NURS 4005 – Week 5 Assignment – Dashboard Analysis and Nursing Plan

NURS 4005 – Week 5 Assignment – Dashboard Analysis and Nursing Plan

Nursing dashboards contain data sourced from various databases that represent different aspects of nursing care. The purpose of creating these dashboards is to analyze pertinent data and promote decision-making and adherence to evidence-based guidelines that reflect the data (Wilbanks & Langford, 2014). The Nurse-Sensitive Quality Indicator dashboard showed how the nursing team performed in areas like addressing pressure ulcers and acquired pressure ulcers, falls and risk of falls, hours per patient per day, patient length of stay, and functional independence measures. There are also data on nursing satisfaction related to courtesy, promptness, special needs attention, pain response, home care instructions, and care coordination. The purpose of this paper is to identify one sensitive quality indicator and develop a nursing plan for improvement.

The chosen aspect of the National Database of Nursing Quality Indicators (NDNQI) is the health care’s team response to acquired pressure ulcers. A pressure ulcer, also called bedsore, is characterized by an injury to the skin or its underlying tissue, typically caused by pressure, moisture, and friction on the area (UCSF Health). Patients with debilitating conditions or those who are bedridden are more susceptible to acquired ulcers due to limited mobility. Individuals with cardiovascular diseases, diabetes, chronic pulmonary conditions, renal diseases, and neurodegenerative diseases like Alzheimer’s and dementia are also at risk of developing acquired ulcers (Jaul et al., 2018). This condition is highly treatable, but it requires immediate medical attention to prevent other comorbidities like chronic pain, infection, decreased quality of life, and even death.

Hospital-acquired pressure ulcers are when the patient develops the condition within the duration of his or her hospital stay. The rate of acquired pressure ulcers indicates not only the quality of the nursing care but also the patient’s morbidity and mortality risk. The health and financial impacts of acquired pressure ulcers can be mitigated with enough nursing manpower, clear guidelines, enough medical supply, and timely coordination with the care team and family.

NURS 4005 – Week 5 Assignment – Dashboard Analysis and Nursing Plan

Dashboard Analysis

Based on the dashboard provided, the hospital’s goal is to have zero hospital-acquired pressure ulcers from the second quarter of 2009 to the first quarter of 2010. During the Q2 and Q4 of 2009, the variance of the condition is zero, although the mean incidence is at 7.73 and 6.58, respectively. Q3 of 2009 and Q1 of 2010 have a variance of -5.26 and -4.35, respectively. This means that the hospital’s care team performed below the expected rate, although there was a slight improvement at the beginning of FY 2010.

A study by Gill (2015) reported that although hospitals have their program to prevent or address hospital-acquired pressure ulcers, several factors can lead to increased incidence: being ventilated and intubated, being on inotropes, complete bed rest, very restricted mobility, and incontinence. Most patients with limited mobility suffer from incontinence. Diarrhoea itself does not cause pressure ulcers, but the accumulation of urine and faeces can damage skin integrity and lead to infection.

It is important to remember that acquired pressure ulcer is a multifactorial problem. Aside from the patient’s existing condition/s, studies have shown that the care staff’s skills, expertise, and confidence in managing cases of acquired pressure ulcers influence the team’s success (Gill, 2015). Studies also showed that many qualified nurses and health staff do not follow the guidelines set by the hospital and evidence-based practices. Other confounding factors could be the insufficient number of care staff, the inability to immediately identify an at-risk patient at admission, and poor nurse-patient relationship.

NURS 4005 – Week 5 Assignment – Dashboard Analysis and Nursing Plan

Performance Improvement

 A survey of hospitals indicated common reasons for adopting a hospital-acquired pressure ulcer prevention program. These are current prevention campaigns, availability of nursing care specialists, and level of prevention knowledge among care staff. Other factors also include financial restraints, regulatory compliance issues, and information sharing among peer institutions (Padula et al., 2015). The following is a proposed improvement plan of the current prevention plan.

Consultation meeting with key players. Conduct an initial meeting with the intensive care unit nurse manager, tissue viability manager, director or assistant director of nursing, head of the prevention program team, and head of the respiratory department. They should discuss the current status of the prevention campaign, including statistics and feedback from patients, families, and health staff. They should also identify key successes and failures.

Create a plan to revise the current prevention campaign. Conduct a survey to assess the team’s Using the Braden scale; the team should be able to identify which patients have a low, moderate, and high risk of developing acquired pressure ulcers. A score of 18 or below is deemed to be a risk.

Improve the team’s skills and expertise in handling acquired pressure ulcers. The education shall include all aspects such as identifying and allocating clinical resources, patient risk assessment using the Braden scale, offloading pressure, skin protection, and referral to other care professionals like dietitians and physiotherapists.

Train members of the care team for hands-on treatment of pressure

Conduct a post-assessment survey identifying the level of staff expertise, patient pain level, length of wound care, and incidence of

The plan mentioned above should be able to identify areas of a gap in the prevention and management of acquired pressure ulcers. Upon identification, key decision-makers should be able to implement an approach according to evidence-based practices. Doing so should help them reach their target.

References

Cullen Gill E. (2015). Reducing hospital-acquired pressure ulcers in intensive care. BMJ Quality Improvement Reports, 4(1), u205599.w3015. doi:10.1136/bmjquality.u205599.w3015 Hospital-acquired pressure ulcers. UCSF Health. Retrieved 13 May 2019 from https://www.ucsfhealth.org/about/pressure-ulcers/

Jaul, E., Barron, J., Rosenzweig, J. P., & Menczel, J. (2018). An overview of comorbidities and the development of pressure ulcers among older adults. BMC Geriatrics, 18(1), 305. doi:10.1186/s12877-018-0997-7

Padula, W. V., Valuck, R. J., & Wald, H. L. (2015). Factors influencing adoption of hospital-acquired pressure ulcer prevention programs in the US academic medical centres. Journal of Wound, Ostomy, and Continence Nursing, 42(4):327-330. doi: 10.1097/WON.0000000000000145

Wilbanks, B. A. & Langford, P. A. (2014). A review of dashboards for data analytics in nursing. Computer Informatics Nursing, 32 (11):545-549. doi: 10.1097/CIN.0000000000000106

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Draft a 3- to 4-page paper analyzing areas where there is good performance and areas of opportunity from the sample.

Analyze the data provided in the Dashboard and select an area of performance that needs improvement. Include information on why this area was

Develop a nursing plan that includes suggestions on how to improve performance on the selected indicator. Be sure to provide at least three best practices from the evidence-based literature to support your suggested nursing.