Quality Assurance program in ICU
What is Quality Assurance Program?
Quality assurance is a complex process that includes multiple steps united by the same goal: to ensure the safety and quality of the Patient in Hospital. Quality Assurance is an important element in the perspective of clinical as well as administrative management of ICU. It helps in improving best practices in ICU Q, patient related outcomes and also helps in proper utilization of resources like equipment, human resources etc
How Quality Assurance program can be implement in ICU?
By implementing best practices
and by measuring quality measures like process measures and outcome measures.
How to improve Quality in ICU?
1. Whenever there is a variation, it leads to Poor Quality.
2. To improve quality, variation needs to be decrease.
3. Variation
in care delivery makes it very difficult to monitor process and outcome.
4. So process of decreasing variation and continuous monitoring leads to improved quality.
5. ICU intensivist and nursing can lead major role
for initiation of Quality Assurance Program.
Various parameter Of Quality in ICU?
1. Mortality
Crude, severity adjusted, disease based hospital mortality
Standardized mortality rate (SMR) by APACHE II, SAP, PRISM
2.
Morbidity
Accidental extubation, reintubation in planned extubated
patients, pneumothorax, unanticipated cardiac arrest, hypotension, renal
failure.
3.
Process
measures
Rate of delayed admission
Appropriate use of blood/ blood products
Prevention from VAP
4. Resource
Utilization
Patient in ICU LOS >7, Bed occupancy %, readmission,
Average ventilator days utilization in days/month
5. Error
and patient Safety
Patient fall rate, medication error, Adverse event/error
rate, reintubation rate
6. Infection
Rate
VAP, CAUTI, CLABSI, SSI, Bedsore and Rate of resistant
infection
7. Staff
Ratio
Nurse to patient ratio 1:1 for ventilator patients and
1:2 for the Non Ventilator
8. Equipment
Down time in days or hours/month
9. Customer
Focus
Patient satisfaction rate
Quality Improvement steps
1. Dedicated Medical intensivist and nurse: patient
ratio is between 1:1 (ventilated patients) and 1:2 (for non-ventilated
patients) in all the three shifts.
2. Better nursing care to promote recovery and to
prevent deterioration.
3. To meet the patient/relative expectation in
respect of specialized care of patient, reversal of patient’s conditions and to
prevent any occurrence of further complication.
4. Continuous and complete monitoring of the
patient conditions and implementation of modified early warning sign to get alert
against any deterioration, unexpected changes in the condition of patient.
5. Timely and quick communication to the treating consultant
whenever MEWS is observe.
6. Medical gas and vacuum supply to each bed (oxygen
outlets, vacuum outlets, electric sockets for using the equipment’s).
7. Availability of point of care equipment’s like bed
side monitors with monitoring system, Crash cart with defibrillator and
portable oxygen cylinder, adequate number of infusion pumps, ventilators, suction
machine, refrigerator and motorized beds adjustable to right bed height.
8. Provision for doing ECHO cardiography, USG
equipment, ECG machine, , and portable X-ray at bedside whenever needed.
9. Adequate stock of emergency medications and
availability of medication as needed in timely manner.
10.Room Temperature 20-25*C, humidity 50-60%,
positive pressure ventilation, uninterrupted stable power and adequate potable
water supply should be ensured.
KPI FOR THE QA PROGRAMME in ICU
1. TAT for Initial
Assessment in wards
2. Rate of Medication
error
3. Medication
chart with error prone abbreviation
4. Incidence
of adverse drug reactions
9. Standardized mortality ratio for ICU using (APACHE II scoring system)
5. Monitoring
of HAI rates
a)
CLABSI Rate
b)
UTI Rate
c)
VAP rate
d)
SSI Rates
e)
pressure ulcer (Bed sore)
10. Stock out
of emergency medication
11. Re-intubation
rate within 48 hours
12. Re-admission
rate within 48 hours
13. Incidence
of fall in the ICU
14. Near Miss
15. Needle
stick injury
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