Nursing Sensitive Quality Indicators Discussion

Prepare an 8-10 minute audio training tutorial (video is optional) for new nurses on the importance of nursing-sensitive quality indicators. As you begin to prepare this assessment you are encouraged to complete the Conabedian Quality Assessment Framework activity. Quality healthcare delivery requires systematic action. Completion of this will help you succeed with the assessment as you consider how the triad of structure (such as the hospital, clinic, provider qualifications/organizational characteristics) and process (such as the delivery/coordination/education/protocols/practice style or standard of care) may be modified to achieve quality outcomes. The American Nursing Association (ANA) established the National Database of Nursing Quality Indicators (NDNQI®) in 1998 to track and report on quality indicators heavily influenced by nursing action. NDNQI® was established as a standardized approach to evaluating nursing performance in relation to patient outcomes. It provides a database and quality measurement program to track clinical performance and to compare nursing quality measures against other hospital data at the national, regional, and state levels. Nursing-sensitive quality indicators help establish evidence-based practice guidelines in the inpatient and outpatient settings to enhance quality care outcomes and initiate quality improvement educational programs, outreach, and protocol development. The quality indicators the NDNQI® monitors are organized into three categories: structure, process, and outcome. Theorist Avedis Donabedian first identified these categories. Donabedian’s theory of quality health care focused on the links between quality outcomes and the structures and processes of care (Grove, Gray, Jay, Jay, & Burns, 2015). Nurses must be knowledgeable about the indicators their workplaces monitor. Some nurses deliver direct patient care that leads to a monitored outcome. Other nurses may be involved in data collection and analysis. In addition, monitoring organizations, including managed care entities, exist to gather data from individual organizations to analyze overall industry quality. All of these roles are important to advance quality and safety outcomes. The focus of Assessment 4 is on how informatics support monitoring of nursingsensitive quality indicator data. You will develop an 8–10 minute audio (or video) training module to orient new nurses in a workplace to a single nursing-sensitive quality indicator critical to the organization. Nursing Sensitive Quality Indicators Discussion

Your recording will address how data are collected and disseminated across the organization along with the nurses’ role in supporting accurate reporting and high quality results. Reference Grove, S. K., Gray, J. R., Jay, G.W., Jay, H. M., & Burns, N. (2015). Understanding nursing research: Building an evidence-based practice (6th ed.). St. Louis, MO: Elsevier. Demonstration of Proficiency By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria: • • • • • • • • • Competency 1: Describe nurses’ and the interdisciplinary team’s role in informatics with a focus on electronic health information and patient care technology to support decision making. Describe the interdisciplinary team’s role in collecting and reporting quality indicator data to enhance patient safety, patient care outcomes, and organizational performance reports. Competency 3: Evaluate the impact of patient care technologies on desired outcomes. Explain how a health care organization uses nursing-sensitive quality indicators to enhance patient safety, patient care outcomes, and organizational performance reports. Competency 4: Recommend the use of a technology to enhance quality and safety standards for patients. Justify how a nursing-sensitive quality indicator establishes evidence-based practice guidelines for nurses to follow when using patient care technologies to enhance patient safety, satisfaction, and outcomes. Competency 5: Apply professional, scholarly communication to facilitate use of health information and patient care technologies. Deliver a professional and effective audio tutorial on a selected quality indicator that engages new nurses and motivates them to accurately report quality data in a timely fashion. Follow APA style and formatting guidelines for citations and references. Preparation This assessment requires you to prepare an 8–10 minute audio training tutorial (with optional video) for new nurses on the importance of nursing-sensitive quality indicators. To successfully prepare for your assessment, you will need to complete the following preparatory activities: • Select a single nursing-sensitive quality indicator that you see as important to a selected type of health care system. • • • • • • • Conduct independent research on the most current information about the selected nursing-sensitive quality indicator. Interview a professional colleague or contact who is familiar with quality monitoring and how technology can help to collect and report quality indicator data. You do not need to submit the transcript of your conversation, but do integrate what you learned from the interview into the audio tutorial. Consider these questions for your interview: What is your experience with collecting data and entering it into a database? What challenges have you experienced? How does your organization share with the nursing staff and other members of the health care system the quality improvement monitoring results? What role do bedside nurses and other frontline staff have in entering the data? For example, do staff members enter the information into an electronic medical record for extraction? Or do they enter it into another system? How effective is this process? Watch the Informatics and Nursing-Sensitive Quality Indicators Video Examplar. Nursing Sensitive Quality Indicators Discussion

