Healthcare Quality Assurance in Nursing: Elements & Steps

Controlling the quality of an institution is crucial to correcting its course when performance fails due to deviating from acceptable frameworks, often a result of ineffective supervision, which may prevent the organization from achieving its goals. Therefore, quality control is necessary to organize, monitor, test, and adjust performance. Quality assurance in nursing can be defined as the process of establishing a target level of quality and implementing the necessary procedures to ensure the patient receives that agreed-upon level of care.

Elements of Healthcare Quality Assurance in Nursing

The elements of quality assurance can be summarized as follows:

• Structural Element: This refers to the tools and physical environment through which nursing care is managed. Examples include goals, philosophy, records, policies, operations, financial resources, expectations, equipment, and staff attitudes.
• Process Element: This involves the steps of the nursing process itself, such as diagnosis, planning, evaluation, and implementation, along with all subsystems, including physical examination, health history, writing care plans, treatment, reporting patient responses, care, and task coordination.
• Outcomes: This includes the changes in the patient's health systems resulting from nursing interventions.

Steps of Quality Assurance in Nursing

• Establishing Standards: Standards represent the required amount or level of performance for the quality equation, along with identifying the criteria used to measure that performance. While ANA set general nursing performance standards, each care unit must set specific standards for the patient population it serves. These serve as the foundation for other quality assurance standards and dictate the expected outcomes of nursing care.
• Clarifying Responsibility: Assigning it clearly to a committee or an individual.
• Clarifying the Scope of Care: By creating a list detailing the types of patients served, diagnoses, treatment conditions, the care provided, treatments administered, and the practitioners involved.
• Identifying Important Aspects of Care: Prioritizing the most critical and frequently occurring aspects of care that significantly impact many patients, have severe consequences/risks, or whose improper handling deprives patients of major benefits.
• Specifying Criteria: Determining whether these standards are met and to what extent. Criteria should be specific and critical, representing the value of the variable or quality indicator.
• Data Collection: Achieved through random sampling and continuous monitoring. It is essential to collect reliable data to build a useful database. Monthly samples of no less than 10% of patients should be taken. Data collection methods include personal interviews and patient follow-ups.
• Performance Evaluation: Conducted by monitoring activities, examining patients, and reviewing the records where cases are documented.
• Defining the Problem: Data gathered from reporting and evaluations help identify and clearly define the problem. Evidence is collected through records, rounds, and follow-ups. The nursing director is responsible for investigating any deviations and can gather data to analyze all issues.
• Problem Solving: After analyzing, clarifying, and isolating the problem, solutions based on priorities are formulated. This is a critical step that must prioritize patient safety and well-being.
• Monitoring and Feedback: The effectiveness of changes is a vital step in performance quality and an absolute necessity in the quality assurance process.

Methods of Quality Assurance

The quality assurance program aims to measure and improve the quality of patient service provided by nurses within the organization. This is achieved through the following:

• Nursing Audit: A process to evaluate the quality of nursing service by assessing nursing procedures or care outcomes documented in patient care records.
• Peer Review: A mechanism through which nurses evaluate each other's job performance.
• Patient Care Profile Analysis: Conducted by analyzing cross-sectional and longitudinal complications related to data of patients presenting with a specific problem or diagnosis.
• Quality Circles: Groups of 5 to 15 employees performing similar tasks who meet weekly for an hour to develop solutions to problems they face in their work.
• Patient Satisfaction: Patient satisfaction is utilized as a key indicator of multidimensional quality.
• Providing Feedback to Nurses: It is crucial to provide nurses with feedback regarding their performance during the nursing process.