A quality assurance plan for an epidural analgesia program

A midwestern community hospital established an Acute Pain Service to implement epidural analgesia on the general care units. It developed a multidisciplinary quality assurance plan using the Joint Commission on Accreditation of Healthcare Organizations' 10-step monitoring and evaluation process. Quality assurance monitors provided information regarding important aspects of care. Data collected from the monitors enabled nurses and other disciplines to make decisions and changes about the growing epidural analgesia program.     

CB6-01: Is Quality Assurance a Commodity?

Background/Aims Quality Assurance is a broad term with widely varying expectations about the nature of QA activities. The HMORN Virtual Data Warehouse (VDW) has an expanding set of quality assurance data checks. These checks improve the reliability and consistency of the data across sites. By reviewing several real-world examples, we will step through and evaluate several of the 'FYings' of quality assurance work. Q1: Can we justiFY QA? Q2: Can we codiFY QA? Q3: Can we quantiFY QA? Q4: Can we demystiFY QA? And finally Q5: Can we commodiFY QA? Methods Masking site information, we will review specific examples of current quality assurance work, asking each question for each example. We will then describe each set of QA activities and include tables, graphs, comments, dissemination information, actions (or inactions) that happen after the QA review. Results Quality assurance is definitely a hot topic, although perhaps misunderstood. We often think there are electriFYing moments when we discover and save a project from disaster. We think it will indemniFY our projects from failure. Investigators ediFY it. But have we convinced funders to commodiFY QA? Discussion We will clariFY whether quality assurance is a commodity.     

Quality of health care for women: a demonstration of the quality assessment tools system

BACKGROUND: Consumers, purchasers, and regulators are seeking information on quality for a variety of purposes. To address these demands, methods are required that are flexible in meeting the information needs of different audiences. OBJECTIVES: To test a new clinically detailed, comprehensive approach to quality measurement called Quality Assessment (QA) Tools. DESIGN: Quality measures were developed for women ages 18 to 50 years for preventive care and 17 clinical areas that included chronic and acute health problems. A stratified random sample of women enrolled in 1 of 2 health plans in 1996 to 1997 was drawn and data abstracted from the medical records of all their providers for a 2-year period. FINDINGS: We evaluated quality for 758 women in 2 managed care plans. Quality of care varied substantially depending on the dimension being examined. For example, acute care was significantly better than chronic or preventive care. Quality was highest for follow-up care and lowest for treatment in both plans. Quality by modality ranged from approximately 90% for referral or admission to 16% for education and counseling. We found significant differences between the plans in the quality of care for 7 of the 17 conditions studied. CONCLUSION: The QA Tools system offers an alternative approach to evaluating health system performance. Potential advantages include the richness of the information produced by the system, the ability to create summary scores for consumers and purchasers, and the system-level performance information for use in quality improvement activities.     

循证医学实践与干部医疗保健工作

循证医学实践在临床工作中已取得一定经验，采用循证医学的原理和方法指导干部和老年人群的医疗保健工作是一项全新的课题。不仅对临床医生认识疾病诊治和判断疗效及预后，建立客观合理的健康保健计划具有指导意义。对保健对象获取科学先进的预防保健知识，认知疾病治疗目标和预后，避免不合理和不必要的医疗负荷具有重要意义。同时对卫生行政部门的医疗保健决策也有一定的参考意义。     

A Public Health Quality Assurance System

Quality assurance (QA) systems are commonplace among hospitals. They are even found in home health and health maintenance organizations, but they are less common among public health agencies. This article enumerates the discrepancies between the design of traditional QA and that necessary to meet the needs of a department of health's public health nursing service. It characterizes the subsequent changes that must be inserted into the QA system for it to comply with the mission and services of a public health setting. The system and instruments presented are used in the Baltimore County Department of Health, Public Health Nursing Services.     