Recording Your Presentation To prepare to record the audio for your presentation, complete the following: • • • • • • • Set up and test your microphone or headset using the installation instructions provided by the manufacturer. You only need to use the headset if your audio is not clear and high quality when captured by the microphone. Practice using the equipment to ensure the audio quality is sufficient. Review the for Kaltura to record your presentation. View Creating a Presentation: A Guide to Writing and Speaking. This video addresses the primary areas involved in creating effective audiovisual presentations. You can return to this resource throughout the process of creating your presentation to view the tutorial appropriate for you at each stage. Notes: You may use other tools to record your tutorial. You will, however, need to consult Using Kaltura for instructions on how to upload your audio-recorded tutorial into the courseroom, or you must provide a working link your instructor can easily access. You may also choose to create a video of your tutorial, but this is not required. If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact DisabilityServices@Capella.edu to request accommodations. Instructions For this assessment, imagine you are a member of a Quality Improvement Council at any type of health care system, whether acute, ambulatory, home health, managed care, et cetera. Your Council has identified that newly hired nurses would benefit from comprehensive training on the importance of nursingsensitive quality indicators. The Council would like the training to address how this information is collected and disseminated across the organization. It would also like the training to describe the role nurses have in accurate reporting and high-quality results. The Council indicates a recording is preferable to a written fact sheet due to the popularity of audio blogs. In this way, new hires can listen to the tutorial on their own time using their phone or other device. As a result of this need, you offer to create an audio tutorial orienting new hires to these topics. You know that you will need a script to guide your audio recording. You also plan to incorporate into your script the insights you learned from conducting an interview with an authority on quality monitoring and the use of technology to collect and report quality indicator data. Nursing Sensitive Quality Indicators Discussion

