Informatics And Nursing Sensitive Quality Indicators Paper

Informatics And Nursing Sensitive Quality Indicators Paper

Hello and welcome to this video presentation. I am ….and I would like to present about informatics, healthcare quality, and nursing care. Quality and safety in nursing care go hand in hand. Quality care is safe, timely, centered on the patient, effective, efficient, and equitable. These six domains are used to assess quality. To evaluate success in achieving quality these domains need to be measurable in certain outcomes. The nursing quality indicators (NQI) represent a set of criteria used to objectively assess care, improve clinical practice, evaluate quality and performance, and make informed clinical and administrative decisions. These indicators are influenced by nursing care and are used to monitor nursing care quality ad safety nationally, at the state, and the organization levels. Nursing quality indicators are numerous but can be categorized into staffing measures, patient safety measures, pediatric safety measures, psychiatric safety, and job satisfaction among others. Information science, nursing science, and computer science come in handy when data and information handling are required to guide decisions and evidence-based practice. In this video, I will explain the

In 1998, the American Nurses Association (ANA) established the National Database of Nursing Quality Indicators, also known as NDNQI after the ANA’s Safety and Quality Initiative. This database collects and reports back safety and quality-related data to the subscribing institutions. This process enhances nursing evaluation which will improve patient care outcomes. Our institution is among the 2000 hospitals nationwide that use the NDNQI to assess and evaluate unit-level performance. There are various measures entered into the database and these measures concern the two main nursing care stakeholders – the nurses and patients. Nurses contribute uniquely to patient outcomes in both low and high-income care settings. Nurse researchers, Gathara et al. 2020 conducted a scoping review in low and middle-income countries and found that these nurse indicators are interpreted and used differently to evaluate nursing care. There is wide heterogeneity in the ways these indicators are used by nurse administrators and policymakers to influence care. There each organization uses standardized and specific nursing-sensitive indicators through the NDNQI database in the United States.

Veldhuizen et al. in 2021 through their Delphi study determined various nursing-sensitive quality indicators among older adults in long-term care settings in the community. They assessed 46 outcomes and found that only 56.5% are nursing-sensitive. Therefore, there is a need to operationalize these outcomes and make them specific to various subgroups. In the inpatient units in our organization, patient care complications are the major cause of prolonged patient stays, increased costs of care, high safety risks, and reduced quality of care. Longer hospital stays are also associated with other patient complications and the vicious cycle continues. Pressure ulcers and immobility among patients are safety risks among patients with long hospital stays. This is the NDNQI measure that I will focus on in this video from my health organization.

The agency for healthcare and research quality (AHRQ) recommends monitoring pressure ulcers as part of quality improvement. To monitor pressure ulcers as part of promoting patient care safety and quality, the nurse needs to set measurable outcomes. On their website ahrq.gov, AHRQ recommends measuring pressure ulcer incidence or prevalence rates to evaluate nursing care processes such as skin assessments. Reducing pressure ulcers, especially hospital-acquired ulcers has attracted international attention. According to a cross-sectional study by Cramer et al. in 2019, pressure ulcer prevention among ICU patients is best handled through automated risk stratification and evaluation using measurable outcomes. The quality of nursing care to prevent pressure ulcers should be reflected in the pressure ulcer incidence or prevalence rates in the organization. Our facility has installed various measures to prevent pressure ulcers among patients in the inpatient units. These measures aim at preventing readmission, increasing care costs, reducing the length of stay, improving patient satisfaction, minimizing mortality and morbidity, and generally improving nursing care quality. The nursing care hierarchy is headed by a chief nursing officer (CNO) who answers to the hospital administrator. My interview with the CNO yielded great insights into how nursing informatics and patient care quality concerning pressure ulcer prevention and nursing-sensitive quality indicators have been handled.

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Pressure ulcer prevention has been the responsibility of every nurse at different points of patient care in the facility. Identification of patients at risk of developing pressure ulcers and implementation of nursing interventions has been overseen by various managers in different units in the hospital. The inpatient units are important areas where nurses get the primary data on pressure ulcers. Weekly the nurse managers record the new cases of pressure ulcers from various wards to the chief nursing officers who share the data from the electronic health record and the weekly reports to the NDNQI. The CNO noted that this process of data and information handling has been successful for the past few years save for a few setbacks regarding the interpretation of pressure ulcers from primary nurses working with these patients. Integrating new nurses to understand the importance of quality data for quality outcomes has been a culture in the nursing department. However, overreporting cases of ulcers has been a concern. Sometimes, primary nurses enter cases of ulcers that are not in real sense pressure ulcers but ulcers from friction or lacerations from falls. Sharing the data with the NDNQI database has been done per the Health Insurance Portability and Accountability Act of 1996 (HIPAA) primacy rules. Care has been taken by the nursing and technology departments to protect patient sensitive information even when reporting these important outcome measures.

