Quality Indicators Safety Initiative Group 4 Part 3

Quality Indicators & Safety Initiative: Group 4, Part 3 Kristin De. Jonge Ferris Stat University MSN Program

Nursing Sensitive Indicators • Quality must become the center of healthcare • Improved outcomes = Improved nursing care • Data collection helps build relationship and understanding to nursing measures • Ultimate goal of improving organizational processes and outcomes (6) (16)

Restraints • What’s the problem with physical restraints? • Physical harm: pressure ulcers, joint/nerve injury, death or strangulation • Physiological harm (16) • “But we have to use them to prevent our patients from falling” -NO! • Restraints show increased harm to patients • Restraint removal does not correlate with increased falls (4)

Restraints • Psychiatric unit Pilot Study (13) • Restraint use decreased from 36 to 0 incidents • Nurses were key to developing new care models • Interventions: • • focused staff training; ward projects for change and hope; staff support through coaching; and enhanced staff and patient communication projects • Limitations: Small sample • Support the strong impact of nursing

Pressure Ulcer • 1 in 10 patients • 10, 000 to 20, 000 dollars in increased health care expenses (10) • The Agency for Health Care Policy and research published guidelines for the prevention and early treatment • Braden & Norton Scales • Research of 723 patients on 33 different units • Relationship between skin integrity and number of beds on unit and daily census on the unit • Relationship between skin integrity and nursing assessments (10)

Pressure Ulcer • Reliability of Assessment tools? (8) • “Do risk assessment tools accurately predict risk? ” • “Does risk assessment using risk assessment tools prevent pressure ulcer development? ” • “Do escalation strategies prevent pressure damage? ” • Score may be more reflective of nursing judgment rather than actual patient status (2) • Questions point to the significance of developing nurses who have the necessary knowledge, skills, and attitudes to identify areas of quality improvement (8)

QSEN: Why Quality Improvement? • Safety and Quality are key issues • Organization cost: • Financial • Patient Satisfaction • Staff morale • HCAPS • Nursing plays a key role • Must be prepared! (14) (5, 9) (6)

QSEN Competencies: Quality Improvement • Improve Nursing’s quality & safety (3, 14) 1. Practice of inquiry 2. Evidence-based standards 3. Systematic approach to adverse events/incidents Change Nursing Profession Change Nursing Education

QUALITY IMPROVEMENT (QI) (12) Definition: Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems. Knowledge Describe strategies for learning about the Skills Seek information about outcomes of care for Attitudes Appreciate that continuous quality outcomes of care in the setting in which one is populations served in care setting improvement is an essential part of the daily engaged in clinical practice work of all health professionals Seek information about quality improvement projects in the care setting Recognize that nursing and other health Use tools (such as flow charts, cause-effect Value own and others’ contributions to professions students are parts of systems of diagrams) to make processes of care explicit outcomes of care in local care settings care and care processes that affect outcomes for patients and families Participate in a root cause analysis of a sentinel event Give examples of the tension between professional autonomy and system functioning Explain the importance of variation and Use quality measures to understand Appreciate how unwanted variation affects measurement in assessing quality of care performance care Use tools (such as control charts and run Value measurement and its role in good charts) that are helpful for understanding patient care variation Identify gaps between local and best practice Describe approaches for changing processes Design a small test of change in daily work Value local change (in individual practice or of care (using an experiential learning method such team practice on a unit) and its role in creating as Plan-Do-Study-Act) joy in work Practice aligning the aims, measures and Appreciate the value of what individuals and changes involved in improving care teams can to do to improve care

Support for Quality Improvement Initiative • Nursing is the largest division of the healthcare workforce (7) • The Good (11) • Students showed increased self-efficacy & self-confidence related to quality & safety in nursing practice • The Not-So Good (15) • Quality Improvement in nursing education continues to lag in comparison to other QSEN initiatives • Need to continue to research and develop new teaching strategies and curriculums that produce nurses with the necessary knowledge, skills, and attitudes to face quality improvement in healthcare.

Conclusion • Nursing sensitive indicators • Recognition is vital to improving the quality of care provided • Nursing plays a key role • Nurses must be prepared with adequate knowledge, skills, and attitudes associated with quality improvement • QSEN provides a reliable foundation to the educational preparation of professional nurses

References

References

References