Assessment 04 – Informatics and Nursing-Sensitive Quality Indicators For this assessment, you will prepare an 8–10 minute audio training tutorial (video is optional) for new nurses on the importance of nursing-sensitive quality indicators.

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Prepare an 8–10 minute audio training tutorial (video is optional) for new nurses on the importance of nursing-sensitive quality indicators.

Introduction

The focus of Assessment 4 is on how informatics support monitoring of nursing-sensitive quality indicator data. You will develop an 8–10 minute audio (or video) training module to orient new nurses in a workplace to a single nursing-sensitive quality indicator critical to the organization. Your recording will address how data are collected and disseminated across the organization along with the nurses’ role in supporting accurate reporting and high quality results.

Professional Context

The American Nursing Association (ANA) established the National Database of Nursing Quality Indicators (NDNQI®) in 1998 to track and report on quality indicators heavily influenced by nursing action.

NDNQI® was established as a standardized approach to evaluating nursing performance in relation to patient outcomes. It provides a database and quality measurement program to track clinical performance and to compare nursing quality measures against other hospital data at the national, regional, and state levels. Nursing-sensitive quality indicators help establish evidence-based practice guidelines in the inpatient and outpatient settings to enhance quality care outcomes and initiate quality improvement educational programs, outreach, and protocol development.

The quality indicators the NDNQI® monitors are organized into three categories: structure, process, and outcome. Theorist Avedis Donabedian first identified these categories. Donabedian’s theory of quality health care focused on the links between quality outcomes and the structures and processes of care (Grove et al., 2018).

Nurses must be knowledgeable about the indicators their workplaces monitor. Some nurses deliver direct patient care that leads to a monitored outcome. Other nurses may be involved in data collection and analysis. In addition, monitoring organizations, including managed care entities, exist to gather data from individual organizations to analyze overall industry quality. All of these roles are important to advance quality and safety outcomes.

Reference

Grove, S. K., Gray, J. R., Jay, G. W., Jay, H. M., & Burns, N. (2018). Understanding nursing research: Building an evidence-based practice (7th ed.). Elsevier.

Preparation

As you begin to prepare this assessment you are encouraged to complete the Conabedian Quality Assessment Framework activity. Quality health care delivery requires systematic action. Completion of this will help you succeed with the assessment as you consider how the triad of structure (such as the hospital, clinic, provider qualifications/organizational characteristics) and process (such as the delivery/coordination/education/protocols/practice style or standard of care) may be modified to achieve quality outcomes.

This assessment requires you to prepare an 8–10 minute audio training tutorial (with optional video) for new nurses on the importance of nursing-sensitive quality indicators. To successfully prepare for your assessment, you will need to complete the following preparatory activities:

• Review the nursing-sensitive quality indicators presented in the Assessment 04 Supplement: Informatics and Nursing Sensitive quality Indicators [PDF]  Download Assessment 04 Supplement: Informatics and Nursing Sensitive quality Indicators [PDF]resource and select one nursing-sensitive quality indicator to use as the focus for this assessment.

·        Assessment 04 –Informatics and Nursing-Sensitive Quality IndicatorsFor this assessment, you will prepare an 8–10 minute audio training tutorial (video is optional)for new nurses on the importance of nursing-sensitive quality indicators.Before you complete the detailed instructions in the courseroom, first review the Nursing-Sensitive Quality Indicators below and select the one you’re most interested in. Nursing-Sensitive Quality Indicators reflect the structure, process, and patient outcomes of nursing care.Nursing-Sensitive Quality Indicators are developed by identifying potential indicators that reflectnursing care and are not represented by current indicators, performing a literature review, anddetermining the validity of the potential indicator in nursing practice.After you select one of the Nursing-Sensitive Quality Indicators below, return to the courseroomto review the detailed instructions and complete your assessment.• Incidence of Hospital-Acquired Infections – Outcome.• Patient Falls Without Injury – Process.• Restraint Use Duration – Process and Outcome.• Staffing Levels – Structure.• Nursing Care Hours Per Patient Day by Registered Nurses With a Bachelor ofScience in Nursing (BSN) Degree – Structure.

 

• Conduct independent research on the most current information about the selected nursing-sensitive quality indicator.
• Interview a professional colleague or contact who is familiar with quality monitoring and how technology can help to collect and report quality indicator data. You do not need to submit the transcript of your conversation, but do integrate what you learned from the interview into the audio tutorial. Consider these questions for your interview:
  • What is your experience with collecting data and entering it into a database?
  • What challenges have you experienced?
  • How does your organization share with the nursing staff and other members of the health care system the quality improvement monitoring results?
  • What role do bedside nurses and other frontline staff have in entering the data? For example, do staff members enter the information into an electronic medical record for extraction? Or do they enter it into another system? How effective is this process?
• Watch the Informatics and Nursing-Sensitive Quality Indicators Video Exemplar.

