Nursing-Sensitive Quality Indicator (NDNQI®)

Nursing-Sensitive Quality Indicator (NDNQI®)

Hello and welcome to the Excel Care System. I am Fete Maher. The nursing team is excited to welcome you on board.  I will explain the concept of quality of nursing care and its significance to our career as nurses. We are mandated with a significant responsibility of ensuring that patients are managed with care prior to, during, and after treatment and consultations. Assessment of the quality of nursing care is an important task because it highlights areas that need improvement and aspects that meet the requirements. This script will discuss the National Database of Nursing Quality Indicators (NDNQI), a tool that highlights specific nursing aspects that have the potential to affect the quality of care.

What is the Nursing-Sensitive Quality Indicator (NDNQI®)?

The National Database of Nursing Quality Indicators is abbreviated as NDNQI. The NDNQI is a voluntary databank that entails specific indicators that assess the quality of nursing care. The national database provides a structure that supports annual as well as quarterly reporting. The principal areas of assessment include structure, outcome, and process.  It is necessary for nurses to understand NDNQI because we are the first-line responders in the healthcare sector (Quigley, Neily, & Watson, 2007). In addition, our role in ensuring patient safety through the application of evidence-based care and the provision of critical data is significant enough to warrant sensitization on NDNQI.

What are the Nursing-sensitive quality indicators?

The NDNQI uses various quality indicators to assess nursing care. The indicators include patient falls, falls that lead to injury, the number of nursing hours for each patient, pediatric pain Assessment, Intervention, and Reassessment (AIR) cycle, Pediatric peripheral intravenous infiltration rate, psychiatric, physical assault rate, rate of sexual assault, the prevalence of restraint, pressure ulcer prevalence, skill mix, educational qualifications of the Registered Nurses (RN), voluntary turnover of nurses, the rate of nurse vacancies, and nosocomial infections. These quality indicators may be further divided into sub-indicators (Montalvo, 2007). For instance, the skills mix indicator addresses RNs, Licensed Practical/Vocational Nurses (LPN/LVNs), Unlicensed Assistive Personnel (UAP), and the percentage of the total time that Agency staff spend in nursing. The Registered Nurse satisfaction survey options highlight job satisfaction scales, practice environment scales (PES), and job satisfaction scales in short form. The pressure ulcers may be acquired from the community, hospital, or unit. The patient falls that lead to injuries assess the level of the sustained injuries. The number of nursing hours that each patient receives is categorized into RNs, Licensed Practical/Vocational Nurses, and Unlicensed Assistive Personnel (Quigley, Neily, & Watson, 2007). All the indicators mentioned herein address structural, process, and outcome measures.

Let’s discuss Patient Falls.

As we know, patient falls affect the safety and quality of care that can be accessed in a facility. The Excel Care facility is responsible for our patients’ well-being during admission and care. Patient falls undermine the quality of care and could lead to fatal injuries. In addition, patient falls can attract litigations, which could cost the facility financial resources and time and end in a negative reputation. The most vulnerable patients are aged 65 years and above. Falls result in painful injuries, loss of independence, emotional unrest, lower quality of life, increased days of admission, mortality, and morbidity. As the number of seniors increases, the developed nations’ healthcare providers should prepare to proactively manage patient falls because the patient population will also have more seniors. Our ability to avoid patient falls is important in ensuring that the facility’s care quality remains high. Fall rates range between 1.3 and 8.9 falls for every one thousand days of hospitalization (Toren & Lipschuetz, 2017). The highest falls are encountered in rehabilitation units. These falls result from urinary incontinence, medications that target patients’ psychology, impaired gaits, and confusion. Thus, this quality indicator is a significant determinant of care quality and patient safety now and in the future.

Patient falls are an economic burden that hospitals must shoulder. The cost of hospitalization following a fall increases by $12,000 up to $23,000. According to the Centers for Disease Prevention (CDC), the costs associated with falls are expected to rise to at least $67.7 billion by 2020 (Toren & Lipschuetz, 2017). Besides litigation costs, the facility must hospitalize the patients for an additional four days and offer rehabilitation during this period.

