Informatics and Nursing-Sensitive Quality Indicators

Informatics and Nursing-Sensitive Quality Indicators

Hello, and welcome to this comprehensive training session. My name is Jane Doe. I am here today to educate you on the importance of nursing-sensitive quality indicators. I will define the National Database of Nursing Quality Indicators and identify the specific quality indicator that is relevant to our facility. Additionally, I will explain our organization collects and disseminates data on the selected quality indicator. Thereafter, I will enlighten you about the important role you can play to uphold accurate reporting and increasing the quality of results. You are our representatives in embracing best practices that promote accurate reporting of data.

The National Database of Nursing Quality Indicators avails annual and quarterly reports on the indicators that evaluate nursing care in various healthcare organizations. In 2020, authors Koch, Kutz, Conca, Wenke, Schuetz, and Mueller reported that nursing-sensitive indicators are categorized into structural, process, and outcome indicators. Structural indicators entail staffing, education, and certification of nurses. Process indicators entail the techniques used in assessing patients and various nursing interventions. Outcome indicators refer to desirable patient outcomes that reflect quality care.

Authors Oner, Zengul, Ivankova, Karadag, and Patrician, writing in 2021, reported that more than 1100 healthcare facilities in the USA avail their data to the NDNQI. Our facility is part of this team. We report our data by completing surveys that are facilitated by Press Ganey NDNQI. In 2020, authors Koch, Kutz, Conca, Wenke, Schuetz, and Mueller reported that Press Ganey works in concert with the NDNQI and healthcare organizations to make annual and quarterly reports available. These reports focus on the three nurse-sensitive quality indicators. This feedback is relevant and beneficial to us because it helps us to know how we rank against other healthcare facilities nationally. Furthermore, the feedback helps us to make pertinent interventions that achieve a better quality of healthcare services and improve patient safety and outcomes.

Allow me to share a quality indicator of concern in this healthcare organization. Feedback from the Press Ganey NDNQI surveys demonstrates that our facility has experienced a surge in the incidences of catheter-associated urinary tract infections (CAUTI). The surge in the incidence of CAUTI reflects a decline in the quality of healthcare services provided by our nurses. This has a negative implication because patients have been expressing dissatisfaction with nursing services when completing the Press Ganey surveys. In 2022, authors Mong, Ramoo, Ponnampalavanar, Chong, and Nawawi stated that CAUTI refers to urinary tract infections diagnosed within two or more days after the insertion of a urinary catheter. The definitive diagnosis is made after obtaining positive bacterial culture results. Authors Patel, Gupta, Vaughn, Mann, Ameling, and Meddings, writing in 2018, reported that Escherichia coli, Pseudomonas species, Staphylococcus aureus, and Enterococcus species are the common causative agents of CAUTI.

CAUTI has both negative implications on clinical outcomes and the economic aspect. In 2020, authors Wanat, Borek, Atkins, Sallis, Ashiru-Oredope, and Beech reported that the daily incidence of CAUTI is approximately 3 to 10 percent for patients who have urinary catheterization. AHRQ n.d. reports that about 90 to 100 percent receiving long-term catheterization develop CAUTI. This is associated with decreased recovery rates and prolonged hospital stays. AHRQ n.d. points out that patients have to incur extra financial costs when managing CAUTI rather than their presenting complaints at the time of admission. AHRQ, n.d. reports that patients spend approximately $4,690 to more than $29,740 to manage CAUTI. Additionally, the surge in the incidence of CAUTI has affected our reimbursements from Medicare. We have been handed a 3 percent reduction in reimbursement. Medicare considers CAUTI to be a preventable disease. An increase in the incidence of preventable diseases attracts penalties from the insurer.

Our nurses have adopted various strategies to mitigate the problem of CAUTI. Authors Patel, Gupta, Vaughn, Mann, Ameling, and Meddings, writing in 2018, proposed various interventions to prevent CAUTI. The interventions are categorized as appropriate use of the urinary catheter, proper insertion techniques, and proper urinary catheter maintenance techniques. Appropriate use entails using catheters only when indicated and minimizing the duration of use in high-risk patients such as women. Proper insertion techniques entail the use of aseptic insertion procedures and training nurses on insertion techniques. Aseptic techniques are achieved by adequate hand washing, use of gloves, and sterile equipment. Authors Patel, Gupta, Vaughn, Mann, Ameling, and Meddings, writing in 2018, indicate that proper maintenance techniques entail the use of a closed drainage system after catheter insertion.

