National Database Of Nursing Quality Indicators Research Articles

Differences in Perioperative Nurse Job Satisfaction by Specialty Certification Status

PurposeTo describe differences in perioperative RN job satisfaction by specialty certification status. DesignA retrospective, exploratory, cross-sectional design. MethodsWe conducted a secondary analysis of annual data from the National Database of Nursing Quality Indicators (NDNQI) RN Survey with 12 Job Satisfaction Scales. The sample consisted of 776 perioperative units in 206 hospitals with 13,061 study participants. We used multilevel mixed modeling to examine differences in job satisfaction for nurses holding CAPA (Certified Ambulatory Perianesthesia Nurse), CPAN (Certified Post Anesthesia Nurse), CNOR (certification for perioperative registered nurses), CRNFA (Certified RN First Assistant), other specialty certification, and not specialty certified. FindingsTwelve percent of RN participants held a perioperative nursing certification (CAPA, CPAN, CNOR, CRNFA), 15% held other nursing specialty certifications, and 73% were not certified. Regardless of certification status, nurses were the most satisfied with nurse-nurse interactions and task. They were the least satisfied with nursing administration, decision-making, and pay. CNOR certified nurses reported the lowest levels of job satisfaction in the study. CAPA and CPAN certified nurses reported higher job satisfaction than their noncertified colleagues on multiple job satisfaction scales (ie, CAPA 10 of 12; CPAN 5 of 12). CNOR certified nurses did not report meaningful differences in job satisfaction from non-certified nurses. ConclusionsAs job satisfaction impacts retention, productivity, and patient care quality, our findings have important implications for hospital leaders, nurses, and health care consumers. Based on our findings, we identified nursing professional development as a potential gap in job satisfaction that leaders can target for improvement. Our findings suggest that higher specialty nursing certification rates in perianesthesia nurses may potentially improve job satisfaction and retention of nurses.

Effects of Implementing an Acuity Tool on a Psychiatric Intensive Care Unit.

Staff shortages, reduced budgets, and high acuity of violent psychiatric patients can create challenges in psychiatric intensive care units (PICUs). Staffing of the psychiatric unit was based on patient census rather than evidence-based practices. A pre-/postintervention design was used to examine changes in nursing satisfaction and patient outcomes as measured with the National Database of Nursing Quality Indicators (NDNQI) survey results. A psychiatric specific acuity tool was implemented on the PICU of a Veterans Administration hospital. After an initial decrease related to the COVID-19 pandemic, total acuity and the total number of nurses remained relatively stable while the unit census declined. NDNQI survey results improved with the largest being a 52-percentile increase for the quality-of-care summary measure. An acuity tool can help standardize practice, determine fair patient assignments among staff, increase nurse satisfaction, and promote best practices for patient safety.

Nurses as Agents of Safety: Identifying unique contributors to falls in hospitalized Adult Hematology Patients: A Retrospective Study

Falls continue to be a major safety concern in acute care settings and are the second cause of unintentional injury deaths globally [1].The World Health Organization defines a fall as an event that results in a person coming to a rest inadvertently on the ground or floor or other lower level. Prevention of a fall is a safety measure, which is significantly affected by nursing care according to the National Database of Nursing Quality Indicators (NDNQI) [2].This retrospective review of one hundred medical records was conducted to assess if there are unique contributors to falls in hospitalized adult hematology patients. The study sample was drawn from the parent study that examined the impact of video-based educational intervention on the occurrence of falls among hematology patients hospitalized for the management of cancer treatment and complications. Patients with cancer are at an increased risk of sustaining a fall related injury due to impaired functional status, low blood counts, treatment related fatigue, frailty, and poor nutritional status [3,4]. Simple logistic regression between continuous variables and dependent variable, and cross-tabulation between categorical variables and the dependent variable was used to analyze study results.The study revealed that there was a significant relationship between fall incident and fall risk assessment scores on admission; X2 (1) = 6.153, p = .013, Cramer’s V = .256.

