Informatics and Nursing Sensitive Quality Indicators

Informatics and Nursing Sensitive Quality Indicators

Hello, and welcome to this healthcare facility. This presentation aims at equipping you with adequate knowledge about nursing-sensitive quality indicators. We will begin by defining and discussing the role of the National Database of Nursing Quality Indicators (NDNQI). We will then identify and discuss this healthcare facility’s quality indicator of concern. Finally, we will discuss the techniques used by this organization to collect and disseminate data on quality indicators. This will enable you to recognize that, as nurses, you play a significant role in maintaining the accuracy and credibility of data.

Nursing-Sensitive Quality Indicator

When the NDNQI was established, its primary purpose was to provide periodic data to the American Nurses Association (ANA). In 2021, Stifter, Sermersheim, Ellsworth, Dowding, Day, Silvestri, Margwarth, and Shaw reported that the NDNQI provides key information on nursing-sensitive indicators (NSIs) by availing data annually and quarterly. NSIs are measures that evaluate the impact of nursing care on patients. By so doing, NSIs determine the quality of care and direct the decision-making process. Writing in 2020, Koch, Kutz, Conca, Wenke, Schuetz, and Mueller revealed that NSIs target the structure, procedure, and outcomes of nursing care. Structure entails aspects such as resource allocation and nurse-to-patient ratios. The procedure evaluates nurse-patient interaction. On the other hand, outcomes are dependent on the structure and procedure. Outcomes are a direct reflection of the quality of nursing care.

It is important to know that this healthcare facility is among the facilities that report NSI data to the NDNQI. To accomplish this, stakeholders in this facility complete Press Ganey surveys. Writing in 2020, Koch, Kutz, Conca, Wenke, Schuetz, and Mueller revealed that Press Ganey collaborates with the NDNQI to ensure NSI reports are generated annually and quarterly. As a key stakeholder to NDNQI, these reports enable us to compare our performance with that of other facilities. As such, we can make evidence-based decisions to improve the quality of healthcare services.

I would like to discuss an NSI of concern to this facility. Over the past nine months, the prevalence and incidence of central line catheter-associated bloodstream infection (CLABSI) has been on the rise. As such, the quality of healthcare services has been compromised significantly. Patients have expressed high dissatisfaction with the quality of nursing care in the medical unit. In 2020, authors Patel, Weiner-Lastinger, Dudeck, Fike, Kuhar, Edwards, Pollock, and Benin revealed that CLABSIs occur within forty-eight of a central line catheter placement. Various organisms have been implicated as the causative factors of nosocomial infection. In 2022, Haddadin, Annamaraju, and Regunath reported that gram-positive bacteria account for about 40 to 80 percent of all cases of CLABSI. Furthermore, gram-negative bacteria account for about 20 to 30 percent of cases, whereas fungi cause approximately 11 percent of the cases.

Additionally, CLABSI impacts the quality of care and treatment costs. In 2022, Haddadin, Annamaraju, and Regunath reported that more than 200,000 bloodstream infections occur annually in the USA. In 2022, Haddadin, Annamaraju, and Regunath reported that in the USA, the incidence of CLABSI is about 0.8 cases in every 1000 days of central line catheters. CLABSI is associated with prolonged hospitalization. Prolonged hospitalization increases treatment costs and lowers patients’ quality of life. AHRQ.gov n.d.-b reports that CLABSI-related prolonged hospitalization increases treatment costs by about $17,800 to $94,800. Furthermore, AHRQ.gov n.d.-a reveals that CLABSI accounts for approximately 28,000 deaths annually. We have been penalized by insurers due to the increase in the incidences of CLABSI. As such, our reimbursements have been lowered by about four percent.

Our nurses recognize that they are key stakeholders in managing and preventing nosocomial infections such as CLABSI. They have adopted various evidence-based practices to address this problem. Firstly, they have enforced strict hygiene measures. In 2022, Haddadin, Annamaraju, and Regunath reported that this entails hand washing using clean water and soap, skin disinfection before inserting catheters, and upholding aseptic insertion techniques. Secondly, the subclavian rather than the femoral vein is used when the catheters are not tunneled. Thirdly, all central lines inserted during emergencies are replaced within 48 hours. This is attributed to the fact that emergency insertions are not aseptic.

Furthermore, nurses monitor patients daily to determine whether the central lines should be removed. Writing in 2022, Haddadin, Annamaraju, and Regunath reported that central line catheters should be removed once the patient is stabilized to avoid the risk of CLABSIs. Therefore, as new nurses, you should be familiar with this quality indicator because it has lowered the quality of care, attracted penalizations for this facility, and increased patient dissatisfaction. You should collaborate with other nurses to embrace evidence-based practices to address CLABSI.

Consistently, I will address how you should collaborate with other members of the interdisciplinary team. As aforementioned, nurses play a significant role in enhancing the accuracy and credibility of our data. You will be key stakeholders in completing Press Ganey surveys and submitting data to the NDNQI. Other key members of the interdisciplinary team include physicians and pharmacists. Our healthcare facility has a quality assurance committee comprising nurses and interdisciplinary team members. The committee is dedicated to mitigating the incidence of CLABSI. To achieve this, they conduct periodic patient monitoring and emphasize data accuracy. Additionally, the committee ensures that all stakeholders adhere to the guidelines and standard operating procedures. This committee’s efforts have optimized our data’s reliability and accuracy.

