Using the NDNQI Data Base for Nursing Research. Rachel Behrendt, DNP, RN, AOCNS Senior Director, Magnet Program and Staff Development

Transcription

1 Using the NDNQI Data Base for Nursing Research Rachel Behrendt, DNP, RN, AOCNS Senior Director, Magnet Program and Staff Development

2 Objec&ves Understand the value of nursing focused databases Iden&fy opportuni&es for research using NDNQI data

3 Quality Indicators Quality Indicators (QIs) measure quality associated with processes of care that occurred in an outpa&ent or an inpa&ent secng.

4 What IS an Indicator? Indicator: Valid and reliable quan&ta&ve process or outcome measure related to one or more dimensions of performance, such as effec&veness or appropriateness (The Joint Commission)

5 Selec&ng a Quality Indicator STEP 1 STEP 2 STEP 3 Expert members across healthcare (and pa&ents) define quality with uniform standards and measures that apply to the many facets of care pa&ents receive. Informa&on iden&fied from measuring performance is reported and analyzed Caregivers examine informa&on about the care they are providing and use it to improve.

6 Diagram of the Causes of Mortality in the Army in the East

7 Nurse Sensi&ve Outcomes (NSO) Any interven&on that is: sensi&ve to the input of nursing care within the scope of nursing prac&ce integral to the processes of nursing care AKA Nurse sensi&ve indicator (NSI)

8 nursing sensi&ve performance measures are processes and outcomes and structural proxies for these processes and outcomes (e.g., skill mix, nurse staffing hours) that are affected, provided, and/or influenced by nursing personnel, but for which nursing is not exclusively responsible. Nursing sensi&ve measures must be quan&fiably influenced by nursing personnel, but the rela&onship is not necessarily causal Na&onal Quality Forum: Na&onal Voluntary Consensus Standards for Nursing Sensi&ve Care: An Ini&al Performance Measure Set. Washington, DC: 2004

9 Nursing Sensi&ve Outcomes represent the consequences or effects of nursing interven&ons and result in changes in pa&ents : symptom experience func&onal status safety psychological distress cost

10 Example Measures for Nursing Sensi&ve Care Structure Process Outcome Size Teaching status Payer mix Magnet status CNO/manager Prac&ce environment (e.g., autonomy) NHPPD Staff mix Use of agency staff Educa&on Specialty Cer&fica&on Other creden&als Turnover Risk assessment Implementa&on of preven&on protocols Pain management Medica&on administra&on Counseling Communica&on, teamwork, decision making Injury falls HAPUs Nosocomial infec&ons Failure to rescue Mobility Sa&sfac&on with care Unplanned readmissions

11 Na&onal Database of Nursing Quality Indicators (NDNQI) ANA s Na&onal Center for Nursing Quality (NCNQ). Goals: Provides unit level compara&ve data to hospitals for use in QI ac&vi&es Develop na&onal data on the rela&onship between nurse staffing and pa&ent outcomes Magnet Implica&ons

12 NDNQI Primary focus Collect data at the unit level to capture nursing prac&ce Data come from direct care nursing prac&ce Leads to ability to focus on outcomes that are nurse sensi&ve Reports can be obtained by unit or hospital type

13 Na&onal Database of Nursing Quality Indicators (NDNQI) Currently > 1500 par&cipa&ng hospitals Comparison Groups Teaching Status (Academic Medical Center) Bed Size ( beds) Magnet Status Quarterly Data Reports

14 Indicators Pa&ent focused: Sa&sfac&on Pain management Educa&on Process focused Skin integrity Catheter related infec&on Structure focused Nursing hours per pa&ent day RN/UAP Skill Mix

15 NDNQI Core Measures Original Indicators Nursing Hours per Pa&ent Day Skill Mix Hospital and Unit Acquired Pressure Ulcers Falls and Falls with Injury

16 NDNQI Core Measures Addi&onal Data Collected Contract/Agency Nurse Hours RN Educa&on and Cer&fica&on Pressure Ulcer and Fall Processes Risk Assessment Preven&on Protocols Severity Hospital Characteris&cs Staffed Beds Magnet Status Teaching Status

