Informatics and Nursing Sensitive Quality Indicators
Prepare audio training tutorial for new nurses on the importance of nursing-sensitive quality indicators.
As you begin to prepare this assessment you are encouraged to complete the Conabedian Quality Assessment Framework activity. Quality healthcare 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. Donabedians theory of quality health care focused on the links between quality outcomes and the structures and processes of care (Grove, Gray, Jay, Jay, & Burns, 2015).
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. 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.
Demonstration of Proficiency
By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:
Competency 1: Describe nurses and the interdisciplinary teams role in informatics with a focus on electronic health information and patient care technology to support decision making.
Describe the interdisciplinary teams 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 and 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
Introduction
Donabedians Quality Assessment framework focuses on health, the subject of care (the patient), and the provider of care. This theory looks at a triad of:
Structure, such as the hospital, clinic, provider qualifications or organizational characteristics.
Process, such as the delivery, coordination, education, protocols, practice style, or standard of care.
Outcomes.
The structures enhance the process that will be used to achieve the quality improvement outcome, which may be either intermediate (that is, simultaneous or short-term) or long-term. In some instances, the care process may not accurately reflect the outcome measure. When the outcome is not achieved, something has occurred in the structure and/or process, or the outcome needs to be evaluated over a longer time period.
Nurses can use this theory as a way to improve quality of care, patient care outcomes, and patient satisfaction by looking at the Nursing Sensitive Quality Indicators.
Three Functions
This figure represents the relationship between the structure (health care providers and organization) and factors that need to be considered to come together to achieve a desired outcome. Patients, providers, and regulators may not have the same view of what health is as an outcome or a behavior. Each may have different reasons for measuring quality outcomes, so the patient, provider, and health need to be viewed as individual energies to achieve the outcome. Three functions are considered: Social, psychological, and physical-psychological.
3D cube repersenting physical, psychological, and social functions of the structure of the Donabedian framework.
Example
Consider a nursing sensitive indicator, such as a pressure ulcer. Perhaps the protocol to prevent pressure ulcers was adhered to, but the patient still gets a pressure ulcer. The nurse, patient, and provider need to look objectively at what happened and what needs to be accomplished or changed to create a quality outcome (an absence of pressure ulcers). People, places, and dynamics combine to deliver health care.
There are three functions to consider: Social, psychological, and physical-psychological. The nurse needs to consider all three functions when delivering care and measuring outcomes. The patients needs and perceptions need to be taken into consideration so that quality outcomes are achieved.
Physical-psychological function:
How does a pressure ulcer relate to health? Health, patients, and providers would all agree that pressure ulcers are something to be avoided, unlike something like exercising or eating cookies.
How does a provider (the institution or system) think about a pressure ulcer? That is, how was it acquired? Is it a failure? It is somebody else’s problem? Might it depend on the provider (whether at home or in the hospital)?
How should nurses (the individual practitioner) think about pressure ulcers?
Social function:
How might a pressure ulcer impact a persons sense of self and experience of the world?
Psychological function:
How does a patient think about and experience a pressure ulcer?
You are the nurse manager in a rapidly growing office-based practice. The office has only one staff member and is not compliant with electronic documentation. The fax and patient charts are in plain view. The average wait time to see the physician is two hours and patients complain that they lose their prescriptions.
Using this information, consider how structure (such as the hospital, clinic, provider qualifications, and organizational characteristics) and process (such as the delivery, coordination, education, protocols, practice style, or standard of care) may be modified to achieve quality outcomes. Then answer the questions below.
1- What structure issues do you need to consider?
2- What processes need to be modified to effectively deal with these structures?
3- What outcomes are desired? What Nursing Sensitive Quality Indicators are involved?
PAPER SAMPLE
Introduction
The National Database of Nursing Quality Indicators (NDNQI) is a program for measuring the quality of nursing nationally. The program gives healthcare facilities their unitlevel performance information in comparison with state, national, and regional percentile distributions. The program provides hospitals and other healthcare facilities with data comparison reports to help them improve the quality of care they provide to patients. Nursing-sensitive quality indicators refer to the aspects of patient care that are influenced by the actions of nurses directly. These elements include structural, process, and outcome indicators. Structural indicators reflect the availability of qualified nurses, their skills, and their education and certification levels. Process indicators are used in measuring the methods used in assessing patients and nursing interventions. Job satisfaction of nurses is also part of the process indicators. Outcome indicators denote patient outcomes determined to be nursing-sensitive due to their dependence on the quantity and quality of nursing care. Nursing-sensitive quality indicators show the influence of nurses on the quality of patient care (Mangold & Pearson, 2017). I have chosen the patient safety indicators as the topic of discussion for this assignment. Patient safety is an increasingly important national priority in healthcare. Monitoring patient safety indicators is important because it provides a quantitative basis for healthcare providers and planners aimed at attaining an improvement in care and the processes by which the care is provided. These indicators have an impact on the quality of care as they are based on standards of care provided by evidence-based practices, academic literature, or panels of experts in the absence of scientific evidence (Asgari et al., 2015). By monitoring patient safety indicators,
nurses can evaluate how their actions impact patient outcomes and take corrective measures where weaknesses are noted. New nurses should be aware of patient safety indicators because their actions are directly linked to patient outcomes. Having a look at the hospitals patient safety indicators can help new nurses identify where the hospital is strong or weak in patient safety. This can inform the new nurses to capitalize on the strengths while finding ways to improve upon the weak points.
Collection and Distribution of Quality Indicator Data
The hospital has an electronic health records system. Through this system management of patient care is improved, medication errors are reduced, unnecessary investigations are avoided, and communication and interactions among care teams, other providers involved in care, and patients are improved. The electronic health record system enables healthcare providers in the hospital to ensure medication adherence. The system is designed in a way that it provides medication alerts thus notifying care teams of potential adverse outcomes from drug allergies, over and under dosage, and drug interactions (Backman et al., 2015). These alerts contribute to patient safety improvement. Another way the hospital collects data on the patient safety indicators is by providing patients and their families with questionnaires to fill and giving them interviews during and after they have been attended to gauge how best they were served. Their feedback is important in informing healthcare professionals of areas that need to be improved on. Also, healthcare professionals are also provided with questionnaires to fill and interviews on key aspects of their work including job satisfaction and patient safety. The results are used to implement strategies to improve working conditions which are directly linked to patient safety. From staff surveys,
hospital management can also identify the skills gap and find ways of upgrading the competencies of their staff. Besides, the hospital has checklists such as the postoperative checklist that is used to record any postoperative complications, their causes, and corrective actions. This, therefore, contributes to improved patient care. After gathering aggregate data on patient safety indicators, the data is disseminated through staff meetings in which clinicians and physicians are given time to analyze the data before it is discussed. Areas needing improvements are pointed out and the responsible staff members are given the support required for the implementation of the improvements. Sensitive data is discussed at the hospital executive board meeting and the outcomes of deliberations are communicated to the staff through emails, notice boards, and departmental meetings. The hospital also organizes annual seminars in which some of the information gathered from monitoring patient safety indicators is analyzed and discussed reports on the way forward being produced. Nurses have an important role in supporting accurate reporting and high-value results. They are responsible for completing the checklists provided by the hospital and filing all important information related to patient safety. They are also required to provide accurate feedback to the surveys and interviews given to them so that it can help in improving the hospital’s working environment. Accurately entering data about nursing interventions and recording outcomes can help nurses to defend themselves against malpractice claims when they care
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