Analysis of Nursing-sensitive and Quality Indicators that Require Improvement

Overview and Purpose of the Assignment

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The aim of the task is to provide a critical overview and analysis of NDNQI statistical data to discover nursing sensitive and quality indicators that require improvement. Both nursing-sensitive quality indicators reflect the outcomes, process, and structure of healthcare as the three core components of patient care. In the contemporary nursing practice, nursing-sensitive pointers are among the essential NDNQI elements for developing evidence-based practice strategies (Gill, 2015). Furthermore, coming up with measurement strategies for the indicators has ethical imperativeness. In the assignment, the nursing-sensitive quality pointers under analysis include NDNQI data, general and specific nursing-sensitive indicators, and patient satisfaction indicators. Regarding NDNQI data, the assignment analyzes statistical data regarding total patient falls per 1,000 days, percentage number of patients assessed for pressure ulcers per day, the portion of patients with pressure ulcers, the number of hours for RN care and NHPPD. RN courtesy, promptness, attaining specific needs, coordination of healthcare, and response to pain are the indicators for scoring patient satisfaction. Through the analysis of the indicators, it is possible to identify an area that requires improvement. In so doing, the assignment will have satisfied one of the nursing's foundational guidelines and principles stating that nursing professionals have the obligation of measuring, evaluating, and improving the quality and effectiveness of nursing care and practice (Gill, 2015).

Data Analysis

There is a small variation in NHPPD for the three time periods. From a target of 6.69 hours in the first two periods, the target is not achieved as there is a variation in the actual values by 0.13 and 0.10. However, with the last period Q1FY1, the target was 7.19 hours, but the real value was 7.23 hours indicating a positive variance. The implication of the NHPD data is that the maximum nursing hours for every patient in the rehabilitation unit is not up to the mark due to fluctuations. On the other hand, while it is expected that the RN care hours should be 61.86, there is a deviation from the target by 3.15, 5.96, 5.24 and 7.79 for the three periods. The lowest attainable value is at the Q4FY1 period where the RN care hours is 54.07 with the highest actual value of 58.71 during the Q2FY09 period. Regarding a total number of patient falls in every 1,000 days, there is a significant discrepancy from the minimum target value of 3.14. In the three periods, Q2FY09, Q3FY09, Q4FY09 and Q1FY10, the attainable values of total falls in the rehabilitation unit are 6.96, 0.00, 5.97 and 9.19 respectively. On the other hand, there are no changes in the percentage of patients at fall and risk protocol. The target is 100, a figure achievable at Q2FY09, Q3FY09 and Q1FY10 periods but the value drops to 80 during the Q4FY09 period. Percentage BSN and CERT are the NDNQI data that have significant improvement score with the maximum variation of 17.30 from the target of 45.20 and 7.38 from the target of 23.87 respectively. % BSN and % CERT are the components of nursing care structure which describe the nature of nursing staff supply, their certification, skill level and turnover within the rehabilitation unit. There is the fair attainment of Length of Stay (LOS) value whose target is 11, but the actual figure ranges from 8 to 9. All the satisfaction indicators have been achieved somewhat in the care unit reflected by variance from the target by between -8 for response to pain and +3.86 for RN courtesy.

The NDNQI data that need improvement is the affiliate aspects of Hospital-acquire pressure ulcers (HAPUs). During Q2FY09, Q3FY09 and Q4FY09 periods, 100% of the patients were screened for pressure ulcers. Consequently, there were 0% cases of acquired pressure ulcers (AQPRULC) in the three periods except on Q2FY09 where %AQPRULC was -5.25% variance. When the percentage of patients assess reduced to 60.86% in the last period, %AQPRULC is -4.35%. While the rehabilitation unit has a target of 2.84% for percentage number of patients with pressure ulcers, there is a variance as high as -17.1%. It is possible to have as high as 80-90% reduction in the cases of HAPUs hence it is the area that requires significant improvement. According to Revello and Fields (2014), it is essential to fully eradicate the cases of HAPUs because it bears concerns such as reimbursement issues, the cost of treatment, and patient morbidity. Furthermore, reducing hospital-acquired pressure ulcers increases the quality of healthcare hence improving patient satisfaction and increasing reputation of the hospital.

