Quality in Health Care

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Quality Assurance in Healthcare:

Quality Assurance in Healthcare State Institute of Health & Family Welfare, Jaipur 1 SIHFW: an ISO 9001:2008 certified institution

Quality ?:

Quality ? Subjective Different meaning to different people Context dictated by situation Need Resources Availability Purchasing Power Individual Perception Expectation 2 SIHFW: an ISO 9001:2008 certified institution

Quality:

Quality Perspective among different Stakeholders Client: Relief from the ailment Service & Treatment with compassion Provider: Offering state of the art-- technical care Outcome comparable to known standards Protection from legal systems Program Manager: Will quality improvement impact utilization? If yes, does the investment justify the return ? 3 SIHFW: an ISO 9001:2008 certified institution

Quality in Health :

Quality in Health More than 100 definitions The Professional Perspective The proper performance (according to standards) of interventions that are- safe, Affordable, and Affect mortality , morbidity, disability, and malnutrition. (Roemer and Aguilar, WHO, 1988 ) The Managerial Perspective Doing the right thing right, right away, right time (Deming ) The Client’s Perspective The ability and capacity of healthcare to satisfy the client’s needs 4 SIHFW: an ISO 9001:2008 certified institution

Quality ?:

Quality ? " Degree to which a set of inherent characteristic fulfills requirements" “Quality is a set of attributes of a service” Quality is “conformance to the norms of Input, Process and Output” Quality is “conformance to the requirements and Customer Satisfaction” 5 SIHFW: an ISO 9001:2008 certified institution

Some common questions:

Some common questions Is quality intangible and difficult to measure ? Are quality concepts applicable to Service industry ? Is quality improvement feasible in public sector? 6 SIHFW: an ISO 9001:2008 certified institution

Quality of Care:

Quality of Care What is Quality? Why Quality? Can it be measured? How can we do assessment? 7 SIHFW: an ISO 9001:2008 certified institution

Myths of Quality :

Myths of Quality Luxury, Costly - not affordable Intangible - not measurable Problems - due to workers Originates from Q. Dept. 8 SIHFW: an ISO 9001:2008 certified institution

Challenges that Quality poses to Health System :

Challenges that Quality poses to Health System Complex systems – clinical standards not enough Capacity to manage these complexities Cultural and organizational challenges Competing power structures 9 SIHFW: an ISO 9001:2008 certified institution

Why Quality?:

Why Quality? Uniformity in Process -Standards and Norms –Reduce Error, Reduce waste , Reduce Cost Accreditation Legal issues –consumer protection Increased motivation, this is what satisfies people Right thing to do (Hippocratic oath) 10 SIHFW: an ISO 9001:2008 certified institution

Why Quality?:

Why Quality? Performance measurement Satisfaction-utilization-economy of scales –cost effectiveness Increases the health status Poor quality can do harm Social and economic benefits 11 SIHFW: an ISO 9001:2008 certified institution

Types of Quality:

Types of Quality Expected Perceived Actual 12 SIHFW: an ISO 9001:2008 certified institution

Perspectives of Quality:

Perspectives of Quality User’s or Client’s Provider’s Manager’s 13 SIHFW: an ISO 9001:2008 certified institution

The Client Perspective:

The Client Perspective “Quality service? Neither I ask nor do I expect too much I simply do not want to wait indefinitely. Yes, if there are some emergencies in between, I might wait But then please keep me informed on that. It should reflect that my Doctor is paying attention, I do not expect an hour from him “Patients don’t care how much you know until they know how much you care” 14 SIHFW: an ISO 9001:2008 certified institution

The Client Perspective:

The Client Perspective “Services and activities that meet the needs of clients in achieving their expectations and outcomes.” Relief from the ailment Service & Treatment with compassion 15 SIHFW: an ISO 9001:2008 certified institution

Determinants of expectations :

Determinants of expectations Nature of medical illness. Past experience in the same set up. Experience at other set up. Financial and social standing. Level of education. 16 SIHFW: an ISO 9001:2008 certified institution