You determine that you will cover the following topics in your audio tutorial script: Introduction: Nursing-Sensitive Quality Indicator • • • • • • What is the NDNQI®? What are nursing-sensitive quality indicators? Which particular quality indicator did you select to address in your tutorial? Why is this quality indicator important to monitor? Be sure to address the impact of this indicator on quality of care and patient safety. Why do new nurses need to be familiar with this particular quality indicator when providing patient care? Collection and Distribution of Quality Indicator Data • • • • According to your interview and other resources, how does your organization collect data on this quality indicator? How does the organization disseminate aggregate data? What role do nurses play in supporting accurate reporting and high-quality results? As an example, consider the importance of accurately entering data regarding nursing interventions. After completing your script, practice delivering your tutorial several times before recording it. Resources • • • • • • • • • • • • • • National Database of Nursing Quality Indicators. (n.d.). NDNQI nursing-sensitive indicators. Retrieved from https://nursingandndnqi.weebly.com/ndnqi-indicators.html Please note the acronym for the Joint Commission is now TJC. U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. (n.d.). Quality improvement and monitoring at your fingertips. Retrieved from https://www.qualityindicators.ahrq.gov Connolly, D., & Wright, F. (2017). The nursing quality indicator framework tool. International Journal of Health Care Quality Assurance, 30(7), 603–616. This paper presents a nursing quality indicator (NQI) framework using multiple approaches that provides a comprehensive reporting mechanism for nursing care. Lavin, M. A., Harper, E, & Barr, N (2015). Health information technology, patient safety, and professional nursing care documentation in acute care settings. Online Journal of Issues in Nursing, 20(2), 6. This study attempts to better understand staff nurses’ perspectives, reflections, and recommendations for improving patient record documentation and documentation technology and encourages nurses to develop informatics skills. MacDonald, V., Maher, A. B., Mainz, H., Meehan, A. J., Brent, L., Hommel, A., . . . Sheehan, K. J. (2018). Developing and testing an international audit of nursing quality indicators for older adults with fragility hip fracture. Orthopaedic Nursing, 37(2), 115– 121. This article examines an audit process created to identify the extent to which accepted nursing quality care indicators for older adults are reflected in acute care policies and protocols. Ju, Q. -Y., Huang, L. -H., Zhao, X. -H., Xing, M. -Y., Shao, L. -W., Zhang, M. -Y., & Shao, R. -Y. (2018). Development of evidence‐based nursing‐sensitive quality indicators for emergency nursing: A Delphi study. Journal of Clinical Nursing, 27(15–16), 3008– 3019. This article reports on the efforts to establish evidence-based nursing‐sensitive quality indicators for emergency nursing in China. Rahn, D. J. (2016). Transformational teamwork: Exploring the impact of nursing teamwork on nurse-sensitive quality indicators. Journal of Nursing Care Quality, 31(3), 262–268. This study investigates the relationship between nursing teamwork and NDNQI® outcomes, including pressure ulcers, falls, and catheter-associated urinary tract infections. van Dishoeck, A. -M., Looman, C. W. N., Steyerberg, E. W., Halfens, R. J. G., & Mackenbach, J. P. (2016). Performance indicators; the association between the quality of preventive care and the prevalence of hospital‐acquired skin lesions in adult hospital patients. Journal of Advanced Nursing, 72(11), 2818–2830. • • This study explores the relationship between the occurrence of pressure ulcers or incontinence dermatitis and the quality of preventative care. Nursing Sensitive Quality Indicators Discussion

Informatics and Nursing-Sensitive Quality Indicators Video Examplar. Transcript: Hello and welcome to the University Hospital Health Care System. My name is Diane Tate. We are so excited to have you on our nursing team. I am here today to help you better understand how our healthcare system uses Nursing Sensitive Quality Indicators – also known as the NDNQI – to enhance quality care outcomes, improve training procedures, establish best practices, and improve patient satisfaction. These indicators also help in workflow and the recruitment and retention of quality staff. You play an important part of this. You are our eyes and ears when it comes to safe evidence-based practice and reporting data to help evaluate our Nursing Sensitive Quality Indicators. We are very fortunate to be one of the 1100 facilities in the United States providing the data to NDNQI to fulfill nursing’s commitment to advancing our knowledge base to evaluate and improve patient care. The NDNQI is a national nursing database evaluating nursing care that provides annual and quarterly reporting of three major indicators which evaluate nursing care. In 2018, the authors Griggs, Wiechula & Cusack described those indicators as structure (staff/skill competency), process (patient assessment, nursing intervention, and job satisfaction) and outcome of patient care related to the quantity or quality nursing care. NDNQI is managed by a company named Press Ganey. Press Ganey sends us surveys for the data needed and then provides participating facility research driven reports with statistics and data themes. Multiple authors including Smith (writing in 2018) and Griggs, Wiechula & Cusack point out that this data allows us to understand what we are doing well in our facility and what we need to improve on, in comparison to national data, to enhance patient safety, patient care outcomes, and organizational performance reports. Now I’d like to share an example, Our Chief Nursing Officer used the NDNQI ratios and acuity data on staffing to validate the need various levels of nurse staffing. Authors Mangold and Pearson, writing 2017, identify how this type of data can contribute to significant changes to our staffing matrix and ratios because of the data produced by nurses like you. Our nurses are better able to provide quality care as a result of this information and our patient satisfaction scores have almost doubled over that past 6 months. Imagine a small snowball made of 5 pieces of snow, then imagine one made of 100 pieces of snow, and one made of 1100 pieces of snow…the greater the number the bigger the impact. If you were in the snowball fight, do you want the snowball made with five snowflakes or the one made with 1100 snowflakes? The same is true of the data in the NDNQI, when one facility implements a change the data from the change is shared with everyone through NDNQI so the dissemination of information is relatively quick and provides real time evaluation data. For another example, over the past few months, we have experienced a dramatic rise in catheteracquired urinary tract infections also known as CAUTIs and Hospital Acquired Conditions throughout the facility. This has dramatically affected the quality of patient care and ultimately our Press Ganey patient satisfaction surveys. Our rate of CAUTIs and Hospital Acquired Conditions have also impacted our rate of Medicare reimbursement. We have experienced a 1 percent reduction in reimbursement related to this CAUTI and associated HAC increase. Porter (2018) estimates CAUTI costs to be over $10,000. To give this number a little more impact, the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative reported in 2015 that there was a total of $330 million dollars lost in Hospital Acquired Conditions penalties across 721 facilities. Our nurses have identified CAUTI in their patients with indwelling catheters as a concern as well as other Hospital Acquired Conditions. Recognizing that they are the first line of defense for patient safety, our nurses are participating in a hospital wide Acquired Condition Reduction Program modeled after the Centers for Medicare and Medicaid services (n.d). Our initiative looks at all infections acquired during treatment in this facility. I encourage you to look at this website. Nursing Sensitive Quality Indicators Discussion

