QUALITY INDICATORS NURS 8302
QUALITY INDICATORS NURS 8302
QUALITY INDICATORS NURS 8302
Hello, and welcome to this tutorial about informatics and nursing sensitive quality indicators. My name is Rosemary McCarthy. I take this opportunity for making this significant and life-changing step for selecting and joining our health care organization. The purpose of this presentation is to help you have a more refined perspective about the need to understand Nursing Sensitive Quality Indicators as a critical part of effective quality safe patient care (Oner et al., 2021). Patient safety is the main approach to assessing quality performance. A core objective of nursing-sensitive quality indicators is to ascertain and evaluate patient conditions that occur while staying in hospitals. Consequently, nurses should consider patient safety and satisfaction as the main aspects that will inform the quality indicators in a facility.
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Quality Indicators and NDNQI
Nursing sensitive quality indicators allow nurses to analyze data based on a certain indicator. This may comprise of one indicators like structural indicator which determines the quality of care and others like outcome and process indicators. Quality indicators (QI) are standardized, evidence-based measures of healthcare quality which can be used with readily accessible hospital inpatient administrative data and information to measure and track clinical performance and outcomes.
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The National Databased of Nursing Quality Indicators (NDNQI) measures the quality of nursing care. The NDNQI is the only national nursing database created by the American Nurses Association to offer quarterly and annual reports of structural, process, and outcome indicators to assess the level of quality of nursing care at different levels in organizations. The ANA developed the NDNQI with the primary purpose of developing best practices, enhancing and ensuring improved healthcare quality, enhancing patient satisfaction and safety, and ascertaining training procedures are improved and promoted in the nursing profession. The NDNQI focuses on specific aspects of nursing care and its benefits include improvement of quality, nursing and patient education and effective allocation of resources. The implication is that the quality indicators to illustrate the impact of nurses on provision of quality care.
Within the NDNQI are nursing sensitive quality indicators (Afaneh & Abu-Moghli, 2020). These are elements in nursing care that have direct impact of patient outcomes. Nurses can only attain patient safety indicators through effective service delivery and quality care. The main indicators, as mentioned earlier, include structural, process, and outcomes. Structure indicators denote to nursing staff and nursing skills developed and the level of education among practitioners providing care. Process indicators denote the patient assessment process, and nursing interventions and job satisfaction while outcome indicators refer to patient results after getting treatment. Outcomes are utilized to determine the quality of nursing care and include indicators like pressure ulcers, patient falls and related injuries. Process quality measures include nursing interventions like the medication administration process to reduce and prevent the occurrence of medication errors.
Process Quality Indicators
The process quality indicator that I select to use as an example is the occurrence of medication administration errors (MAEs) which occur in the process of nurses giving medications to patients during their stay in hospitals. Healthcare systems, like our organization, need valid ways to evaluate effective service delivery (Fujita et al., 2017). This implies that the occurrence of medication administration errors has adverse effects on the quality of the medication process in a facility and affects the overall outcomes of patients. Medication administration errors are among the leading causes of death and poor patient outcomes.
Studies document the link between adverse events and medication errors among hospitalized patients. The Agency for Healthcare Research and Quality (AHRQ) asserts that medication administration errors emanate from the failure to observe any of the five rights of the medication administration process. These rights include right patient, medication, time, dose, and route (AHRQ, 2021). The implication is that the five rights have been integrates into nursing curriculum as standard processes to get safe medication administration. Studies demonstrate that the medication administration process is complex and implore health care professionals to work as multidisciplinary care teams to ensure patient-centered care delivery.
Medication administration errors threaten trust in the healthcare system, lead to corrective therapies, and extended patient’s hospitalization. These errors also cause increase in cost of and, in extreme cases, permanent disabilities and injuries that may lead to death (Gathara et al., 2020). Therefore, institutional-based strategies and nursing interventions are essential as they follow the set standards like the five rights and application of evidence-based practice interventions.
