Nursing quality control inspection how to implement

I. The purpose and content of nursing quality evaluation (a) the purpose and principles of evaluation 1.Purpose ① can measure the completion of the work plan, measure the degree of progress and the level of work achieved.　　② To check whether the work is carried out according to the predetermined goals or directions.　　③ To evaluate the extent to which nursing care needs to satisfy the patient, the reasons for non-satisfaction and the factors affecting it, based on the quantity and quality of nursing care provided. Provide reference for managers to improve the quality of care.　　④ The establishment of evaluation indicators and approvals is the main form of quality control and a guide for nursing care.　　⑤ By evaluating the results of work, achievements can be recognized, shortcomings and deficiencies can be identified, and future efforts can be pointed out. It can also be used to select the best program through comparison, such as choosing new technologies and methods.　　(6) It can check the actual lack of knowledge and skills in the work of nursing staff and provide direction and content for nurses' continuing education.　　 2. Principles (1) Evaluation should be factual. Evaluation should be based on facts, comparing the actual implementation with the original standards and requirements. These standards must be acceptable to the subject of evaluation and be measurable in practice.　　(2) The comparison should be made among personnel of the same level and grade on both sides, that is, the standards set should be appropriate and not too high or too low. Excessively high standards are not achievable by all nurses.　　(B) the content of nursing quality evaluation The object of nursing workers' work quality control mainly includes two aspects: the quality of nursing work and the quality of nursing staff. According to the control of corrective action operation link different classification methods, the control content includes: the nursing work of the basic quality (is feed-forward control, can also be called background or elemental quality), the process of quality (is the site control, also known as link quality), the results of the quality (is the feedback control, also known as the quality of the end) control, the quality of the quality of the nursing staff (is the feed-forward control), the quality of the behavior (is the site or link control) Quality of nursing staff (is a feed-forward control), quality of behavior (is a site or session control), quality of results (is a feedback control) to control.　　1. Nursing staff quality evaluation Definition: that is, a regular formal evaluation of the personnel who perform nursing work, to examine how well they have done their nursing work.　　The tasks and ways of nurses' work are diversified. Therefore different aspects should be taken into account in the evaluation. For example, the motivation and creativity of the nurse, the basic knowledge he/she possesses to accomplish the tasks, the ability to coordinate the work with other people, and so on. In recent years, the evaluation of nursing service focuses more on the basic conditions and quality of nursing staff, the effect of nursing service, the quality of the process of nursing activities, or combines several items for comprehensive evaluation.　　(1) Quality evaluation The evaluation system should emphasize the basic conditions of personnel, basic quality, and the evaluation of each person's ability. Such as human enthusiasm, firmness, pioneering spirit, moral cultivation, psychological quality, work attitude and so on. This evaluation should generally be repeated many times, and should not be concluded after one evaluation, and should be considered in conjunction with other evaluation contents.　　(2) Behavioral evaluation Evaluation of nursing staff's behavior in nursing services, that is, pay attention to the reality of how nursing staff do their work, for example, whether the implementation of nursing operation procedures in line with the standard, in the implementation of medical advice in the process of any error. The evaluation criteria focuses on the service behavior of nursing staff and observes the quality of nurses' behavior in all aspects. The advantage of this kind of evaluation is that it can give nursing staff specific standards and indicators, which is conducive to the improvement of work quality. The disadvantages are that the evaluation process is too time-consuming, the evaluation content is limited to the scope of specific characters, which is relatively narrow, and it can only evaluate the work of nursing staff on duty.　　A ward on the implementation of the tasks of the nurse in charge of the evaluation of the following: Evaluation items evaluation grade and pass need to improve to meet the standard exceeds the standard excellent 1. implementation of medical advice 2. grasp of the condition of the situation 3. basic care whether to implement the 4. instrumentation operation and maintenance records (3) the results of the evaluation is the results of the nursing staff nursing services evaluation, nursing staff can make clear that the specific requirements of the work of the workers. However, in practice, it is not easy to determine the specific standards, quantities and measurement criteria for many nursing service qualities, especially because the clinical nursing results of patients depend on many factors, and some of the results are not short-term responses, so it is more difficult to evaluate the results. Therefore, this evaluation method is less often used alone, and a comprehensive evaluation method can be used to comprehensively evaluate the quality of care.　　(4) Comprehensive evaluation That is, the evaluation is done by combining the standards of several aspects, and all activities related to the results of the nursing staff's work can be combined, such as the comprehensive evaluation of the expectations to achieve the goals, behavior, quality, the desired results of the work, and the work of the specific indicators required.　　