Patient Needs: Hospitalization v/s Hospitality:

Patient Needs: Hospitalization v/s Hospitality Medical Doctor Competent Rationality Evidence based decision Diagnosis Accuracy Cost Timeliness Drugs Safety & Efficacy Cost Availability Non medical Physical facilities Water Sitting Toilets Waiting area Shelter for attendants Food Empathy Communication Documentation 17 SIHFW: an ISO 9001:2008 certified institution

The Provider Perspective:

The Provider Perspective “Services and activities which meet the needs of clients, need to be- Medically safe Professionally ethical, and Accessible, & acceptable to all.” Offering state of the art-- technical care Outcome comparable to known standards Protection from legal systems If you are interested in something, you do it when you have time. If you are committed to something, you make time to do it. 18 SIHFW: an ISO 9001:2008 certified institution

Managers Perspective:

Managers Perspective Doing the right thing right, right away, right time “Services and activities that meet the needs of clients and program goals need to be- Safe Satisfying Affordable Accessible Delivered in a technically competent manner within the socio-cultural context of the country.” 19 SIHFW: an ISO 9001:2008 certified institution

Concepts in Quality:

Quality Management Concepts in Quality Quality Assurance Quality Control 20 SIHFW: an ISO 9001:2008 certified institution

What to expect from Healthcare?:

What to expect from Healthcare? Fundamentally, delivery of healthcare should be: Safe Effective Patient- Centered Timely Efficient Accessible Equitable & Consistent with Good Outcomes 21 SIHFW: an ISO 9001:2008 certified institution

Dimensions of Quality:

Dimensions of Quality Quality Access Appropriateness Continuity Effectiveness Efficiency Responsiveness Safety 22 SIHFW: an ISO 9001:2008 certified institution

Safety:

Safety Examples: The use of protective gears Safe disposal of needles Barrier nursing Isolation? Display - fire and emergency exit routes Anti-skid floors Lighting 23 SIHFW: an ISO 9001:2008 certified institution

Safety:

Safety WHO Solution to Patient Safety Look-Alike, Sound-Alike Medication Names Patient Identification Communication During Patient Handovers Performance of Correct Procedure at Correct Body Site Control of Concentrated Electrolyte Solutions Assuring Medication Accuracy at Transitions in Care Avoiding Catheter and Tubing Misconnections Single Use of Injection Devices Improved Hand Hygiene to Prevent Health Care-Associated Infections 24 SIHFW: an ISO 9001:2008 certified institution

Safety:

Safety The degree to which the risks of injury, infection or other harmful sentinel/adverse outcomes, near miss effects are minimized. Improving Patient safety means…………………. Reducing Medical Errors……. DO NO HARM………… 25 SIHFW: an ISO 9001:2008 certified institution

Improve the safety of using medications.:

Improve the safety of using medications. Goal: Improve the safety of using medications. Requirement: Identify and, at a minimum, annually review a list of look-alike/sound-alike drugs used by the organization, and take action to prevent errors involving the interchange of these drugs. Applies to: Ambulatory Care, Behavioral Health Care, Critical Access Hospital, Home Care, Hospital, Long Term Care, Office-Based Surgery 26 SIHFW: an ISO 9001:2008 certified institution

Medication Safety:

Medication Safety Requirement: Reduce the likelihood of patient harm associated with the use of anticoagulation therapy. Label all medications Medication containers (for example, syringes, medicine cups, basins), or other solutions on and off the sterile field. Applies to: Ambulatory Care, Critical Access Hospital, Hospital, Office-Based Surgery 27 SIHFW: an ISO 9001:2008 certified institution New for 2008

Medication Safety:

Medication Safety Develop policies and /or procedures to address The location Labeling Storage of concentrated electrolytes. Remove the Conc. Electrolytes to avoid inadvertent administration from patients care area, including, but not limited to, the followings: Potassium Chloride Potassium Phosphate Sodium Chloride> 0.9% 28 SIHFW: an ISO 9001:2008 certified institution

Slide 29:

