Effective Quality Assurance Program Research Articles

Quality assurance considerations for nuclear plant modifications

This paper discusses those quality assurance requirements of 10 CFR 50, Appendix B, that may require interpretation and adjustment when applied to plant modification work. Of particular importance is the establishment of the current design baseline for the modified system and its interacting systems. The roles of walkdowns, analysis, engineering judgment, and interfaces are discussed. The paper also addresses the various reviews that a modification package must undergo and the management controls required throughout the modification process. Auditing of backfit projects, document control, testing, and personnel training are presented, with emphasis on area that utility and NRC inspections have found to be in need of increased attention. Finally, many Nuclear Regulatory Commission findings about modification projects are analyzed and related to the application of an effective quality assurance program.

Chest radiography: a survey of techniques and exposure levels currently used.

In diagnostic radiology, the routine measurement of exposure levels for a reference patient is an important part of an effective quality assurance program. In the United States, chest radiography is the most frequent examination and has the lowest exposure level of all radiologic examinations. We estimated the amount of exposure an average patient received from both manual and automatic exposure-controlled radiographic techniques by using a "patient-equivalent" chest phantom during measurements. A densitometric procedure was used to assess processor performance. The mean exposure from 194 chest systems was 20 mR (5.16 X 10(-5) C/kg); the mean film density, 1.38; and the mean processing speed, 108. It is interesting to note that a wide range of radiographic techniques, processing conditions, and screen-film speeds are currently being used. With the information given in our study, investigators can begin to identify the problems that lead to unusual exposure levels and, perhaps, poor image quality.

Risk Management in the Dental Office

Owing to a massive increase in malpractice suits directed against dentists and an escalation in the amount of settlements and court ordered awards, professional liability premiums are increasing at an alarming rate. Perhaps more important to the dentist is the anguish caused by the legal process that exposes him or her to allegations made in the public arena of the courts and the press regarding the delivery of substandard care. In addition, the dentist may suffer considerable loss of money as a result of findings of negligence by the courts. The license to practice also is at risk. In today's environment, the practice of a health profession does not appear to be emotionally, professionally, or financially secure. Despite these disadvantages in the practice of dentistry, there is much the practitioner can do to reduce or eliminate legal vulnerability. In addition to maintaining a level of care that meets the standards of other dentists in the community through the process of quality assurance, legally sound office practices and practice management procedures may contribute significantly to minimizing legal risks. A process known as risk management is currently available to assist the practicing dentist in achieving these goals. The principles of risk management was borrowed from industry by the health care industry following the crisis in medical malpractice of the early 1970s. Its primary focus is the protection of resources from losses due to legal action. The activities associated with risk management are easily adapted to dental practice. The focus of these activities is directed at identifying areas of legal vulnerability, taking steps directed at reducing or eliminating them, and purchasing insurance to offset potential financial losses. The current areas of legal vulnerability center around issues of (1) absence of consent to care, (2) negligence, and (3) breach of contract. Consent to care, to be valid, must be informed and granted voluntarily. To meet the test of "informed," the information given to the patient must be in understandable language and contain the risks, benefits, and alternatives to the recommended treatment. In addition, the patient must be given an opportunity to have his or her questions answered. Obtaining consent from one having legal capacity to grant consent is another essential requirement. The treatment of minors and those that are emancipated, raises many problems with consent.(ABSTRACT TRUNCATED AT 400 WORDS)

Radiation Exposures in Clinical Diagnostic Studies

DOI: http://dx.doi.org/10.5915/17-1-12721 The basic objective of this paper is to outline radiation doses to various critical organs of an average adult person during .x-ray procedures and clinical studies in Nuclear Medicine. A comparative study is conducted to confirm clinical exposure using thermoluminescent dosimeters. Absorbed doses to critical organs are also computed. Radiation doses vary for different types of examinations and techniques. Repeats of .x-ray and unnecessary clinical examinations can cause harmful effects. Biological effect~ of radiation for pregnant women and her fetus in early pregnancy have been discussed. To minimize radiation exposure and improve quality of image various factors have been reviewed. Routine calibration of x-ray units and implementation of effective quality assurance program can reduce the radiation exposure and achieve the optimal clinical objective. Presented at the 17th Annual Convention of the Islamic Medical Association, St. Louis, Missouri, August 10-12, 1984

A Computer Assisted Quality Assurance Model

This article describes a modular quality assurance program that was designed for computer automation. The author explains how the quality assurance model not only meets this need but also satisfies other critical objectives, including integration with the hospital's multidisciplinary quality assurance program and minimal redundancy in developing standards and measurement criteria. Readers will benefit from ideas for refining or developing effective quality assurance programs that can also use computer technology to increase productivity.