17 Added Indicators RN Sa&sfac&on (survey) Pain Assessment Peripheral IV Infiltra&on Physical/Sexual Assault Restraint Prevalence Nurse Staff Turnover Healthcare Acquired Infec&ons

18 NSI and Magnet Recogni&on Program Exemplary Professional Prac&ce EP3 and EP3EO RN Sa&sfac&on EP32 and EP32EO Culture of Safety (NSI) EP35 and EP35EO Pa&ent Sa&sfac&on Organiza&onal Overview Skill Mix HPPD Cer&fica&on rates

19 What NSI Databases Can be Used For 1. NDNQI Core Measures 2. Access hospital and unit level data and comparison with na&onal trends 3. Monitor trends in nurse sensi&ve indicators 4. Target opportuni&es for prac&ce improvement or nursing research 5. Review evidence and construct projects

20 Monitor trends in nurse sensi&ve indicators Quality/Performance Improvement Staffing and pa&ent trends over &me Nursing Administra&on Resource/Strategic Planning Recruitment RN Reten&on or Hiring Risk Management

21 Research Considera&ons Data may enable us to isolate nursing s impact or contribu&on Strongly related to nursing (workforce or processes) For example: Does changing skill mix to have more RN HPPD impact pa&ent falls on the oncology unit? Ques&on to consider: Is the impact quan&fiable or are there other influences? Characteris&cs or ac&ons of the padents Influence of other healthcare providers OrganizaDon and environment of hospital

22 Research Considera&ons Comparison Data Comparison data are owned by ANA and may not be published by NDNQI member hospitals. PublicaDon of Reports You may publish your hospital s data. ALL readers of the report within the facility must be informed that comparison data are owned by ANA and may not be published without prior wri@en consent from ANA. You may reference the direc&on that your scores are from the NDNQI comparison data

23 An Example of Using NSI Data and EBP in a Research Project: Evidence Based Skin Care Problem: Demonstrated increase in hospitalacquired pressure ulcers EBP Plan: ID staff nurse champions (Dermal Defense RG RNs) Implement evidence based Braden Scale into all assessment tools Develop skincare algorithm Evaluate new products 23

24 Measurements: Before and Aper Research ques&on: Does educadon on pressure ulcer prevendon combined with an evidenced based screening tool improve padent outcomes in hospital acquired pressure ulcers? Evaluate nursing knowledge: Pre test/post test of nurses knowledge Develop educa&on/use NDNQI tutorial Use NDNQI Data Base for Pressure ulcer prevalence # of pa&ents with PU # of pa&ents assessed x 100 = % prevalence Report change in knowledge, change in pressure ulcer prevalence 24

25 In Conclusion Using a nursing specific database provides opportunity to: Iden&fy prac&ce gaps Inves&gate best prac&ces Develop research ques&ons using data to support the need for the research

26 References Agency for Healthcare Research and Quality (2009). Quality indicators. Retrieved May 15, 2010 from ANCC (2008). Magnet Recogni&on Program Applica&on Manual. Silver Spring, MD: ANCC. Dossey, B.M., Selanders, L.C., Beck D.M., & Avewell, A. (2005). Florence Nigh&ngale today: Healing, leadership, global ac&on. Silver Spring, MD: Nursesbooks.org. Given, B., Beck, S., Etland, C., Gobel, B.,Lampkin, L., Marsee, V. (2004). Nursing Sensi&ve pa&ent outcomes descrip&on and framework. Retrieved May 15, 2010 from Hart, S., Berquist, S., Gajewski, B., & Dunton, N. (2006). Reliability tes&ng of the Na&onal Database of Nursing Quality Indicators pressure ulcer indicator. Journal of Nursing Care Quality 21(3), Montalvo, I., & Dunton, N. (2007)Transforming nursing data into quality care: Profiles of quality improvement in U.S. healthcare facili&es. Silver Spring, MD: Nursing World Na&onal Quality Forum. (2004). Na&onal Voluntary Consensus Standards for Nursing Sensi&ve Care: An Ini&al Performance Measure Set. Washington, DC. Available at: hvp:// r/nursing Sensi&ve_Care_Ini&al_Measures/Nursing_Sensi&ve_Care Ini&al_Measures.aspx