Quality Assurance/Quality Improvement (QA/QI) For Public .
Department of Public HealthOffice of NursingQuality Assurance/QualityImprovement (QA/QI) forPublic Health Nursing PracticeManualFebruary 2015http://dph.georgia.gov/resourcesformsmanuals
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TABLE OF CONTENTSQUALITY ASSURANCE/QUALITY IMPROVEMENT(QA/QI) FOR PUBLICHEALTH NURSINGPRACTICE MANUAL
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DEPARTMENT OF PUBLIC HEALTHQUALITY ASSURANCE/QUALITY IMPROVEMENT FOR PUBLIC HEALTH NURSINGPRACTICE MANUALFEBRUARY 2015TABLE OF CONTENTSPage NumberPURPOSE AND BACKGROUNDPurpose and Background11.1QA/QI MODELDescriptionQA/QI Graphic2.12.12.3GUIDELINES FOR CONDUCTING QA/QI REVIEWSGuiding Principles for Conducting QA/QI ReviewsDepartment of Public Health Policy: Quality Assurance/Quality Improvementfor Public Health NursingSteps for Conducting QA/QI Reviews Within a DistrictCounty Preparation Guidelines for QA/QI ReviewRole and Responsibilities of the District QA/QI CoordinatorRole and Responsibilities of the State QA/QI MemberQA/QI for Public/Health Nursing Practice Site Visit AgendaGuidelines for Documenting the QA/QI Site VisitQA/QI Review ReportsDocumentation Sources To Be Used During QA/QI Site VisitsGuidelines for the QA/QI Site Visit Exit ConferenceSAMPLE MEMORANDUMCLINICAL RECORDS33.1Table of Contents3.23.43.53.63.63.73.83.93.103.123.133.141
Page Number4QA/QI Standards and ToolsINTRODUCTION/PURPOSE4.1SECTION ILeadership4.2SECTION IICustomer Satisfaction4.3SECTION IIICultural Competencies4.4SECTION IVCredentialing4.5SECTION VTraining/Education for the Following Nurse Protocols:Child HealthAttachment A - HemoCue Hemoglobin ProcedureAttachment B - HemoCue Hb 201 Procedure TemplateHIV/AIDS RelatedHypertension, PrimarySexually Transmitted DiseasesTuberculosisWomen’s Health/Family Planning4.94.154.224.294.354.394.444.49SECTION VIDrug Dispensing and Ordering4.54SECTION VIIClinical Practice4.58SECTION VIIIManagement of Drug Reactions4.59SECTION IXClinic Operations – Standards and Measures4.6SECTION XPopulation Health Practice4.61SITE VISIT REPORT SUMMARY4.62ATTACHMENT A – CLINICAL SKILLS CHECKLIST4.64Table of Contents2
IMMUNIZATIONImmunization Practice for Public Health Nurses and Support StaffSection I: CredentialingSection II: Training/EducationSection III: Policies and ProceduresSection IV: Clinical PracticeSection V: Storage, Handling and Labeling of DrugsSection VI: Management of Drug ReactionsSummary PageAttachmentsGUIDELINES FOR CUSTOMER SATISFACTIONGuidelines and Standards for Customer SatisfactionSection I: Measuring Customer SatisfactionSection II: Guidelines for Customer SatisfactionCustomer Satisfaction Survey (English)Customer Satisfaction Survey (Spanish)Example for District Procedure on How to Implement Standards forCustomer Satisfaction SurveysPage 6.116.126.13PEER REVIEW STANDARDS AND MEASURESPeer Review Standards and MeasuresPeer Review Tool for the Advanced Practice Registered Nurse in PublicHealthPeer Review Standards and Measures for Interpreters77.17.4CLINICAL RECORD DOCUMENTATION STANDARDSClinical Record Documentation Standards88.1RECORD REVIEW PRINCIPLESClinical Record Review PrinciplesGeneric Clinical Record Review Principles (Form)99.19.2CLINICAL OPERATIONS STANDARDS AND MEASURESClinic Operations Standards and MeasuresStandards for Clinic OperationsClinic Operations Review FormTable of Contents7.71010.110.210.53
LEADERSHIP COMPETENCY MEASUREMENT TOOLLeadership Competency Measurement ToolPage Number1111.1GUIDELINES FOR CULTURAL COMPETENCY SKILLSCore Competencies for Public Health Professionals – Cultural CompetencySkillsTraining Resources for Cultural Competency Skills1212.1POPULATION HEALTH COMPETENCY MEASUREMENT TOOLPopulation Health Competency Measurement Tool1313.1WORKPLACE SAFETYWorkplace Safety Checklist1414.1EMERGENCY PREPAREDNESSEmergency Preparedness for Public Health NursesEmergency Preparedness - TrainingGeorgia NIMS Training Guidelines – Baseline for TrainingEmergency Preparedness Checklist1515.115.315.615.7Table of Contents12.24
Quality Assurance/QualityImprovement (QA/QI) forPublic Health NursingPractice ManualPurpose and Background
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TABLE OF CONTENTSPURPOSE AND BACKGROUNDPurpose and Background11.1
