

3. Legal level
Accountability is enshrined/preserved by law
through:
Acts of Parliament
Case law
Tribunals
Inquiries
 Systems for Accountability and
Responsibility

Question: What are some of the systems

present at the facility at which you work that
require nurses to be accountable?
Systems for Accountability and
Responsibility (cont’d)
Answer:
Customer Relations Officer (CRO) Department
Register for Arrival and Departure
Nurses Documentation / Nurses Notes / I&O
Charts
Incident Reporting
Policy: Definition
A statement of expectations that sets
boundaries for action taking and decision
making.
(Paige, 2003)

A designated plan or course of action to be

taken in a specific situation
(Ellis & Hartley,
2008)
Effective Clinical Policy contributes to
quality

What is an Effective Policy?

A policy must meet two basic criteria to be
considered effective:
It should effectively and unambiguously
communicate what is expected of employees along
with the intent and purpose behind the
expectations.

It should be able to withstand legal scrutiny and

adequately defend the organization’s rights in
case of litigation.
Key Components of an Effective Clinical Policy
Why Writing Effective Policies is Challenging?
Legal language is difficult to understand for most
people

Simple language is often not able to withstand legal

scrutiny

Many policies are mixed with procedures and

processes making the policy lose focus and
effectiveness

Policies sometimes overlap with other policies, making

it hard to find or follow the correct rules of the
organization
 Usefulness of Policies for organizational
effectiveness
Policies can also be thought of as plans of an
organization that are condensed into
comprehensive statements or instructions that
direct organizations in their decision-making.

Policies are derived from an organization’s

philosophy, goals, and objectives

Policies explain how goals will be met and guide

the general course and scope of an organization’s
activities
 Usefulness of Policies for Organizational
Effectiveness
Policies tend to be specific to individual institutions,
and provide management with a means for internal
control

Policies direct individual behavior toward the

organization’s mission and identify desired outcomes

Policies define broad limits or boundaries

Policies help to assure quality care and safe practice

by providing guidelines for nursing actions in
particular circumstances
 Key Components of an Effective Clinical
Policy
First, understand the difference between a policy,
procedure and a standard:
Policy – a statement of expectations that set the
boundaries for action taking and decision making.

Procedure – a step by step process of how a

particular activity/task is to be completed

Standard – a predetermined, authoritative

statement that detail the level of excellence that
serves as a guide for practice
COMPANY NAME POLICY & PROCEDURE

Subject Title: Manual Section Number/Page

RESTRAINTS

Approved By: Date Issued: 03/08/05

Date Revised:15/08/05
Date Revised:
Date Approved: Date Revised:

POLICY:
Restraints (chemical / physical) are used under certain conditions for
specified duration at (Company Name). This is in compliance with,
charter of patient rights and obligation.
PURPOSE:
Protect medical personnel, other patients, visitors and the patient from
injury.
Prevent damage to property / assets.
Ease of treatment by clinicians.
PROCEDURE:
Restraints are to be used ONLY in fully documented emergencies, or as
authorized in writing after examination by a patient’s physician /
authorized office for a specified and limited period of time and only when
necessary to protect him/her from self injury or injuring others (charter
of patient rights and obligation 5.2).
Assessing Effectiveness of Clinical Policy
Estimate the behavioural responses to the
policy
Determine the efficiency of policy measures
(cost-benefit analysis)
Determine the impacts of policy measures
Measure the impact of the policy
Assess the consumer response
Determining the efficiency of policy
measures (cost-benefit analysis)
It is necessary to determine whether the economic
costs of implementing the policy are outweighed by
the benefits.
For the policy to be beneficial to the society, the net
benefits must be positive.
 Define the objectives and scope to the policy
 Identify and screen the alternatives
 Identify and value the costs and benefits for the
remaining alternatives
 Rank the alternatives in order of preference
 Conduct a risk analysis for the preferred alternative(s)
 Make a final recommendation
Measuring the impact of the policy
The impact of a policy may be defined as
changes in the quality and/or supply of a
service that result from the policy.
Types of Impact
Types of Impacts Description
Positive normally referred to as benefits

Negative referred to as damages

On-site occurs on the site where the policy is

applied

Off-site occurs off the project site

Physical exposure to carcinogenic or other

hazardous substances

Social and Economic lost income, employment generation,

displacement of people

Psychological increased stress as a result of

implementation of the policy
Types of Impact
Types of Impacts Description

Short-termed impacts that can occur at the onset of or soon

after the policy is put in place

Long-termed • impacts that extend several years after the

policy
• some impacts may be irreversible

Internal • impacts that are reflected in the prices or

costs of services
• only affect the consumers or providers of
care

External impacts not reflected in prices or which affect

those directly involved as consumers or
providers of care
Assessment
Do not stop after the implementation on the policy

Assess effectiveness at 1 to 3 months (short term)

Assess effectiveness at 3 months to 1 year (long

term)

Evaluate over a longer period (1 to 3 years)

Assessment data assist in justifying changes to the

policy

Revise policy after 3 years if necessary

Framework for Evidence-based Policy
Any framework should share the following characteristics:
It tests a theory as to why the policy will be effective and
what the impacts of the policy will be if it is successful
Inclusion of a counterfactual: what would have occurred
if the policy had not been implemented
They incorporate some measurement of the impact
Examines both direct and indirect effects that occur
because of the policy
Separates the uncertainties and controls for other
influences outside of the policy that may have an effect
on the outcome
Should be able to be tested and replicated by a third
party
Policies related to Risk Management

Patient falls
Restraints
Harassment
Patient abuse
Discrimination
Occupational health and safety

Question: Name other risk management

policies that you have encountered in the
clinical area?
THE END

THANK YOU