As new team players, you may be unaware of your role in the interdisciplinary team. Nurses play a key role in submitting accurate data to the NDNQI. As mentioned earlier, this is done by completing the Press Ganey NDNQI surveys. The data allows us to evaluate our performance against other healthcare facilities and identify underperformances. In this context, NDNQI reports enabled us to detect the surge in CAUTI. Other members of the interdisciplinary team, such as physicians, pharmacists, and health information administrators, also play a key role. The interdisciplinary team has established a committee that collects and reports data concerning CAUTI. This is an effort to minimize the incidences of this nosocomial disease. Additionally, accurate patient biodata is provided by health information administrators. This has increased the accuracy of our reports. I urge you to read more about the activities of NDNQI by visiting Their website.

At this point, I will discuss how our facility handles and disseminates aggregate data and reports from NDNQI. Nurses are actively involved in reporting accurate data by completing surveys. Reports from NDNQI provide us with the opportunity to evaluate our performance. By so doing, modifications are made to optimize the three nursing-sensitive quality indicators and improve patient outcomes. Our facility has a committee comprised of members of the interdisciplinary team that evaluate reports from the NDNQI. Thereafter, the committee proposes evidence-based interventions to address nursing-sensitive indicators with low performance.

Allow me to point out how your accuracy in data collection and reporting can impact this healthcare facility. You promote the growth of the nursing practice in this institution and nationally by completing the Press Ganey surveys. Nationally, the NDNQI can identify indicators with the worst performances and engage with relevant stakeholders to ensure that appropriate interventions that address the problem are implemented. Institutionally, the three nurse-sensitive indicators help to optimize staff ratios. Authors Drennan and Ross, writing in 2019, reported that optimized staff ratios help to minimize the incidence of medication errors, increase the quality of healthcare services, and improve patient outcomes.

This healthcare facility utilizes reimbursements from health insurers and out-of-pocket fees for service delivery. Your active involvement in improving the performance of nursing-sensitive indicators will be beneficial to this organization. For instance, a decrease in the cases of CAUTI will reduce the penalty enforced by Medicare and ensure that our organization receives full reimbursements.

In conclusion, the quarterly and annual reports from the NDNQI address the performance of three nursing-sensitive indicators. These are process, structure, and outcome indicators. Nurses are key players in ensuring the accurate completion of surveys provided by Press Ganey NDNQI. Please feel free to consult any member of our team for any clarification. We value you as a team member and a frontline of upholding accuracy in data and improving patient outcomes. Welcome on board.

Thank you.

References

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

Drennan, V. M., & Ross, F. (2019). Global Nurse Shortages – The Facts, the Impact, and Action for Change. British Medical Bulletin, 130(1), 25–37. https://doi.org/10.1093/bmb/ldz014

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

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

Oner, B., Zengul, F. D., Oner, N., Ivankova, N. V., Karadag, A., & Patrician, P. A. (2021). Nursing-Sensitive Indicators for Nursing Care: A Systematic Review (1997–2017). Nursing Open, 8(3), 1005–1022. https://doi.org/10.1002/nop2.654

Patel, P. K., Gupta, A., Vaughn, V. M., Mann, J. D., Ameling, J. M., & Meddings, J. (2018). Review of Strategies to Reduce Central Line-Associated Bloodstream Infection (CLABSI) and Catheter-Associated Urinary Tract Infection (CAUTI) in Adult ICUs. Journal of Hospital Medicine, 13(2), 105–116. https://doi.org/10.12788/jhm.2856

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-crine, 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

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Assessment 4 Instructions: Informatics and Nursing Sensitive Quality Indicators

• Prepare an 8-10 minute audio training tutorial script (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.
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.
• 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.