Hello everyone. I welcome you all at the Coliseum Northside to the Medical-Surgical Unit, where our mission is to offer exceptional and compassionate service care to our clients every day. At this facility, I am a board member of the Quality Improvement Council. This presentation will explore how the National Database of Nursing Quality Indicators (NDQI) can improve patient quality and patient safety.
How a Health Care Organization Uses Nursing Sensitive Quality Indicators
Zadvinskis et al. (2019) indicate that NDQI was developed in 1998 by the ANA to integrate nursing knowledge and particular information to improve the quality of care and patient safety. Data-centered research is gathered from the nationwide facilities, and they are compared to assess the nursing care quality. It affects patient outcomes at different levels of the healthcare system. The NDQI houses the nursing-sensitive indicators, which the ANA refers to as the documentation standards. These are the components of nursing care that directly impact patient outcomes. According to ANA documentation standards, there are three nursing-sensitive indicators, namely structure, process, and outcomes. Structure talks about the nursing skills and the nursing staff, and the level of education. Process delineates nursing interventions and patient assessment alongside nursing job satisfaction. Outcome sensitive indicator refers to meeting expected patient outcomes.
The nursing quality indicator chosen for analysis in this assessment is the patient fall. Zhao et al. (2018) coincide that the amount and the quality of nursing care given to patients directly impacts the probability of these patients experiencing a fall. The NDQI shares data which healthcare organizations use to compare in-house fall rates. In simple terms, the NDQI provides a measuring tool for healthcare organizations regarding how good or not present standards, policies, and procedures are documented, implemented, and maintained. As nurses, we must prevent falls within our facilities to continue building trust in the community, improve the organization’s financial viability, and satisfying the ANA documentation standards. Nurses play a significant role in the prevention of falls and fostering patient safety. Coliseum Northside is mainly a medical-surgical facility. Studies like those by Tsuda (2017) indicate that falls have a higher tendency to occur in medical surgical sections than in other hospital units.
Multiple studies have shown that thousands of patients experience falls in different hospitals throughout the country each year. Consequentially, it has led to a financial burden for both the patients and healthcare organizations. Kobayashi et al. (2017) mention loss of income, litigation expenses, and temporary placement in rehabilitation centers as examples of financial obstacles clients may incur after a nasty fall. For the healthcare organization, repairing patient harm experienced during the fall becomes a huge burden because reimbursement is no longer provided. Moreover, Medicaid and Medicare services believe that falls occurring due to injuries in hospitals are avoidable incidences, and they no longer cover such costs.
Justification Of How a Nursing-Sensitive Quality Indicator Establishes Evidence-Based Practice Guidelines for Nurses
As noted earlier, nurses play a pivotal role in preventing the occurrence of patient falls in hospitals. Since the nurses are the frontline soldiers in avoiding falls, they should implement interventions like examining patients for fall risks, setting bed alarms, creating awareness about falls to the patients and their families, and ascertaining that bed wheels are locked; nurses can effectively prevent falls. Michalcova et al. (2020) show that highly engaged nurses have a higher probability of integrating best practices, which have proven to reduce fall rates and boost family and patient satisfaction, positively impacting patient safety.
I interviewed one of the Quality Improvement Practitioners at Coliseum Northside to better understand how data is used and transmitted to help advance patient safety. The practitioner said that when patients face a fall in the hospital, the assigned RN submits a report via an online reporting database known as the safety portal. Such information helps the quality improvement practitioner identify a problem at hand, leading to a comprehensive analysis of the patient chart.
Coliseum Northside uses MEDITECH, an electronic medical record for documenting patient interventions. Certified Nursing Aids, registered nurses, Licensed Practice Nurses like the MORSE Fall Scale for assessing fall risks, ambulation abilities, hourly rounding, assistance needs, patient orientation, and the utilization of bedside sitters in the MEDITECH, which is then made available when required for analysis. After the practitioner has analyzed the data in the chart and MEDITECH, the fall is transferred to New York State Database. The interdisciplinary meeting is organized every Monday by the Quality Improvement Practitioner to explore the quality indicators and root cause analysis to create a solution to what is causing the fall or to mitigate the falls that have been occurring. Moreover, assessing pertinent findings in the client’s chart, including communication between physicians and nurses, happens.
For example, suppose a nurse communicated concern to the doctors regarding the side effects of medications such as lethargy or dizziness. In that case, we want to know if these side effects can increase the probability of a patient experiencing a fall. On the physician’s side, the advantage versus the danger of prescribing medication is assessed. At the same time, additional or new approaches must be implemented on the nurse’s end to ensure the patient’s safety. As nurses, adequate documentation and assessment ascertain that our patients are given the best quality care that meets their satisfaction.
The meeting findings directly show what new mandates or education and policies need to get implemented to prevent further patient falls. When inquired about the challenges encountered during the execution of quality improvement meetings, the quality improvement practitioner fostering change within the nursing staff said that giving direct patient care was the most challenging task. No person likes change; however, sometimes change is inevitable to grow patient safety, especially in avoiding patient falls positively.
I want to emphasize the importance of nurses communicating through shift reports, documentation, and assessments. Besides being a requirement by the Joint Commission responsible for accrediting hospitals that every facility must perform a fall risk assessment, nurses also take oaths to safeguard those in care facilities. Prevention of falls is among the approaches nurses are using to bring changes to the safety of patients. I urge my fellow nurses to expand the scope of their education to gain knowledge about nursing-sensitive indicators and how we can bring change to the healthcare system. Once more, I welcome you to the Coliseum Northside team. I look forward to working with you.