Competence Technical Managerial Communication Effectiveness Ability to attain the greatest improvements in health achievable by the best care Efficiency Ability to lower the cost of care without decreasing attainable improvements in health. Acceptability Conformity to the wishes, desires and expectations of patients and responsible members of their families. 29 SIHFW: an ISO 9001:2008 certified institution

Patient Identification:

Patient Identification Requirement : Use at least two patient identifiers when providing care, treatment or services at: Giving medications Giving blood and blood products Taking blood samples Taking other samples for clinical testing Providing treatment or procedure Patient’s room can not be used as an identifiers Applies to: Ambulatory Care, Assisted Living, Behavioral Health Care, Critical Access Hospital, Disease-Specific Care, Home Care, Hospital, Lab, Long Term Care, Office-Based Surgery 30 SIHFW: an ISO 9001:2008 certified institution

Patient Identification:

Patient Identification Requirement : Prior to the start of any invasive procedure, conduct a final verification process, (such as a “time out,”) to confirm the correct patient, procedure and site, using active—not passive—communication techniques. Applies to: Assisted Living, Home Care, Lab, Long Term Care 31 SIHFW: an ISO 9001:2008 certified institution

Patient Identification:

Patient Identification Information for two identifiers include Name ID No. Birth date, address Different identifiers can be used in different settings If patient can speak and wrist band is available, use the 2 identifiers on wristband For unidentifiable patients, use Patient X until identification made and follow hospital Policies & Procedures for these patients, if present Documents collaboration efforts in the development of policy 32 SIHFW: an ISO 9001:2008 certified institution

Access: :

Access: Access - Services at the right place and right time irrespective of income, culture, geography Examples: Ramps Availability of staff Services to the entire population regardless of …. Outreach services 33 SIHFW: an ISO 9001:2008 certified institution

Appropriateness:

Appropriateness Services designed around needs of client groups and skills and knowledge to provide services 34 SIHFW: an ISO 9001:2008 certified institution

Effectiveness:

Effectiveness The degree to which desired results (outcomes) of care are achieved Examples: HIV patient – ART prolonged second stage labor - c-section; a pregnant woman - in Malaria endemic area - presumptive treatment persistent fever - blood smear to confirm 35 SIHFW: an ISO 9001:2008 certified institution

Efficiency of Service Delivery:

Efficiency of Service Delivery The ratio of the outputs of services to the associated costs of producing those services. Examples: Bulk processing in the lab Growth monitoring clubbed with routine immunization (MCHN Day) Sufficient instruments reducing frequency of sterilization Use of FEFO (first expiry, first out) – wastage and expiry SIHFW: an ISO 9001:2008 certified institution 36

Basic premise of quality of services:

Basic premise of quality of services Improved Service Quality Increased Client Satisfaction Increased Loyalty Increased Utilization of Services Increased Revenue Increased Cure Rate Improved Health (Reduced Morbidity & Mortality) 37 SIHFW: an ISO 9001:2008 certified institution

Goals of Quality Improvement:

Goals of Quality Improvement 38 SIHFW: an ISO 9001:2008 certified institution

Principles of improving Quality :

Principles of improving Quality Transparency – sharing information Ethical practice – professionalism Evidence-based practice – science Top-down and bottom-up – balance From blame to improvement – culture Accountability – everybody’s business Information sharing and communication - brings sustainability 39 39 SIHFW: an ISO 9001:2008 certified institution

Strategies for improvement:

Strategies for improvement Empowering consumers Professional development Institutional development Management development Clinical practice development 40 40 SIHFW: an ISO 9001:2008 certified institution

PDCA of Quality Cycle(Deming cycle) :

Develop/revise: standards/goals Implement Evaluate Review & improve PDCA of Quality Cycle (Deming cycle) SIHFW: an ISO 9001:2008 certified institution 41

Quality - Services and Systems:

Quality - Services and Systems National National and Regional Institutional Individual 42 SIHFW: an ISO 9001:2008 certified institution

Three Measures of Quality (Donobedian’s Model):