PRONING-RELATED PRESSURE ULCERS IN COVID ICU PATIENTS: AN UNNOTICED EPIDEMIC IN THE MIDDLE OF THE PANDEMIC

TOPIC: Education, Research, and Quality Improvement TYPE: Original Investigations PURPOSE: Intensive care units have been strained across the globe due to the impact of the coronavirus disease (COVID) pandemic responsible for over 147 million confirmed cases and 3 million deaths. (Source: Johns Hopkins COVID resource center) Nearly 26-32% of the hospitalized COVID patients require admission to the intensive care unit (ICU) and aggressive management of ventilation for Acute Respiratory Distress Syndrome (ARDS). Proning has emerged as a supportive therapy in mechanically ventilated patients with ARDS. (Source: CDC) Such patients may remain proned for 12-16hours which increases the risk of pressure-injury. Furthermore, We wanted to see how proning has impacted the incidence of pressure ulcers in COVID ICUs when compared to the Non-COVID ICUs at a tertiary care hospital. METHODS: This study was conducted in the ICUs at a tertiary care academic medical center. Permission was obtained from the 'System Quality & Patient Safety' and 'Quality Operations' departments for the use of data. The data for the rate of unit acquired Pressure injury (UAPI) was obtained from all ICUs across the hospital. UAPI rate in COVID ICU compared to non-COVID ICUs. To minimize any other variable, it was noted that the COVID ICU was equipped with a special proning team from day one of the inception of the COVID unit in our institution. RESULTS: We observed a steep increase in the rate of UAPI 2+/1000 patient days from 4 to 22 in our COVID ICU unit. While the rates of UAPI 2+ in the cardiovascular, cardiac, surgical ICU remained consistent throughout the year at 7.16, 2.50, and 7.16. The neuro-ICU had the lowest pressure ulcer rate of 1.00. The pressure ulcers in COVID ICU were noted to affect the forehead, cheeks, jaw-line, anterior shoulder, chest, abdomen, and anterior lower extremities. The only variable in COVID ICU was proning. The target UAPI rate for our institution was 5.10 /1000 patient days using the definition of 2016's National Pressure Ulcer Advisory Panel (NPUAP) and the European Pressure Ulcer Advisory Panel (EPUAP), and as per the National Database of Nursing Quality Indicators (NDNQI). There is a 450% increase in pressure ulcers due to proning in COVID ICU. Despite the presence of staff members trained to perform proning, the spike in pressure ulcers was noticed in the COVD-ICU. In addition, there was no shortage of personal protective equipment (PPE) during this time. CONCLUSIONS: Our results show that the incidence of pressure ulcers has increased several-fold (450%) throughout the year 2020 (pandemic) in the COVID unit. The rates of UAPI remained consistent and comparable to the years prior to 2020 in the non-COVID ICUs. This unintended life-threatening consequence of the pandemic went relatively unnoticed due to other major co-existent high morbidities. CLINICAL IMPLICATIONS: Pressure ulcers can prolong the course of illness in ICU patients thereby increasing patient morbidity and mortality. Furthermore, it can lead to a prolonged hospital stay and increased healthcare costs, As pressure ulcers are preventable more effective strategies are needed especially in the COVID ICU setups. There is a need to address this life-threatening complication during disaster preparedness with special beds or the application of pads at the body area prone to UAPI. DISCLOSURES: No relevant relationships by Sahar Fatima, source=Web Response No relevant relationships by FAISAL MASUD, source=Web Response No relevant relationships by Iqbal Ratnani, source=Web Response No relevant relationships by AYESHA SAFDAR, source=Web Response No relevant relationships by Salim Surani, source=Web Response

Decline in Physical Restraint Use Following Implementation of Institutional Guidelines.

To investigate the strategies implemented at our institution to reduce medical restraint use. Restraints have been utilized to prevent agitation, self-extubations, and falls, although they are often associated with negative repercussions for nurses and patients. The restraint data at our institution were compared with the National Database of Nursing Quality Indicators (NDNQI) benchmark. We also described the measures taken to improve restraint documentation. The number of patients in medical restraints, medical restraint hours, medical restraints/patient-days, and deaths in restraints at our institution all significantly decreased (P < 0.00001). There were 27 self-extubations of restrained patients compared with 11 self-extubations of nonrestrained patients. The percentage of inpatients with restraints in critical care and step-down areas declined and remained below the NDNQI benchmark. This study reports the processes implemented to reduce restraint use through enhanced communication and increased documentation. Further exploration into factors that may attain a restraint-free environment is warranted.

