Ensuring quality and saving time

IT’S A GIVEN that nurses want to provide quality care to our patients. But in the past few years, the stakes have been raised around quality and performance improvement, and ways to measure it. Healthcare facilities, for example, risk losing federal dollars if so-called “never” events and hospital-acquired conditions, such as pressure ulcers and catheter-associated urinary tract infections, occur when patients are on their watch.

In 1994, ANA began exploring concrete ways to show that registered nursing care makes a crucial difference in the outcomes of hospitalized patients. The result was the development of nursing-sensitive indicators and the establishment of the National Database of Nursing Quality Indicators &#174 (NDNQI &#174). Now, nearly 2,000 hospitals in the United States alone participate in this global quality measurement program, which allows hospitals to track their progress on as many as 18 measures, including patient falls, pressure ulcers, infections, and staffing.

There are other articles in this issue about NDNQI and ANA’s work around quality, but let me explain briefly how the program works. Participating hospitals collect data on several or all of the measures and send them to NDNQI. In return, facilities receive quarterly unit-based reports showing how they compare to like units at hospitals of similar size and type. For example, a rural intensive care unit (ICU) can see how it measures up to other rural ICUs nationwide on the incidence of patient falls. Hospitals then use this vital information in their ongoing quality-improvement programs.

One concern staff nurses, nurse managers, and nurse administrators express is the amount of time it takes to manage work around quality initiatives. To help ease those challenges, the NDNQI program is refining its reporting system so healthcare facilities will be able to review their data in a quicker, more user-friendly way through an approach known as business intelligence reporting. These quality intelligence reports will portray a sophisticated array of data graphically—for instance, displaying the incidence of ventilator-associated pneumonia over time using bar or line graphs. Moreover, the reports will include in-depth analyses of the data, freeing nurses from this time-consuming but critical task.

Presenting information this way is designed to bridge the gap that often exists among data, information, and the knowledge needed to improve quality. It’s a powerful way for nurses to see how their interventions matter and to make adjustments to care more efficiently.

Another time-saving change on the more distant horizon is the creation of “e-measures.” This eventual change will save nurses time collecting and inputting data, because computers will be programmed to automatically compile required data from electronic health records using data nurses already have documented in the chart.

ANA also has taken the lead on efforts that elevate nurses’ visibility and voice on the quality front. We constantly are looking for strategic opportunities to nominate ANA members to key national panels and workgroups that focus on various aspects of performance improvement, including quality measures. More than 50 nurses have been appointed to these positions—including being seated on panels that will take on issues that could greatly affect nursing, such as reimbursement for care-coordination activities. The importance of this work can’t be overstated, and I encourage interested ANA members to e-mail us at npp@ana.org so we are ready to forward nominations when positions arise. If you are not a member, consider joining ANA so you can engage at the highest possible level.

Quality will continue to drive many healthcare decisions, and quality reporting and analysis will still take some degree of energy, resources, and time. But the benefits of closely tracking the care we provide using NDNQI data in hospitals are many. We can make the alterations we need to improve our practice, patient outcomes, and work environment based on solid information. And these efforts bring even greater value to the work we do. For more information on ANA’s quality work, go to www.ncnq.org.

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