Why Medical Audits Are in Disfavor

The Professional Standards Review Organization legislation enacted in 1972 (Public Law 92-603) had dual, interrelated objectives²: cost saving by reimbursing only for necessary services and hospital admissions, and assuring quality of care to patients by peer review. The first goal was to be achieved by utilization review, while medical care evaluation (MCE) studies were to satisfy the quality assurance component. In April 1979, the Joint Commission on Hospital Accreditation, while supporting the necessity for effective quality assurance programs, deemphasized the MCE component. The MCE studies are a type of medical audit and for the purposes of this discussion are used interchangeably with process-oriented medical audits. It is the purpose of this editorial to examine why MCE studies, which are commonly performed in accredited hospitals, have failed to substantially affect patient care. The language of quality assurance breeds confusion, since the vocabulary is technical and the same terms are frequently

A quantitative evaluation of the effectiveness of quality assurance as experienced on a large-scale software development effort

The purpose of quality assurance on software projects is to achieve high quality products on schedule, within cost, and in compliance with contract requirements. However, historically, the effectiveness of these activities on software projects has not been quantitatively demonstrable because of a lack of data collected on the project combined with a lack of insight into the operational reliability of the system. Quality assurance is a collection of activities on a contractual deliverable whose purpose is to impart a degree of confidence that the deliverable will conform to the customer's concept of what was procured. Under these conditions, quality assurance must be performed with respect to a documented baseline of the concept. This baseline can address the need in the form of requirement statements; the conceptual approach to be followed in the form of a functional specification; or the design to be implemented in the form of a design specification. Further, these baselines are hierarchical in the sense that when quality assurance is applied to a level it is implicitly applied to all lower levels; e.g., if the need is to be satisfied, the conceptual approach must be satisfied. Effective quality assurance programs impart a high degree of confidence to the customer without significant impacts on schedule or cost. Historically, this effectiveness has not been quantitatively demonstrable because of a lack of data collected on the project combined with a lack of insight into the operational reliability of the system.

A quantitative evaluation of the effectiveness of quality assurance as experienced on a large-scale software development effort

The purpose of quality assurance on software projects is to achieve high quality products on schedule, within cost, and in compliance with contract requirements. However, historically, the effectiveness of these activities on software projects has not been quantitatively demonstrable because of a lack of data collected on the project combined with a lack of insight into the operational reliability of the system. Quality assurance is a collection of activities on a contractual deliverable whose purpose is to impart a degree of confidence that the deliverable will conform to the customer's concept of what was procured. Under these conditions, quality assurance must be performed with respect to a documented baseline of the concept. This baseline can address the need in the form of requirement statements; the conceptual approach to be followed in the form of a functional specification; or the design to be implemented in the form of a design specification. Further, these baselines are hierarchical in the sense that when quality assurance is applied to a level it is implicitly applied to all lower levels; e.g., if the need is to be satisfied, the conceptual approach must be satisfied. Effective quality assurance programs impart a high degree of confidence to the customer without significant impacts on schedule or cost. Historically, this effectiveness has not been quantitatively demonstrable because of a lack of data collected on the project combined with a lack of insight into the operational reliability of the system.

Development of Outcome Criteria for the Patient with Congestive Heart Failure

An effective quality assurance program requires involvement and commitment from all levels of health care professionals. Nurses delivering direct services to the consumer can and must provide the essential elements toward implementation. Development of a framework and clinical expertise support and facilitate the process of defining outcome criteria for the patient population served. Once outcome criteria are developed and utilized, clinical practice gains direction and consumer involvement takes form. Even so, further steps in the process of developing a quality assurance program are essential. Critical evaluation and testing of the outcome criteria are requisites for effecting quality health care.