To manage falls in the facility proactively, we must be familiar with the fall prevention programs and strategies that are in place, factors that increase the risk, the importance of prevention, the impact on patient safety and care quality, and predisposing patient characteristics. Old age, certain medications, impaired gait, confusion, urinary incontinence, poor vision, weakness, and anxiety are the predisposing characteristics that increase the risk of patient falls. Environmental factors that heighten the risk include improper shoe wear, obstacles on a path, slippery floors, cables, absence of bed rails for support, and unstable beds (Toren & Lipschuetz, 2017). To prevent falls, we should closely monitor patients who have the above-mentioned predisposing factors, encourage patients to use bed rails and other walking support, respond to alarms promptly, maintain clear paths, and encourage the management to install proper lighting.

How do we collect and distribute patient fall data?

To collect data on patient falls, the facility relies on the reporting and records system that the risk manager establishes. All healthcare workers are encouraged to record all patient falls, identify injuries, and describe the context and causes. The aftermath, such as litigations, further hospitalization, and rehabilitation, are also recorded. Recording this data not only provides a source of information but also highlights hazards that need addressing.

To disseminate this data, the facility utilizes social media, internal memorandums, and the company website. The targeted audience consists of nurses, physicians, support staff, management, and other healthcare workers. The external audience constitutes current patients, investors, and potential patients. Most importantly, other healthcare institutions and government agencies can access the data. Memorandums are used to alert the internal audience about the occurrence of a patient fall. This information is posted on social media and the company website once strategies for elimination or management of the identified hazards are identified. Proper analysis is provided to keep all members of the audience informed about the facility’s management of falls. Such transparency is expected to initiate trust among patients, investors, and the public.

We play a critical role in ensuring that accurate reporting occurs for high-quality results. The risk manager is responsible for training nurses on record maintenance to ensure that entry is done accurately. The right content should also be recorded in a timely manner. Once nurses and other healthcare professionals are trained in these aspects, they can record data accurately each time. This promotes the facility’s ability to reduce patient falls because they address the current hazards and continually train employees on proactive management of the quality indicator. Eventually, healthcare professionals improve the patient safety and quality of care that they deliver to clients.

Let’s review a practical case.

A female in her late sixties visited a local facility after experiencing chest pain and shortness of breath. The patient had suffered from chronic obstructive pulmonary disease (COPD). The physician admitted the patient due to aggravated COPD and chest pain. The patient fell severely in the acute care area and was transferred to the hospital’s rehabilitation unit. The patient was found on the floor with a fractured hip. She fell while trying to get a nurse to assist her in going to the bathroom. There was no response. The husband to the patient noted that the wife was overmedicated with zolpidem and acetaminophen. These drugs increased the patient’s risk of falling. Unfortunately, the attending nurse did not highlight this risk on the patient’s bedside file or wristband. The zolpidem had been administered at the wrong time, which violated the hospital’s policy. The nurse did not document the falls and claimed to have checked on the patient fifteen minutes prior to the fall while she was asleep. The patient had hip surgery and further rehabilitation. After discharge, the patient died after two weeks. The facility encountered a lawsuit that alleged poor patient management of the patient considering the patient’s medication and physiological status. The lawsuit also highlighted the absence of a bedside alarm, commode, a sitter to monitor the patient, and door signage alerting other healthcare workers (MedPro Group, 2018).

As we conclude, this example highlights the role that the attending nurse should have played if they had received training or sensitization on the quality indicator. The negligence and ignorance that the healthcare workers demonstrated led to the lawsuit. Suppose the facility had created a reporting framework that enabled reporting. These issues would not have affected the patient’s well-being. True to the research findings, the patient succumbed to a different situation other than COPD, which had led to admission initially.

Thank you!

References

MedPro Group. (2018). Case Study: Multiple Lapses Result in Patient Fall and Injury.

Montalvo, I. (2007). The National Database of Nursing Quality Indicators® (NDNQI®). The Online Journal of Issues in Nursing, 12(3). doi:10.3912/OJIN.Vol12No03Man02

Quigley, P., Neily, J., & Watson, M. (2007). Measuring Fall Program Outcomes. Online Journal of Issues in Nursing, 12(2). doi:10.3912/OJIN.Vol12No02PPT01

Toren, O., & Lipschuetz, M. (2017). Falls prevention in hospitals- the need for a new approach: an integrative article. Nurse Care Open Acces J., 2(3), 93-96. doi:10.15406/

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You determine that you will cover the following topics in your audio tutorial script:

Introduction: Nursing-Sensitive Quality Indicator
What is the NDNQI®?
What are nursing-sensitive quality indicators?

Nursing-Sensitive Quality Indicator (NDNQI®)

Which particular quality indicator did you select to address in your tutorial?
Why is it important to monitor this quality indicator?
Be sure to address the impact of this indicator on 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.