Hide Transcript from video.(example) below

Hello and welcome to the University Hospital Health Care System. My name is Diane Tate. We are so excited to have you on our nursing team. I am here today to help you better understand how our healthcare system uses Nursing Sensitive Quality Indicators – also known as the NDNQI – to enhance quality care outcomes, improve training procedures, establish best practices, and improve patient satisfaction. These indicators also help in workflow and the recruitment and retention of quality staff. You play an important part of this. You are our eyes and ears when it comes to safe evidence-based practice and reporting data to help evaluate our Nursing Sensitive Quality Indicators.

We are very fortunate to be one of the 1100 facilities in the United States providing the data to NDNQI to fulfill nursing’s commitment to advancing our knowledge base to evaluate and improve patient care. The NDNQI is a national nursing database evaluating nursing care that provides annual and quarterly reporting of three major indicators which evaluate nursing care. In 2018, the authors Griggs, Wiechula & Cusack described those indicators as structure (staff/skill competency), process (patient assessment, nursing intervention, and job satisfaction) and outcome of patient care related to the quantity or quality nursing care. NDNQI is managed by a company named Press Ganey. Press Ganey sends us surveys for the data needed and then provides participating facility research driven reports with statistics and data themes. Multiple authors including Smith (writing in 2018) and Griggs, Wiechula & Cusack point out that this data allows us to understand what we are doing well in our facility and what we need to improve on, in comparison to national data, to enhance patient safety, patient care outcomes, and organizational performance reports.

Now I’d like to share an example, Our Chief Nursing Officer used the NDNQI ratios and acuity data on staffing to validate the need various levels of nurse staffing. Authors Mangold and Pearson, writing 2017, identify how this type of data can contribute to significant changes to our staffing matrix and ratios because of the data produced by nurses like you. Our nurses are better able to provide quality care as a result of this information and our patient satisfaction scores have almost doubled over that past 6 months.

Imagine a small snowball made of 5 pieces of snow, then imagine one made of 100 pieces of snow, and one made of 1100 pieces of snow…the greater the number the bigger the impact. If you were in the snowball fight, do you want the snowball made with five snowflakes or the one made with 1100 snowflakes? The same is true of the data in the NDNQI, when one facility implements a change the data from the change is shared with everyone through NDNQI so the dissemination of information is relatively quick and provides real time evaluation data.

For another example, over the past few months, we have experienced a dramatic rise in catheter-acquired urinary tract infections also known as CAUTIs and Hospital Acquired Conditions throughout the facility. This has dramatically affected the quality of patient care and ultimately our Press Ganey patient satisfaction surveys. Our rate of CAUTIs and Hospital Acquired Conditions have also impacted our rate of Medicare reimbursement. We have experienced a 1 percent reduction in reimbursement related to this CAUTI and associated HAC increase. Porter (2018) estimates CAUTI costs to be over $10,000. To give this number a little more impact, the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative reported in 2015 that there was a total of $330 million dollars lost in Hospital Acquired Conditions penalties across 721 facilities.

Our nurses have identified CAUTI in their patients with indwelling catheters as a concern as well as other Hospital Acquired Conditions. Recognizing that they are the first line of defense for patient safety, our nurses are participating in a hospital wide Acquired Condition Reduction Program modeled after the Centers for Medicare and Medicaid services (n.d). Our initiative looks at all infections acquired during treatment in this facility. I encourage you to look at this website. As a nurse you are the leader of healthcare quality, we depend upon you as the expert in patient care. YOU are extremely powerful in contributing to patient care in not only preventing CAUTIs but in providing a timely reporting of needed data in the Press Ganey surveys so that our data is contributed to NDNQI.

You May Ask… How Can I Help?