Reporting from the NDNQI database is done every three months. The department uses this feedback for quarterly planning and adjustment in quality improvement projects to quarterly. During quarterly continuous nursing education (CNE) quality conferences, the CNO shares the relevant outcomes on nursing-sensitive quality measures that might impact the quality of care. The process of data entry and sharing with the NDNQI database has been facilitated by the institution’s electronic health record system. Our institution uses EPIC as the EHR software due to its interoperability features and usability. The CNO and the other nurse administrators input the new cases of pressure ulcers as well as the already existing cases of pressure ulcers after every seven days to the database. The role of interdisciplinary teams has been evident in this process. Various nurses at every point of care have a responsibility to assess their patients through physical examinations especially skin assessments to report to their nurse administrators at the end of their shifts about new cases and record through electronic health records.

Interdisciplinary meetings are held weekly in various nursing departments to review performance on nursing-sensitive quality indicators to forge a way forward based on successes, near misses and failures of the team. Teamwork and collaboration have been the backbone of quality care in the institution. Collaboration does not only stop among nurses in various disciplines but also with patients and their caregivers to optimize care for patients with pressure ulcers.

Our health organization has utilized the nursing sensitive quality indicators especially pressure ulcer incidence to improve care to patients. An increase in incidence has prompted various change management and quality improvement projects after every three months to adjust the quality outcomes. Pressure ulcer incidence at the organizational level is evaluated and compared to previous reports on the same indicator by the interdisciplinary nursing administration team. National reports on similar indicators are also compared and goals are set to reduce incidences to below the nationally reported rates. Data on national quality indicators are used as the benchmark baseline targets for quality improvement.

The whole process of quality improvement has relied on nurses’ data reporting roles. Periodically nurses are retrained on how to identify, assess, record, and report these nurse-sensitive indicators to enhance skill development and accuracy in data reporting. Prevention especially against pressure ulcers has been a responsibility of various departments. Therefore, nurse collaboration with doctors in ulcer prevention has been encouraged when making care plans during the rounds. Key take-home messages from this video presentations have included the importance of nurses in quality improvement in pressure ulcer prevention, the need to provide accurate data for decision-making and policy-making purposes, the vital role of interdisciplinary team collaboration in health prevention and quality improvement, and the role of technology and nursing informatics in quality care delivery and policy making. Thank you!

References

Agency for Healthcare and Research Quality. (n.d.). 5. How do we measure our pressure ulcer rates and practices? Ahrq.gov. Retrieved July 31, 2022, from https://www.ahrq.gov/patient-safety/settings/hospital/resource/pressureulcer/tool/put5.html

Cramer, E. M., Seneviratne, M. G., Sharifi, H., Ozturk, A., & Hernandez-Boussard, T. (2019). Predicting the incidence of pressure ulcers in the intensive care unit using machine learning. EGEMS (Washington, DC), 7(1), 49. https://doi.org/10.5334/egems.307

Gathara, D., Zosi, M., Serem, G., Nzinga, J., Murphy, G. A. V., Jackson, D., Brownie, S., & English, M. (2020). Developing metrics for nursing quality of care for low- and middle-income countries: a scoping review linked to stakeholder engagement. Human Resources for Health, 18(1), 34. https://doi.org/10.1186/s12960-020-00470-2

Veldhuizen, J. D., van den Bulck, A. O. E., Elissen, A. M. J., Mikkers, M. C., Schuurmans, M. J., & Bleijenberg, N. (2021). Nurse-sensitive outcomes in district nursing care: A Delphi study. PloS One, 16(5), e0251546. https://doi.org/10.1371/journal.pone.0251546