As nurses joining this organization, it is critical to understand the complex nature of the medication administration process to deliver quality care and better outcomes. Medication administration errors cause adverse harm to patients, including death (AHRQ, 2021. The five rights don’t guarantee administration safety as a standalone process. consequently, the addition of four rights that include right documentation, action and reason, form, and response, make it critical for nurses to be familiar the process quality measures.
As a hospital, we value patient safety and as health care delivery system, we evolve and place emphasis on system design that comprise of technology and clinical workflows to complement the medication administration process (Oner et al.,2021). The emphasis here is to integrate and be part of the inter-professional and multidisciplinary team since preventing and reducing medication administration errors require effective collaboration, communication and coordination among all nurses and other professionals in the facility.
Collection and Distribution of Quality Indicator Data
The collection and distribution of data on quality indicator mentioned is essential in understanding the issue and developing evidence-based interventions. In this regard, through an interview with an informatics nurse in the facility, I gathered that the hospital collects data on medication administration errors in different ways. The first one is self-reporting where nurses make daily reports when on duty on any adverse events to patients while doing their rounds. Secondly, the physicians also make their daily reports that are submitted to the quality assurance nurse manager at the nurse station. Thirdly, the barcode scanning system captures all types of medications and the requisite patients supposed to receive to catch any discrepancies. Therefore, collection of data on this quality indicator is elaborate and effective in the facility. A core aspect of this approach is self-reporting by nurses.
The organization disseminates aggregate data to federal and state agencies through monthly reports while internally, the data is analyzed and corrective actions taken based on the causes of such events. The organization uses a root-cause analysis framework to develop solutions and reduce medication administration errors. As such, the role of nurses and other health care professionals in multidisciplinary and inter-professional teams is essential.
Nurses play critical roles in supporting accurate reporting and high quality results since they interact more with patients and are the primary professionals who give medications (Tsegaye et al., 2020). The implication is that through accurate reporting, nurses ensure that healthcare teams come up with effective remedies for different adverse events emanating from errors in the medication administration process. An example of effective reporting would be nurses communication any concern about the side effects of medication like dizziness or lethargy. These side effects may indicate an adverse reaction or event that may require intervention before it escalates to another level. Nurses need to know that attaining high quality care requires proper assessment and documentation as well as reporting any adverse reaction or event.
Conclusion
As I conclude, I want to emphasize the need to focus on nursing sensitive quality indicators in different aspects that include structure, process, and outcomes. One important aspect to remember is that all these measures or indicators are related implying that meeting one enhances the ability to meet the other two. Communication models are essential in ensuring that during shift change, nurses can have effective transition in medication administration process.
References
Afaneh, T., & Abu-Moghli, F. A. (2020). Consistency of Nursing Directors, Nursing
Supervisors, and Nursing Quality Specialists’ Perception about Nursing-Sensitive Indicators in Acute Care Settings. Open Journal of Nursing, 10(7), 705-715. DOI: 10.4236/ojn.2020.107050
Agency for Healthcare Quality and Research (AHQR) (2021). Medication Administration Errors.
Fujita, K., Moles, R. J., & Chen, T. F. (2018). Quality indicators for responsible use of
medicines: a systematic review. BMJ open, 8(7), e020437. http://dx.doi.org/10.1136/bmjopen-2017-020437
Gathara, D., Zosi, M., Serem, G., Nzinga, J., Murphy, G. A., Jackson, D., … & English, M.
(2020). Developing metrics for nursing quality of care for low-and middle-income countries: a scoping review linked to stakeholder engagement. Human resources for health, 18, 1-16. https://doi.org/10.1186/s12960-020-00470-2
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
Tsegaye, D., Alem, G., Tessema, Z., & Alebachew, W. (2020). Medication administration errors
and associated factors among nurses. International Journal of General Medicine, 13, 1621-1632. https://doi.org/10.2147/IJGM.S289452
Florence Nightingale introduced research to the field of nursing, and with this introduction, a focus on improving patient care has continued to be at the forefront of nursing practice. Improving patient care lends itself to the study of quality care and patient safety, and nurse-sensitive quality indicators highlight the elements of healthcare in which patients are directly impacted by the care provided by nurses.