Nurses have an essential role within the interdisciplinary healthcare team. They are responsible for collecting and reporting data for the NDNQI. The data collected will contribute to improved outcomes, improved patient safety, and an overall improved patient experience. In our facility we provide the data using online surveys received from Press Ganey, all members of the interdisciplinary healthcare team receive the surveys. In a personal communication, our Chief Nursing Officer, Dr. Smith, underscored that the current facility best practice is to check your hospital email every day you work and complete any surveys sent to you. The data is very easy to enter into the survey. Dr. Smith stated that in the beginning there was a lot of lag time between data entry by the interdisciplinary team and the time the survey was sent out but that has improved. We have a quality team at the hospital responsible for supplying the general data related to CAUTIs. Other data provided to Press Ganey includes incident reports, patient admission dates, length or stay, readmission data, number of patients with catheters vs patients with CAUTIs diagnosed in facility vs after discharge. To learn more about Press Ganey please go to their website.

Your job as a nurse is to provide care according to the current practice policies, complete all required documentation which includes all popups on CAUTIs and then to enter data when emailed a survey from Press Ganey. Your role is incredibly powerful in this initiative because as you know we have a huge amount of responsibility in placing, caring for and assessing indwelling catheters and straight caths. Imagine if your work in completing all required documentation and some quick online surveys prevents future CAUTIs, the impact would be huge!

I would now like to discuss what we do WITH THE DATA

The data you provide, and which is found in the patient records provides insights into how the nursing care and interventions we provide influence patient outcomes. The data found within the NDNQI gives healthcare leaders an understand of what actions influence quality and patient safety. Within the NDNQI the data is trended and the themes and or statistical information is pulled out to help guide safety and quality initiatives.

Within this organization we have quality improvement teams on each unit where data from NDNQI and plans for improving quality are shared. We use the data for guiding us in creating quality improvement plans and ensuring patient safety. Quality improvement teams on your unit will share updates with the NDNQI data and how we plan to use the data.

As we wrap up I’d like to share some ideas about how your actions IMPACT HEALTH CARE IN GENERAL

Your involvement in accurate charting and completing surveys provides data used for the greater science of nursing. This information helps the nursing profession to identify nurse-sensitive indicators of quality to use for improvement in our patient care. Our nursing leaders use the NDNQI data to determine the best practices for their unit and facility to improve both quality care outcomes and workplace safety, including nurse patient staffing ratios.

Our facility models itself after the 2015 Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative Policy Brief for not only quality and safety improvement, but to achieve higher outcome-based hospital payments. Our Value Based Purchasing program provides acute care facilities incentive money when the facility has good performance on quality measurements and makes improvements in the facilities quality and safety of care. There is also an overlap of the Value Based Purchasing program and the Medicare reimbursement program so facilities are able to potentially have double the financial benefit because the nurse sensitive outcomes influence the requirements for full reimbursement from Medicare. John Hopkin’s hospital has been a leader in using the NDNQI data to make improvements in safety and quality with a 41% reduction in CAUTIs with the use of national data on nursing interventions from NDNQI. Nursing leaders need to work to ensure they use the data from the nursing sensitive outcomes to make improvements in care within individual facilities and units.

In CONCLUSION

Our involvement in NDNQI is a wonderful and positive influence on the profession of nursing and patient care. Your responsibility is to ensure you have accurate and complete documentation and to complete any Press Ganey surveys you receive. Our role as a facility is to provide all additional data to NDNQI and to support you in your work while focusing on quality improvement and sharing data with you from NDNQI and our quality improvement work. The success of NDNQI is relying on our commitment to provide data in a timely manner and then to use the national data to make improvements at the facility. Nurses are at the front line of quality improvement and evidence-based practice. We can all make a huge improvement in patient care. You are a valuable asset to our team!

Thank you!

 Resources:

• AHRQ(2019). High reliability. Retrieved from https://psnet.ahrq.gov/primers/primer/31.
• CFAR, Inc., Tomasik, J., Fleming, C. (2015). Promising interprofessional collaboration. Retrieved from https://www.rwjf.org/en/library/research/2015/03/lessons-from-the-field.html
• Clarke, J.R.(2013)The use of collaboration to implement evidence-based safe practices Journal of Public Health Research:2:(e26)
• Deloitte(2017). Transforming into a high reliability organization in health care. Retrieved from https://www2.deloitte.com/content/dam/Deloitte/us/Documents/life-sciences-health-care/us-lshc-health-care-high-reliability-organization.pdf
• Donnelly, P., & Kirk, P. (2015). Using the PDSA model for effective change management. Education for Primary Care, 26(4), 279–281.
• Institute for Healthcare Improvement. (2018). Plan-do-study-act (PDSA) worksheet. Retrieved from https://www.ihi.org/resources/Pages/Tools/PlanDoStudyActWorksheet.aspx

 

Recording Your Presentation

To prepare to record the audio for your presentation, complete the following:

• Set up and test your microphone or headset using the installation instructions provided by the manufacturer. You only need to use the headset if your audio is not clear and high quality when captured by the microphone.
• Practice using the equipment to ensure the audio quality is sufficient.
• Review Using Kaltura for Kaltura to record your presentation.
• View Creating a Presentation: A Guide to Writing and Speaking. This video addresses the primary areas involved in creating effective audiovisual presentations. You can return to this resource throughout the process of creating your presentation to view the tutorial appropriate for you at each stage.