Three Measures of Quality ( Donobedian’s Model) Structures& Inputs Human and physical resources Equipments/supplies Organizational settings Processes& Outputs All processes and activities required to be undertaken to deliver medical/health care,--- timeliness, readiness standards, behavior, management. Outputs & Outcomes Results of care processes Impact on morbidity , mortality & quality of life Patient’s satisfaction levels 43 SIHFW: an ISO 9001:2008 certified institution

How can Quality be assured:

How can Quality be assured Define Standards Norms Guidelines Measure Variations Improve Compliance with norms 44 SIHFW: an ISO 9001:2008 certified institution

Approach? :

Approach ? The Paradigm Shift in Quality From we know best what is good for you To customer orientation, From finished product evaluation To continuous improvement, From inspection and control To self assessment. 45 SIHFW: an ISO 9001:2008 certified institution

Improving Quality: Approaches:

Improving Quality: Approaches Traditional Norms Trainings Aids Quality Assurance Team work Process analysis Data Monitoring Collaborative Change process Sharing experience Competition Best practices 46 SIHFW: an ISO 9001:2008 certified institution

Quality Improvement Aspects:

Quality Improvement Aspects Rationalization of service norms – infrastructure, equipment, manpower Monitoring and Performance evaluation Housekeeping/ ‘hotel’ functions Behavior change of service providers Quality enhancement of processes Certification & Accreditation 47 SIHFW: an ISO 9001:2008 certified institution

Improving Quality: Six sigma approach:

Improving Quality: Six sigma approach Define Measure Analyze Improve Control Modify Design Redesign Yes No 48 SIHFW: an ISO 9001:2008 certified institution

Indicator – Judges correctness of the process :

Indicator – Judges correctness of the process Dia gnosis and treatment is a process It has its input and output judged by indicator Process has its owner It should have a certain procedure with the possibility of an individual decision making Minimal standard level of the diagnosis and treatment- not defined 49 SIHFW: an ISO 9001:2008 certified institution

Key processes/sub processes (ISO 9001:2000) focused on quality of care and indicators :

Key processes/sub processes (ISO 9001:2000) focused on quality of care and indicators Measurement, monitoring and improvement Monitoring and measuring of provided health care outcomes Customer satisfaction Internal audit Monitoring and measurement of process Monitoring and measurement of product (provided health care outcome) Control of nonconforming quality of health status 50 SIHFW: an ISO 9001:2008 certified institution

Slide 51:

Validation of data/quality indicators and indicators of conformity in relation to achieved results and progress of health all over the world Improvement Continual improvement Corrective action Preventive action 51 SIHFW: an ISO 9001:2008 certified institution

Criteria for good quality Indicators:

Criteria for good quality Indicators The overall importance of the aspects of quality being measured Burden of disease Effectiveness of the intervention The scientific soundness of the measures The feasibility of collecting data on the indicators 52 SIHFW: an ISO 9001:2008 certified institution

Some Indicators of Quality:

Some Indicators of Quality Waiting Time (not > 30 mts .) No. of dehydration deaths in Diarrhea No. of IPD admissions(not > 10 % OPD) No. of cases with Hb . > 10 gm% given blood No. of repeat X-rays ( not >10 %) No of enteric cases developing enteric ulcers 53 SIHFW: an ISO 9001:2008 certified institution

Some Indicators of Quality:

Some Indicators of Quality No. of LAMA cases Average Length Of Stay No. of cases developing abscess after injection Surgeries postponed No. of new born where birth wt. not recorded Dropouts between DPT 1 & DPT 3 54 SIHFW: an ISO 9001:2008 certified institution

Determinants of Customer Satisfaction:

Determinants of Customer Satisfaction Basic, Performance, Delight. 55 SIHFW: an ISO 9001:2008 certified institution

Determinants of Customer Satisfaction:

Determinants of Customer Satisfaction Basic Factors. ( Dissatisfiers , Must have.) Cause dissatisfaction if they are not fulfilled, ( Doctor not there, Lab. not functional) But do not cause customer satisfaction if they are fulfilled (or are exceeded).(Staff in uniform, signage) 56 SIHFW: an ISO 9001:2008 certified institution