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Prepare an 8-10 minute audio training tutorial (video is optional) for new nurses on the importance of nursing-sensitive quality indicators.
Introduction
As you begin to prepare this assessment you are encouraged to complete the Conabedian Quality Assessment Framework activity. Quality health care 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 et al., 2018).
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 nursing-sensitive 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. 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. (2018). Understanding nursing research: Building an evidence-based practice (7th ed.). Elsevier.
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. Choose from the following list:
o Staffing measures.
o Nursing hours per patient day.
o RN education/certification.
o Skill mix.
o Nurse turnover.
o Nursing care hours in emergency departments, perioperative units, and perinatal units.
o Skill mix in emergency departments, perioperative units, and perinatal units.
o Quality measures.
o Patient falls.
o Patient falls with injury.
o Pressure ulcer prevalence.
o Health care-associated infections.
o Catheter-associated urinary tract infection.
o Central line catheter associated blood stream infection.
o Ventilator-associated pneumonia.
o Ventilator- associated events.
o Psychiatric physical/sexual assault rate.
o Restraint prevalence.
o Pediatric peripheral intravenous infiltration rate.
o Pediatric pain assessment, intervention, reassessment (air) cycle.
o Falls in ambulatory settings.
o Pressure ulcer incidence rates from electronic health records.
o Hospital readmission rates.
o RN satisfaction survey options.
o Job satisfaction scales.
o Job satisfaction scales – short form.
o Practice environment scale.
• 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:
o What is your experience with collecting data and entering it into a database?
o What challenges have you experienced?
o How does your organization share with the nursing staff and other members of the health care system the quality improvement monitoring results?
o 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 Exemplar.
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 nursing-sensitive 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.
You determine that you will cover the following topics in your audio tutorial script:
Introduction: Nursing-Sensitive Quality Indicator
• What is the National Database of Nursing-Sensitive Quality Indicators?
• 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?
o Be sure to address the impact of this indicator on the 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?
o 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.
Additional Requirements
• Audio communication: Deliver a professional, effective audio tutorial on a selected quality indicator that engages new nurses and motivates them to accurately report quality data in a timely fashion.
• Length: 8–10 minute audio recording. Use Kaltura to upload your recording to the courseroom, or provide a working link your instructor can access.
• Script: A separate document with the script or speaker’s notes is required. Important: Submissions that do not include the script or speaker’s notes will be returned as a non-performance.
• References: Cite a minimum of three scholarly and/or authoritative sources.
• APA: Submit, along with the recording, a separate reference page that follows APA style and formatting guidelines. For an APA refresher, consult the Evidence and APA page on Campus.
Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and 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.
o 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.
o 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.
o 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.
o Deliver a professional, effective audio tutorial on a selected quality indicator that engages new nurses and motivates them to accurately report quality data in a timely fashion.
o Follow APA style and formatting guidelines for citations and references.

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Informatics and Nursing-Sensitive Quality Indicators Scoring Guide

CRITERIA	NON-PERFORMANCE	BASIC	PROFICIENT	DISTINGUISHED
Describe the interdisciplinary team’s role in collecting and reporting quality indicator data to enhance patient safety, patient care outcomes, and organizational performance reports.	Does not describe the interdisciplinary team’s role in collecting and reporting quality indicator data to enhance patient safety, patient care outcomes, and organizational performance reports.	Begins to identify but does not describe the interdisciplinary team’s role in collecting and reporting quality indicator data.	Describes the interdisciplinary team’s role in collecting and reporting quality indicator data to enhance patient safety, patient care outcomes, and organizational performance reports.	Describes in a professional manner the interdisciplinary team’s role in collecting and reporting quality indicator data to enhance patient safety, patient care outcomes, and organizational performance reports. Offers valuable insight into the impact of the interdisciplinary team on data collection.
Explain how a health care organization uses nursing-sensitive quality indicators to enhance patient safety, patient care outcomes, and organizational performance reports.	Does not explain how a health care organization uses nursing-sensitive quality indicators to enhance patient safety, patient care outcomes, and organizational performance reports.	Attempts to explain how a health care organization uses nursing-sensitive quality indicators to enhance patient safety, patient care outcomes, and organizational performance reports.	Explains how a health care organization uses nursing-sensitive quality indicators to enhance patient safety, patient care outcomes, and organizational performance reports.	Provides a comprehensive, professional, and academic explanation for how a health care organization uses nursing-sensitive quality indicators to enhance patient safety, patient care outcomes, and organizational performance reports.
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.	Does not 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.	Describes but does not 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.	Justifies 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.	Provides a comprehensive and scholarly justification for 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.
Deliver a professional, effective audio tutorial on a selected quality indicator that engages new nurses and motivates them to accurately report quality data in a timely fashion.	Does not deliver an audio or a video tutorial with a script or speaker’s notes on a selected quality indicator that engages new nurses and motivates them to accurately report quality data in a timely fashion.	Provides a script or speaker’s notes of a tutorial without audio or video on a selected quality indicator, or the tutorial lacks purpose, coherence, or focus or has technical issues that distract from the presentation.	Delivers a professional and effective audio or video tutorial along with speaker notes on a selected quality indicator that engages new nurses and motivates them to accurately report quality data in a timely fashion. Submission includes a reference list with at least three scholarly references.	Delivers a polished, professional, and effective audio or video tutorial along with speaker notes on a selected quality indicator that engages new nurses and motivates them to accurately report quality data in a timely fashion. Audio or video presentation is appropriate for the audience. Submission includes a reference list with at least three scholarly references.
Follow APA style and formatting guidelines for citations and references.	Does not follow APA style and formatting guidelines for citations and references.	Partially follows APA style and formatting guidelines for citations and references.	Follows APA style and formatting guidelines for citations and references. Academic citations and references are largely error-free.	Follows APA style and formatting guidelines for citations and references with flawless precision and accuracy.