As a nurse you are the leader of healthcare quality, we depend upon you as the expert in patient care. YOU are extremely powerful in contributing to patient care in not only preventing CAUTIs but in providing a timely reporting of needed data in the Press Ganey surveys so that our data is contributed to NDNQI. You May Ask… How Can I Help? Nurses have an essential role within the interdisciplinary healthcare team. They are responsible for collecting and reporting data for the NDNQI. The data collected will contribute to improved outcomes, improved patient safety, and an overall improved patient experience. In our facility we provide the data using online surveys received from Press Ganey, all members of the interdisciplinary healthcare team receive the surveys. In a personal communication, our Chief Nursing Officer, Dr. Smith, underscored that the current facility best practice is to check your hospital email every day you work and complete any surveys sent to you. The data is very easy to enter into the survey. Dr. Smith stated that in the beginning there was a lot of lag time between data entry by the interdisciplinary team and the time the survey was sent out but that has improved. We have a quality team at the hospital responsible for supplying the general data related to CAUTIs. Other data provided to Press Ganey includes incident reports, patient admission dates, length or stay, readmission data, number of patients with catheters vs patients with CAUTIs diagnosed in facility vs after discharge. To learn more about Press Ganey please go to their website. Your job as a nurse is to provide care according to the current practice policies, complete all required documentation which includes all popups on CAUTIs and then to enter data when emailed a survey from Press Ganey. Your role is incredibly powerful in this initiative because as you know we have a huge amount of responsibility in placing, caring for and assessing indwelling catheters and straight caths. Imagine if your work in completing all required documentation and some quick online surveys prevents future CAUTIs, the impact would be huge! I would now like to discuss what we do WITH THE DATA The data you provide, and which is found in the patient records provides insights into how the nursing care and interventions we provide influence patient outcomes. The data found within the NDNQI gives healthcare leaders an understand of what actions influence quality and patient safety. Within the NDNQI the data is trended and the themes and or statistical information is pulled out to help guide safety and quality initiatives. Within this organization we have quality improvement teams on each unit where data from NDNQI and plans for improving quality are shared. Nursing Sensitive Quality Indicators Discussion

We use the data for guiding us in creating quality improvement plans and ensuring patient safety. Quality improvement teams on your unit will share updates with the NDNQI data and how we plan to use the data. As we wrap up I’d like to share some ideas about how your actions IMPACT HEALTH CARE IN GENERAL Your involvement in accurate charting and completing surveys provides data used for the greater science of nursin …Nursing Sensitive Quality Indicators Discussion