NURS FPX 4040 Assessment 4 Informatics and Nursing Sensitive Quality Indicators GC

NURS FPX 4050 Assessment 1 Preliminary Care Coordination Plan GC

Assessment 04: Script

Greetings all,

Today, we will be discussing the Importance of Nursing-Sensitive Quality Indicators;

Safety culture and patient outcomes can be greatly influenced by the quality of nursing care delivered.  In 1998, the American Nursing Association founded the National Database of Nursing Quality Indicators, a national database charged with providing annual and quarterly reports of the process, structure, and outcomes to assess patient care at the unit level. Before its establishment, there existed a link between nurse staffing and patient outcomes, but more information and reporting were required to assess other indicators of nursing care at the unit level. The National Database of Nursing Quality Indicators (NDNQI) became the first national database to collect data on the unit level. Today, the database supplies healthcare centers with performance reports that permit hospital administrators to compare their data with other important information, national averages, and percentile rankings. An important part of the equation as regards the establishment of evidence-based practice guidelines is the nursing-sensitive quality indicators (NSIs). Nursing-sensitive quality indicators are criteria for alterations in the health condition of a person that can be directly affected by the nursing care and form the basis for evaluating the quality of patient care. These indicators identify the structure of care and care processes that eventually affect nursing care outcomes. 

Initially, the American Nursing Association identified 10 nursing quality sensitive indicators such as patient falls, pressure ulcers, patient satisfaction with nursing care, and nurse job satisfaction among others. Since then, this list has been refined and expanded countless times with new indicators coming in yearly. In this tutorial training, I will be discussing the nursing quality sensitive indicator of patient falls which reflects the aspects of process and outcome nursing care. I work in an acute care setting in which patient falls and its associated injuries are not only devastating to clinicians and patients but also the entire healthcare system.  In the United States, about 700k-1Million falls occur in hospitals and cost the healthcare system about $50 billion. According to Tzeng and Yin (2017), patients who have fallen are more likely to spend 6.3 days more days in the hospital compared to their unfallen counterparts. Clinically, the client may have endured a break or may no longer be stable after this fall. In terms of health, falls can lead to a lesser quality of life for the elderly, cause disabilities, functional decline, and reduce independence. Financially, the healthcare organization is liable for any surgeries, tests, or x-rays that happen due to a patient’s fall. In this view, it is important to implement a monitoring system to reduce incidences of patient fall and the amount spent for a patient sitter. In the words of Rheaume and Fruh (2015), those at risk-fall patients should be identified, closely monitored and requests for help should be responded to fast.  A recent study by Spring Abor University (2019) has shown that one-third of hospital falls can be prevented and nurses have a crucial role to play in patient safety. As new nurses, you should be familiar with falls when providing patient care as falls can lead to lacerations, internal bleeding, fractures, and other injuries that can burden medical care use. 

One important principle of quality measurement is that if you cannot measure it, then you cannot improve it. As part of a quality improvement program, therefore, fall rates, as well as fall prevention practices, should be counted and monitored. By monitoring performance, we can ascertain whether nursing care is improving, worsening, or staying the same in order to formulate efforts to alter the practice. Besides, monitoring will help us understand where we are starting from and whether our gains are sustainable. At provident, we regularly count the number of falls and the number of occupied bed days on the unit, fall risk factors and actions taken to lower the risk, and monitoring for interdisciplinary involvement in the implementation team. Since patients within this facility come and go quickly, we use the hospital information system to calculate the average daily census on the unit or hospital at large for a specific period. The hospital has implemented the Fall Prevention Program (FPP) and uses the Tracking Record for Improving Patient Safety (TRIPS) tool to measure falls, patients who fall, and patients with multiple falls and serious injuries related to falls. The nurse uses the information recorded on the TRIPS form to identify fall-related trends. On rare occasions, nurses are asked to choose a point in time daily that is convenient to check the number of occupied beds in their units and record that number daily which is then tallied. 

The management at Provident hospital disseminates the information obtained on patient falls to the unit staff and major stakeholders. Monthly rates are usually posted in areas where all healthcare staff can see how well the unit is performing. More so, reports are sent to organizational leadership for strategic decision-making. The hospital understands that the dissemination of information is critical to quality improvement efforts. Another way the hospital uses data is by investigating what caused the occurrence of each fall, especially those that caused an injury. Root cause analysis is used to understand the reasons for a failure in the system. Two types of root cause analyses are done at our facility: individual and aggregate. Root cause analysis at the individual level is conducted by the unit team immediately following a fall. With aggregate root cause analysis, the implementation team reviews all fall that happened on a quarterly and yearly basis. The team then determines the primary causes of falls within the healthcare setting or on units by use of incident report information gathered in a standard fashion. Thereafter, changes to curb these causes are implemented. Reports that can be reviewed as part of an aggregate root cause analysis are prepared by staff from the hospital’s Quality Management department. 

Nurses at Provident play a pivotal role in supporting accurate reporting and high-quality results. First, nurses are directly involved in nearly all elements of hospital quality, including but not limited to bedside and medication management, helping with surgeries, collecting and reporting patient data, and patient care. Besides, nurses oversee other healthcare providers such as caregivers, LPNs, and patient care technicians. More so, nurses are tasked with assessing and monitoring clients as well as doing immediate interventions to prevent or lower the risk of health complications. Lastly, nurses on shift or rather attending nurse helps educate patients and their family members and provide discharge guidelines before leaving the facility.  Because of this, all efforts to train them and retain their value need to be dealt with. in the end, nurses will pass the same care and value to their clients. 

References

Afaneh, T., Abu-Moghli, F., & Ahmad, M. (2021). Nursing-sensitive indicators: a concept analysis. Nursing Management28(3).

Lucero, R. J., Lindberg, D. S., Fehlberg, E. A., Bjarnadottir, R. I., Li, Y., Cimiotti, J. P., … & Prosperi, M. (2019). A data-driven and practice-based approach to identify risk factors associated with hospital-acquired falls: applying manual and semi-and fully-automated methods. International journal of medical informatics122, 63-69.

Montalvo, I. (2007). The national database of nursing quality indicators (NDNQI®). OJIN: The Online Journal of Issues in Nursing12(3), 112-214.

Moser, S. (2021). Fall Prevention: Remote Video Monitoring.

Rheaume, J., & Fruh, S. (2015). Retrospective case reviews of adult inpatient fall in the acute care setting. Medsurg Nursing24(5), 318-325.

Spring Arbor University. (2019). Fall prevention precautions: The nurse’s role | Spring arbor University. Online Masters Programs | Spring Arbor University Online. https://online.arbor.edu/news/advanced-nursing-and-your-role-fall-prevention#:~:text=Fall

Tzeng, H. M., & Yin, C. Y. (2017). A multihospital survey on effective interventions to prevent hospital falls in adults. Nursing Economics35(6), 304-314.

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