Development of a quality assurance tool for critical care

Current conditions in the health care arena demand that nurses be held accountable for the quality of nursing care delivered. Nursing administrators today face multiple challenges which include incorporating the expanding role of the nurse, dealing with financial constraints, and meeting the demands of an increasingly informed public. These factors combine to emphasize the need to examine the quality of care delivered and to identify and promote effective nursing care behaviours. The use of a quality assurance tool can be invaluable in revealing areas of both excellence and weakness in the care of clients, as well as providing a solid foundation for change. This paper will follow the authors through the development and implementation of a unit-specific quality assurance tool for a critical care area. We begin with a brief review of the literature and explore the factors relevant to our decision to choose a concurrent chart audit as our tool. We then describe the discovery of standards, the design of the tool itself, and follow the process of testing, approval and implementation of the tool for use in our institution. Finally, we explain the methods used to introduce the tool to staff and elicit their support to monitor and thus improve the quality of nursing care delivered.