The Effect of a Certified Wound Ostomy Nurse Educational Bundle on Hospital Acquired Pressure Injuries in the Intensive Care Unit: A Quality Improvement Project

<i>Purpose:</i> Patients in critical care units are considered high risk for pressure injury (PI) development with reported rates in the United States topping 40% in some cases. Multiple factors contribute to the risk of this population including a knowledge deficit among nurses which often leads to a lack of assessment and prevention measures needed to reduce pressure injuries. This project was launched after data collected by the Wound, Ostomy and Continence Nurse (WOCN) team showed an increase in hospital acquired pressure injuries (HAPI) in the intensive care unit (ICU) in the first quarter of 2016. The rate was 11.56 per 1000 patient days. This data was collected as part of our quarterly prevalence study reported to the National Database of Nursing Quality Indicators (NDNQI). Although this rate is lower than the national average, our patients deserve process improvement to achieve 0% incidence. <i>Participants and Setting:</i> The setting was a 16-bed ICU at a tertiary care hospital in the Southeastern United States. Monthly data was collected over the span of a year to evaluate incidence rates of hospital acquired pressure injuries (HAPI) from Q1 2016 to Q 4 2017. <i>Approach:</i> The cornerstone of this project was to focus on nursing education surrounding pressure injury prevention (PIP) intervention selections. The overall goal was to heighten the quality of patient care by implementing an innovative PIP bundle that was supported by Certified Wound, Ostomy Nurse (CWON) education and knowledge sharing throughout the ICU. The Plan, Do, Study, Act (PDSA) methodology was used to monitor interventions and outcomes. <i>Outcomes:</i> The measurable goal of this project was to decrease the quarterly rate of hospital acquired pressure injuries in the ICU by 50% by 4Q 2017, as compared to a rate of 11.54 per 1000 patient days 1Q 2016. Subsequent quarters demonstrated incremental decreased HAPI rates of 0.9, 1.8, 1.7, 5.2, 4.3, 0.9 and 0 by 4Q 2017. This was a total reduction rate greater than 50% which was our goal. The PIP bundle highlighted by WOC nurse education resulted in significant and clinically relevant reductions in incidence of HAPI in the ICU. Our future goal is to continue with an ongoing PIP bundle and WOC nurse rounding as part of our best practice within this hospital setting. In addition, we continue to share knowledge gained by this QI project with our extended WOCN team working at our surrounding facilities.

The value of intentional self-care practices: The effects of mindfulness on improving job satisfaction, teamwork, and workplace environments

BackgroundBurnout rates among nurses have detrimental impact on job satisfaction, teamwork, and patient care. This costs millions of dollars in the healthcare system and challenges nurse leaders to address in order to keep up with the healthcare demands. Furthermore, burnout is especially relevant in our current healthcare climate, as frontline nurses have increased workload and multiple psychosocial stressors during the coronavirus disease (COVID-19) pandemic (Sultana, Sharma, Hossain, Bhattacharya, & Purohit, 2019). Literature also suggests that mindful self-care practices need to be reinforced in order to impact burnout long term (Chamorro-Premuzic & Lusk, 2017). Project7 Mindfulness Pledge© is an accessible and voluntary mindfulness tool that nurses can utilize in their individual practice to reduce burnout and does not require significant time commitment. ObjectiveTo evaluate the effectiveness of intentional self-care practices on nurse burnout and workplace environment by measuring job satisfaction and teamwork among nurses. MethodsComparisons between inpatient units on data from the National Database of Nursing Quality Indicators (NDNQI) with the Practice Environment Scale (PES), specifically on job enjoyment and teamwork, were done utilizing ANOVA. ResultsResults show that nurses in an inpatient unit that implemented Project7 has significantly higher job satisfaction as compared to units that did not implement Project7. ConclusionsThis suggests that this tool provides an effective and accessible mindfulness framework managers and directors can utilize to improve job satisfaction, teamwork, and thereby reduce burnout to create healthier work environments.

Methods and Processes Used to Collect Pressure Injury Risk and Prevention Measures in the National Database of Nursing Quality Indicators® (NDNQI®).

