Quality control of outpatient nursing care services - Outcome of on area-wide investigation implemented by the health insurance medical service (MDK)of Baden-Wuerttemberg

Discussions surrounding the quality of nursing care, fuelled by recurring p ress reports, prompted the State Nursing Insurance Associations in Baden-Wu erttemberg to request the Health Insurance Medical Service to perform a qua lity control of outpatient nursing care services in the state. Based on a c oordinated concept and for the first time in the Federal Republic of German y, all authorized ambulatory institutions area-wide were subjected to a uni form assessment (total survey) during an official inquiry time period. The end results of these controls failed to verify the judgement often propagat ed by the press based on individual cases that high-quality nursing care ca n no longer be afforded under the present circumstances. On the average, 55 % of the personnel provided to patients by outpatient nursing services were health care professionals. What is more, this professional staff rendered 75% of all nursing care services. The evaluation of the accompanied medical visits indicated that the vast majority attempted to take active nursing c are into account. With regard to quality assurance, a great optimisation po tential was indicated primarily in the a rea of nursing documentation. Only in about 35% of the nursing documents inspected was the nursing procedure always clearly evident. A future problem could arise from the fact that of all nursing professionals with leadership responsibilities, at the time of the survey only about 37% had completed the requisite professional training qualification programme of 460 training hours. If the time before the inte rim deadline (March 31, 2002) is not utilised, the institutions in question could face consequences that could threaten their very existence. It is ev ident that a large number of outpatient nursing care services in the state of Baden-Wuerttemberg do not have their economic foundation in the domain o f the Nursing Care Insurance Law, which affects both patient structure and care intensity. As a consequence, there is no quality control or inspection whatsoever for the majority of nursing care services rendered by ambulator y nursing care services at present because they are not under the jurisdict ion of the German Federal Social Legislation SGB XI.