N108: Transition to the Registered Professional Nurse Role Study Guide terms of the market or getting the consumer what he wants. On the other hand, quality could be defined in terms of conforming to the currently accepted standards of nursing practice and achieving expected outcomes. Optimal care is the long-term goal of quality management. In the short term, quality management works to improve efficiency and effectiveness of care. Continuous quality improvement (CQI) is a cyclical process in which QI actions are connected. The process involves doing, evaluating, improving, doing again, and recycling. The four basic elements of continuous quality improvement are: • Teamwork • Including the patient perspective • Measuring work processes • Insuring adequate resources for implementation Mechanisms for Quality Assurance • Peer review: This is the process by which colleagues of an individual review her practice. This can be done through informal feedback or as part of a formal, systematic review process. The peer review is used to look at the nurse’s practice, compare it to previously set standards. then shares those findings with the nurse and sometimes with her supervisor. The peer review findings may be used for determining rewards and punishments. Peer review is guided by objective standards, and only looks at evidence that affects the nurse’s practice. • Outcome achievement: This may also be called outcome criteria or outcomes management. Outcome achievement is statements of results expected as the end result of patient care. These should be specific, quantifiable, and measurable. Outcomes managements can include clinical pathways, cost containment, patient access to services, degree of clinical outcomes, and variance from stated goals of care. • Clinical or critical pathways: These are used in quality assurance or quality improvement programs in partnership with outcome measurement. A pathway is created using graphics and text to illustrate the normal sequence of critical activities and care processes for a specific type of patient. These generally describe what should happen to the average patient not an individual patient. These documents can be called different names such as critical paths, clinical outcomes, practice guidelines/parameters, clinical guidelines, clinical protocols, clinical algorithms, and anticipated recovery paths or target tracks. Care might be described by diagnosis or by describing the care and outcomes expected for patients experiencing a usual procedure. Pathways should be re-evaluated on a regular basis to assure usefulness. Clinical pathways have been used to deliver care more effectively, as well as to track outcome data for continuous quality improvement. Establishing pathways should be done in collaboration with colleagues, other professionals, and administrative reports. These should always be consistent with other requirements of the institution. • Record audit: This is a process in which records are reviewed and measured according to set criteria. The audit collects specific information about patient outcomes to be used to evaluate nursing care. This can be done concurrently or retrospectively. The audit may reveal a need for quality improvement.