Previous research found that reliability estimates for chart-extracted quality of care data vary. The purpose was to examine methods and processes used to gather data on the National Database of Nursing Quality Indicators (NDNQI) pressure injury (PI) risk and prevention measures to identify factors that may influence their reliability. Study participants (N = 120) from 36 hospitals completed a 35-item online survey. Included were the NDNQI PI Survey Team member with the most experience and/or skill in patient record review from each hospital (n = 36) and 84 other NDNQI PI Survey Team members. In general, participants followed NDNQI PI data collection guidelines. However, deviations were noted such as 60 (50%) participants collected PI data on units where they work, and 92 (76.7%) determined whether moisture management was performed by direct observation of patients rather than chart documentation. Findings provide insight on how to improve the reliability of hospital-acquired PI risk and prevention measures that includes clarification of the data collection guidelines.

16 A Framework for a Successful Pressure Injury Prevention Program in a Regional Burn Center

Burn-injured patients are inherently at-risk for pressure injuries. Little evidence exists regarding pressure ulcer prevention practices for burn centers. Our verified burn center sought to decrease the incidence of hospital-acquired pressure injury (HAPI) by reducing device and positioning related pressure injuries. A key part of our plan includes education for all staff. We conducted the study at a verified regional burn center serving adult and pediatric populations. While on our journey to Magnet designation, we tracked National Database of Nursing Quality Indicators (NDNQI) data quarterly. Preliminary data indicated our rate of HAPI was above the national benchmark. We currently employ interventions such as turning every 2 hours, padding of bony prominences, use of pressure reducing or air circulating beds, proper skin care, nutritional assessment, measures that decrease length of stay, use of the Braden Scale to assess risk, and early mobilization. In addition to, we elevated some of these practices by frequent reposition of catheter securement and other invasive devices to prevent mucosal injury, elimination of supine laying in turning schedule, and improved nutritional management. The risk reduction strategy includes an improved method for securing nasogastric tubes, moisture management of wounds, standardizing heel protection, padding securement ties for endotracheal tubes, restricted use of touch fasteners on all ace bandages, regulating c-collar care, directing splint checks and addition of a stretch bandage training protocol. We collected data from monthly surveys reported to NDNQI for a total of 8 quarters. All HAPIs are reported to NDNQI specifically as the total number of HAPIs, number of patients with a HAPI, and HAPIs identified per patient. Our findings demonstrate a decrease in the overall number of HAPIs occurring in our unit since the introduction of our prevention program (p= 0.037). The number of patients with HAPIs and the number of HAPIs adjusted for unit census also dropped (p= 0.021 and p= 0.040 respectively). In addition to the decrease in the number of overall HAPIs, we have seen historically low incidence of HAPI. The burn center has experienced a dramatic decline in the incidence of hospital-acquired pressure injury due to prevention initiatives and risk reduction strategies. Burn centers should adopt programs to prevent hospital-acquired harm rather than maintain a reactive approach. Involving bedside nursing staff increases effectiveness of programs. Research is ongoing to evaluate the impact of various prevention strategies for hospital-acquired pressure injury specific to the burn population. A coalescence of practices is needed to establish industry standards of care.

Incontinence-Associated Dermatitis and Intertriginous Dermatitis as Nurse-Sensitive Quality Indicators: A Delphi Study.

This purpose of this study was to determine whether consensus exists concerning the need to collect epidemiologic data about 2 forms of moisture-associated skin damage, incontinence-associated dermatitis (IAD) and intertriginous dermatitis (ITD), and whether these data should be part of data routinely collected as part of the National Database of Nursing Quality Indicators (NDNQI). Modified Delphi technique. Questionnaires were sent via e-mail to 50 identified experts, with an initial response of 17. Thirteen clinical experts responded to the second round and 11 responded to a third round. Items on the questionnaires were investigator-developed. Consensus was defined as 80% or more agreement. Three rounds of questionnaires were employed to attempt consensus. Descriptive statistics were performed using mean and standard deviation for continuous data and frequencies and percentages for categorical data. Qualitative data were analyzed question by question by the primary researcher using content analysis. Consensus was achieved indicating that individual facilities should regularly collect data about IAD prevalence or incidence. Consensus was not reached about the need to regularly collect data about ITD prevalence or incidence. Panelists also failed to reach consensus that IAD or ITD prevalence or incidence should be incorporated into the NDNQI indicators. Panelists did not reach consensus that IAD or ITD epidemiologic data should be incorporated on the NDNQI. Additional research is needed, particularly in the area of ITD, before benchmarks can be established regarding these data as nurse-sensitive indicators of quality care.

Prevalence of fall injuries and risk factors for fall among hospitalized children in a specialized childrens hospital in Saudi Arabia.

