[Quality assurance and total quality management in residential home care]. / Qualitätssicherung und Qualitätsmanagement in der stationären Altenpflege.

Quality, quality assurance, and quality management have been important topics in residential care homes for several years. However, only as a result of reform processes in the German legislation (long-term care insurance, care quality assurance) is a systematic discussion taking place. Furthermore, initiatives and holistic model projects, which deal with the assessment and improvement of service quality, were developed in the field of care for the elderly. The present article gives a critical overview of essential developments. Different comprehensive approaches such as the implementation of quality management systems, nationwide expert-based initiatives, and developments towards professionalizing care are discussed. Empirically based approaches, especially those emphasizing the assessment of outcome quality, are focused on in this work. Overall, the authors conclude that in the past few years comprehensive efforts have been made to improve the quality of care. However, the current situation still requires much work to establish a nationwide launch and implementation of evidence-based quality assurance and quality management.

Legal implications of standard setting in nursing.

Patients are increasingly holding health professionals to account for their care. The practice of standard setting has important legal implications. Standard setting can be seen to aid the communication process in healthcare and can therefore help avoid expensive litigation. Standard setting can improve the quality of patient care. Standard documentation could be disclosed in a medical/nursing negligence case. Standards should not be automatically applied. Standard setting can be patchy, misdirected and irrelevant to actual problems. Standards can create unreal patient expectations of care. Patient care may suffer if unrealistic or unreasonable standards are in place. Standard setting can show that there is a controlled environment of care.

A look at nursing peer review, delegation rules.

The Nurse Practice Act passed by the 70th Legislature mandated a peer review program which was implemented in Texas in 1987. Texas Hospitals asked Louise Waddill, executive secretary of the State Board of Nurse Examiners to give an overview of the program by responding to questions concerning the program and the delegation rules which became effective in September 1987.