Nursing Role in Implementing Quality and Patient Safety

1. Nursing Role in Implementing Quality and Patient Safety

2. Introduction � Nurses determine the quality of care received by people minute by minute, every day, every where� Norma M. Lang Dr. Lisa Harris (Regenstrief Institute for medical Informatics) indicates that >60% of patients� satisfaction with the care they receive in acute care settings is directly related to interaction with nurses.

3. Introduction Nurses represent the largest segment of caregivers in the health care system. In US there are two million registered nurses, representing more than 13 percent of American health care and social assistance workers according to may 2005 figures the U.S Department of Labor.

4. Introduction 85% of errors are detected by nurses Nurses make up 54% of health care providers 30%-35% of workforce

5. General Questions What is Quality health Care? What do science and best practices tell us? What is valued and by whom? How is it measured in terms of process and outcomes? How much can we afford?

6. History of Quality in Health Care He was an advocate of hospital reform and is the acknowledged founder of what today is known as outcomes management in patient care. It was his lifelong pursuit to establish an "end results system" to track the outcomes of patient treatments as an opportunity to identify clinical misadventures that serve as the foundation for improving the care of future patients. He also believed that all of this information should be made public so that patients could be guided in their choices of physicians and hospitals. The American College of Surgeons is an educational association of surgeons created in 1913[1] to improve the quality of care for the surgical patient by setting high standards for surgical education and practice. He was an advocate of hospital reform and is the acknowledged founder of what today is known as outcomes management in patient care. It was his lifelong pursuit to establish an "end results system" to track the outcomes of patient treatments as an opportunity to identify clinical misadventures that serve as the foundation for improving the care of future patients. He also believed that all of this information should be made public so that patients could be guided in their choices of physicians and hospitals. The American College of Surgeons is an educational association of surgeons created in 1913[1] to improve the quality of care for the surgical patient by setting high standards for surgical education and practice.

7. The History of Improving

8. What is Quality? Quality means doing the right things right the first time. Quality can be said to be, at least in part, compliance with standards. Standards are created when experts are able to understand what the right things are and how the right things are best achieved based on Research and Clinical Evidence

9. What is Quality? The Institute of Medicine defines quality as: "The degree to which health care services for individuals and populations increase the probability of desired health outcomes and are consistent with current professional knowledge of best practice."

10. What is Quality? The Joint Commission defines the quality as �the degree to which patient care services increases the probability of desired outcomes and reduce the probability of undesired outcomes given the current state of knowledge

11. Principles of Quality Improvement Population & Clients Know who we serve

12. Dimensions of Quality Appropriateness. Continuity. Effectiveness. Efficiency Respect and caring. Environment and Safety. Timeliness.

13. 13 This is the quality cycle first introduced by the USAID Quality Assurance Project and later modified utilized by a number of countries world-wide. It identifies four areas or major steps in quality; quality design (steps 1-3); quality control (steps 4-5); quality improvement (steps 6-10); and quality management (the whole cycle).This is the quality cycle first introduced by the USAID Quality Assurance Project and later modified utilized by a number of countries world-wide. It identifies four areas or major steps in quality; quality design (steps 1-3); quality control (steps 4-5); quality improvement (steps 6-10); and quality management (the whole cycle).

14. Quality and Cost

16. Facts Quality can be improved by utilizing available resources and even decrease required resources Quality not luxury, its essential to improve services and utilization of resources

17. What is accreditation? Accreditation is a process in which an entity, separate and distinct from the health care organization, usually nongovernmental, assesses the health care organization to determine if it meets a set of requirements (standards) designed to improve the safety and quality of care. Accreditation is usually voluntary. Accreditation standards are usually regarded as optimal and achievable.

18. The benefits of accreditation The accreditation process is designed to create a culture of safety and quality within an organization that strives to continually improve patient care processes and results. In doing so, organizations improve public trust that the organization is concerned for patient safety and the quality of care, provide a safe and efficient work environment that contributes to worker satisfaction; negotiate with sources of payment for care with data on the quality of care;

19. Cont� The benefits of accreditation listen to patients and their families, respect their rights, and involve them in the care process as partners; create a culture that is open to learning from the timely reporting of adverse events and safety concerns; and establish collaborative leadership that sets priorities for and continuous leadership

20. What is the JCI Manual and JCI standards? The JCI Healthcare Accreditation Manual based on two functional sections with 14 chapters (329 Standards and 1162 Measurable Elements)

21. What is the standard in JCI manual ? A standard is a statement of expectation that defines the structures and processes that must be substantially in place in an organization to enhance the quality of care.

22. JCI Accredited hospitals Total 277 hospitals 68 in Arab countries

23. Accreditation Map Health care Accreditation Council (HCAC) hospitals 5 accrdited JCIA hospitals . 5 accredited 3 prepare

24. Accreditation chapters

25. Patient-Centered Standards International Patient Safety Goals Access to Care and Continuity of Care Patient and Family Rights Assessment of Patients Care of Patients Anesthesia and Surgical Care Medication Management and Use Patient and Family Education

26. Health Care Organization Management Standards

27. Health care advancement in the last century

29. Medication Errors According to the 1999 report of the IOM, "To Err is Human," 1.3 million Americans are affected by errors in health care each year, at least 100 patient deaths occur daily in the US. Add to that the recent assertion that the number may be as high as 195,000 patient deaths each year because of errors. 34% - 38% of such errors during the nurses administration of meditation.

30. To Err is human�.. In NY, adverse events* occurred in 2.9% of hospitalizations In Colorado and Utah the number was 3.7% Of the above 13.6% resulted in deaths in NY and 6.6% in the other states At least 44,000 and up to 98,000 deaths occur per year in the US due to medical errors What is the number in the rest of the world? IOM (2000)

32. Key International Concerns (1 of 2) 3.5-16.6% of hospital patients suffer some sort of preventable harm 25% of medical errors occur when medications are prescribed 50% of all medical equipments in developing countries are unsafe 77% of reported cases of counterfeit and substandard drugs occur in developing countries

33. Key International Concerns (2 of 2) Staggering costs associated with additional hospitalizations, litigation claims, nosocomial infections, lost income, disability and medical expenses Issues seen in developing countries include unsafe blood transfusions, counterfeit and substandard drugs, and overall unreliable practices within poor work conditions. Adverse medical events affect every country, hospital, and health clinic �round the world,� as well as, all healthcare disciplines. (Sources: World Health Professions Alliance Fact Sheet, 2002; Bulletin of the World Health Organization 11 Nov 2004) Adverse events may cost the US $29 billion and the United Kingdom $6 billion annuallyAdverse events may cost the US $29 billion and the United Kingdom $6 billion annually

37. �The Problem Is with the system and the System belongs to Management� D. Edward Deming

38. Medication Management Cycle

40. DOCUMENTATION of the care process is CRUCIAL� ACCURATELY COMPREHENSIVELY TIMELY CONTINUOUSLY

41. Documentation� �People lie, people die, but the medical record lives forever.� Author unknown

42. Legibility�

50. Healthcare errors Medication Errors Nosocomial infections Patients falls Pressure sores Phlebitis associated with intravenous lines Restraint related strangulation Preventable suicides Failure to provide prophylaxis

51. Common Challenges

52. Common Challenges---Cont�d

54. �Knowing is not enough; we must apply. Willing is not enough; we must do.� � Goethe