NURS 4005 – Week 5 Assignment- Dashboard Analysis and Nursing Plan DUE
The purpose of this paper is to review a quarterly Dashboard of an inpatient rehab unit. The provided information includes data regarding nurse-sensitive quality indicators, including pressure ulcers (including patients who were assessed for pressure ulcers within 24 hours of point prevalence assessments), total falls and patients at risk on fall protocol, RN care hours, and interpret the data and frame a nursing plan low scoring are based on best practices. Also included are nurse-sensitive patient satisfaction survey indicators, including RN courtesy, promptness, attention to special needs, response plan, instruct home, and well-care coordinator. In the past, experience-based and opinion-based practices have proved to be ineffective or even harmful, hence the use of evidence-based medicine (Leape et al). This paper will provide a thorough description of the area of performance selected that needs improvement, will discuss the statistical findings, and why the area was selected.
Analysis of Dashboard
Utilizing information provided by the National Data Nursing Quality Indicators (NDNQI) helps healthcare organizations provide the best care to patients. NDNQI is the richest database of nursing performance in the country. Each NDNQI member hospital identifies a site coordinator whose primary responsibility is being a point of contact for all NDNQI-related activities. The NDNQI site coordinator serves a vital role in ensuring that all data collection and reporting adhere to NDNQI guidelines. (NDNQI, 2015).
The Dashboard analyzes areas where there is good performance and areas of opportunity for improvement (Garrad). Benchmarking – the perpetual search for evidence-driven practice improvements in the quest for exceptional competitive performance with other similar hospitals in a confidential context – is an important element in this process (ncbi). Recent public reporting initiatives and the pay-for-performance demonstration project funded by the Centers for Medicare & Medicaid Services (CMS) represent the report-card strategy in which hospital performance is judged by external constituents incorporating incentives for performance improvement (NCBI). Nurse-sensitive service-line / unit-specific indicators, general indicators, NDNQI data, and patient satisfaction survey indicators. The overall data showed the performance improved over time. This includes a thorough description of the area of performance selected that needs improvement; this paper will include the statistical findings and why the area was selected.
Pressure ulcers did worsen over the last quarter and will be the focus of nursing care.
NURS 4005 – Week 5 Assignment- Dashboard Analysis and Nursing Plan DUE
Plan.
The nurse-sensitive patient satisfaction survey indicators showed overall improvement going into the third quarter, with a decline in the last quarter. The total falls show a higher target than the pressure ulcer target. The patients who were assessed for pressure ulcers within 24 hours of point prevalence assessment showed a large increase in the last quarter.
Falls
The dashboard data shows that the results for total falls in the last quarter were increased over the target. Falls are an area of performance that needs improvement. “Best practices” are those care processes that, based on literature and expert opinion, represent the best way we currently know of preventing falls in the hospital (AHRQ). Falls are common adverse events experienced by patients in hospitals and continue to pose challenges to healthcare quality. Fall reduction is identified as a patient safety priority in the United States (National Priorities Partnership, 2011).
While falls have a tremendous impact on the patient, they also directly affect a healthcare organization’s cost per case and length of stay. Falls are a major contributor to a patient’s functional decline and increased healthcare use. Even if a fall doesn’t cause a serious injury, it may triple the patient’s likelihood of requiring placement in a skilled nursing facility.
Pressure Ulcer
In addition to falls, pressure ulcers are another poor performance indicator, according to the information on the Dashboard.
The prevalence and incidence rates of pressure ulcers, coupled with the cost of treatment, constitute a substantial burden for our health care system. In 2008, the Centers for Medicare and Medicaid Services announced that they would not pay for additional costs incurred for hospital-acquired pressure ulcers (Cooper). The cost of one stage III or IV pressure ulcer may be between $5,000 and $50,000, depending on co-morbidities (Cooper). Quality care aimed at preventing and minimizing skin breakdown and pressure ulcers has been identified as a nursing research priority (EBN). Per the Dashboard, the incidence of pressure ulcers increased over the last quarter.
