Part 4 Quality Indicators Safety Initiatives Ferris State

Part 4 Quality Indicators & Safety Initiatives Ferris State University - Nursing 541 Shannon Sharrar, Juline Lloyd, Leslie Peterson, Elizabeth Watson, and Rosilind Richardson

Nursing Hours per Patient Day/Patient. Staff Ratio What is a nursing hours per day? Number of nurses allocated according to the nursing hours per patient day What is Nurse – Patient Ratio? Number of nurses per number of patients or patient days determines staffing levels Who endorses the NSI nursing hours per patient day? American Nurses Association National Quality Forum (Montalvo, 2007) Complications associated with nursing hours per day/nurse-patient ratio: • • Budget Errors Quality of care Nursing burnout

Nursing Hours per Patient Day/ Patient-Staff Ratio Performance Analysis of Data Study Needleman, Buerhaus, Pankratz, Leibson, Stevens & Harris (2011) Findings Decreased mortality rates with higher nursing hours per patient day Discussion Staff target level Need for laws regarding nursing hours per day

Nursing Hours per Patient Day/ Patient-Staff Ratio Performance Analysis of Data Study He, Staggs, Bergquist-Beringer, & Dunton (2016) Findings Increased staffing led to lower event rate with all outcomes Discussion RN staffing numbers affect NSIs – fall rate and pressure ulcer

NSI: Falls What is a fall: “An unplanned decent to the floor” (National Database of Nursing Quality Indicators, 2013). Who endorses the NSI falls? The Joint Commission The Institute of Medicine The Centers for Medicare and Medicaid Services Complications associated with falls: • Injuries • Considered hospital acquired if injury (Centers for Medicare and Medicaid, 2015) • Costly • Decreased quality of life for patient

NSI: Falls Performance Analysis of Data Study Findings • Nurses are key players in falls Barker, Morello, Ayton, prevention Hill, Brand, Livingston & • Practical benefits Botti (2017) • Fall risk tools are useful in preventing falls Discussion • 6 -PACK nurse led falls prevention program • uses interventions known to decrease falls • ease of use for nurses • decrease noncompliance with nurses implementing fall risk interventions

NSI: Falls Performance Analysis of Data Study Findings Multifactorial fall Spoelstra, Given & Given prevention intervention (2012) programs decrease both falls and fall injuries in hospitalized patients Discussion Multifactorial fall prevention intervention programs include evidence based interventions

: Quality Improvement Identify areas for improvement Quality Improvement: a systematic approach that is driven by data and meant to improve systems within an organization (Shirey et al, . 2011) Purpose of Quality Improvement: Evaluate response Analyze data Improve the quality and safety of health care systems (Weston & Roberts, 2013) Quality improvement initiatives: falls, patient-staff ratios, medication errors, hospital acquired infections, hospital readmits (Agency for Healthcare Research and Quality, 2017) Implement Formulate goals/plan

Influence on Healthcare Quality: Environment Quality Improvement: Influence on nurse hours per patient day 1. Identify : nurse hours per patient day effect patient outcomes 2. Analyze: laws, patient acuity, experience of nursing staff 3. Develop: what ratio are we going to use 4. Implement: staffing plan/ratio 5. Evaluate: track outcomes. Is this creating positive patient outcomes? Does something need to be done differently? Can we continue with current plan (University of Irvine California Healthcare, 2012)

Influence on Healthcare Quality: Environment Quality Improvement: Monitoring fall rates Spectrum Health, 2017 Quality Improvement Project: Silkworth, Baker, Ferrara, Wagner, Gevaart, Morin, 2016)

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