Quality assurance is as important in the private office as in large medical care institutions. In hospitals or MCOs, there are many people who may observe the medical practitioner. In small offices, if the physician is not checking on the people he or she supervises, dangerous deficiencies may go unnoticed. The simplest form of quality assurance for NPPs is to have the physician read and sign every chart. This will allow correction of errors and ongoing education of the nurse or physician’s assistant.

There should be a formal quality assurance program, usually a chart audit. Sample charts should be reviewed for every provider and for a range of patient problems. Each case should be evaluated to see if the protocols were followed and if the care was documented properly. General considerations, such as whether the entries were made at the time the care was rendered and whether they can be read by the other providers, should be included in the audit. At intervals, the actual care rendered should be checked. The chart entry may be perfect, yet bear no relationship to the patient’s actual condition.

Every quality assurance program should have a system for correcting all identified deficiencies. It must have provisions for changing questionable practices and for immediately suspending anyone who may be dangerous to patients for any reason.