Nursing Action Plan

The appropriate nursing action plan should entail the best practices for quality improvement interventions such as patient repositioning, using wound and skin assessment teams to conduct biweekly rounds, application of specialty beds, sharing and storing patients' data on pressure ulcers among nurses and educating the healthcare team (Revello & Fields, 2014). Regarding repositioning of the patients, the action entails turning the patients in their bed at intervals of 1 to 2 hours. Repositioning is a fundamental component in the prevention of pressure ulcers and involves moving patients from one sleeping or resting position to another for the purpose of redistributing pressure across different parts of the body (Kallman, 2015). The use of specialty beds augment the repositioning practice and entail the use of special beds at an angle of 300 or at any other angles that are compatible with medical conditions for the patients and prevent the occurrence of shear-related injuries. It can also entail the application of alarms that serve as reminders to the nurses in the rehabilitation unit when time to reposition patients in their beds is due.

The other nursing action plan is thorough and regular wound and skin assessment (Peterson, Gravenstein, & Schwab, 2013). Evaluation procedure entails the use of an interdisciplinary team of expert nurses and other practitioners to conduct rounds of assessments of patients two times per week. During the evaluation process, nurses will be examining the patients' bodies, measure and document data on pressure ulcers. The last practice entails education of both the patients and caregivers on the strategies of minimizing the risks of obtaining HAPUs. Documentation is essential to provide the platform for comparing patients' conditions upon entry into the unit and their conditions after leaving the hospital (Mallah, Nassar, & Badr, 2015). Documentation and assessment assist in determining patients who are predisposed to HAPUs. It also helps in classifying the patients and differentiating those already affected from those without pressure ulcer conditions. Education initiative also extends to the RN nurses and other members of the multidisciplinary team by enlightening them on the products and plans for according patients with signs of HAPUs depending on assessments results (Gill, 2015). The rationale for the including education initiative in the nursing action to reduce cases of HAPUs is to empower the nursing team to detect pressure ulcers before the development of medical issues such as sepsis and cellulitis infections (Mallah, Nassar, & Badr, 2015). The occurrence of HAPUs is preventable through effective documentation of pressure ulcers cases. In most cases, documentation is the role of the RNs in recording data such as stages of the pressure ulcers, presence, and the location of wounds. The data are inputs of electronic medical record (EMR) which is useful for facilitating incidence tracking. According to Mallah, Nassar, and Badr, (2015) staff education, skin rounds and assessments enhance pressure ulcers documentation and nursing accountability and hence promoting the prevention of the possible occurrence of HAPUs cases within the rehabilitation unit.

Summary of Main Points

NDNQI data serve as the database for nursing that offers annual and quarterly reports in the outcome, process and structure indicators for evaluating the quality and effectiveness of the nursing care. The statistical data from the study in the rehabilitation unit include total patient falls per 1,000 days, percentage number of patients assessed for pressure ulcers per day, the number of patients with pressure ulcers, the number of hours for RN care and NHPPD. Across the three periods, Q2FY09, Q2FY09, Q4FY09 and Q1FY10, the data deviate from the actual values. The NDNQI indicator that requires improvement is the concept of pressure ulcers primarily acquired pressure ulcer (AQPRULC) whose real value diverge from the target of 0.00%. The nursing action entails the prevention of hospital-acquired pressure ulcers. The plan involves the use of patient repositioning, using wound and skin assessment teams to conduct biweekly rounds, application of specialty beds, sharing and storing patients' data on pressure ulcer among nurses and educating the healthcare team.

References

Gill, E. C. (2015). Reducing hospital-acquired pressure ulcers in intensive care. BMJ Quality Improvement Report, 4(1):102-117. doi:doi:10.1136/bmjquality.u205599.w3015

Kallman, U. (2015). Evaluation of Repositioning in Pressure Ulcer Prevention. Sweden: Linkoping University.

Mallah, Z., Nassar, N., & Badr, L. (2015). The effectiveness of a pressure ulcer intervention program on the prevalence of hospital-acquired pressure ulcers: Controlled before and after study. Applied Nursing Research, 28(2):106-113. doi:http://dx.doi.org/10.1016/j.apnr.2014.07.001

Peterson, M., Gravenstein, N., & Schwab, W. (2013). Patient repositioning and pressure ulcer risk: Monitoring interface pressures of at-risk patients. The Journal of Rehabilitation Research and Development, 50(4):477-488.

Revello, K., & Fields, W. (2014). A Performance Improvement Project to Increase Nursing Compliance with Skin Assessments in a Rehabilitation Unit. Rehabilitation Nursing, 37: 3742. doi:doi:10.1002/RNJ.00006