Determinants of Customer Satisfaction:

Determinants of Customer Satisfaction Excitement Factors. (Satisfiers, Attractive) Increase customer satisfaction if Delivered (clean facilities, reduced wait time) Do not cause dissatisfaction if they are not delivered. 57 SIHFW: an ISO 9001:2008 certified institution

Determinants of Customer Satisfaction:

Determinants of Customer Satisfaction Performance Factors. Cause satisfaction if the performance is high, (low infection rate, home visits for ANC) Cause dissatisfaction if the performance is low. Directly connected to customers’ explicit needs and desires 58 SIHFW: an ISO 9001:2008 certified institution

Determinants of Customer Satisfaction:

Determinants of Customer Satisfaction Indifferent attributes. The customer does not care about this feature. (RO water, horticulture) Questionable attributes. It is unclear whether this attribute is expected by the customer.(escort presence) Reverse attributes. The reverse of this product feature was expected by the customer. (surgery in time) 59 SIHFW: an ISO 9001:2008 certified institution

Improve Communication:

Improve Communication Goal: Improve the effectiveness of communication among caregivers. Requirement: For verbal or telephone orders or for telephonic reporting of critical test results, verify the complete order or test result by having the person receiving the information record and "read-back" the complete order or test result. Applies to: Ambulatory Care, Assisted Living, Behavioral Health Care, Critical Access Hospital, Disease-Specific Care, Home Care, Hospital, Lab, Long Term Care, Office-Based Surgery 60 SIHFW: an ISO 9001:2008 certified institution

Improve Communication:

Improve Communication Ensure that there is collaborative process to determine what critical results are Clinical Laboratories Bedside Testing Imaging Studies Electrocardiogram Pulmonary Function Testing Other 61 SIHFW: an ISO 9001:2008 certified institution

Compliance Solutions:

Compliance Solutions Discourage verbal orders unless absolutely necessary e.g. Emergency Repeat name and drug dosage to the prescriber and request or provide spelling Spell out numbers e.g. “One-six” for 16. Avoid using abbreviations e.g. mg tid Sign, date and time the order Use a page marker so that physicians can sign No voice orders. What about SMS? Don’t allow the verbal orders for high-risk medications 62 SIHFW: an ISO 9001:2008 certified institution

Compliance Solutions:

Compliance Solutions Develop a process or checklist to verify all documents in place equipment for surgery – available, correct and functioning Mark the precise site for surgery. Use a clearly understood mark, involve the patients Final verification process (Time-out) at location of procedure, just before starting the procedure. Involve the entire operating team and use active communication. 63 SIHFW: an ISO 9001:2008 certified institution

Health Care-Associated Infections:

Health Care-Associated Infections Goal : Reduce the risk of health care-associated infections. Requirement: Comply with current WHO Hand Hygiene Guidelines or Centers for Disease Control and Prevention (CDC) hand hygiene guidelines. Applies to: Ambulatory Care, Assisted Living, Behavioral Health Care, Critical Access Hospital, Disease-Specific Care, Home Care, Hospital, Lab, Long Term Care, Office-Based Surgery Expanded for 2008 64 SIHFW: an ISO 9001:2008 certified institution

Health Care-Associated Infections:

Health Care-Associated Infections Requirement: Manage as sentinel events all identified cases of unanticipated death or major permanent loss of function associated with a health care-associated infection. Applies to: Ambulatory Care, Assisted Living, Behavioral Health Care, Critical Access Hospital, Disease-Specific Care, Home Care, Hospital, Lab, Long Term Care, Office-Based Surgery 65 SIHFW: an ISO 9001:2008 certified institution

Reconcile Medications:

Reconcile Medications Goal: Accurately and completely reconcile medications across the continuum of care. Requirement: There is a process for comparing the patient’s current medications with those ordered for the patient while under the care of the organization. Applies to: Ambulatory Care, Assisted Living, Behavioral Health Care, Critical Access Hospital, Disease-Specific Care, Home Care, Hospital, Long Term Care, Office-Based Surgery 66 SIHFW: an ISO 9001:2008 certified institution

