The Importance of Nursing-Sensitive Quality Indicators

The Importance of Nursing-Sensitive Quality Indicators

Hello and welcome to this healthcare facility. We are delighted to have you as our team members as we continue to discharge quality nursing services. I am here to enlighten you on the importance of nursing-sensitive quality indicators. I will describe how the data on nursing-sensitive quality indicators is collected and disseminated across this healthcare facility. Furthermore, I will help you understand your role in accurate and timely reporting and achieving high-quality results. High-quality results are an indication that patients receive the best healthcare services and increase the level of their satisfaction with nursing services. You play a key role in the quality improvement council by upholding evidence-based practices and providing accurate data to enable us to assess our Nursing Sensitive Quality Indicators.

The National Database of Nursing Quality Indicators is the national nursing database that evaluates nursing care services and avails quarterly and annual reports of indicators that evaluate nursing care. The National Database of Nursing Quality Indicators is abbreviated as NDNQI. We are among the USA facilities that provide data to the NDNQI. In 2021, authors Oner, Zengul, Ivankova, Karadag, and Patrician reported that these indicators entail three significant aspects of nursing practice: structure, process, and outcomes. In this context, the structure involves our staffing, skills, certification, and academic levels as nurses. The process entails the interventions we take, how we assess patients, and our job satisfaction. Outcomes, in this context, are patient outcomes that depend on the availability of nurses and the quality of services nurses provide.

Just like other healthcare facilities in the USA, our facility submits its report via the surveys provided by Press Ganey NDNQI. Authors Koch, Kutz, Conca, Wenke, Schuetz, and Mueller, writing in 2020, report that Press Ganey NDNQI provides quarterly and annual reports with insights on the three nursing-sensitive indicators. This data helps us gauge our performance against that of other facilities nationally. It enables us to make necessary modifications to increase the quality of our services that promote safety and better patient outcomes.

Now, allow me to share an example of a relevant quality indicator to our institution. Data obtained from the NDNQI has revealed that we have experienced an increase in hospital-acquired infections over the past four months. Notably, the increase in ventilator-associated pneumonia, also known as VAP, has been alarming. VAP has significantly reduced the quality of nursing services provided to the patients. Consequently, patients filling the Press Ganey surveys have reported low satisfaction levels with nursing services. Authors Sousa, Ferrito, and Paiva, writing in 2019, report that VAP develops within 48 hours or more following mechanical ventilation. Our nurses have reported that VAP is common after endotracheal intubation or tracheostomy. As nurses, we need to be aware of the prevalence of VAP and how it occurs. In 2018, Martin-Loeches, Rodriguez, and Torres reported that VAP occurs when microorganisms invade the lower respiratory tract due to compromised integrity caused by intubation.

VAP has clinical and economic implications. It leads to reduced patients’ recovery rates and prolongs their hospital stay. This is applicable both in the general ward units and in intensive care units. In 2018, the authors Lacherade, Azais, Pouplet, and Colin, G. reported that patients who suffer from VAP spend approximately $ 40,000 more than what they are required to pay. This is attributable to prolonged stays and extra costs incurred treating the VAP rather than the patient’s presenting complaint at admission. The incidence of VAP in our hospital has significantly reduced reimbursements from Medicare. We have experienced a 2 percent reduction in the reimbursement rates. HAP is considered a preventable disease; this is the cause of the drop in reimbursements.

Our nurses have reported VAP in mechanically ventilated patients as a concern in this facility. Our nurses have adopted various strategies to ensure that the problem is mitigated. This engagement stems from the fact that they recognize their role as first-line responders to the safety of patients. They embrace evidence-based practices, reported Martin-Loeches, Rodriguez, and Torres in 2021. These practices include minimizing patient exposure to mechanical ventilation, aspirating subglottic secretions, and offering patient-centered oral care. Writing in 2019, the authors Sousa, Ferrito, and Paiva identified other strategies, such as optimizing cuff pressures and using passive humidifiers in ventilator circuits. I urge you to familiarize yourself with these interventions by discussing them with your colleagues (our existing nurses) and researching them.