2. Evaluation of nursing quality There are three main types: ① Basic quality: that is, the evaluation content established on the organizational structure and plan of nursing services, focusing on the background aspects of the implementation of nursing work, including organizational structure, staffing, resources, instruments and equipment, etc., which can affect the quality of the conditions of nursing work. For example, nursing department management quality standards fall into this category.　　a. Environment: e.g. whether the patient unit is quiet, clean, comfortable and safe.　　b.Manpower arrangement: according to the needs of the condition, whether the head nurse has made appropriate arrangements in staffing, including whether the composition of the staff is appropriate and whether the quality of the staff meets the standards.　　c. Apparatus: Whether the equipment is in normal working condition is measured according to objective standard data. For example, the pressure in oxygen cylinders, the period of use of spare sterilized items, the number of drugs and substance bases, etc.　　d. Ward structure, record of forms, formulation of rules and regulations: whether the layout of the ward is reasonable, whether the arrangement of patients' beds is appropriate or not and whether the writing system of nursing documents is clear.　　These are the standards for the elements of nursing services, which are important for the provision of high-quality care.　　② Process quality: Evaluate whether the process of nursing activities meets the quality requirements. It includes: a. The accuracy rate of executing medical advice: such as the number of errors, whether the execution of clinical advice is timely.　　b. Observation of condition and treatment results: such as temperature, pulse, respiration measurement time, condition records, observation items for critically ill patients, observation time and special observation requirements for various diseases.　　c. Management of patients: such as life care, diet and morning and evening care, management of hospital-acquired infections and sterilization and isolation.　　d. Interaction and management of other medical and technical personnel involved in nursing: such as patient X-ray appointment, management of various specimens, management of hygienists and dieticians, etc.　　e. Quality of nursing reports and writing of various documents.　　f. Steps and techniques for applying and following through on nursing procedures: This includes evaluating the quality of each step in following through on the nursing procedures and evaluating the nursing history.　　g. Psychological care and health education: such as preoperative, postoperative, discharge patient education, knowledge of medication, hygiene habits, diet and nutritional guidance.　　In addition, the quality of nursing care can also be evaluated according to the standards of tertiary care.　　③ Outcome quality: that is, evaluate the final result of nursing service. Such as the patient's wound care, whether to keep dry; reflect the effect of nursing services, the incidence of decubitus ulcers, the incidence of blood transfusion accidents, intravenous penetration of a success rate, nursing errors and accidents, the first level of nursing care qualified rate, the patient's satisfaction with the nursing service, accompanied by the rate of accommodation and so on. This is to evaluate the outcome and quality of care received from the patient's point of view.　　The selection and formulation of standards for nursing outcomes are influenced by more factors, and some of the outcomes do not necessarily indicate the effectiveness of nursing care; it is also related to a combination of other ancillary medical diagnoses, treatment effects, and length of hospitalization.　　The comprehensive evaluation of the three aspects of nursing service structure, process and outcome basically reflects the quality of nursing care. At present, the Ministry of Health has formulated evaluation standards for nursing care at all levels of hospitals, which belongs to the comprehensive evaluation standard system.　　The above three aspects of the quality standard is an inseparable whole, it reflects the overall quality of nursing requirements, the relationship between the three is: nursing elements of quality evaluation, can grasp the overall situation of quality control; specific nursing process link quality evaluation, is conducive to the implementation of measures and to ensure that the normal conduct of nursing work; the end of the quality of the results of the nursing care evaluation, feedback control of the quality of nursing care.　　Second, the nursing quality assessment process (a) evaluation of the organization and method of the establishment of a perfect quality control organization is the nursing quality management is a crucial issue. Hospital nursing command system that is the director of the nursing department - section chief nurse - chief nurse of the three-tier administrative management system, but also the hospital's nursing quality control system. It can also be based on the size of the hospital, select the head nurse with rich clinical experience to form a quality control team, often in-depth to the grassroots, directly access to the nursing work information, feedback to the nursing department. The control methods used are mainly of the following two types: 1. Vertical control combined with horizontal control. The director of the nursing department to the head nurse of the department, the head nurse of the department to the head nurse, the head nurse to the nurse, from top to bottom layer by layer, ring control, that is, vertical control. Such as level by level for regular or irregular inspection, assessment, nursing department adhere to the day and