Reconcile Medications:

Reconcile Medications Requirement: A complete list of the patient’s medications is communicated to the next provider of service when a patient is referred or transferred to another setting, service, practitioner or level of care within or outside the organization. The complete list of medications is also provided to the patient on discharge from the facility. Applies to: Ambulatory Care, Assisted Living, Behavioral Health Care, Critical Access Hospital, Disease-Specific Care, Home Care, Hospital, Long Term Care, Office-Based Surgery 67 SIHFW: an ISO 9001:2008 certified institution

Ensure Correct-Site, Correct Procedure, Correct Surgery:

Ensure Correct-Site, Correct Procedure, Correct Surgery Collaborative process used to develop policy and procedure Mark the precise site in clearly understood way and involve patient in doing this Develop process or Checklist to verify correct documents and functioning equipment Use a checklist including “Time-out” just before surgical procedure 68 SIHFW: an ISO 9001:2008 certified institution

Risk Factors for Wrong-site Surgery:

Risk Factors for Wrong-site Surgery Emergency cases More than one surgeon involved in the case Multiple procedures conducted on the same patient during one trip to the operating room Unusual time pressures related to an unusual start time or pressure to speed up the preoperative procedures, often involving staff –perceived time pressures Unusual equipment or setup in the operating room Change from the scheduled operating room 69 SIHFW: an ISO 9001:2008 certified institution

Universal Protocol:

Universal Protocol Correct Documents Surgery Site Equipment Body Part Procedure Patient 70 SIHFW: an ISO 9001:2008 certified institution

Reduce the Risk of Patient Harm Resulting from Falls:

Reduce the Risk of Patient Harm Resulting from Falls Develop PP using collaborative process Assess and periodically Reassess each patient’s risk for falling, including the potential risk associated with the patient’s medication regime Take action to decrease or eliminate any identified risks. Applies to: Assisted Living, Critical Access Hospital, Disease-Specific Care, Home Care, Hospital, Long Term Care 71 SIHFW: an ISO 9001:2008 certified institution

Compliance Solutions:

Compliance Solutions Program should include an assessment process, risk reduction strategies, transfer protocols, in-services, involvement of patients /families in education, and evaluation of the hospital’s environmental issues Use a reliable and valid instrument to predict and identify prone-to-fall patients. Identify some of the drugs/drug classes that are more frequently associated with and increased risk for falling 72 SIHFW: an ISO 9001:2008 certified institution

Compliance Solutions:

Compliance Solutions Use the transfer protocol from a wheelchair, chart, stretcher or bed. Consider the environment of care by Making sure the patients’ needed objects are accessible at all times, Improving lighting Controlling noise, and Moving higher risk patients closer to the nurses’ station 73 SIHFW: an ISO 9001:2008 certified institution

Compliance Solutions:

Compliance Solutions Provide visual reminders Colored ID band, Identifiers on the doors or beds Communicate a patient’s fall risk to the patient and family and remind patients to call for assistance before Getting out of bed or Getting up from a chair 74 SIHFW: an ISO 9001:2008 certified institution

Surgical Fires:

Surgical Fires Goal: Reduce the risk of surgical fires. Requirement: Educate staff, including operating licensed independent practitioners and anesthesia providers, on how to control heat sources and manage fuels with enough time for patient preparation, and establish guidelines to minimize oxygen concentration under drapes. Applies to: Ambulatory Care, Office-Based Surgery 75 SIHFW: an ISO 9001:2008 certified institution

Patient Involvement:

Patient Involvement Goal: Encourage patients’ active involvement in their own care as a patient safety strategy. Requirement: Define and communicate the means for patients and their families to report concerns about safety and encourage them to do so. Applies to: Ambulatory Care, Assisted Living, Behavioral Health Care, Critical Access Hospital, Disease-Specific Care, Home Care, Hospital, Lab, Long Term Care, Office-Based Surgery 76 SIHFW: an ISO 9001:2008 certified institution