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Georgia Department Public HealthQuality Assurance/Quality Improvement for Public Health Nursing PracticeFebruary 2015PURPOSEThe purpose of the Quality Assurance/Quality Improvement for Public Health NursingPractice Manual is to provide specific standards, measurement tools and processes forimproving the quality of public health nursing practice in Georgia. This manual replaces the2002 manual, Guidelines for Quality Assurance in Public Health Nursing Practice. The StateOffice of Nursing has the responsibility to set training and practice standards in accordancewith the most current research and evidence-based practice. The extent to which thestandards are implemented is determined by those who govern the day-to-day activities ofpublic health programs and services at the local level.BACKGROUNDAccountability for nursing practice has significant roots in the history of nursing. FlorenceNightingale, the founder of modern nursing, was one of the first to document the need for asystematic approach for reviewing the quality of nursing care. She identified the need toincorporate health data and statistics in quality assurance activities.HISTORYSince the 1970's, there have been a wide range of quality assurance and qualityimprovement models and processes developed by and for the health care system. Qualityassurance has been defined as a widely accepted system that compares the care provided toinstitutionally held standards, evaluates data, identifies problems, plans and implementsactivities to alleviate the problems and determines whether the activities achieved the desiredresults (Rowland & Rowland, 1987). Models of quality assurance frequently incorporatethree types of standards (outcome, process and structure). Outcome standards defineexpectations in terms of desirable and achievable benefit, either at the individual client/patientlevel or at the community level. Process standards reflect expectations in terms of bestpractices, policies, procedures and interventions, which are evidence-based. Structurestandards indicate the operational requirements, staffing characteristics, materials and/orspace requirements necessary to provide quality services.In the 1980's, the concept of total quality management (TQM) or continuous qualityimprovement (CQI) received considerable attention in the health care arena. TQM/CQIrepresents an all-encompassing management philosophy that permeates the organization'smanagement infrastructure, policies and practices. TQM principles call for a focus on thecustomer, an emphasis on systems, the use of data-driven decision-making, the activeinvolvement of leaders and employees and continuously improving performance in all areas(Deming, 1986).In the 1990's, the emphasis on accountability for public health began an importantevolutionary process as part of the health system(s) within the community. This communitybased process involves the selection of community indicators that can be used to measurethe process and outcomes of intervention strategies for health improvement. Performanceimprovement should promote health improvement in a context of shared responsibility andaccountability for achieving desired outcomes (IOM, 1996).Purpose And Background1.1
Georgia Department Public HealthQuality Assurance/Quality Improvement for Public Health Nursing PracticeFebruary 2015In 1997, the District Health Directors requested that a more coordinated approach to QA bedeveloped. The Office of Nursing was charged with leading the new approach to QA/QI.The highlights of the QA/QI initiative follow:DATEFOCUS1997 – 1998Developed first model of QA that was a mix of process andcommunity indicators, but it was rejected and scratched.Developed second QA model that was focused on nursingpractice under nurse protocol.Conducted pilot; revised model; produced first site visitmanual; completed baseline site visits to one site in each of19 districts.Reviewed results of site visits; produced 2nd edition of QAManual with expanded components.District teams began making site visits to counties withintheir respective districts.State office site visits were made to 13/18 districts toassess the QA/QI process and experience. The process ofrevising the QA/QI Manual began.Surveyed state office programs regarding QA/TA and SiteVisit activities; developed report of findings andrecommendations for improved coordination andintegration.New Record Retention Schedules were approved by theDivision of Archives and History and distributed. A newCD-ROM on Documentation Standards was produced anddistributed. The new standards and training tool werereviewed with District QA/QI Teams via VICS onSeptember 24, 2007. District QA/QI teams continue tomake site visits to counties within their districts.19981999—20002000—200120022004 – 200520062007PROGRESSIn 1997, a new model of QA, that focused on outcomes as well as processes was proposedbut not implemented. In 1998, the second model, Quality Assurance for Public HealthNursing Practice under Nurse Protocol, was developed. In January 1999, a pilot of the newQA/QI initiative was conducted at the Bibb County Health Department. The QA/QI initiativebegan with the development of standards and tools for measurement of quality andopportunities for improvement. A quality assurance site visit team was formed to includerepresentatives from state offices, districts and counties. The team conducted a two-day sitevisit to at least one location within each district between January 1999 and December 2000.All site visits were conducted according to schedule, except for Fulton County, which had tobe rescheduled to a later date due to Hurricane Floyd, which struck September 15, 1999.Purpose And Background1.2
Georgia Department Public HealthQuality Assurance/Quality Improvement for Public Health Nursing PracticeFebruary 2015The site visit methodologies included review of written documentation, staff interviews, peerreview, direct observations of clinical practice and an exit conference.In June 2000, a survey was distributed to each state office program to identify the QA/QIactivities by program and the extent to which those activities meshed with the Division’sQA/QI initiative. The 2000 survey showed that most programs conducted their respectiveQA/QI activities separately and apart from the Division’s QA/QI initiative. The Child Health,STD, SHAPP, TB and Immunizations programs have been coordinating some or most of theirQA/QI activities with the Divisions’ initiative, while other programs continue their QA/QIactivities separate from the statewide effort. The districts have expressed the need tocoordinate all QA/QI activities as part of providing an efficient and effective system ofaccountability. Development of the QA/QI initiative needs to identify the barriers that arekeeping programs from merging their QA/QI activities with the Division’s statewide initiativeand to recommend action steps to eliminate those barriers.In 2001, the QA/QI team focused on reviewing the results of the site visits by the QA/QI teamand refining the standards and measurement tools for future site visits. The QA/QI standardsand measurement tools were revised to incorporate the recommendations and feedback fromthe districts and counties and were expanded to include such components as leadership,customer service, cultural competency and population health.During 2004-2005, site visits were made by the state office QA/QI Coordinator to 13 of the 18public health districts to assess the QA/QI process and experience. These site visitsassessed such factors as learning how the districts prepared for, conducted, documentedand followed up on the findings of the QA/QI processes that they used. A summary of thisassessment is on file.In 2004, the process for updating the 2002 QA/QI Manual began. Although considerationwas given to delaying the manual revision until the new direction for public health becameclearer, it was decided to proceed with plans to revise the manual in order to support the localpublic health momentum and ownership of QA/QI and to respond to their demands for themanual to be updated. Revisions to the manual were later postponed due to turnover in theAssistant Chief Nurse position in the Office of Nursing that manages the QA/QI initiative.In 2005, the Division gained a new Director who began a new strategic direction for publichealth. According to Dr. Stuart Brown, Director for the Division of Public Health, “Thegreatest change needed is a shift from serving as the state’s safety net health care provider.We must strengthen our role as leaders for prevention and protection of the public’s health.We will never have enough resources to fulfill the role of safety net provider. We know thatmany communities have no alternatives today. People in these communities need preventivehealth services and the county health department may be their only option. However, countyhealth departments are not resourced to serve in this capacity alone. The responsibilities forensuring that all Georgians have access to preventive health services must be shared amongmany partners. Public health must galvanize support for efforts like development of federallyqualified health clinics and sliding scale health service providers” (Just the PHacts, Volume17, April/May 2007, page 1).Purpose And Background1.3
