Assessment 4: Informatics and Nursing Sensitive Quality Indicators

Selected Quality Indicator

Providers, regulatory agencies, and suppliers as well as patients find it critical to evaluate the quality of care through the use of data to benchmark, document the outcomes and develop regulations to guide care provision. These stakeholders also use the data for accreditation and supporting accountability, especially through the value-based purchasing model (Lorini et al., 2018). Structural indicators measure the sufficiency of capability of facilities and equipment, the qualification of the medical staff and the administrative structures and programs to ascertain their impact to patient safety and quality of care. Imperatively, the selected structural measure is the impact of nurse turnover on patient outcomes.

Nurse Turnover as a Structural Quality Indicator

Nurse turnover is one of the leading causes of nurse shortage and occurs when nurses leave a facility for different reasons that include retirement, change of profession or going to another healthcare facility. Nurses are important in provision of direct patient care and ascertaining their safety. Consequently, nurse turnover has immense negative effects on their ability to maintain a safety culture and improve patient care outcomes (Oner et al., 2021). Nurse turnover leads to increased workload, fatigue, burnout and lack of concentration which makes nurses susceptible to medication errors and other safety issues. Nurse turnover increases the overall cost of care because of the need to recruit new nurses offer orientation and ensure that they understand the organization’s culture. Healthcare facilities also lose revenue because of nurse turnover due to a reduction in productivity for it takes time for nurses to adapt to the new environment and get trust from customers.

Importance of Monitoring Nurse Turnover Indicator & Nurses Being Familiar

Nurse turnover is an issue impacting the healthcare systems across the world implying the need for effective interventions, especially ensuring that nurses are familiar with and assess its overall effects on patient care (Start et al., 2018). Through understanding their environment and their roles in patient care outcomes, new nurses can develop effective interventions to improve patient safety and outcomes. Hospital management and administration need to identify and address the factors that lead to nurse turnover to mitigate and prevent fragmented care. Nurses should be familiar with the nurse turnover indicator because of the need to develop innovative solutions and use evidence-based practice models to address the problem.

Collection and Distribution of Quality Indicator Data

Collection of Data on Quality Indicator

In recent times, quality measurements have been influential in improving care provision and attracting research interest. Upon interviewing the head nurse in charge of quality control, the facility collects its data on the measures using questionnaire and health surveys on patients who give their feedback and assessment upon discharge. Through this approach, the facility understands the different areas that it should improve, especially in relation to nursing care provided by nurses.

Dissemination of the Aggregate Data

The department then prepares presentation using applications like Microsoft Excel spreadsheets and the PowerPoint. The presentation always details nurse turnover and retention levels in the hospital against the required levels (Lorini et al., 2018). The department then shares the data with the human resource department to inform on the right measures to retain nurses and ensure that the turnover rates are controlled.

Role of Nurses in Supporting Reporting and Quality Results

Nurses also participate in open sessions to propose a raft of solutions that the unit and the facility can adopt to address the issue. The findings from the interview assert that many nurses are leaving the organization due to issues like terms of service, need for professional development and growth opportunities, including tuition reimbursement, and the high patient-to-nurse ratios that mean more workload (Evangelou et al., 20121). Therefore, nurses should report on the negative effects of nurse turnover like increased workload and the associated burn out and fatigue. Accurately entering such data is essential in knowing the number of adverse events and measures that can work to eliminate and reduce the occurrence of incidences as a result of nurse turnover.

Conclusion

Nursing quality sensitive indicators (NQSI) are essential in healthcare as they allow providers to evaluate the effects of nursing services on patients. The three main types of these indicators are structural, outcome and process. Nurse turnover is an example of quality measures that impact patient safety and outcomes. Therefore, it is essential to develop effective interventions, based on evidence to address the issue of nurse turnover on patient safety and outcomes.  

