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QUALITY INDICATOR IN NURSING.pptx
1. D R . A N J A L A T C H I M I T H U K U M A R A N
V I C E P R I N C I P A L
E R A C O L L E G E O F N U R S I N G
E R A U N I V E R S I T Y , L U C K N O W - 2 2 6 0 0 3
QUALITY INDICATOR IN
NURSING
2. INTRODUCTION
Quality indicators are the means to judge the real
performance of certain clinical as well as managerial
parameters selected for monitoring and evaluation.
The Quality Indicators (QIs) are measures of health
care quality that make use of readily available
hospital inpatient administrative data.
3. Meaning of quality indicator in nursing
Quality Indicators (QIs) are standardized, evidence-
based measures of health care quality that can be used
with readily available hospital inpatient administrative
data to measure and track clinical performance and
outcomes.
4. Meaning of quality indicators in NABH
Quality Indicators are the backbone on which
quality assurance program of a hospital
relies.
NABH ( National Accreditation Board for Hospitals
& Healthcare Providers) accreditation expects
hospitals to calculate several quality indicators and
use it for monitoring the quality of care.
Checklist for quality indicator as per NABH
5. SUMMARY OF STANDARDS
NQI.1 There is a structured quality improvement and
continuous monitoring program for nursing service.
NQI.2 The organization identifies key indicators to
monitor the structures, processes and outcomes,
which are used as tools for continual improvement
for nursing services.
6. STANDARD CONTINUED
NQI.3 The nursing quality improvement program is
supported by the management
NQI.4 There is an established system for nursing
audit
NQI.5 Incidents, complaints and feedback from
nursing professionals are collected and analyzed to
ensure continual quality improvement.
7. NQI.1
STRUCTURED QUALITY IMPROVEMENT AND
CONTINUOUS MONITORING PROGRAMME
Objective
The quality improvement program is developed,
implemented and maintained by a committee with a
representative from nursing personnel
Elements Interpretation
There is need for a formal controlled documentation.
This will be aligned with the organizations quality
improvement program
Remarks
At minimum, a “nursing manual” shall be established.
8. CONTINUED
Objective
There is a designated individual for coordinating and
implementing the nursing quality improvement
program.
Elements Interpretation
Self explanatory
Remarks
This individual shall necessarily be a senior and
experienced nursing professional preferably with
exposure to NABH and quality standards
9. CONTINUED
Objective
The quality improvement program shall be reviewed
at periodic intervals.
Elements Interpretation
Self explanatory
Remarks
It should be reviewed and updated at least once
every year.
10. NQI 2
IDENTIFICATION OF KEY INDICATORS
Objective
The patient falls are monitored and the incident of
patient falls is documented by the appropriate nursing
professionals.
Elements Interpretation
The factors responsible for patient fall can be classified
as under
1) Nursing related
2) Patient related unbalanced or unsteady gait,
incorrect use of equipment.
3) Falls requiring medical intervention.
Remarks
Self explanatory
11. CONTINUED
Objective
The hospital acquired decubitus/pressure ulcers in
various departments are monitored and recorded as
per laid down protocols by the HCO
Elements Interpretation
Self explanatory
Remarks
Self explanatory
12. CONTINUED
Objective
The medication errors during provisioning of care
are monitored and recorded on occurrence by the
concerned nursing staff in forms as laid down by the
HCO
Elements Interpretation
Self explanatory
Remarks
Self explanatory
13. CONTINUED
Objective
Monitoring of accidental declining ( If applicable)
Elements Interpretation
Self explanatory
Remarks
Self explanatory
14. CONTINUED
Objective
All needle stick injuries are documented and
monitored as per the policy laid down by the HCO
that should be in consonance with the national and
international guidelines.
Elements Interpretation
Self explanatory
Remarks
Self explanatory
15. CONTINUED
Objective
All extravasations are recorded and monitored as per
the laid down protocols.
Elements Interpretation
Self explanatory
Remarks
Self explanatory
16. CONTINUED
Objective
The hand hygiene compliance is monitored and
recorded by the nursing professional responsible for
the same.
Elements Interpretation
Self explanatory.
Remarks
The monitoring should be as per the criteria
identified by the WHO guidelines on hand hygiene.
Self explanatory
17. CONTINUED
Objective
All restraint related incidents are monitored and
documented
Elements Interpretation
Self explanatory
Remarks
Self explanatory
18. CONTINUED
Objective
The compliance with pain assessment and
management is monitored by the senior nursing
professional while undertaking their professional
rounds and the same is documented.
Elements Interpretation
Self explanatory
Remarks
Self explanatory
19. CONTINUED
Objective
The satisfaction of patients with the nursing care is
monitored by the senior nursing professionals and
the same is documented.
Elements Interpretation
Self explanatory
Remarks
Self explanatory
20. NQI 3
NURSING QUALITY IMPROVEMENT PROGRAMME
Objective
The management makes available adequate
resources required for quality improvement
program.