BACKGROUNDFall injuries among children during hospital stay is a major patient safety issue. Inpatient pediatric falls can lead to numerous negative consequences. In contrast to adults, there is a paucity of information on the prevalence and risk factors associated with children’s falls during hospitalization.OBJECTIVESIdentify the prevalence of fall injuries among hospitalized children and describe the demographic and environmental factors that could predict a higher risk of severe outcomes of fall.DESIGNDescriptive, cross-sectional prevalence study.SETTINGSpecialized children’s hospital.PATIENTS AND METHODSData was obtained through the electronic Safety Reporting System (SRS). All reported fall events during hospitalization in children ≤14 years of age for the period from 1 April 2015 to 30 April 2016 were included. Fall events that occurred in the day care unit and the outpatient clinic were excluded.MAIN OUTCOME MEASURESPrevalence and possible risk factors for fall events.SAMPLE SIZE48.RESULTSThe prevalence of falls among the 4860 admitted children was 9.9 (95% CI=7.5, 13.1) per 1000 patients (48/4860). A majority of the falls were among boys (n=26, 54%), in the age group from 1–5 years old (n=22, 46%), in children at high risk of falling (n=35, 73%), with normal mobility status (n=21, 44%), and with no history of previous falls (n=33, 69%). Severe injuries accounted for 25% of falls (n=12). However, falls among the moderate risk category (n=9, 69%) were more often severe than falls among the high risk category of children (n=12, 34%) (P=.03).CONCLUSIONRisk factor identification is required to prevent falls and their severe outcomes.LIMITATIONSUnderreporting and single-centered study.

Factors Associated With Pediatric Hospital-Acquired Pressure Injuries

The purpose of this study was to identify associations among pediatric patient characteristics (age and gender), hospital characteristics, inpatient unit characteristics (unit type, pressure injury prevention practices, and nurse staffing measures), and hospital-acquired pressure injuries (HAPIs) in a group of pediatric patients and in those determined to be at risk for pressure injury. A descriptive, correlational analysis of data from a large dataset. The sample comprised 39,984 children aged 1 day to 18 years of age from 678 pediatric units in 271 participating hospitals across the United States. Data related to pressure injuries and prevention among pediatric patients from the National Database of Nursing Quality Indicators (NDNQI) were analyzed. All data were collected during the year 2012. Descriptive statistics were used to summarize the study sample. Hierarchical logistic regression analysis was used to analyze patient age and gender, unit type, pressure injury risk, prevention and staffing measures, and hospital characteristics associated with HAPI. The likelihood of a HAPI was more than 9 times higher among patients who were determined to be at risk for pressure injuries (odds ratio [OR]: 9.42, 95% confidence interval [CI]: 7.28-12.17, P < .001) compared to patients deemed not at risk. Hospital-acquired pressure injury was more likely to occur on pediatric critical care units (OR: 2.59, 95% CI: 1.28-5.26, P = .009) and rehabilitation units (OR: 4.05, 95% CI: 1.21-13.55, P = .02). Patients from hospitals that only provided care for children (OR: 2.6, 95% CI: 1.42-4.78, P = .002) were also more likely to be associated with HAPI compared to hospitals that provided care for adults and children. Among the 11,203 pediatric patients deemed at risk for pressure injuries, 95.8% received one or more prevention interventions. There were no prevention interventions associated with a lower occurrence of HAPI. Study findings support pressure injury risk assessment among pediatric patients and elucidates important information regarding pediatric unit and hospital characteristics associated with HAPI.

Aggression Management Education for Acute Care Nurses: What’s the Evidence?

Aggression Management Education for Acute Care Nurses: What’s the Evidence?

Relationship of Wound, Ostomy, and Continence Certified Nurses and Healthcare-Acquired Conditions in Acute Care Hospitals.