Georgia Department Public HealthQuality Assurance/Quality Improvement for Public Health Nursing PracticeFebruary 2015In 2006, Dr. Janice Carson was appointed as Deputy Director and Liaison to the Districts. Dr.Carson mapped out an integration project in response to the district requests for betterintegration of state initiatives, including Quality Assurance, technical assistance and sitevisits. A survey of state office public health branches and offices (Environmental Health,Laboratory, Emergency Preparedness, Family Health Branch, Prevention Branch, andChronic Disease Branch) showed that all state offices and programs are committed tocollaborating on the goal of taking quality to a higher level. All disciplines and all programareas actively participated in the internal assessment process for developing plans for a newand integrated approach to quality. The combined success of each state office program’scommitment to quality and the enthusiastic support by local public health for taking quality toa higher level are strong indicators for success in achieving this goal.In 2007, Meshell McCloud, R.N., A.P.R.N., W.H.N.P.-B.C., was appointed Assistant ChiefNurse and assigned as manager of the QA/QI Initiative. Under her leadership, efforts tocomplete and approve the QA/QI manual continued. The new Record Retention Schedulewas approved by the Division of Archives and History and distributed to the districts and stateoffices. The new CD-ROM on clinical record documentation was distributed and training forimplementing the new standards was conducted on September 24, 2007.In 2010, Dr. Angela Guidry was appointed Assistant Chief Nurse to serve as the state Officeof Nursing leader for QA/QI related to public health nursing practice. In alignment with thestrategic goals of the Office of Nursing, Dr. Guidry maintains a vision to advance public healthnursing practice to ensure the delivery of quality nursing care to improve the health andsafety of all Georgians.Currently, all districts are conducting their internal QA/QI site visits to each of thecounties/sites within the district. Representatives from the state office QA/QI team haveparticipated as members of some of the district internal site visits, but these site visits areprimarily managed by the district leadership staff. The county site visit reports are kept withineach district and are no longer being submitted to the state office, at the request of the stateoffice. The reason that the state office requested districts to stop sending the QA/QI site visitreports to the state office was that the state office did not establish a process for reviewingthe reports, monitoring trends or producing any trend reports based on the reports. Thisrepresents a major gap in the QA/QI initiative that needs to be addressed.Purpose And Background1.4
Quality Assurance/QualityImprovement (QA/QI) forPublic Health NursingPractice ManualQA/QI Model
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TABLE OF CONTENTSQA/QI MODELDescriptionQA/QI Graphic22.12.3
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Georgia Department of Public HealthQuality Assurance/Quality Improvement for Public Health Nursing PracticeFebruary 2015QUALITY ASSURANCE/QUALITY IMPROVEMENT MODELFOR PUBLIC HEALTH NURSING PRACTICEDESCRIPTIONThe system wide efforts of the Georgia Department of Public Health, District PublicHealth Offices and the County Health departments contribute to accountability in publichealth nursing. These three points of service for public health nursing practice convergeto ensure accountability through infrastructure support, health outcomes, andprofessional development. According to the Office of Nursing Quality Assurance/ QualityImprovement Model for Public Health Nursing Practice, infrastructure support fostersaccountability through standardized methods for Data Collection and Analysis, ClinicalRecord Documentation, and Clinical Operations. The framework further demonstratesthe influence of Health Outcomes on accountability through Public Health Priorities,Determinants of Health, and Customer Satisfaction. Finally, the influence ofProfessional Development on accountability is demonstrated through competencies inpopulation health and emergency preparedness, as well as clinical and leadershipcompetencies.The Quality Assurance/ Quality Improvement Model is presented to promoteunderstanding of the holistic nature of public health nursing practice accountability.Nursing Protocols, Practice Standards, Rules & Regulations, and Program Standardsare rigorous system components that contribute to a robust public health nursingpractice in Georgia. The model effectively represents how each system component isintegrated and interrelated to assure accountability and quality nursing care.Quality Assurance/Quality Improvement Model2.1
