The National Database of Nursing Quality Indicators
Nathalie Pierre-Paul
Harriet Rothkopf Heilbrunn School of Nursing
Introduction
Throughout our nursing school career we have been instilled one specific theme and that is we, as nurses, are at the forefront to reduce suffering and deliver patient-centered care.
Nurses are in pivotal positions to improve quality, prevent errors, and improve patient satisfaction in hospitals. As advocates we have a responsibility to measure, evaluate, and improve practice.
Introduction
"By providing a national database and RN surveys for examining relationships between nursing and patient outcomes, the National Database of Nursing Quality Indicators® (NDNQI®) delivers evidence to support the importance of nurse sensitive measures in overall patient experience strategy” (Press Ganey Associates, Inc., 2018).
History
Understanding NDNQI
The National Database of Nursing Quality Indicators was established in 1998 by the American Nurses Association (ANA)
PURPOSE:
- to collect and build on data obtained from earlier studies
- further develop nursing's body of knowledge related to factors which influence the quality of nursing care (Montalvo, 2007).
What is NDNQI?
- A national database to which hospitals submit nursing-sensitive data about structure, process, and outcomes of nursing care.
- The NDNQI aggregates the data quarterly and returns reports to participating hospitals.
- Nurse administrators and managers receive unit-level information that is compared across time periods and benchmarked to similar units from other hospitals (Sewell, J., 2016).
MISSION
- Aid the nurse in patient safety and quality improvement by providing research based, comparative data on nursing care and its relationship to patient outcomes.
- Support and adapt activities that may improve nursing indicators.
- Implement a standard of care throughout participating facilities across the nation.
NDNQI & Informatics
Data
- Nursing informatics actively supports nursing by providing standard language systems, databases, decision support, readily accessible research results, and technology assessments.
- Nursing informatics tools, such as NDNQI, support improvement of healthcare by answering questions about patient outcomes and quality improvement on an enterprise scale.
- By also providing documentation for strategic planning, advanced practice nurses are able to examine their practice and the effect of their actions on patient outcomes.
- Analysis of patient outcomes may lead to initiatives for quality improvement, such as gaining leadership support, funding and resources.
- Nursing informatics is dedicated to finding ways to make clinical documentation visible and accessible for evaluation and comparison.
(Charters, 2003)
Nursing Implementation
Quality Care
What are Indicators?
Quality Indicators
Measures that reflect the structure, processes and outcomes of nursing care (American Nurses Association, 2006)
Responses to the need for multidimensional, accessible quality measures that can be used to gage performance in health care.
They are evidenced based and can be used to identify variations in the quality of care provided on both inpatient and outpatient basis (Farquhar, 2008)
ACCORDING TO THE JOINT COMMISSION:
- Every year in the United States, hundreds of thousands of patients fall in hospitals
- 30-50 percent resulting in injury
- Placing an additional average of 6.3 days to the hospital stay
- The average cost for a fall with injury is about $14,000.
(Tzeng & Yin, 2015)
Why are patients falling in the hospital?
- Impaired cognition, mobility, gait, and balance
- Dependence in daily living activities
- Influenced by surgery and/or procedures
- Physiological changes due to a medical condition or diagnostic testing
(Tzeng & Yin, 2015).
WHAT IS A RESTRAINT?
“Any device, material or equipment attached to or near a person's body and which cannot be controlled or easily removed by the person and which deliberately prevents or is deliberately intended to prevent a person's free body movement to a position of choice and/or a person's normal access to their body (Gastman & Milisen, 2006)."
RESTRAINT vs. FALSE IMPRISONMENT
- “False imprisonment is defined as the unlawful restraint or detention of another person against his or her wishes” (Mahlmeister, 2016 ).
- Restrained unlawfully can initiate a civil suit against the care provider or hospital.
- EXAMPLES - excessive use of restraints, refusing to give patient their clothes or use of telephone, intimidating patient with a security guard, sedating the patient against his or her will.
FOLLOW STANDARD PROTOCOL:
- Perform a complete clinical assessment
- Evaluation must show that the patient is at risk to causing harm to themselves.
- All less restrictive measures have been considered:
-having staff or a family member sit with the patient
-using distraction or de-escalation strategies
-offering reassurance
-using bed or chair alarms
-administering certain medications
Catheter-associated Urinary Tract Infections
- The most common healthcare–associated infection (HAI)
- Caused by the development of bacterial biofilms - E.coli, that are found on the catheter inner surface.
- These infections often are under recognized and undertreated
- Lead to complications such as renal abscesses, epididymitis, periurethral gland infections, and bacteremia.
FOLLOW STANDARD PROTOCOLS:
Nurses implement health promotion through preventive measures such as
- avoidance of unnecessary catheterization
- early removal of indwelling catheters
- proper handwashing technique
- using aseptic technique during instrumentation procedures
- routine and thorough perineal hygiene
After insertion, maintenance and protection of the closed drainage system are major nursing responsibilities.
- should not routinely irrigate the catheter
- maintain patency of the catheter
- manage fluid intake
- provide patient’s comfort and safety
CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTION
“A central line-associated bloodstream infection (CLABSI) is defined as a laboratory-confirmed bloodstream infection not related to an infection at another site that develops within 48 hours of a central line placement” (Haddadin et al., 2018).
- Central venous catheters (CVC) account for about 90 percent of catheter related bloodstream infections (BSIs).
- There are somewhere between 500 and 4,000 patient deaths each year in the U.S.
FOLLOW STANDARD
PROTOCOL:
Implement Central-line Maintenance Bundles
- proper hand hygiene
- catheter disinfection before central-line access
- strict aseptic technique for site care, tubing, and dressing changes.
- use of 2% chlorhexidine skin preparations
Evidence based interventions
- prompt removal of any central line that is no longer required
- disinfect the catheter hubs, injection ports, and connections before accessing the line
- assess the need for the central line daily
- use a checklist
(Haddidin et al, 2018)
PROGRESS
New Indicators
Ongoing Investments and Database Enhancements
2007
2017
2014
FUTURE
Enhanced Reporting
Over 1100 facilities