The purpose of this study was to describe the (a) number and types of employed WOC certified nurses in acute care hospitals, (b) rates of hospital-acquired pressure injury (HAPI) and catheter-associated urinary tract infection (CAUTI), and (c) effectiveness of WOC certified nurses with respect to lowering HAPI and CAUTI occurrences. Retrospective analysis of data from National Database of Nursing Quality Indicators. The sample comprised 928 National Database of Nursing Quality Indicators (NDNQI) hospitals that participated in the 2012 NDNQI RN Survey (source of specialty certification data) and collected HAPI, CAUTI, and nurse staffing data during the years 2012 to 2013. We analyzed years 2012 to 2013 data from the NDNQI. Descriptive statistics summarized the number and types of employed WOC certified nurses, the rate of HAPI and CAUTI, and HAPI risk assessment and prevention intervention rates. Chi-square analyses were used to compare the characteristics of hospitals that do and do not employ WOC certified nurses. Analysis-of-covariance models were used to test the association between WOC certified nurses and HAPI and CAUTI occurrences. Just more than one-third of the study hospitals (36.6%) employed WOC certified nurses. Certified continence care nurses (CCCNs) were employed in fewest number. Hospitals employing wound care specialty certified nurses (CWOCN, CWCN, and CWON) had lower HAPI rates and better pressure injury risk assessment and prevention practices. Stage 3 and 4 HAPI occurrences among hospitals employing CWOCNs, CWCNs, and CWONs (0.27%) were nearly half the rate of hospitals not employing these nurses (0.51%). There were no significant relationships between nurses with specialty certification in continence care (CWOCN, CCCN) or ostomy care (CWOCN, COCN) and CAUTI rates. CWOCNs, CWCNs, and CWONs are an important factor in achieving better HAPI outcomes in acute care settings. The role of CWOCNs, CCCNs, and COCNs in CAUTI prevention warrants further investigation.

Transforming a unit’s culture to improve clinical outcomes.

243 Background: Leadership identified an unhealthy work environment existed in our Oncology Hematology Special Care Unit (OHSCU). This was evidenced by increased turnover, low National Database of Nursing Quality Indicators (NDNQI), and nurse sensitive quality indicator scores. In the fall of 2014 changes were made to the unit with a goal of creating within the unit a culture of clinical excellence, engagement, professionalism, accountability, and improve staff satisfaction. Methods: Leadership met to define the future state of the unit and develop a vision statement. The Quality Manager met with our Unit based Council (UBC) to review data, discuss shared accountability between leadership, and staff and the impact each individual can have on culture and clinical outcomes. Organizational Development facilitated staff focus groups without unit leadership present. Questions asked included: What behaviors would you like to see more or less of? What is your role in supporting change? Focus group results were shared with staff, and guided the development of an OHSCU Guidelines for Professional Behavior. Leadership met with lead staff nurses to discuss their willingness to embrace cultural change and unit vision. Leads completed the Crucial Conversations Class to help them provide immediate, direct, and specific feedback to staff. Leadership met with each staff member to review the guidelines and discuss their commitment to support change. The unit vision was incorporated in all written and verbal communication with staff. Changes in leadership behaviors included increased leadership presence on nights and weekends, daily rounding with patients and staff, and increased amount of positive feedback. Results: Fall injury scores were decreased from 1.55 to 0.25 per 1,000 patient days, target of 0.72. OHSCU has had no catheter associated urinary tract infections (CAUTI) or pressure ulcers in the last 17 months. Patient satisfaction scores have consistently improved over the last nine months. Response of hospital staff scores have increased from 53.6 to 70.9 and currently 90% of patients rate the hospital as a 9 or 10. Conclusions: Through focused efforts and thoughtful actions, it is possible to change the culture of a unit and have a positive impact on quality metrics.

A Study of Chief Nurse Executives Indicates Low Prioritization of Evidence-Based Practice and Shortcomings in Hospital Performance Metrics Across the United States

Although findings from studies indicate that evidence-based practice (EBP) results in high-quality care, improved patient outcomes, and lower costs, it is not consistently implemented by healthcare systems across the United States and globe. The purpose of this study was to describe: (a) the EBP beliefs and level of EBP implementation by chief nurse executives (CNEs), (b) CNEs' perception of their hospitals' EBP organizational culture, (c) CNEs' top priorities, (d) amount of budget invested in EBP, and (e) hospital performance metrics. A descriptive survey was conducted. Two-hundred-seventy-six CNEs across the United States participated in the survey. Valid and reliable measures included the EBP Beliefs scale, the EBP Implementation scale, and the Organizational Culture and Readiness scale for EBP. The Centers for Medicare and Medicaid Services Core Measures and the National Database of Nursing Quality Indicators (NDNQI) were also collected. Data from this survey revealed that implementation of EBP in the practices of CNEs and their hospitals is relatively low. More than one-third of the hospitals are not meeting NDNQI performance metrics and almost one-third of the hospitals are above national core measures benchmarks, such as falls and pressure ulcers. Although CNEs believe that EBP results in high-quality care, it is ranked as a low priority with little budget allocation. These findings provide a plausible explanation for shortcomings in key hospital performance metrics. To achieve higher healthcare quality and safety along with decreased costs, CNEs and hospital administrators need to invest in providing resources and an evidence-based culture so that clinicians can routinely implement EBP as the foundation of care.