As new team members of our nursing workforce, you may be unaware of your role and how you can help. To answer this, you should know that nurses are important interdisciplinary team members. Nurses are active participants in data collection and submitting reports to the NDNQI. This data forms the background for evaluating key indicators and improves the quality of service delivery, patient outcomes, and patients’ quality of life. As earlier mentioned, our facility uses the Press Ganey NDNQI surveys to collect and report data. The surveys are emailed to all members of the interprofessional team. Nurses and other members of the interprofessional team accomplish this. A quality assurance team comprising nurses, physicians, and pharmacists collects and avails data related to VAP. Other interprofessional team members, such as health information administrators, provide patient information such as date of admission or discharge. This is useful when submitting reports on VAP during surveys. I urge you to visit the Press Ganey NDNQI website and familiarize yourself with its operations.

Allow me to discuss how this healthcare facility handles collected data and feedback from the NDNQI. The surveys you complete and additional patient data retrieved from the electronic health record system provide key information on the performance of this institution. Feedback from NDNQI enables the hospital administration to determine practices that can increase the quality of nursing services and improve patient outcomes. This is important for the well-being of the patient and the reputation of the healthcare facility. National and hospital trends of the NDNQI indicators are evaluated and prioritized. Indicators with suboptimal performance are addressed promptly through policy formulation or embracing evidence-based practices.

This facility has quality assurance teams that facilitate the evaluation and effective prioritization of each NDNNQI indicator. These teams are involved in policy formulation and identifying evidence-based practices to address underperforming indicators. The evidence-based practice aims at increasing the quality of nursing services and improving patient outcomes. As a team member, you should always participate in data collection and reporting. Furthermore, you should work in concert with members of the quality assurance team in your department.

As we edge towards the end of this session, I would like to provide some insights on how you impact this healthcare facility by embracing accurate collection and reporting of data. Your participation in data collection and reporting is beneficial to nursing practice, both institutionally and nationally. This feedback helps to pinpoint nurse-sensitive quality indicators that improve patient care and outcomes. Our facility uses structural and process indicators from the NDNQI to optimize nurse-to-patient ratios. This optimization is beneficial to this facility because it helps to reduce staff burnout, increase job satisfaction and reduce medication errors. This is important because it increases the productivity of staff, increases the quality of services, and creates better patient outcomes.

Our facilities accept both out-of-pocket payments and reimbursements from health insurers. Desirable nurse-sensitive outcomes will have a positive monetary impact on our facility. In this context, a reduction in VAP will elevate patients’ satisfaction levels with the hospital and its services. They are likely to come back or refer other patients. Furthermore, VAP is considered a preventable disease by health insurers such as Medicare. The high incidence of VAP has reduced our reimbursements from Medicare. Therefore, evidence-based practices that minimize VAP and create good nurse-sensitive outcomes should be embraced.

In conclusion, NDNQI provides quarterly and annual data that aims at improving patient outcomes and bettering nursing practice. You, as an important member in the provision of quality services, should provide accurate data when completing the Press Ganey NDNQI surveys. This facility will ensure that data from NDNQI is evaluated and appropriate interventions that promote quality service delivery are adopted. Furthermore, we promise to avail any relevant support in your daily engagements to promote quality. Together, we can ensure that quality is upheld and better patient outcomes are achieved. Welcome to our team.

Thank you.

References

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

Lacherade, J.-C., Azais, M.-A., Pouplet, C., & Colin, G. (2018). Subglottic Secretion Drainage for Ventilator-Associated Pneumonia Prevention: An Underused Efficient Measure. Annals of Translational Medicine, 6(20), 422–422. https://doi.org/10.21037/atm.2018.10.40

Martin-Loeches, I., Rodriguez, A. H., & Torres, A. (2018). New Guidelines for Hospital-Acquired Pneumonia/ Ventilator-Associated Pneumonia: USA vs. Europe. Current Opinion in Critical Care, 24(5), 347–352. https://doi.org/10.1097/MCC.0000000000000535

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

Sousa, A. S., Ferrito, C., & Paiva, J. A. (2019). Application of a Ventilator-Associated Pneumonia Prevention Guideline and Outcomes: A Quasi-Experimental Study. Intensive and Critical Care Nursing, 51, 50–56. https://doi.org/10.1016/

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Prepare an 8-10 minute audio training tutorial (video is optional) on the importance of nursing-sensitive quality indicators for new nurses.

The Importance of Nursing-Sensitive Quality Indicators

Introduction

As you prepare this assessment, you are encouraged to complete the Canadian Quality Assessment Framework activity. Quality healthcare 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 with patient outcomes. It provides a database and quality measurement program to track clinical performance and compare nursing quality measures against other national, regional, and state hospital data. 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 structure, process, and outcome. Theorist Avedis Donabedian first identified these categories. Donabedian’s theory of quality health care focuses 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 supports the 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.