Collection and Distribution of Quality Indicator Data

As earlier stated, nurses play a key role in collecting and reporting accurate data. This is accomplished via Press Ganey surveys. After that, we receive annual and quarterly reports from the NDNQI. These reports enable us to make informed decisions regarding various NSIs. Firstly, we evaluate the reports to determine the performance of each NSI. This forms the basis for formulating strategies for addressing underperforming NSIs. Secondly, we use this feedback to compare our performance with that of other healthcare facilities. By so doing, we can identify NSIs that require prompt improvement to give us a competitive advantage. We disseminate our data using both hardcopy and softcopy publications. Hard copies are disseminated in the form of handouts. Soft copies are availed electronically. We use both techniques to publish and distribute policy briefs.

Our commitment to data accuracy impacts nursing practice nationally. It enables various organizations, such as the ANA, to identify the performance of NSI nationally. This forms the basis of policy formulation and targeted interventions to address underperforming metrics. Furthermore, data accuracy enables stakeholders from various organizations to make key decisions. For example, the nursing shortage is a problem of national concern, as evidenced by the lack of optimized nurse-to-patient ratios. This information enables stakeholders from other organizations to initiate individualized strategies to address the problem. In this context, the nursing shortage is a problem of concern that lowers the quality of healthcare services in all healthcare facilities.

In conclusion, the NDNQI provides key information on nursing-sensitive indicators (NSIs) by making data available annually and quarterly. Our healthcare facility is among those that report data on NSIs. As such, we have played a significant role in the growth of the nursing practice nationally and institutionally. Our commitment has influenced policy formulation and targeted interventions to address underperforming metrics. Nurses play a significant role in upholding the accuracy and credibility of data. I welcome you to our great family as we aim to improve the quality of our services.

Thank you.

References

AHRQ.gov. (n.d-a). Central Line-Associated Bloodstream Infections (CLABSI). https://www.ahrq.gov/topics/central-line-associated-bloodstream-infections-clabsi.html#accordions

AHRQ.gov. (n.d-b). Estimating the Additional Hospital Inpatient Cost and Mortality Associated With Selected Hospital-Acquired Conditions. https://www.ahrq.gov/hai/pfp/haccost2017-results.html

Haddadin, Y., Annamaraju, P., & Regunath, H. (2022). Central Line Associated Blood Stream Infections. https://www.ncbi.nlm.nih.gov/books/NBK430891/

Koch, D., Kutz, A., Conca, A., Wenke, J., Schuetz, P., & Mueller, B. (2020). The Relevance, Feasibility, and Benchmarking of Nursing Quality Indicators: A Delphi Study. Journal of Advanced Nursing, 76(12), 3483–3494. https://doi.org/10.1111/jan.14560

Patel, P. R., Weiner-Lastinger, L. M., Dudeck, M. A., Fike, L. V., Kuhar, D. T., Edwards, J. R., Pollock, D., & Benin, A. (2022). Impact of COVID-19 pandemic on central-line-associated bloodstream infections during the early months of 2020, National Healthcare Safety Network. Infection Control and Hospital Epidemiology, 43(6), 790–793. https://doi.org/10.1017/ice.2021.108

Stifter, J., Sermersheim, E., Ellsworth, M., Dowding, E., Day, E., Silvestri, K., Margwarth, J., Korkmaz, K., Walkowiak, N., Boudreau, L., Hernandez, L., Harbert, B., Ambutas, S., Abraham, A., & Shaw, P. (2021). COVID-19 and nurse-sensitive indicators: Using performance improvement teams to address quality indicators during a pandemic. Journal of Nursing Care Quality, 36(1), 1–6. https://doi.org/10.1097/NCQ.0000000000000523

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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 Canadian 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 focuses 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 supports the 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 healthcare system. Choose from the following list:
Staffing measures.
Nursing hours per patient day.
RN education/certification.
Skill mix.
Nurse turnover.
Nursing care hours in emergency departments, perioperative units, and perinatal units.
Skill mix in emergency departments, perioperative units, and perinatal units.
Quality measures.
Patient falls.
The patient falls with injury.
Pressure ulcer prevalence.
Healthcare-associated infections.
Catheter-associated urinary tract infection.
Central line catheter-associated blood stream infection.
Ventilator-associated pneumonia.
Ventilator-associated events.
Psychiatric physical/sexual assault rate.
Restraint prevalence.
Pediatric peripheral intravenous infiltration rate.
Pediatric pain assessment, intervention, reassessment (air) cycle.
Falls in ambulatory settings.
Pressure ulcer incidence rates from electronic health records.
Hospital readmission rates.
RN satisfaction survey options.
Job satisfaction scales.
Job satisfaction scales – short form.
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:
What is your experience with collecting data and entering it into a database?
What challenges have you experienced?
How does your organization share the quality improvement monitoring results with the nursing staff and other members of the health care system?
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 courtroom, 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 [email protected] 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, etc. 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?
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?
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 courtroom 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.
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 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 the use of health information and patient care technologies.
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.
Follow APA style and formatting guidelines for citations and references.