night checking system, holiday checking system, all kinds of quality checking system, etc.; section chief nurse is responsible for belonging to the section of the head nurse of the ward nursing quality and quality control of ward management; head nurse is responsible for the quality control of the work of each nursing staff, put the medical belonging, checking off, handover off, special checking diagnostic and treatment off, etc.. As the quality of nursing work by the interpersonal, departmental, departmental coordination between the relationship between a variety of factors such as constraints, horizontal relationship factors such as quality control between health care quality control, wards and pharmacies, laboratories and other medical and technical departments and the quality control of the logistical sector, are a greater impact on the quality control of nursing, so only to achieve vertical quality control and horizontal quality control closely integrated, in order to make quality control perfect and effective. Control is perfect and effective.　　2. Preventive control and feedback control combined method. Preventive control, also known as prior control, feed-forward control, is a future-oriented control, is to prevent the occurrence of the problem of control, is the management of the error occurred before that is the use of the means of action on the possibility of error to take measures to correct the error, such as planning to carry out the nursing staff at all levels of business training, education on professional ethics, training in technical operations, the development of nursing errors and accidents to prevent the development of nursing standards of writing documents, the development of sterilization and isolation measures, are all The development of sterilization and isolation measures, etc. are all preventive quality control.　　Feedback control is also called retrospective quality control. This type of control is mainly to analyze the results of the implementation of the work, and compared with the control standards, for the problems that have arisen or are about to arise, analyze the causes and possible impact on the future, timely correction, to prevent similar problems from recurring. For example, the incidence of bedsores and the number of serious nursing errors in nursing quality control are such control indicators. Feedback control has a continuous improvement process, which focuses on the evaluation of the results of the implementation, with the aim of avoiding the continuation of the adverse consequences that have occurred, or preventing the recurrence.　　(ii) The procedure of nursing care quality assessment Quality assessment is a complex activity process, but also a continuous cycle and gradual improvement process. Evaluation can be carried out according to the following procedures: 1. Generate standards Develop standards, identify relevant evaluation information, and determine the methods and means of information collection.　　2. Measuring effectiveness Collecting evaluation information, compiling and analyzing the information, and evaluating the information against the criteria.　　3. Correcting deviations Making judgments, providing appropriate outputs and checking the evaluation cycle.　　(1) Generating standards The generation of evaluation standards is a critical step. Evaluation criteria are generally developed by the evaluator based on the purpose of the evaluation. In nursing, evaluation criteria are mostly measured against program objectives and quality standards for nursing care. Ideally, the criteria should detail the required behavioral situations or visible outcomes. That is: ① Quantity, degree, and condition are concise and specific. ② The conditions available are appropriate. ③ There are objective evaluation methods that can be measured. ④ Clear and easy to understand. ⑤ Reflects patient needs and nursing practice.　　(2) Identification and collection of information After determining the content to be evaluated, it is necessary to collect information and data that can reflect the status of the work, such as finding information on the implementation of nursing procedures from nursing cases, finding information on the basic quality from on-site inspection of physical objects or observation of nursing skills, and obtaining information on the quality of the process or the behavior of nurses by observing the process of nurse operation. After clarifying the information and sources, the tools for collecting information can be determined, such as the evaluation form, which should list the evaluation items, requirements, etc., and should be collectible and easy to operate for the selected information.　　(3) Comparison of information and standards Compare the collected detailed information with the standards, how much has been accomplished, how much has not been accomplished, and what are the results.　　(4) Judgment analysis After the implementation of the results of the comparison with the standard, to make a judgment on the actual results of the work, which can be expressed in terms of the percentile value of the completion of the indicators, but also can be described in terms of different grades. Evaluation results to analyze and measure, not only to the evaluation of the data required to elaborate on the evaluation results should be analyzed objectively, but also to explain some of the factors affecting, in order to establish standards in the future evaluation work to pay attention to.　　(5) Appropriate feedback The purpose of evaluation is to improve the work and the quality of nursing care. Therefore, the evaluation results should be fully utilized and should not be formalistic and ineffective. Appropriate feedback should be provided to analyze and communicate the results of the evaluation in order to help motivate the nursing staff, put forward corrective measures and improvement programs to promote nursing care.