Assessment 4: Informatics and Nursing Sensitive Quality Indicators NURS–FPX4040

Informatics and Nursing Sensitive Quality Indicators

The National Database of Nursing Quality Indicators (NDNQI®) is a national nursing database that gives quarterly and annual reporting of structure, process, and outcome indicators to assess nursing care at the unit level. NDNQI supplies healthcare organizations with performance reports that enable administrators to compare their data with national averages, percentile rankings, and other vital information (Oner et al., 2021). Nursing-sensitive indicators refer to elements of patient care that are directly influenced by nursing practice. Nursing-sensitive quality indicators reflect three aspects of nursing care: structure, process, and outcomes (Oner et al., 2021). Structural indicators comprise nursing staff supply, the skill level of nursing staff, and nurses’ education and certification levels. Process indicators assess methods of patient assessment and nursing interventions (Oner et al., 2021). Outcome indicators denote patient outcomes that are considered nursing-sensitive since they are based on the quantity or quality of nursing care.

Nursing-Sensitive Quality Indicator

In this tutorial, I will address the quality indicator on rates of nosocomial infections, which is an outcome indicator. Nosocomial infection refers to an infection in a health care facility, in a patient whom the infection was not present or incubating during admission (Khan et al., 2017). It is crucial to monitor nosocomial infection rates in healthcare settings since it reflects the quality of care in hospitals. About one-third of nosocomial infections are potentially preventable, and changes in the rates of the infections reflect variations in quality (Khan et al., 2017). Nosocomial infections adversely impact the quality of care and patient safety, and health care costs. For instance, they add to a patient’s functional disability and emotional stress and may contribute to disabling conditions that lower the quality of life. Furthermore, nosocomial infections are one of the leading causes of mortality (Khan et al., 2017). They incur significant economic costs, with the prolonged length of patient stay being the greatest contributor to high costs.

New nurses need to be conversant with the quality indicator on nosocomial infection when providing patient care because the nosocomial infection rate in patients in a hospital is an indicator of quality and safety. Nosocomial infections are significant contributors to morbidity and mortality (Haque et al., 2018). Besides, they are likely to become even more significant as a public health problem with increasing economic and human impact. New nurses need to be familiar with potential nosocomial infections such as urinary infections, surgical site infections, nosocomial pneumonia, and nosocomial bacteremia (Haque et al., 2018). The problem is likely to worsen because of an increased number of patients with impaired immunity, new disease-causing microorganisms, and increasing bacterial resistance to antibiotics.

Collection and Distribution of Quality Indicator Data

I interviewed a professional colleague who is well-versed with quality monitoring and how technology can help to collect and report quality indicator data.  I learned that the organization collects data on nosocomial infections through multiple sources of information since no method, by itself, is sensitive enough to guarantee data quality. The organization has an infection control team with trained data extractors who perform active surveillance. Data is collected from ward activity, including records of fever and clinical signs consistent with infection; laboratory tests; patients on antimicrobial therapy; and medical and nursing chart review. Besides, the infection control team assesses the presence of devices or procedures that are a risk for infection, such as mechanical ventilation, indwelling urinary and intravascular catheters, and surgical procedures.

The infection control team obtains laboratory reports that provide reliable information on bloodstream infections, urinary tract infections, and multiple-drug-resistant bacteria. Furthermore, data is also collected using data collection forms that obtain information on prevalence and surgical site infections. The prevalence form is filled for every patient. It collects administrative data, demographic risk factors, and presence or absence of infection, including date of onset, site of infection, microorganisms isolated, and antimicrobial susceptibility.

How the Organization Disseminate Aggregate Data

The organization’s infection control team also disseminates aggregate data to hospital units, management, and laboratories.  The team organizes departmental meetings to share the data on the rates of nosocomial infections in the hospital. The team discusses with other healthcare professionals on strategies to improve nosocomial infection rates in the various departments. Furthermore, the organization disseminates data through infection rate summaries and graphic presentations posted on notice boards in various hospital units.

Role Nurses Play In Supporting Accurate Reporting and High-Quality Results

Nurses play a crucial role in reporting nosocomial infections and ensuring high-quality results since they are involved in direct patient care. They have the role of reporting patients who develop nosocomial infections and providing accurate information on their demographic information, risk factors, and interventions implemented (Donohue-Ryan & Schneider, 2021). Besides, nurses are tasked with reporting nosocomial incidents on a hospital’s incident reporting system to ensure all incidences are accounted for. Nursing documentation is crucial in ensuring high-quality results. Nurses have the role of documenting signs of nosocomial infections on patients’ charts and electronic medical records to facilitate monitoring (Donohue-Ryan & Schneider, 2021). Furthermore, nurses have a role of filling surveillance forms correctly to enable the infection control team to monitor the number of patients who develop hospital-associated infections. Lastly, nurses have a role of ensuring that all records are stored appropriately, either in electronic or paper-form to avoid loss of data.