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What are nurse-sensitive indicators? What elements of a patient’s care are directly impacted by the role and delivery of care of nurses? How might these nurse-sensitive indicators change healthcare delivery and the nursing profession for a future DNP-prepared nurse?
For this Discussion, you will explore your understanding of nurse-sensitive indicators of quality by reflecting on those quality indicators that may pertain most to your practice setting. You will conduct a literature search for articles that address these quality indicators and reflect on the connections between the quality indicators and quality improvement theories and philosophies.
To Prepare:
- Review the Learning Resources on quality indicators for this week. Focus on those quality indicators that most pertain to your practice setting.
- Consider the influence of early quality improvement theories and philosophies on the development of those quality indicators.
- Using the Walden Library, locate at least two scholarly research articles to focus on, for this Discussion, that discuss how quality indicators may influence your practice setting.
- Select one definition of quality published by any peer-reviewed source that particularly resonates with your thinking about quality.
- Identify and select at least two nurse-sensitive indicators of quality related to patient care. Note: Do not select nurse-sensitive indicators related to staffing.
By Day 3 of Week 2
Post a brief description of the two nurse-sensitive indicators of quality that you selected. Analyze the influence of early quality improvement theories and philosophies on the development of the quality indicators you selected. Be specific. Then, cite the two (2) nursing research articles you selected, and explain how these indicators may influence your practice setting. Be specific and provide examples.
By Day 6 of Week 2
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days by expanding on your colleague’s post and explaining how the quality indicators selected by your colleague may influence your practice setting.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Quality of care is measured by the degree in which services rendered achieve desired health outcomes. Today, most healthcare institutions are on the verge of adopting absolute quality measures in the healthcare processes. Quality measures are always based on the best practices that have been adopted in the management of different healthcare processes. While some organizations are involved in the application of research processes, others base their approaches on the evidence-based practices to ensure effective patient outcomes. Pressure ulcers and patient falls are some of the approaches that can be taken to enhance the quality of treatment processes (Hoedl et al., 2019). Pressure injuries (PIs) are defined as an insult to the skin and underlying soft tissue usually over a bony prominence that may cause and open wound and cause pain. Through measuring the rates of patient’s falls, healthcare professionals are able to determine the best strategies to reduce the cases of falls in the future care. Patient falls are a common cause of patient injury during hospitalizations (Morgan et al., 2017). On the other hand pressure ulcers are common occurrences particularly for the patients under critical care units. Pressure injuries (PIs) are defined as an insult to the skin and underlying soft tissue usually over a bony prominence that may cause and open wound and cause pain.
Quality indicators are mainly applied to determine areas of weaknesses and strength to shape or transform the treatment processes. Through understanding the rates of pressure ulcer and injuries resulting from fall, healthcare providers are able to identify the best strategies to enhance the application of appropriate measures. The outcomes or the results of quality measures can be used to direct different processes aimed and increasing or enhancing the quality of treatment and general healthcare processes.
References
Hoedl, M., Eglseer, D., & Lohrmann, C. (2019). Structure, process, and quality indicators for pressure injury prevention and care in Austrian hospitals: A quality improvement project. Journal of Wound, Ostomy, and Continence Nursing, 46(6), 479–484. https://doi.org/10.1097/WON.0000000000000586
Morgan, L., Flynn, L., Robertson, E., New, S., Forde-Johnston, C., & McCulloch, P. (2017). Intentional rounding: a staff-led quality improvement intervention in the prevention of patient falls. Journal of Clinical Nursing, 26(1-2), 115–124. https://doi.org/ezp.waldenulibrary.org/10.1111/jocn.13401