Informatics and Nursing Sensitive Quality Indicators

Informatics and Nursing Sensitive Quality Indicators

Hello, and welcome to this presentation. The presentation defines the National Database of Nursing-Sensitive Quality Indicators and nursing-sensitive indicators. Furthermore, it discusses a quality indicator of concern. The presentation will also discuss the collection and dissemination of data on the quality indicator.

Nursing-Sensitive Quality Indicator

The National Database of Nursing-Sensitive Quality Indicators (NDNQI) provides vital information on nursing-sensitive indicators (NSI) by making data available quarterly and yearly. Writing in 2021, Stifter, Sermersheim, Ellsworth, Dowding, Day, Silvestri, Margwarth, Korkmaz, Walkowiak, Boudreau, and Hernandez reported that the NDNQI allows healthcare facilities to evaluate the success of their units. It also permits healthcare institutions to compare their performance to comparable facilities at state and national levels. The NDNQI hopes to improve the quality of important metrics to advance patient safety. Writing in 2021, Stifter, Sermersheim, Ellsworth, Dowding, Day, Silvestri, Margwarth, Korkmaz, Walkowiak, Boudreau, and Hernandez reported that the organization, technique, and outcomes of nursing services are the focus of NSI. The structure includes things like resource allocation and nurse-to-patient ratios. The technique assesses the relationship between the nurse and the patient. Outcomes are determined by structure and technique.

I would now like to discuss an NSQI that impacts our health facility. The quarterly reports indicate that the cases of catheter-associated urinary tract infections (CAUTI) have increased over the past three quarters. Writing in 2022, Werneburg reports that CAUTI occurs within forty-eight hours after the insertion of urinary catheters. In 2022, authors Mong, Ramoo, Ponnampalavanar, Chong, and Wan Nawawi reported that examples of factors that increase the likelihood of CAUTI include underlying medical conditions such as diabetes mellitus, prolonged catheterization, elderly population, and females. It is important to monitor CAUTI because it is estimated that the risk of developing it increases by about three to seven percent daily after catheterization. CAUTI is caused by bacteria and fungi. Examples of bacteria that have been implicated include Klebsiella pneumonia, Staphylococcus aureus, Enterococcus, and Escherichia coli, whereas Candida species is the common fungal cause of CAUTI. Writing in 2022, Werneburg reports that indwelling urinary catheters provide a conduit for colonization by rectal or urethral microbes. Additionally, catheters might disrupt the barrier of the uroepithelium and predispose it to microbe colonization.

CAUTI impacts patient safety and the quality of care and increases healthcare costs. Writing in 2022, Werneburg reports that it is estimated that more than one million cases of CAUTI are recorded in the USA annually. Writing in 2022, Werneburg reports that approximately three cases of CAUTI are reported for every one thousand catheter days in long-term care facilities. Writing in 2022, Werneburg reports that the incidence of CAUTI in the ICU is approximately 7.7 cases per one thousand catheter days. CAUTI impacts patient safety by increasing the risk of secondary bloodstream infections. In addition, CAUTI prolongs hospital stays, resulting in antibiotic overuse and increasing healthcare costs. Writing in 2022, Werneburg reports that the annual cost of managing preventable CAUTI ranges from at least $110 million to $1.8 billion. Writing in 2017, AHRQ reports that each patient spends approximately $4,600 to $29,700 to manage CAUTI annually.

Our interdisciplinary team has embraced various strategies to combat this problem. To begin with, they have embraced aseptic catheter insertion techniques. Writing in 2020, Wanat, Borek, Atkins Sallis, Ashiru-Oredope, Beech, Butler, Chadborn, and Hopkins reported that this entails maintaining hand hygiene before, during, and after inserting the catheter. Furthermore, they have adopted a closed drainage system (CDS) to avert contamination and reduce the risk of CAUTI. In 2019,  Schiessler, Darwin, Phipps, Hegemann, Heybrock, and Macfadyen reported that other considerations related to a closed drainage system include positioning the drainage bag below the bladder. Any breakage in the CDS necessitates the replacement of the catheter and drainage bag aseptically.

