Home and Community Care Nursing Handbook
Quality Assurance and Risk Management
St. Elizabeth Health Care (2000) states in their Standards Template that "quality is about doing the right things and doing things right". "Quality assurance" and "quality improvement" are processes used to assist programs in service delivery. The two terms are often used interchangeably. Humphrey and Milone-Nuzzo (Humphrey, Carolyn J. & Milone-Nuzzo, Paula, (1996) Orientation to Home Care Nursing, Gaithersburg , Maryland : Aspen Publishers), two renowned home care authorities, describe quality assurance and quality improvement as being the "systematic monitoring process that identifies opportunities for improvement in client care delivery, designs ways to improve the service and continues to evaluate the followup actions taken on those opportunities for improvement."
The implementation of the First Nations and Inuit Home and Community Care (FNIHCC) Program involved the development of many tools that support Quality Assurance, such as service delivery plans, program standards and policies. This section provides communities with information and tools that help to monitor program delivery, identify risk management issues, improve service, and evaluate the followup actions taken for improvement.
The FNIHCC Program is committed to providing high quality and client-focused care. Quality Assurance is an ongoing process that examines the efficiency, quality and effectiveness of a program or service.
Effective quality control involves all staff and volunteers. All members of the home care team should be involved in quality assurance, receive training related to it, and be responsible for it. When issues are identified, staff and volunteers are consulted and corrective action is taken to resolve the situation. Regular team meetings and staff meetings are held and information is shared to ensure that an acceptable level of quality control is maintained. The effectiveness of any corrective actions taken is evaluated by the supervisor, using feedback from everyone involved.
There are several sources of information such as client complaints and incident reports. These are reviewed on a regular basis to ensure that quality control measures have been taken, that the correct process was followed and to measure staff judgment and performance.
Chart Audit
Client Chart Audits are reviews of clients' clinical records to identify goal attainment and evaluate services delivered and are a critical component of a quality assurance program. These audits can be carried out on a regular basis by a home care nursing supervisor, other nursing peers or a nursing consultant. A sample can be found in the Reference Kit.
Incident Form
Incident Forms areçused to document situations or incidents that are of actual or potential concern with regard to the client, employee or the provision of home care service. A summary incident log is useful and can help to categorize various types of incidents. Examples of each can be found in the accompanying Reference Kit.
Client Satisfaction Survey
Client Satisfaction Surveys are one method that home care programs can use to monitor home care services as perceived by the client. A sample survey can also be found in the Reference Kit.
Risk is defined as current or potential harm that can occur . Areas of risk include:
- abuse (e.g. physical, emotional, psychosocial, sexual, or financial)
- personal injury
- medical
- environmental (e.g. fumes, smoking, pets, equipment)
- property
- financial
- reputation
Risk Management is essential for ensuring the overall viability of an organization. Specifically risk management helps to:
- enhance the quality of the service delivered;
- promote accountability to clients and funders;
- enhance the safety of clients, caregivers and paid staff/volunteers;
- identify and reduce or eliminate potentially harmful situations;
- avoid liability situations that could impact significantly on an agency's financial stability and reputation;
- make paid staff and volunteers more aware of risk situations when carrying out work-related activities;
- instill client confidence in the organization and its services; and
- reduce insurance claims and satisfy insurers that the agency is risk conscious.
Continuous Risk Management Process includes:
- identification of risk;
- prioritization of risk;
- development of strategies to address risk;
- establishment of indicators and targets for monitoring success in managing risk;
- collection and analysis of data to determine success in managing risk; and
- implementation of continuous quality improvement to improve strategies to manage risk.
A Risk Management Plan is necessary to reduce potential harm to the program, staff, and clients. A sample of a Risk Management Checklist can be found in the accompanying Reference Kit.
All members of the home care team should be involved in risk management, receive training related to it and be responsible for it. Through a thorough orientation, which includes discussion and review of risk management / quality assurance documents, the new employee will be better able to determine where he/she fits in the quality improvement process. All staff needs to be provided with training as to the use of the tools. The tools and the processes will need to be continually refined to meet the ongoing service delivery requirements of the program and program changes made evident by the quality improvement program's findings. By having these programs in place, the FNIHCC Program will be better prepared for accreditation should health employers wish to enter into the process.
According to the Canadian Council on Health Services Accreditation (CCHSA),
accreditation is a voluntary process in which many organizations participate.
The process allows them to receive an objective assessment of the quality
of the care delivered and the services offered to clients. The accreditation
program is based on a continuous quality improvement model whereby
organizations can compare themselves to national standards. Using these
standards, the organization can monitor and improve its performance
on an ongoing basis. The program is administered by the  Canadian Council on Health Services Accreditation and
further information can be obtained from their website.
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