Informatics and Nursing Sensitive Quality Indicators Script
Hello and welcome to East Road Hospital. The Quality Improvement Council at the East Road Hospital welcomes you to the nursing team. In this session, we will discuss how nursing informatics supports nursing-sensitive quality indicators monitoring. Within the tutorial, we will define the National Database of Nursing-Sensitive Quality Indicators (NDNQI) and nursing-sensitive quality indicators (NSI) and report an interview with a council member on how this care organization collects and disseminates data on quality indicators. We will also outline the role of nurses in supporting accurate reporting.
Let us start by defining NDQI and NSI. NDNQI is a nursing database that provides periodic reporting on structure, process, and outcome indicators useful in evaluating the level of nursing care in various institutions of care. It enables researchers to identify nursing factors that impact clinical outcomes. NSI, on the other hand, are specific patient outcomes influenced by nursing care. Accordingly, this tutorial will focus on patient falls as a nursing-related quality measure. Nurses and other caregivers play a role in implementing fall prevention measures in the hospital. For this reason, nurses should be familiar with patient falls as a quality indicator in healthcare.
Nurses’ and the Interdisciplinary Team’s Role in Collecting and Reporting Data
Fall prevention is a quality measure that finds relevance in many patient care settings. As a patient quality and safety safeguard measure, nurses and other members of the interdisciplinary team are tasked with creating a safe environment for their patients to minimize their risk of falling. Collecting and reporting data on patients’ falls is pivotal in informing on mitigating measures for fall incidences. With the advent of electronic medical records and automation of patients’ health information, data on falls can also be obtained from the hospital’s electronic databases. Other vital information that may also be obtained from these databases and indicative of a propensity to fall or unnoticed falls includes unexplained fractures or other injuries on the patients, breathing pulse, blood pressure, and fall assessment scores. This information may be vital in informing a suitable course of action.
Fall reporting is another key healthcare provision that informs quality improvement measures. Incident reporting on falls is an approach currently used to gather data on falls (Min et al., 2019). Members of the interdisciplinary teams must document any falls whenever they occur to facilitate investigation into the causal factor for these falls. Coding falls is one of the best reporting practices on patient falls. Code falls are a qualitative investigation that succeeds in fall incidents. The interdisciplinary team plays a vital role in data collection (Min et al., 2019). Their diversity in roles makes them valuable in identifying fall incidents. Working collectively, they can ensure optimal data collection on falls and facilitate prevention measures that ultimately promote patients’ safety.
Patient Falls as a Nurse Sensitive Quality Indicator
Patient falls remain one of the most commonly reported adverse events in the inpatient hospital setting. A combination of patient and care-related factors have been implicated as causal factors for patients’ falls. Patient falls are a source of quality and safety compromise in healthcare. Whenever they occur, they result in severe injury, loss of life, increased costs of healthcare, longer hospital stay days, and patient suffering (LeLaurin & Shorr, 2019). In addition, patient falls are a vital nursing-sensitive indicator as they show the level of nursing care. Higher fall rates correlate to poor quality nursing care. Thus, this indicator is relevant in informing the level and quality of care that the organization offers to their patients
How the Organization Collects Data on Patient Falls
An interview with members of the Quality Improvement Council of this hospital revealed how this hospital collects data on patient falls. The hospital encourages the documentation of falls through incident report books, which are integrated into the hospital EHR systems. A periodic review of these books often indicates the number of falls reported over time. The hospital also encourages members of the multidisciplinary teams to conduct frequent rounding to identify at-risk patients and implement fall prevention measures on them. This way, the hospital has been able to keep the rate of patient falls considerably low.
How the Hospital Disseminates This Data
Upon review of the collected data on falls, the hospital disseminates this data to the hospital’s clinical teams and the administration for follow-up activities. This data is often disseminated via written texts and memos sent to individual caregivers’ emails. Events that require urgent address are conveyed via phone calls to the affected hospital department. As a result, the hospital has been able to handle the reported fall incidents effectively, thus ensuring the safety of their patients.