NURS 4005 – Week 5 Assignment- Dashboard Analysis and Nursing Plan DUE
Nursing Plan
What are good ways to promote fall prevention? For example, patients wearing fall alert bracelets to alert the staff to know that the patient is high risk. Another way is by turning the bed alarm on the bed of those patients. In some cases, restraints might be used; however, this is not always an ethical way to take care of patients causing issues like pressure ulcers. To help prevent pressure ulcers and improve the Dashboard, there must be a proper assessment by the practitioner. Despite evidence-based prevention protocol, pressure ulcer rates are still higher than in many other clinical areas across all states. Proper assessment of high-risk populations includes older patients, critically-ill patients, and patients with a history of pressure ulcers in prior hospital stays. Insufficient use of preventative measures implemented by best practices can put a patient at high risk (Balzer, Kottner, 2015). Since pressure ulcers are more common on the sacrum, coccyx and heels, these are areas that require more attention for assessment and prevention. Patients that are bed-bound or remain in bed more hours of the day than not need special attention to turn out of bed if possible. The less pressure on those areas, the less likely they are to suffer a breakdown of the skin. Methods to reduce the risk of pressure ulcers on the heel include the use of pillows and heel-lift boots (Cooper). Documentation of the skin assessment should be done once assessed. During the assessment, the RN should consider the patient’s high risk. An easy way to assure accurate assessment is by completing a Braden scale for predicting pressure sore risk. It includes Sensory, Perception, Moisture, Activity, Mobility, Nutrition, Friction and Shear. Each area is rated 1 to 4 in significance and then totalled. An at-risk Braden score of 15 to 18 needs preventive interventions implemented.
Summary
Utilizing information provided by the NDNQI helps healthcare organizations provide the best care to patients. The Dashboard analyzes areas where there is good performance and areas of opportunity for improvement (Garrad). The analysis of the Dashboard showed areas of performance improvement and areas with positive performance. Pressure ulcers did worsen over the last quarter and will be the focus of the nursing care plan. The nurse-sensitive patient satisfaction survey indicators showed overall improvement going into the third quarter, with a decline in the last quarter. The total falls show a higher target than the pressure ulcer target. The development of these benchmarks leads healthcare providers to the data to make changes that are needed to provide optimal patient care.
References
Balzer, Katrin, Kottner,Jan (Nov 2015). Evidence-based practices in pressure ulcer prevention: Lost in implementation?
Brown, S., & Aydin, C. (2017). Beyond Nursing Quality Measurement: The Nation’s First Regional Nursing Virtual Dashboard. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK43614/
Evaluation of the National Database of Nursing Quality Indicators (NDNQI) Training Program on Pressure Ulcers (2009). Retrieved from:https.www:// The Journal of Continuing Education in Nursing
Garrard, L., Boyle, D. K., Simon, M., Dunton, N., & Gajewski, B. (2016). Reliability and validity of the NDNQI® injury falls measure. Western Journal of Nursing Research, 38(1), 111– 128. doi: 10.1177/019394591454281
Leape LL, Berwick DM, Bates DW. What Practices Will Most Improve Safety? Evidence-Based Medicine Meets Patient Safety. JAMA. 2002;288(4):501-507. doi:10.1001/JAMA.288.4.501 Prevention Plus (May 2017). Retrieved from: http://bradenscale.com
Special Supplement to American Nurse Today – Best Practices for Falls Reduction: A Practical Guide (March 2011). Retrieved from: http://www.americannursetoday.com
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Question 
For the purpose of this assignment, review the quarterly Dashboard provided in the online classroom, which contains a variety of clinical and administrative indicators. Write a 3- to 4-page paper analyzing areas where there is good performance and areas of opportunity. Then, select one area that needs improvement and develop a nursing action plan based on best practices.