Risk Assessment:

Risk Assessment Goal: The organization identifies safety risks inherent in its patient population. Requirement: The organization identifies patients at risk for suicide. Applies to: Behavioral Health Care, Hospital (applicable to psychiatric hospitals and patients being treated for emotional or behavioral disorders in general hospitals) 77 SIHFW: an ISO 9001:2008 certified institution

Risk Assessment:

Risk Assessment Requirement: The organization identifies risks associated with long-term oxygen therapy such as home fires. Applies to: Home Care 78 SIHFW: an ISO 9001:2008 certified institution

Changes in Patient Condition:

Changes in Patient Condition Goal: Improve recognition and response to changes in a patient’s condition. Requirement: The organization selects a suitable method that enables health care staff members to directly request additional assistance from a specially trained individual(s) when the patient’s condition appears to be worsening. Applies to: Critical Access Hospital 79 SIHFW: an ISO 9001:2008 certified institution

Universal Protocol for Preventing Wrong-site, person, procedure:

Universal Protocol for Preventing Wrong-site, person, procedure Requirement: Use a pre-op verification process, such as a checklist, to confirm appropriate documents are available. Implement a process to mark the surgical site and involve the patient in the process. Prior to the start of any surgical or invasive procedure, conduct a final “time out” verification to confirm the correct patient, procedure, and site. 80 SIHFW: an ISO 9001:2008 certified institution

QA Scorecard:

QA Scorecard Quality Indicators Benchmark Last Qtr July ‘08 August’ 08 Medication Errors /1000 pt days ME-Project.ppt Good Falls/ 1000 pt days Fall Rate.ppt Alarming Bed Sores/ 1000 pt days Pressure Sore.ppt UTI/1000 Catheter days (GICU) BSI/ 1000 Central line days (MICU) VAP/1000 ventilator days (MICU) Watch out SSI/ 100 discharges 81 SIHFW: an ISO 9001:2008 certified institution

Adverse Event Scorecard:

Adverse Event Scorecard S.No Types July ‘09 June ‘09 May‘09 1) Sentinel Events 1. Patient death due to fall 2. Patient death due medication errors 2) Adverse Events Incorrect Device Insertion Patient injury due to hot Fermentation 3) Near Misses Wrong Patient Identification before Blood Transfusion Broken Glass Piece in Patient Juice Wrong Requisitions for Blood Accidental Drain Removal Medication error 82 SIHFW: an ISO 9001:2008 certified institution

Quality Improvement in Healthcare – some examples :

Quality Improvement in Healthcare – some examples 83 SIHFW: an ISO 9001:2008 certified institution

Helping Patients Find Their Way:

Helping Patients Find Their Way A receptionist observed – A patient confused about where to go, Asked if patient needed help and Discovered that the patient could not locate the place to have blood drawn. Woman not able to read displayed signs or the signs may have been unclear. Patient might need some assistance in finding the clinic. 84 SIHFW: an ISO 9001:2008 certified institution

Slide 85:

Solutions Giving the woman directions, To call someone over to assist her - this could take too much time. To walk with the patient to the clinic, as it was nearby and another receptionist was in the office. 85 SIHFW: an ISO 9001:2008 certified institution

Slide 86:

Result Patient pleasantly surprised by the courtesy and friendliness of the receptionist and thanked her. Verified that this was where the patient needed to be and then returned to her work. Outcome Non-medical addressed Client satisfied 86 SIHFW: an ISO 9001:2008 certified institution

Slide 87:

Lesson learnt Form a team to address this issue and prevent it from occurring again. Code each clinical area with a color. Colored directional lines along the wall Individual health workers were able to identify opportunities for improvement, take initial steps, and pull a team of people together Observant staff members can identify & fix the problem Improvement might seem small; its effects can be far reaching. Satisfied client might be more inclined to revisit the facility and encourage others to do so (increased utilization) 87 SIHFW: an ISO 9001:2008 certified institution

Slide 88:

How do we track Quality assurance in Healthcare? 88 SIHFW: an ISO 9001:2008 certified institution