Effect of Medicare's nonpayment for Hospital-Acquired Conditions: lessons for future policy.

In 2008, Medicare implemented the Hospital-Acquired Conditions (HACs) Initiative, a policy denying incremental payment for 8 complications of hospital care, also known as never events. The regulation's effect on these events has not been well studied. To measure the association between Medicare's nonpayment policy and 4 outcomes addressed by the HACs Initiative: central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), hospital-acquired pressure ulcers (HAPUs), and injurious inpatient falls. Quasi-experimental study of adult nursing units from 1381 US hospitals participating in the National Database of Nursing Quality Indicators (NDNQI), a program of the American Nurses Association. The NDNQI data were combined with American Hospital Association, Medicare Cost Report, and local market data to examine adjusted outcomes. Multilevel models were used to evaluate the effect of Medicare's nonpayment policy on never events. United States hospitals providing treatment for Medicare patients were subject to the new payment policy beginning in October 2008. Changes in unit-level rates of HAPUs, injurious falls, CLABSIs, and CAUTIs after initiation of the policy. Medicare's nonpayment policy was associated with an 11% reduction in the rate of change in CLABSIs (incidence rate ratio [IRR], 0.89; 95% CI, 0.83-0.95) and a 10% reduction in the rate of change in CAUTIs (IRR, 0.90; 95% CI, 0.85-0.95), but was not associated with a significant change in injurious falls (IRR, 0.99; 95% CI, 0.99-1.00) or HAPUs (odds ratio, 0.98; 95% CI, 0.96-1.01). Consideration of unit-, hospital-, and market-level factors did not significantly alter our findings. The HACs Initiative was associated with improvements in CLABSI and CAUTI trends, conditions for which there is strong evidence that better hospital processes yield better outcomes. However, the HACs Initiative was not associated with improvements in HAPU or injurious fall trends, conditions for which there is less evidence that changing hospital processes leads to significantly better outcomes.

Restraint Reduction, Restraint Elimination, and Best Practice: Role of the Clinical Nurse Specialist in Patient Safety.

Baseline restraint prevalence for surgical step-down unit was 5.08%, and for surgical intensive care unit, it was 25.93%, greater than the National Database of Nursing Quality Indicators (NDNQI) mean. Project goal was sustained restraint reduction below the NDNQI mean and maintaining patient safety. Soft wrist restraints are utilized for falls reduction and preventing device removal but are not universally effective and may put patients at risk of injury. Decreasing use of restrictive devices enhances patient safety and decreases risk of injury. Phase 1 consisted of advanced practice nurse-facilitated restraint rounds on each restrained patient including multidisciplinary assessment and critical thinking with bedside clinicians including reevaluation for treatable causes of agitation and restraint indications. Phase 2 evaluated less restrictive mitts, padded belts, and elbow splint devices. Following a 4-month trial, phase 3 expanded the restraint initiative including critical care requiring education and collaboration among advanced practice nurses, physician team members, and nurse champions. Phase 1 decreased surgical step-down unit restraint prevalence from 5.08% to 3.57%. Phase 2 decreased restraint prevalence from 3.57% to 1.67%, less than the NDNQI mean. Phase 3 expansion in surgical intensive care units resulted in wrist restraint prevalence from 18.19% to 7.12% within the first year, maintained less than the NDNQI benchmarks while preserving patient safety. The initiative produced sustained reduction in acute/critical care well below the NDNQI mean without corresponding increase in patient medical device removal. By managing causes of agitation, need for restraints is decreased, protecting patients from injury and increasing patient satisfaction. Follow-up research may explore patient experiences with and without restrictive device use.

Three structures for a healthy work environment.

Three structures for a healthy work environment.

Contemporary issues in nursing: patient safety, decision-making and social support in challenging economic times

Contemporary issues in nursing: patient safety, decision-making and social support in challenging economic times