The Use of Technology to Enhance Quality and Safety Standards for Patients

The prevalence of nosocomial infections has led to the establishment of EBP guidelines on the interventions health providers should take to prevent them.  Nurses play a vital role in controlling hospital infections, protecting patients from nosocomial infections, and promoting better control of diseases (Roy et al., 2018). Nurses who receive EBP guidelines regarding the prevention of nosocomial infections demonstrate a significant improvement in their performance after implementing the guidelines. Improved nursing performance results in enhanced patient safety, patient satisfaction, and health outcomes (Roy et al., 2018). The EBP guidelines incorporate health technologies such as ATP levels and fluorescent markers, which are used as substitutes of contamination to monitor cleaning (Roy et al., 2018). Fluorescent markers have been incorporated in EBP guidelines to teach and measure the adequacy of hand hygiene among health providers. Besides, Hand Hygiene Monitoring New Technologies are used to improve compliance on hand hygiene, which is a core infection prevention strategy in EBP guidelines.

References

Donohue-Ryan, M. A., & Schneider, M. A. (2021). The CNO’s Role in Promoting Staff Nurse Engagement in Quality Reporting. Nursing Economics, 39(1), 45-48.

Haque, M., Sartelli, M., McKimm, J., & Abu Bakar, M. (2018). Healthcare-associated infections – an overview. Infection and drug resistance, 11, 2321–2333. https://doi.org/10.2147/IDR.S177247

Khan, H. A., Baig, F. K., & Mehboob, R. (2017). Nosocomial infections: Epidemiology, prevention, control, and surveillance. Asian Pacific Journal of Tropical Biomedicine, 7(5), 478-482. https://doi.org/10.1016/j.apjtb.2017.01.019

Oner, B., Zengul, F. D., Oner, N., Ivankova, N. V., Karadag, A., & Patrician, P. A. (2021). Nursing‐sensitive indicators for nursing care: A systematic review (1997–2017). Nursing Open, 8(3), 1005-1022. https://doi.org/10.1002/nop2.654

Roy, M. C., Stevens, M., & Fidsa, F. S. H. E. A. (2018). Guide to infection control in the healthcare setting. Int Society Infect Dis, 2.

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

Introduction

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.

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.

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.

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

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:

• Select a single nursing-sensitive quality indicator that you see as important to a selected type of health care system. Choose from the following list:
  • Staffing measures.
    • Nursing hours per patient day.
    • RN education/certification.
    • Skill mix.
    • Nurse turnover.
    • Nursing care hours in emergency departments, perioperative units, and perinatal units.
    • Skill mix in emergency departments, perioperative units, and perinatal units.
  • Quality measures.
    • Patient falls.
    • Patient falls with injury.
    • Pressure ulcer prevalence.
    • Health care-associated infections.
      • Catheter-associated urinary tract infection.
      • Central line catheter associated blood stream infection.
      • Ventilator-associated pneumonia.
      • Ventilator- associated events.
    • Psychiatric physical/sexual assault rate.
    • Restraint prevalence.
    • Pediatric peripheral intravenous infiltration rate.
    • Pediatric pain assessment, intervention, reassessment (air) cycle.
    • Falls in ambulatory settings.
    • Pressure ulcer incidence rates from electronic health records.
    • Hospital readmission rates.
    • RN satisfaction survey options.
      • Job satisfaction scales.
      • Job satisfaction scales – short form.
      • Practice environment scale.
• 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.

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 the 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 [email protected] to request accommodations.

Instructions

For this assessment, 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.

Informatics and Nursing-Sensitive Quality Indicators Scoring Guide

CRITERIA	NON-PERFORMANCE	BASIC	PROFICIENT	DISTINGUISHED
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