Notes:

• You may use other tools to record your tutorial. You will, however, need to consult Using Kaltura for instructions on how to upload your audio-recorded tutorial into the courseroom, or you must provide a working link your instructor can easily access.
• You may also choose to create a video of your tutorial, but this is not required.
• If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact DisabilityServices@Capella.edu to request accommodations.

Instructions

For this assessment, first review the nursing-sensitive quality indicators presented in the Assessment 04 Supplement: Informatics and Nursing Sensitive quality Indicators [PDF] Download Assessment 04 Supplement: Informatics and Nursing Sensitive quality Indicators [PDF]resource and select one nursing-sensitive quality indicator to use as the focus for this assessment.

Next, imagine you are a member of a Quality Improvement Council at any type of health care system, whether acute, ambulatory, home health, managed care, et cetera. Your Council has identified that newly hired nurses would benefit from comprehensive training on the importance of nursing-sensitive quality indicators. The Council would like the training to address how this information is collected and disseminated across the organization. It would also like the training to describe the role nurses have in accurate reporting and high-quality results.

The Council indicates a recording is preferable to a written fact sheet due to the popularity of audio blogs. In this way, new hires can listen to the tutorial on their own time using their phone or other device.

As a result of this need, you offer to create an audio tutorial orienting new hires to these topics. You know that you will need a script to guide your audio recording. You also plan to incorporate into your script the insights you learned from conducting an interview with an authority on quality monitoring and the use of technology to collect and report quality indicator data.

You determine that you will cover the following topics in your audio tutorial script:

Introduction: Nursing-Sensitive Quality Indicator

• What is the National Database of Nursing-Sensitive Quality Indicators?
• What are nursing-sensitive quality indicators?
• Which particular quality indicator did you select to address in your tutorial?
• Why is this quality indicator important to monitor?
  • Be sure to address the impact of this indicator on the quality of care and patient safety.
• Why do new nurses need to be familiar with this particular quality indicator when providing patient care?

Collection and Distribution of Quality Indicator Data

• According to your interview and other resources, how does your organization collect data on this quality indicator?
• How does the organization disseminate aggregate data?
• What role do nurses play in supporting accurate reporting and high-quality results?
  • As an example, consider the importance of accurately entering data regarding nursing interventions.

After completing your script, practice delivering your tutorial several times before recording it.

Additional Requirements

• Audio communication: Deliver a professional, effective audio tutorial on a selected quality indicator that engages new nurses and motivates them to accurately report quality data in a timely fashion.
• Length: 8–10 minute audio recording. Use Kaltura to upload your recording to the courseroom, or provide a working link your instructor can access.
• Script: A separate document with the script or speaker’s notes is required. Important: Submissions that do not include the script or speaker’s notes will be returned as a non-performance.
• References: Cite a minimum of three scholarly and/or authoritative sources.
• APA: Submit, along with the recording, a separate reference page that follows APA style and formatting guidelines. For an APA refresher, consult the Evidence and APA page on Campus.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:

• Competency 1: Describe nurses’ and the interdisciplinary team’s role in informatics with a focus on electronic health information and patient care technology to support decision making.
  • Describe the interdisciplinary team’s role in collecting and reporting quality indicator data to enhance patient safety, patient care outcomes, and organizational performance reports.
• Competency 3: Evaluate the impact of patient care technologies on desired outcomes.
  • Explain how a health care organization uses nursing-sensitive quality indicators to enhance patient safety, patient care outcomes, and organizational performance reports.
• Competency 4: Recommend the use of a technology to enhance quality and safety standards for patients.
  • Justify how a nursing-sensitive quality indicator establishes evidence-based practice guidelines for nurses to follow when using patient care technologies to enhance patient safety, satisfaction, and outcomes.
• Competency 5: Apply professional, scholarly communication to facilitate use of health information and patient care technologies.
  • Deliver a professional, effective audio tutorial on a selected quality indicator that engages new nurses and motivates them to accurately report quality data in a timely fashion.
  • Follow APA style and formatting guidelines for citations and references.