Elements Interpretation
This shall include the men, material, machine,
money and method.
Remarks
These should be in steady supply so as to ensure that
the program functions smoothly
21. CONTINUED
Objective
The management supports and implements use of
appropriate quality improvement, statistical and
management tools in its quality improvement program.
Elements Interpretation
Self explanatory
Remarks
For example, Root Cause Analysis, FMEA, Project
Evaluation and Review Technique (PERT), Critical Path
Method(CPM) control charts, etc.
22. CONTINUED
Objective
The senior nursing professionals as delineated by the
HCO also monitor the nursing satisfaction based on
pre determined criteria in consultation with human
resource department of the HCO
Elements Interpretation
Self explanatory
Remarks
Self explanatory
23. CONTINUED
Objective
The attrition rate and frequency of attrition of the
nursing professional is monitored and documented
by the head of the nursing in consultation with the
human resource department of the HCO
Elements Interpretation
Self explanatory
Remarks
Self explanatory
24. NQI 4
ESTABLISHED SYSTEM FOR NURSING
AUDIT
Objective
The parameters to be audited are defined by the organization As
these audits are retrospective/ concurrent in nature. It is imperative
that this be done using predefined parameters so that there is no
bias.
Elements Interpretation
The parameters could be disease based, nursing protocol based,
nursing documentation based, cost based, community based or
based on morbidity ( length of stay) It shall lay down the objectives,
the parameters that are going to be captured, develop a checklist
where required, sampling and data collection guidelines and
preparation of report.
Remarks
The audit shall encompass all aspects of care including clinical and
nursing
25. CONTINUED
Objective
Patient and staff anonymity is maintained. This means
that the names of the patients and the hospital staff who
may figure in the audit documents must not be disclosed
or any reference be made to them in public discussion/
conferences.
Elements Interpretation
This is at the stage of report preparation and
dissemination.
Remarks
The staff participating in the audit shall maintain patient
and staff anonymity and not reveal names
26. CONTINUED
Objective
All audits are recorded and reviewed
Elements Interpretation
Self explanatory
Remarks
The organization could use a checklist with the
predefined parameters and the audit findings could
be recorded on this sheet.
27. CONTINUED
Objective
Implementation is recorded and reviewed.
Elements Interpretation
All remedial measures as ascertained should be
documented and implemented and improvements
there of recorded to complete the audit cycle.
Remarks
This should preferably be done based on root cause
analysis.
28. NQI.5
COLLECTION & ANALYSIS OF INCIDENTS,
COMPLAINTS AND FEEDBACK
Objective
The organization has an incident reporting system The
incident reporting system includes :-
Elements Interpretation
a) Identification
b) Reporting
c) Review
d) Action on incidents.
Remarks
These could be members of the core committee/ nursing
quality assurance committee, etc.
29. CONTINUED
Objective
Corrective and preventive action are taken based on
the findings of such analysis.
Elements Interpretation
The objective of this is to continually improve the
quality of patient-care services.
Remarks
All such action shall be documented.
30. CONTINUED
Objective
The organization has a process to collect feedback
and receive complaints
Elements Interpretation
Self explanatory
REMARKS
This shall be communicated to the patients using
displays or brochures
31. CONTINUED
Objective
The organization has established processes for
analysis of incidents, feedbacks and complaints.
Elements Interpretation
The quality improvement committee shall be
responsible for this activity
Remarks
This could preferably be done by identifying the root
cause where possible; it is preferable that patients be
included in analyzing the feedback and complaint.
32. NQI.5
COLLECTION & ANALYSIS OF INCIDENTS, COMPLAINTS AND
FEEDBACK
Objective
Feedback about care and service is communicated to
staff.
elements Interpretation
At a minimum, patient satisfaction levels shall be
communicated on a monthly basis.
Remarks
This could be done using internal communication. It
is equally important that positive feedback about
care and services is communicated to staff.
33. Examples of Hospital Quality Measures
for Consumers
Patient safety measure
Effectiveness measure
Patient center measure
Timelines measure
Efficiency measure
Equity measure
34. SUMMARY
Till now we have discussed about quality indicators
of nursing and its significance in nursing care like
introduction, meaning, checklist for NABH, standard
of NQI 1-5 , example of quality measure etc. I hope
you all understand the quality indicator of nursing
measure. If you all get chance to work quality
standard will you able to apply this knowledge
confidently.
35. CONCLUSION
System for monitoring and measurement of nursing
quality standards shall be established
Statistical review and analysis of trends shall be
reviewed by the organization.
These act as tools for excellence in nursing care
delivery and satisfaction with nursing care amongst
patients.
Contributes to overall improvement in quality of care
36. References
NABH standard 5th edition from QCI , India.
NABH standard 4th edition from QCI , India
Licenses ,documents for establishment hospital
Quality indicator of hospital measure