Ch #23: Quality Control

Quality Control - Definition

• A process through which a business seeks to ensure that products quality is maintained or improved

Quality Control - Purpose in Healthcare

• Create a culture of patient safety

• Allow patient healthcare goals to be met

Quality Control is the … and final step of the management process?

• 5th

Quality Control - IOM Definition

• Degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge

Quality Control - IOM Domains

• Effectiveness → Achieving outcomes

• Efficiency → Maximizing the quality of care delivered

• Equity → Equal quality of care for all

• Patient Centeredness → Meeting patient need and preferences and providing education and support

• Safety → Avoiding harm

• Timeliness → Minimizing delays

Quality Control - 3 Step Process

• Standard is determined

• Information is collected to determine if standard has been met

• Educational or corrective action is taken if criteria is not met

Quality Control - 8 Step Process

Who/what sets the standards for nursing to achieve quality control?

• Professionally → ANA Scope and Standards of Practice

• Organizationally → Varies

• Generally → Clinical Practice Guidelines (CPGs)

Clinical Practice Guidelines (CPGs) - Definition

• Provide diagnosis based step by step interventions for providers to follow to promote high quality care while controlling resource utilization and costs

Benchmarking - Definition

• Process of measuring products, practices, and services against best performing organizations

• Serves as role model for standard development and performance improvement

Benchmarking - Purpose

• Allows organizations to determine how and why performance differs from exemplar organizations

• Can identify quality gaps

Quality Gap - Definition

• Difference in performance between top performing organization and national average

Audits are a form of …?

• Quality Control tool

Structure Audits - Definition

• Monitor structure or setting patient care occurs in

• Assumes connection between environment of care and quality

• Ex: Staffing ratios or mix, ED wait times, availability of fire extinguishers

Process Audits - Definition

• How is care provided?

• Assumes connection between process and quality of care

• Compare to critical pathways or standardized CPGs

• Ex: Did we check fetal heart tones to protocol? Check BPs according to protocol?

Outcome Audits - Definition

• Result of care directly correlated to interventions

• Assumption is that outcome will demonstrate quality of care

• Ex (General): Morbidity and mortality, reduced CAUTIs, hospital LOS

• Ex (Nursing): Fall rates, nosocomial infection rates, pressure injuries, restraint use, patient satisfaction rates

Quality Control - Organizations/Things that Influence

• Press Ganey National Database of Nursing Quality Indicators (NDNQI)

• Diagnosis Related Groups (DRGs)

• Sentinel Event Reporting

• ORYX and JC’s Agenda for Change

• Medication Reconciliation Process

• Centers for Medicare and Medicaid Services (CMS)

• Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS)

• National Committee for Quality Assurance (NCQA)

Press Ganey National Database of Nursing Quality Indicators (NDNQI) - Role in QC

• Database of 600+ nursing sensitive indicators of quality for acute and ambulatory care settings

  • Includes RN performance, patient and workforces experience, and health outcomes

Diagnosis Related Groups (DRGs) - Role in QC

• System used to categorize patients with similar diagnoses in order to better control hospital costs and determine payor reimbursement rates

Sentinel Event Reporting - Role in QC

• Patient safety even that reaches patient and results in death, permanent harm, or sever temporary harm and intervention is required to sustain life

  • Database to keep track of serious adverse events

ORYX and JC’s Agenda for Change - Role in QC

• Set of initiatives directed at modernizing the accreditation process

• Focus shifts from organizational performance and outcomes

• Develops clinical indicators to measure QC

Medication Reconciliation - Role in QC

• Process to prevent medication errors at patient transition points

• Can reduce discrepancies and errors

Other ways to avoid medication errors include …?

Centers for Medicare and Medicaid Services (CMS) - Role in QC

Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) - Role in QC

• 32 item survey to measure patient’s perceptions of their hospital experience

National Committee for Quality Assurance (NCQA)

• Private, nonprofit organization for managed care organizations

• Developed HEDIS