Tracking…..:

Tracking….. Regulation Certification Accreditation & Credentialing Grading / Rating Quality Awards ……. and others??? 89 SIHFW: an ISO 9001:2008 certified institution

Regulation:

Regulation A legal restriction Mandated by the government or state Attempts to produce outcomes Control market entries Prices, wages, pollutions, Employment for certain people in certain industries Standards of production Non-compliance / Non-conformance leads to cancellation of operational eligibility …registration of hospital or functional services under different laws / acts 90 SIHFW: an ISO 9001:2008 certified institution

Certification:

Certification Designation earned by a person / organization to perform a job or task Renewed periodically, Valid for a specific period of time Qualifies for certain level of proficiency Can be provided by Body formed / mandated by regulatory mechanism Professional society / body 91 SIHFW: an ISO 9001:2008 certified institution

Accreditation & Credentialing:

Accreditation & Credentialing Accreditation a process in which Certification of competency, authority, or credibility Assessment by Independent agency Credentialing refers to A type of designation, award, status, recognition, or "seal of approval" Refers to individuals or organizations …provides a visible commitment towards improving quality of patient care ensuring a safe environment and reducing risk to staff in healthcare setting 92 SIHFW: an ISO 9001:2008 certified institution

Why Accreditation:

Why Accreditation Better Control of Operations (because operations are documented) Improves staff confidence and evaluate business Reliability of test Insurance companies can rely on test Ensure better support in legal cases Provide traceability 93 SIHFW: an ISO 9001:2008 certified institution

Grading / Rating:

Grading / Rating Is evaluation or assessment of something, in terms of quality (as with a critic rating a novel), quantity (as with an athlete being rated by his or her statistics), or some combination of both Grading / Rating is also a voluntary process wherein an organization opts for comparative evaluation of its services …assumes voluntary & comparative evaluation against laid down parameters & vis-à-vis peers 94 SIHFW: an ISO 9001:2008 certified institution

Quality Awards:

Quality Awards Recommendation on appraisal / evaluation for high degree of consistent & sustained performance over a period of time or range including quality improvement initiatives in a particular sector / domain Instituted by professional societies / bodies and / or independent entities …certification of hospital or functional services under different provisions 95 SIHFW: an ISO 9001:2008 certified institution

Reliability Notation:

Reliability Notation 10 to the power minus 1 = One defect in Ten Tries (90%) 10 to the power minus 2 = One defect in One Hundred Tries (99%) 10 to the power minus 3 = One Defect in One Thousand Tries(99.9%) 96 SIHFW: an ISO 9001:2008 certified institution

As a patient what quality levels would you accept from your health services?:

As a patient what quality levels would you accept from your health services ? 90% 95% 96% 98% 99% 99.9% 97 SIHFW: an ISO 9001:2008 certified institution

Happy at 99.9% ?:

Happy at 99.9% ? 22,000 cheques are deducted from the wrong bank account every day 16,000 mails are lost by the postal service every hour 2,000 unsafe airplane landings are made every day 2 major airplane accidents per week 98 SIHFW: an ISO 9001:2008 certified institution

Slide 99:

If 99.9% is acceptable to you, then… Your heart fails To beat 32,000 Times each year 20,000 wrong Drug prescriptions Made every year 500 surgical Operations are performed wrongly Every week 19,000 babies are dropped by doctors At birth 99 SIHFW: an ISO 9001:2008 certified institution

Slide 100:

Well ….. “ There is only a 1 % Difference in the DNA Genetic code between a chimpanzee and a Human being” 100 SIHFW: an ISO 9001:2008 certified institution

Slide 101:

In our profession there is no scope for error, For any error committed ,Is all the difference between Life and death between relief and Disability There is no second chance Then… ….. 101 SIHFW: an ISO 9001:2008 certified institution

Slide 102:

Thank You For more details log on to www. sihfwrajasthan.com or contact : Director-SIHFW on sihfwraj@yahoo.co.in 102 SIHFW: an ISO 9001:2008 certified institution