General practitioners, complementary therapies and evidence-based medicine: the defence of clinical autonomy

Amidst the substantial change currently gripping primary health care are two developments central to contemporary debate regarding the very nature, territory and identity of general practice - the integration of complementary and alternative medicine (CAM) and the rise of evidence-based medicine (EBM).This paper reports findings from a study based upon 25 in-depth interviews with general practitioners (GPs) personally practising complementary therapies alongside more conventional medicine to treat their NHS patients. The paper outlines the GPs' perceptions of EBM, its relationship to their personal development of CAM, and their notions of good clinical practice more generally. Analysis of the GPs' accounts demonstrates how CAM can be seen as a useful resource with which some GPs defend their clinical autonomy from what they perceive to be the threat of EBM.     

Quality Assurance in Rehabilitation under the German Pension Insurance Scheme

Ten years after its introduction, the German Pension Insurance's quality assurance programme is firmly established within the rehabilitation system. Regular, substantive reporting to rehabilitation centres and pension insurance organisations has contributed to improving the quality of rehabilitation. Legal codification of quality assurance stipulations has existed since 2001. The programme is in constant development, e. g. by optimization of patient interviewing and inclusion of evidence-based clinical practice guidelines. New programmes, e. g. in inpatient rehabilitation of children and youths or in outpatient rehabilitation, are being developed together with the German health care organizations. In the field of vocational rehabilitation quality assurance had started out with a conceptual study followed by projects concerning client interviewing, evaluation of documentation instruments, and analyses relative to the most important outcome factor, namely the vocational reintegration results achieved. External quality assurance is a mayor input factor for the rehabilitation centres' internal quality management. In future, rehabilitation centres will be asked to demonstrate the appropriate use of this information. It will remain the centres' decision which method of quality management system implementation they choose. Quality assurance results of every centre are planned to be made publicly accessible in the medium term, in particular to the insureds. Moreover, the results of the quality assurance programmes are intended to clearly impact the allocation of patients as well as the remuneration of the rehabilitation centres concerned. Quality assurance and quality management will continue to play a major role in the political discussion of health care.     

Quality assurance in a large clinical trials consortium: the experience of the Tuberculosis Trials Consortium

Quality assurance (QA) is essential for data accuracy and proper evaluation of study objectives in clinical trials. The Tuberculosis Trials Consortium (TBTC)-a collaboration of 28 clinical sites and the Centers for Disease Control and Prevention-has developed a comprehensive QA program that provides quantitative assessments of performance based on clearly defined standards that are communicated to data collectors through a feedback process. The Implementation and Quality Committee of the TBTC developed a Site Evaluation Report (SER) that assesses performance measures (PMs) critical to the accomplishment of study objectives. PMs are defined, quantified, and evaluated, and goals and minimum acceptable scores are specified. Sites not meeting a PM minimum must provide an explanation and develop a plan to meet the goal. Site-specific and system-wide problems can be readily identified through this process. The SER is used prospectively for all TBTC treatment trials, and a Web site has been developed to maximize the availability and usefulness of performance data. The TBTC's comprehensive QA program is an example of a successful method for ensuring high quality, evaluable data.     

Evidence‐based medicine: A cornerstone for clinical care but not for quality improvement

Quality improvement (QI) as a clinical improvement science has been criticized for failing to deliver broad patient outcome improvement and for being a top‐down regulatory and compliance construct. These critics have argued that the focus of QI should be on increasing adherence to clinical practice guidelines (CPGs) and, as a result, should be consolidated into research structures with the science of evidence‐based medicine (EBM) at the helm. We argue that EBM often overestimates the role of knowledge as the root cause of quality problems and focuses almost exclusively on the effectiveness of care while often neglecting the domains of safety, efficiency, patient‐centredness, and equity. Successfully addressing quality problems requires a much broader, systems‐based view of health‐care delivery. Although essential to clinical decision‐making and practice, EBM cannot act as the cornerstone of health system improvement.     