Georgia Department of Public HealthQuality Assurance/Quality Improvement for Public Health Nursing PracticeFebruary 2015THIS PAGE INTENTIONALLY LEFT BLANKQuality Assurance/Quality Improvement Model2.2
QUALITY ASSURANCE/ QUALITY IMPROVEMENT MODEL FOR PUBLIC HEALTH NURSING PRACTICEA SYSTEMS FRAMEWORK
Georgia Department of Public HealthQuality Assurance/Quality Improvement for Public Health Nursing PracticeFebruary 2015THIS PAGE INTENTIONALLY LEFT BLANKQuality Assurance/Quality Improvement Model2.4
Quality Assurance/Quality(QA/QI) Improvement forPublic Health NursingPractice ManualGuidelines for ConductingQA/QI Reviews
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TABLE OF CONTENTSGUIDELINES FOR CONDUCTING QA/QI REVIEWSGuiding Principles for Conducting QA/QI ReviewsDivision of Public Health Policy: Quality Assurance/Quality Improvement forPublic Health NursingSteps for Conducting QA/QI Reviews Within a DistrictCounty Preparation Guidelines for QA/QI ReviewRole and Responsibilities of the District QA/QI CoordinatorRole and Responsibilities of the State QA/QI MemberQA/QI for Public/Health Nursing Practice Site Visit AgendaGuidelines for Documenting the QA/QI Site VisitQA/QI Review ReportsDocumentation Sources To Be Used During QA/QI Site VisitsGuidelines for the QA/QI Site Visit Exit ConferenceSAMPLE MEMORANDUMCLINICAL 4
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Georgia Department of Public HealthQuality Assuran
In the 1980's, the concept of total quality management (TQM) or continuous quality improvement (CQI) received considerable attention in the health care arena. TQM/CQI represents an all-encompassing management philosophy that permeates the organization's management infrastructure, policies and practices. TQM principles call for a focus on the
Quality Assurance and Improvement Framework Guidance 2 Contents Section 1: Quality Assurance and Improvement Framework 1.1 Overview 1.1.1 Quality Assurance (QA) 1.1.2 Quality Improvement (QI) 1.1.3 Access 1.2 Funding Section 2: Quality Assurance 2.1 General information on indicators 2.1.1 Disease registers 2.1.2 Verification
critical issues the University has established a Quality Assurance Directorate, which is mandated to develop a Quality Assurance Framework and a Quality Assurance Policy. The Quality Assurance Framework would clearly spell out the Principles, Guidelines and Procedures for implementing institutional quality assurance processes.
Quality Assurance and Quality Improvement Plan I. Purpose The Quality Assurance and Improvement Plan (QA/QI Plan) is a guide designed to assess, enhance, . The steps include: F ind a process to improve O rganize an effort to work on improvement C l
Software Quality Assurance Plan (SQAP) for the SRR-CWDA-2010-00080 H-Area Tank Farm (HTF) Performance Revision 0 Assessment (PA) Probabilistic Model August 2010 Page 5 of 15 1.0 SCOPE This Software Quality Assurance Plan (SQAP) was developed in accordance with the 1Q Quality Assurance Manual, Quality Assurance Procedure (QAP) 20-1, Rev. 11.
This quality assurance manual specifies the methods to prepare and submit Quality Assurance Process Design Diagram for products and parts to be supplied to NSK by suppliers. 2. Purpose Each supplier should prepare quality assurance process design diagram clearly showing the quality assurance methods used in each products and parts production .
Quality Assurance Representative. The Site Manager will appoint a member of the Project Office to control all Quality Assurance issues including - Assisting the Site Manager to co-ordinate and develop the Quality Assurance Plan. Advise Engineers, General Foremen, Foremen and Chargehands in all matters of Quality Assurance.
Quality assurance or software quality assurance is an integral part of the development process and is used in the IT industry by quality assurance professionals as well as testers. Quality assurance is associated with the concept of dependability. Dependability is, first, a guarantee of increased cybersecurity, reliability and
EDLIZ Essential Medicine List of Zimbabwe EMR Electronic Medical Record ENND Early Neonatal Death EPMS Electronic Patient Monitoring System . Quality Assurance and Quality Improvement Strategy 2016-2020 Ministry of Health and Child Care, Zimbabwe vii. viii Quality Assurance and Quality