As new members, you should be familiar with CAUTI when providing patient care. Firstly, CAUTI is a problem of concern, as evidenced by an increase in its incidence over the past few months. Familiarity with this condition will allow one to collaborate effectively with the interdisciplinary team to address this problem. Secondly, familiarity with the condition will enable one to research and uphold the best evidence-based approaches to mitigating CAUTI. Thirdly, familiarity with the condition will enable one to understand its impact on the quality of care at this facility. This will guide your practice to enable the healthcare facility to optimize the quality of care and achieve better patient safety.

Collection and Distribution of Quality Indicator Data

I would like to discuss how our institution collects and disseminates data. This facility is among those that provide their statistics to the NDNQI. This is performed through the use of Press Ganey surveys. Press Ganey is a company dedicated to formulating and distributing surveys by partnering with NDNQI. Nurses play a vital role in gathering accurate data and reporting. Furthermore, patients play an important part in submitting satisfaction questionnaires. Other stakeholders involved in data collection and reporting include physicians and pharmacists. Data collection and reporting are succeeded by quarterly and annual reports from the NDNQI. NDNQI’s reports allow us to plan and formulate appropriate policies to improve the performance of specific metrics. For instance, NDNQI’s reports revealed an increase in hospital-associated falls three years ago. We addressed this by developing a standardized fall risk assessment tool. Furthermore, NDNQI’s reports enable us to assess and compare the performance of our metrics at the state and federal levels. By so doing, we identify our strengths and weaknesses, allowing us to optimize our competitive advantage. We disseminate our data through publications in both hardcopy formats, such as handouts and pamphlets. Also, we disseminate our data virtually via email and social media.

I would like to discuss nurses’ role in enabling correct reporting and increasing optimizing outcome quality. They are crucial players who participate in press Ganey surveys. They assure the credibility and reliability of this data by embracing adequate documentation and working in harmony with the interdisciplinary team. Nurses are required to record their interventions periodically. Data accuracy can be enhanced by embracing strategies such as performing independent checks. Proper documentation reduces the possibility of medical errors.

Finally, this facility is among those that provide their statistics to the NDNQI. The NDNQI database avails quarterly and annual reports to allow healthcare facilities to identify underperforming metrics and make pertinent modifications. Nurses play a vital role in gathering accurate data and reporting. Additionally, patients play an important part in submitting satisfaction questionnaires. NDNQI’s annual and quarterly reports allow us to plan and formulate appropriate policies to improve the performance of specific metrics. I take this opportunity to welcome you to this facility. Please feel free to learn from and share with this great family.

Thank you.

References

Mong, I., Ramoo, V., Ponnampalavanar, S., Chong, M. C., & Wan Nawawi, W. N. F. (2022). Knowledge, attitude, and practice in relation to catheter-associated urinary tract infection (CAUTI) prevention: A cross-sectional study. Journal of Clinical Nursing, 31(1–2), 209–219. https://doi.org/10.1111/jocn.15899

Schiessler, M. M., Darwin, L. M., Phipps, A. R., Hegemann, L. R., Heybrock, B. S., & Macfadyen, A. J. (2019). Don’t Have a Doubt, Get the Catheter Out: A Nurse-Driven CAUTI Prevention Protocol. Pediatric Quality & Safety, 4(4), e183. https://doi.org/10.1097/pq9.0000000000000183

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

Wanat, M., Borek, A. J., Atkins, L., Sallis, A., Ashiru-Oredope, D., Beech, E., Butler, C. C., Chadborn, T., Hopkins, S., Jones, L., McNulty, C. A. M., Roberts, N., Shaw, K., Taborn, E., & Tonkin-crim, S. (2020). Optimizing interventions for catheter-associated urinary tract infections (Cauti) in primary, secondary, and care home settings. Antibiotics, 9(7), 1–13. https://doi.org/10.3390/antibiotics9070419

Werneburg, G. T. (2022). Catheter-Associated Urinary Tract Infections: Current Challenges and Future Prospects. Research and Reports in Urology, 14(April), 109–133. https://doi.org/10.2147/RRU.S273663

ORDER A PLAGIARISM-FREE PAPER HERE

We’ll write everything from scratch

---

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:
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.
Patient falls with injury.
Pressure ulcer prevalence.
Health care-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 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 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 [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, 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?
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.