Competency in nursing: a concept analysis

Competency is a topic of great interest to educators and administrators in practice disciplines, particularly health care disciplines such as nursing. This article focuses on the role of competency in nursing. Through a concept analysis process, various elements of competency were assessed. The defining attributes of competency are the application of skills in all domains for the practice role, instruction that focuses on specific outcomes or competencies, allowance for increasing levels of competency, accountability of the learner, practice-based learning, self-assessment, and individualized learning experiences. The learning environment for competency assurance involves the learner in assessment and accountability, provides practice-based learning opportunities, and individualizes learning experiences.     

Evidence-based laboratory medicine

Evidence-based medicine (EBM) is a method for solving problems concerning the assessment of laboratory testing in patient care. Practising EBM involves the use of the available evidence to make health care decisions. The best way to practice EBM is the development, validation and implementation of guidelines. Guidelines are considered as the process by which healthcare research and experience are translated into improved patient care. In laboratory diagnostics EBM can be best demonstrated in high-prevalence conditions. Because of the number of patients encountered, high-prevalence conditions have a greater impact on patient morbidity and health care expenditure. In evidence-based laboratory medicine the best evidence comes from systematic reviewing studies of diagnostic tests. The reviewing of diagnostic trials and the development of good practice guidelines on the basis of these studies must be an important task of the scientific associations of clinical chemistry and laboratory medicine.     

Needs of nurse educators & clinical nurses regarding quality assurance education

A study was done to determine the needs and educational interest regarding quality assurance of nurses practicing in both academic and clinical settings in Western New York. A written survey questionnaire was developed and distributed to a convenience sample. Responses were received from 98 nurse educators (47% of those contacted) and from 148 clinical area nurses (42% of those contacted). Concepts about quality assurance were itemized and respondents indicated their level of interest in obtaining further information to increase their QA competencies about each. The topics of interest to both groups were similar and included standards of care, legal issues, documentation, techniques for implementation of QA in clinical practice, and measures of quality of care. Characteristics about a continuing education offering that would be desirable were specified.     

A patient satisfaction survey for a rehabilitation unit

The patient satisfaction survey (PSS) collects information on the perception, opinion, or judgment that the patient makes about the hospital experience. Patient satisfaction data is part of a program evaluation for documentation of quality assurance (QA)for the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The PSS information is used to determine patient satisfaction with service, outcome, and post-discharge knowledge, and to improve nursing care as well as the public image of the unit. Rehabilitation units differ from acute care units and, therefore, require a PSS that is specific to the unit. A PSS specific to rehabilitation units is described.     

A comparison of three different quality assurance systems for higher medical training

Quality assurance (QA) of medical training is a growing concern. There have been few studies comparing different methods. A window of opportunity occurred when a Royal College of Physicians (RCP) visit was followed soon after by a pilot of a web-based questionnaire in a deanery which already had a well-developed QA system in geriatric medicine. The different methods of RCP visit, deanery visit and web-based survey were compared. Surveys are easily administered and repeated but may be hindered by poor response rates and lack of corroborating information. Negative aspects can be exaggerated and positive ones overlooked. Trainers' views tend to be underused. Visits consume more time and resources but give a better overview. Each method format was found to have advantages and disadvantages and no one method alone would have picked up all the information. This paper recommends a robust deanery mechanism as a continuous QA mechanism backed up by periodic focused external visits.     

Examining the functionality of the DeLone and McLean information system success model as a framework for synthesis in nursing information and communication technology research

In this review, studies examining information and communication technology used by nurses in clinical practice were examined. Overall, a total of 39 studies were assessed spanning a time period from 1995 to 2008. The impacts of the various health information and communication technology evaluated by individual studies were synthesized using the DeLone and McLean's six-dimensional framework for evaluating information systems success (ie, System Quality, Information Quality, Service Quality, Use, User Satisfaction, and Net Benefits). Overall, the majority of researchers reported results related to the overall Net Benefits (positive, negative, and indifferent) of the health information and communication technology used by nurses. Attitudes and user satisfaction with technology were also commonly measured attributes. The current iteration of DeLone and McLean model is effective at synthesizing basic elements of health information and communication technology use by nurses. Regardless, the current model lacks the sociotechnical sensitivity to capture deeper nurse-technology relationalities. Limitations and recommendations are provided for researchers considering using the DeLone and McLean model for evaluating health information and communication technology used by nurses.     

