Health Care Quality and

Evidence-Based Practice

Ms. Anisha Vadakkepatt

Amrita College of Nursing
Introduction
• Consistent delivery of a product or service according to
expected standards.
• Health care involves three main groups of people, customers
(patients), employees (service providers), and the managers
that interact in healthcare provision.
• Customer (clients) satisfaction was made the focus of all
operations, with managers and employees working together
as a team of decision-makers and providers.
Definition of Quality
According to WHO:- Quality of care is the level of attainment of
health systems‟ intrinsic goals for health improvement and
responsiveness to legitimate expectations of the population.

According to ISO 9000:- Quality is defined as „the degree to which

a set of inherent characteristics fulfills requirements.‟
•It is both objective and subjective in nature.
Quality of care is:

❑Doing the right things (what)

❑To the right people (to whom)

❑At the right time (when)

❑And doing things right first time

Quality Assurance

Anything you do to measure (assess) or improve quality can

be considered as Quality Assurance.
Media coverage

€320k payout as hospital says

sorry over death from
dehydration
Quality Improvement
Quality improvement is the framework used to systematically
improve care. Quality improvement seeks to standardize
processes and structure to reduce variation, achieve
predictable results, and improve outcomes for patients,
healthcare systems, and organizations. Structure includes
things like technology, culture, leadership, and physical
capital; process includes knowledge capital (e.g., standard
operating procedures) or human capital (e.g., education and
training).
Advantages of quality improvement for health
• Ensures proper usage of resources
• Confirm using the latest scientific knowledge and new
technologies in treatment.
• Ensures that people with disorders receive the care they need.
• Helps to build trust in the effectiveness of the system.
• Assists in overcoming barriers to appropriate care at different
levels.
• Provides an opportunity to improve health care systematically.
Role of nurse to ensure quality health care
Nurses play a crucial role in ensuring quality healthcare delivery.
Their responsibilities encompass various tasks directly contributing
to patient safety, well-being, and positive outcomes.
❑Patient Advocacy: Nurses act as advocates for their patients,
ensuring that their rights, preferences, and needs are respected
and addressed in the healthcare process. They communicate with
patients and families to understand their concerns and relay
important information to the healthcare team.
❑Patient Assessment: Nurses conduct thorough assessments of
patients' physical, emotional, and psychological conditions. These
assessments help in identifying potential issues or changes in a
patient's health status, enabling early intervention and preventive
measures.
-Continue
❑Collaborative Care: Nurses work closely with other healthcare
professionals, including doctors, therapists, pharmacists, and social
workers, to create a holistic and well-coordinated care plan. Effective
communication and collaboration among healthcare team members
contribute to improved patient outcomes.
❑Medication Management: Nurses are responsible for accurately
administering medications and monitoring patients for adverse
reactions. They educate patients about their medications, potential
side effects, and the importance of adherence.
❑Patient Education: Nurses provide patients and their families with
essential information about their health conditions, treatment
plans, self-care techniques, and preventive measures. Educating
patients empowers them to participate in their own care and make
informed decisions actively.
-continue
❑Infection Control: Nurses play a vital role in preventing the
spread of infections within healthcare facilities. They follow strict
protocols for hand hygiene, sterile technique, and proper
disposal of medical waste to reduce the risk of infections.
❑Monitoring and Documentation: Nurses continuously monitor
patients' vital signs, symptoms, and overall condition. Accurate
and timely documentation of this information is essential for
tracking progress, identifying trends, and ensuring a
comprehensive medical record.
❑Pain Management: Nurses assess and manage patients' pain
levels, ensuring appropriate and effective pain relief measures.
They advocate for patients' comfort and work to minimize
discomfort during medical procedures and treatments.
-Continue
❑Emotional Support: Nurses emotionally support patients and their
families during challenging times. They offer a caring and
compassionate presence, addressing patients' fears, anxieties, and
emotional needs.
❑Patient Safety: Nurses are at the forefront of ensuring patient
safety by preventing falls, errors, and other adverse events. They
follow established protocols and contribute to creating a safe
environment for patients.
❑Continuing Education: To provide the best care, nurses continue
education and training to stay updated on the latest medical
advancements, technologies, and evidence-based practices.
❑Ethical Decision-Making: Nurses often face ethical dilemmas in
their practice. They must make sound decisions prioritizing patient
well-being while adhering to ethical standards and legal obligations.
 Evidence-based Practice (EBP)
Evidence-based practice (EBP) is an approach to healthcare that
emphasizes the integration of the best available evidence, clinical
expertise, and patient preferences and values to make informed
decisions about patient care. It systematically reviews and
critically appraises the most current and relevant research
evidence to guide clinical decisions and practices.
Evidence-based practice ensures that healthcare interventions
and treatments are grounded in scientific evidence and are most
likely to lead to positive patient outcomes.
Definition

Evidence-based practice is the conscious, explicit, and

judicious use of current best evidence in making decisions
about the care of individual patients.
(Sackett 1996)
Definition
“...a problem-solving approach to clinical decision-making
within a healthcare organization. EBP integrates the best
available scientific evidence with the best available
experiential evidence… and encourages critical thinking in
the judicious application of such evidence to the care of
individual patients, a patient population or system”
Dearholt & Dang, 2012
Why EBP?

Evidence-based
practice is one of the
best strategies to
enable clinicians to stay
informed.
Gap: Find the missing piece

EBP projects
• EBPare usually
projects are
based onusually based on
identified
identified clinical
clinical performance
performance gaps gaps
Scope of EBP

Education and Quality

Clinical Practice Research
training improvement

Clinical guidelines Patient-centered Health Policy and Professional

and protocols care Decision-Making development

Interdisciplinary Public Health and

Collaboration Population Health
 Ask a Clinical Question

Search for Evidence

The process of Appraise the Evidence
evidence-based
Integrate Evidence
practice
Implement and Monitor

Evaluate and Reflect

How to get started?
EBP Begins With a Spirit of Inquiry

Spirit of Inquiry:
A persistent sense of curiosity that informs both
learning and practice. A clinician motivated by a
spirit of inquiry will raise questions, challenge
traditional and existing practices, and seek
creative approaches to problem-solving.

The National League for Nursing (2014)

Ask the Question!
Will changing an IV dressing more
frequently increase or decrease
infection?

Will using a manufactured NG tube

holder decrease nasal skin breakdown
compared to the traditional tape
method?

How can we decrease pain and

bruising with Heparin injections?
Asking the Right Questions

Why am I doing a treatment this way?

Is there any evidence to support this practice?
Can an intervention be done more cost-effectively and efficiently?
Can we improve patient or nurse satisfaction?
The 3 Forms of Inquiry
Differentiating 3 Forms of Inquiry

Cursory
Literature Search

No evidence Evidence

Nursing Research EBP QI

The 3 Forms of Inquiry: Research
Quality
EBP Research
Improvement

Gap in knowledge of Gap in performance for Gap in knowledge

Starting Point best available evidence practice or process evidence

Practice question, Plan-Do-Study-Act

Method Used Evidence, Translation (PET) (PDSA)
Scientific Process

Produces evidence for

Synthesizes best evidence application at local level Generates new knowledge
Outcome to adoption into practice (unit, department, for broad application
organization)
Will a specific What effect will
What are the best
intervention help mobility assistive robots
Example practices to prevent
decrease fall rates on our have on patient fall
falls in elderly patients?
unit? rates?