Quality Indicators Safety Initiatives Tina Adkins Ann Bancroft

Quality Indicators & Safety Initiatives Tina Adkins, Ann Bancroft, & Sarah Rousseau

The National Database of Nursing Quality Indicators (NDNQI®) • Developed by the American Nurses Association and provides • A repository for nursing-sensitive indicators • The only database containing data collected at the nursing unit level • Provides a process to standardize data submission and policies for maintaining confidentiality (6)

• Nursing Sensitive Indicators (NSI’s) Nursing Sensitive Indicators • Examples Include: • • • Nursing Turnover Nosocomial Infections Pressure Ulcer Rate RN Education/Certification Restraints Staff Mix (11)

Nursing Quality Indicators • The following presentation will review: • • • Patient Satisfaction Nursing Hours Per Patient Pediatric Pain Assessment Pediatric IV infiltration Falls w/ Injury

Patient Falls • The National Database for Nursing Quality Indicators (NDNQI) definition of a fall is used in current policy. A falls is defined as. . . • “A fall is defined as an unplanned descent to the floor (or extension of the floor, E. g. trash can or other equipment) with or without injury to the patient: this includes falls that are result of physiologic as well as environmental reasons. Falls include both assisted falls (when a staff member attempts to minimize impact of the fall) and unassisted falls. A fall that is reported to have been assisted by a family member or visitor counts as a fall. ” (11) • Description: All documented falls with or without injury, experienced by patients on an eligible unit in a calendar month

Patient Falls With Injury • Description: All documented patient falls with an injury level of minor or greater. An injury level of minor or greater defined as: • Minor – results in application of a dressing, ice, cleaning of a wound, limb elevation, or topical medication • Moderate – results in suturing, application of steri-strips/skin glue, or splinting • Major – results in surgery, casting, traction, or consultation for neurological or internal injury • Death – results in death as a result of the fall. (11)

Scope of the Problem • Impact of falls on the patient • Impact of falls on the facility • Cost related to falls with/without injury (1 -4)

Impact on patient • Quality of life • Quality of care • Setbacks • Costs (3, 5 -8)

Impact to the Facility & The Associated Cost • Change in care • Costs (3 -6)

What Can We Do? • Internal and external factors • Internal • Fall History • Current Medications • Vision • Balance • Health Condition • External • Surrounding Environment • Footwear • Assistive Device used (7)

Mayo Clinic Falls Prevention Program • Interdisciplinary Team • Identified gaps in the admission process for fall risk • Initiatives implemented: • Review of fall history • Patient education • Introduction of a collaborative team (11)

Falls Prevention Review • Review of the literature • Continues to be a great challenge • Risk Factors • Interventions to decrease falls • • • Exercise Medication management Multilevel interventions Prevention of injury Development of specific programs (4, 8 -9, 13)

Conclusion We can no longer do things the way they have always been done! • Things change • Importance of NSI’s • What difference do they make

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