临床流行病学和循证医学的学科建设

临床流行病学是在临床医学领域内引入现代流行病学和统计学方法，从患病个体诊治扩大到患病群体研究，以探讨疾病病因、预防、诊断、治疗、预后等规律的临床基础学科。循证医学的核心思想是通过检索、评价和应用证据，结合医生技术经验和患者的具体情况，经医患共同决策作出符合患者需求的利大于弊的诊疗决定。加拿大McMaster大学的David Sackett及其学生Gorden Guyatt先后对临床流行病学这门学科的建立、完善和传播，对循证医学概念的提出、发展和推动，起到了里程碑式的作用。20世纪80年代初，我国第一批追随David Sackett的医生方法学家引入了临床流行病学的核心思想，即临床研究的设计、测量和评价，90年代又引入了循证医学的理念。30年来，临床流行病学和循证医学在我国生根、发芽、开花、结果，对我国现代医学的发展起到了巨大推动作用。在全面建设“健康中国”的新时代，加强临床流行病学和循证医学的学科建设刻不容缓。     

Evaluation research in care of the elderly. Some Swedish experiences

Research projects in order to evaluate social and health care programmes are unusual in Sweden. Evaluation studies have had little or no discernible effect on the planning of services for the elderly which is largely the product of convention rather than rational thinking. It is difficult to carry out evaluation studies in a field that is rapidly changing. The variations in elderly care between different areas, between institutions and over time makes it difficult to devise general methods of evaluation. Of five recent and current Swedish studies two are treating innovations inside institutions, two deal with innovations outside institutions and one is a relocation study. One thing common to these studies is that they are administered by university departments. However, evaluation is too important to be a matter just for university disciplines. We should also encourage local initiatives to start more evaluation of 'their' interventions. It will then be a task for more centrally placed researchers to educate and guide the administrators and representatives from other areas in what respects the result of a local study can be generalized.     

Quality assurance and the critical care nurse

Care of the critically ill has become increasingly challenging due to demands from external sources to measure the quality and appropriateness of care provided. Quality assurance is the responsibility of every critical care nurse and requires vigilance as well as a knowledge of the principles of standards, monitoring and evaluation. Through quality assurance activities, the contribution of critical care nurses in the achievement of patient outcomes can be measured. Quality assurance challenges us to evaluate the way we practice, and assists us to continuously improve the way we provide care to critically ill patients.     

The role of health informatics in clinical audit: part of the problem or key to the solution?

The concepts of quality assurance (for which clinical audit is an essential part), evaluation and clinical governance each depend on the ability to derive and record measurements that describe clinical performance. Rapid IT developments have raised many new possibilities for managing health care. They have allowed for easier collection and processing of data in greater quantities. These developments have encouraged the growth of quality assurance as a key feature of health care delivery. In the past most of the emphasis has been on hospital information systems designed predominantly for the administration of patients and the management of financial performance. Large, hi-tech information system capacity does not guarantee quality information. The task of producing information that can be confidently used to monitor the quality of clinical care requires attention to key aspects of the design and operation of the audit. The Myocardial Infarction National Audit Project (MINAP) utilizes an IT-based system to collect and process data on large numbers of patients and make them readily available to contributing hospitals. The project shows that IT systems that employ rigorous health informatics methodologies can do much to improve the monitoring and provision of health care.     

Health care managers' and administrators' roles, functions, and responsibilities.

Health care managers and administrators are increasingly assuming leadership and management responsibilities for multiple units and departments. To determine key roles, functions, and responsibilities of nursing and other health care managers and administrators, a survey was conducted to identify the perceived importance and amount of time these individuals devote to selected activities. Although the amount of time and perceived importance of selected activities varied with each environmental context, some key roles, functions, and responsibilities across practice disciplines did emerge. Regardless of the environmental context, administrators and managers at all levels in health care organizations spend significant amounts of time and place high value on communication, problem solving and decision making, collaboration with other disciplines, people development, and cost containment.