NEW YORK NURSE: April 2010
by Roni Cummings, MSN, RN
Recently, questions have arisen regarding the role of nursing and its impact on the quality of patient care. Nurses are asking:
For years, nurses have been aware of the many issues that impact quality patient care. Rarely a day goes by that discussions are not heard about how the lack of adequate nurse staffing correlates with hospital-acquired infections, fall-related injuries, medication errors, and nursing job satisfaction. Yet providing the data to prove that inadequate staffing has an impact on quality patient outcomes has been difficult.
The Institute of Medicine (IOM), the Centers for Medicare and Medicaid Services (CMS), and healthcare institutions have charged nurses to develop and implement strategies that will improve patient care outcomes. Since the early 1990s, the American Nurses Association (ANA) has initiated measures to collect data that is sensitive to nursing indicators and includes patient falls, pressure ulcers, staff mix, nursing hours per patient day, nosocomial infections, and nursing turnover rates. The challenge is not just in collecting the data and interpreting it, but also in using the data to ultimately improve patient care and patient care outcomes.
One may question what is meant by “nursing sensitive indicators.” These indicators reveal the structure, process and outcomes of nursing care. “Structure” is reflected in the staffing mix, indicated by the educational level of the nurse, specialty certifications held by the nurse, and the skill level of the nursing staff – including number and ratio of registered professional nurses (RNs) to licensed practical nurses (LPNs) to unlicensed assistive personnel (UAP). “Process” refers to how the nurses do their jobs using assessment, planning, intervention, and evaluation of care. “Outcomes” are determined through focused study of infection rates, pressure ulcer rates, or the number of injuries that are the result of falls.
The National Database of Nursing Quality Indicators (NDNQI) was created by the ANA as a part of the National Center for Nursing Quality (NCNQ). The University of Kansas School of Nursing administers the NDNQI program and provides nursing sensitive indicator consultation and research based expertise to NDNQI. The NDNQI is the only national nursing quality measurement program that provides hospitals with unit-level reports that include comparisons to national averages.
How then can nurses contribute to and use the NDNQI data? An approach used by many staff nurses and nurse researchers is to review existing data for chosen indicators, such as post-surgical wound infections or fall rates. Define how the facility determines or defines the indicators and how the indictors are measured. Research the indicators with peer-reviewed literature for causes and solutions used by other nurses or facilities. And finally, make a change in the way nursing performs the care related to the indicators and then measure the outcomes.
Examining data outcomes from a single source, such as a unit or facility, is a good start to explore how much improvement has been made as a result of the proposed or implemented change for that particular source for a given amount of time. But, how would one know if this is a favorable rate overall? It is not until one can compare their unit with another unit or a “like” facility that an assumption can be made that the changes were indeed adequate. One could then question what the rates would have to be in order to be ranked in the top 10% of all units in the region, or even the nation.
NDNQI takes data seriously and maintains confidentiality for participating facilities. It ensures institutional identity will not be disclosed through avenues of transmission of data, storage, or reporting. Protected Health Information (PHI) is not collected or used and staff identities remain anonymous. Database access is restricted to authorized NDNQI personnel and reporting is through a secure firewall system. Only authorized users are able to obtain the quarterly NDNQI data reports.
The survival of nursing depends on a culture of change. Facilities have begun to move forward by analyzing data and making essential changes to improve quality of care for their patients. There are many reasons nurses need to review data. It is a reflection not only of quality-of-care issues, but also patient satisfaction and nursing satisfaction. Nurses can take pride in reviewing data that shows their efforts have improved care and have made a difference in their patient’s lives.
NDNQI, University of Kansas Medical Center (2010). Transforming Data into Quality Care. Retrieved from: https://www.nursingquality.org.
Ms. Cummings is an Associate Director of NYSNA's Education, Practice and Research Program.