The Role of Nurses
Nurses play a role in collecting and reporting data on patient falls. Since their role places them in contact with their patients, nurses can identify patients at high risk for falling. This enables them to implement fall prevention measures in these patients. Nurses are also able to identify unreported falls during rounding and assessment processes. Their role in this respect is to document these incidents and notify other members of the clinical teams to ensure that the affected patients are managed effectively. As newly hired nurses, you play a role in the accurate reporting of fall incidents. As Wehkamp et al. (2021) report, nurses have the ethical obligation of beneficence and non-maleficence that implores them to promote the welfare of their patients and do no harm. Reporting fall incidents will enable the implementation of address measures that ultimately will promote the safety of your patients.
How a Healthcare Organization Uses Nursing-Sensitive Quality Indicators
Nurse-sensitive quality indicators form the groundwork for monitoring the quality of nursing care in care institutions. They can be used as specific benchmarks for quality care as well as provide evidence for the cost-effectiveness of nursing approaches at the point of care. Healthcare organizations can use these indicators to inform quality improvement measures within care organizations. They also inform the overall efficiency of care operations within the hospital, as quality and safety compromises often result from care inefficiencies.
Data on patient falls, as an NSI, maintain significance in informing fall prevention measures in the hospital. Healthcare organizations can utilize this information to leverage organizational resources tarted at addressing identified causal factors for falls. Implementation of fall prevention measures may lower these incidents and subsequently enhance the safety of the patients.
How a Nursing-Sensitive Quality Indicator Establishes Evidence-Based Practice Guidelines for Nurses to Follow
Nurses’ sensitive quality indicators inform on best practices in patient handling. Naik et al. (2020) assert that NSI informs quality improvement measures, including operational adjustments, system enhancements, and refinement of quality indicators in a hospital. Additionally, NSI indicates how nursing practices have impacted patient and clinical outcomes. This helps determine what aspects of nursing practice can be modified to ensure better clinical outcomes and patient safety. Since these indicators are periodically updated and informed by scientific data, they can form part of guidelines for nurses to follow and be used in establishing an evidence-based practice.
In conclusion, let us look at the key findings from this presentation. Nursing-sensitive quality indicators remain significant in informing quality improvement measures in healthcare. Nurses and other members of the interdisciplinary teams play a role in collecting and reporting data on these indices. As you join the nursing workforce of this hospital, you should know that you play a role in collecting and reporting data on NSI. This data can be used to implement quality improvement measures in the hospital.
LeLaurin, J., & Shorr, R. (2019). Preventing falls in hospitalized patients. Clinics in Geriatric Medicine, 35(2), 273–283. https://doi.org/10.1016/j.cger.2019.01.007.
Min, L., Tinetti, M., Langa, K. M., Ha, J., Alexander, N., & Hoffman, G. J. (2019). Measurement of fall injury with Health Care System Data and assessment of inclusiveness and validity of measurement models. JAMA Network Open, 2(8). https://doi.org/10.1001/jamanetworkopen.2019.9679.
Naik, S., Voong, S., Bamford, M., Smith, K., Joyce, A., & Grinspun, D. (2020). Assessment of the nursing quality indicators for reporting and Evaluation (nquire) database using a data quality index. Journal of the American Medical Informatics Association, 27(5), 776–782. https://doi.org/10.1093/jamia/ocaa031.
Wehkamp, K., Kuhn, E., Petzina, R., Buyx, A., & Rogge, A. (2021). Enhancing patient safety by integrating ethical dimensions into critical incident reporting systems. BMC Medical Ethics, 22(1). https://doi.org/10.1186/s12910-021-00593-8.
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.
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.
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.
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:
Nursing hours per patient day.
Nursing care hours in emergency departments, perioperative units, and perinatal units.
Skill mix in emergency departments, perioperative units, and perinatal units.
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 events.
Psychiatric physical/sexual assault rate.
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.
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.
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.
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.
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 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, 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.