Issues up close

In February, ANA recognized six hospitals with its 2013 NDNQI® Award for Outstanding Nursing Quality®. These NDNQI-participating hospitals achieved excellence in different categories of nursing-sensitive quality measures last year.

Chief nursing officers and nurse leaders at the winning hospitals used NDNQI data to evaluate such quality factors as falls, pressure ulcers, and nursing satisfaction. Then they presented data-backed evidence and worked with their teams to establish programs and processes to make the changes necessary to improve quality.

What are some of the areas they were able to improve, and how did they make the needed changes?

Patient falls

When NDNQI data showed problematic fall rates at Stony Brook University Hospital on Long Island, New York, Margaret Duffy, MS, RN, NEA-BC, interim chief nursing officer (CNO) at the 603-bed, Level I trauma center, knew they needed a change.

After looking through the data and finding specific areas where the hospital could make improvements to decrease the number of patient falls, she worked with the hospital to purchase fall monitors for every patient in certain units. The result? A reduction in falls and falls with injury.

“Obviously, we didn’t need alarms for every single unit, but for a cardiac or a medicine unit, it was easy to ask, ‘What’s the price of a fall with injury?’” says Duffy, an American Nurses Association (ANA) member. “An elderly woman gets up and wants to ambulate, and she falls and breaks her hip. That’s an impact to the patient, but also an impact to the unit. That’s part of the value-based purchasing program.”

Pressure ulcers

Pressure ulcers are a major concern for any hospital, and several of the award winners say tracking the data at the unit level made it possible to reduce their frequency. In fact, Shriners Hospital for Children in Chicago eliminated hospital-acquired pressure ulcers by offering nurses retraining in pressure-ulcer awareness, says Terry Wheat, MPH, RN, director of patient care services/CNO.

In an earlier look at NDNQI data, says Wheat, indicators for pressure ulcers came in higher than expected, so the hospital retrained nurses and retained wound-care specialists who could help lead the way for change. Excellence is “second nature now,”
she says.

Craig Hospital in Englewood, Colorado, a three-time winner of the NDNQI award for rehabilitation hospitals, has used NDNQI data over the past 2 years to lower the incidence of pressure ulcers. Diane Reinhard, MBA, MSCIS, BSN, RN, NE-BC, CRRN, vice president of care services and CNO, says her organization committed to sending several nurses for Wound Ostomy and Continence training to learn how to reduce the incidence of pressure ulcers.

It was a sizable investment. Reinhard, a Colorado Nurses Association member, says the organization paid the three nurses’ time and expenses for 6 to 8 weeks of training. “We were that vested and needed them to be a solution,” she explains. They came back with evidence-based information and proven strategies to overhaul the hospital’s policies and procedures.

CAUTIs

The King Faisal Specialist Hospital & Research Centre, Jeddah Branch, in Jeddah, Saudi Arabia, is the first international hospital to win an NDNQI award. NDNQI data showed catheter-associated urinary tract infections (CAUTIs) were an issue in the medical-surgical intensive care unit. After cross-checking with its suppliers, Sandy Lovering, DHSc MBS, BScN, RN, CTN, director of nursing practice and quality, says they discovered a type of urinary catheter bag was the culprit.

“We have problems maintaining our supplies here, and our supply chain guys had changed the bags they were getting to us,” Lovering explains. “We found that because the bags were smaller, nurses had to access them and empty them more often, which created breaks in our sterility, and that contributed to a spike in our UTI rates. We could directly relate the data to what’s happening at the bedside.”

Staffing levels

NDNQI data don’t always lead hospitals to make procedural changes or purchase new equipment. Sometimes it inspires them to make changes in staffing levels.

For example, the Stewart & Lynda Resnick Neuropsychiatric Hospital at the University of California, Los Angeles, found that its nurses weren’t happy, says Kandace Whiting, MSN, RN, ANIII-Magnet® and nursing quality improvement coordinator. “After the 2012 survey, we identified that direct-care nurse involvement was one area where nurses were unsatisfied.”

While the hospital had better-than-benchmark performance ratings for nursing staff levels, Whiting says nurses were still concerned that those levels were too low. “We identified that in times of low census, you’d have a level of [adequate] staffing, but in the middle of the night there might be some admissions that brought levels to where the staff was concerned it wasn’t safe.”

The hospital assembled a leadership team that oversees nurses in unit practice councils. It also expanded its shared governance system into the nursing quality structure and added committees in order to involve nurses at every level. The hospital now has
a pilot program that uses an on-call nurse who can help with an admission or if a patient’s acuity changes in the middle of the night.

General excellence

Parkview Whitley Hospital in Columbia City, Indiana, moved into a brand-new facility in 2011. In July 2013, it implemented a new electronic medical record system. In both cases, NDNQI indicators helped keep the hospital on track, says Vice President of Patient Services Bridget Johnson, MSN, APRN.

Using the NDNQI data makes it easier to focus on evidence-based solutions, Johnson says. “These are the things I tell nurses are important—not just important to me and the metrics, but important to patient outcome. As a nurse on the floor, you have so many multiple priorities. NDNQI helps us with that. It helps us to be better nurses.”

Johnson says her biggest goal in using NDNQI is to empower the nurses themselves to use the data and provide the best care. “That’s our biggest opportunity.”

Building a case for change

Looking at NDNQI data gives hospitals a chance to draw evidence-based conclusions about what’s going on at their organizations. It takes a commitment to action to make changes, but using the data to identify problem areas is a great start for organizations that want to make a change.

For more information about NDNQI and the 2013 award recipients, visit http://www.pressganey.com/solutions/clinical-quality/nursing-quality.

Editor’s note: ANA signed an agreement to sell the assets of its NDNQI program to Press Ganey on June 7. For more
information, please visit http://www.nursingworld.org/.

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