National Database Of Nursing Quality Indicators Research Articles

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

Recent Trends in Hospital Nurse Staffing in the United States

The aim of this study was to examine recent trends in nurse staffing levels and nursing staff composition. Recent trends in hospital nurse staffing have not been well described, and the effects of the 2007 to 2012 recession and 2008 Centers for Medicare & Medicaid Services rule change are unknown. A longitudinal study of unit-level data from the National Database of Nursing Quality Indicators (NDNQI) and hospital-level data from the American Hospital Association (AHA) annual survey was conducted. From 2004 to 2011, total nursing hours per patient day on general care units in NDNQI hospitals increased by 11.5%, and registered nurse (RN) hours per patient day by 22.9%. Trends were similar in AHA hospitals. Hospitals have steadily increased total nurse staffing levels by increasing RN staffing. Use of temporary RNs in hospitals plummeted from mid-2008. There were no apparent changes in staffing levels due to the recession and/or CMS rule change.

An Examination of Nurse Caring and Hospital Acquired Pressure Ulcers

The Nyberg Caring Assessment Scale (NCA) and the National Database of Nursing Quality Indicators (NDNQI) were used to measure nurse caring and hospital acquired pressure ulcers. This is an exploratory, descriptive, single-site study conducted in a large academic, trauma center, twice Magnet® designated in the southeast United States. Caring theory, the mechanics of pressure ulcer development, and wound prevalence between medical-surgical and critical care units was explored. No statistically significant differences in caring scores were identified between nurse groups, although pressure ulcer prevalence differed. Existing high standards of care and the tool itself are noted as factors influencing the results.

Pain care quality and RN staffing characteristics among United States adult medical, surgical units

Previous research has shown that over 50% of adult medical-surgical patients were in pain during the past 24 hours. Nurses are the front-line caregivers in pain management yet there is not a national consensus measure of nurse-sensitive pain quality indicators. Hospitals participating in the National Database of Nursing Quality Indicators (NDNQI), a national nursing database, were recruited to participate in this research study. Pain care quality indicators were assessed in 326 U.S hospitals in 1611 nursing units; including 468 adult medical, surgical and medical-surgical combined units.

Falls Among Adult Patients Hospitalized in the United States

The purpose of this study was to provide normative data on fall prevalence in U.S. hospitals by unit type and to determine the 27-month secular trend in falls before the implementation of the Centers for Medicare and Medicaid Service (CMS) rule, which does not reimburse hospitals for care related to injury resulting from hospital falls. We used data from the National Database of Nursing Quality Indicators (NDNQI) collected between July 1, 2006, and September 30, 2008, to estimate prevalence and secular trends of falls occurring in adult medical, medical-surgical, and surgical nursing units. More than 88 million patient days (pd) of observation were contributed from 6100 medical, surgical, and medical-surgical nursing units in 1263 hospitals across the United States. A total of 315,817 falls occurred (rate = 3.56 falls/1000 pd) during the study period, of which, 82,332 (26.1%) resulted in an injury (rate = 0.93/1000 pd). Both total fall and injurious fall rates were highest in medical units (fall rate = 4.03/1000 pd; injurious fall rate = 1.08/1000 pd) and lowest in surgery units (fall rate = 2.76/1000 pd; injurious fall rate = 0.67/1000 pd). Falls (0.4% decrease per quarter, P < 0.0001) and injurious falls (1% decrease per quarter, P < 0.0001) both decreased over the 27-month study. In this large sample, fall and injurious fall prevalence varied by nursing unit type in U.S. hospitals. Over the 27-month study, there was a small, but statistically significant, decrease in falls (P < 0.0001) and injurious falls (P < 0.0001).

Moving healthcare quality forward with nursing-sensitive value-based purchasing.

Purpose: To underscore the need for health system reform and emphasize nursing measures as a key component in our healthcare reimbursement system.Design and Methods: Nursing-sensitive value-based purchasing (NSVBP) has been proposed as an initiative that would help to promote optimal staffing and practice environment through financial rewards and transparency of structure, process, and patient outcome measures. This article reviews the medical, governmental, institutional, and lay literature regarding the necessity for, method of implementation of, and potential impact of NSVBP.Findings: Research has shown that adverse events and mortality are highly dependent on nurse staffing levels and skill mix. The National Database of Nursing Quality Indicators (NDNQI), along with other well-developed indicators, can be used as nursing-sensitive measurements for value-based purchasing initiatives. Nursing-sensitive measures are an important component of value-based purchasing.Conclusions: Value-based purchasing is in its infancy. Devising an effective system that recognizes and incorporates nursing measures will facilitate the success of this initiative. NSVBP needs to be designed and incentivized to decrease adverse events, hospital stays, and readmission rates, thereby decreasing societal healthcare costs.Clinical Relevance: NSVBP has the potential for improving the quality of nursing care by financially motivating hospitals to have an optimal nurse practice environment capable of producing optimal patient outcomes by aligning cost effectiveness for hospitals to that of the patient and society.

Staff Autonomy and Decision Making in Large Stem Cell Transplant Clinic

Nurses in the Stem Cell Transplantation Clinic (SCT) and the Apheresis Center of a large cancer center participated in the National Database of Nursing Quality Indicators (NDNQI) RN satisfaction survey. Although scores for Decision-Making, defined as the “opportunity to participate in administrative decision-making” and Autonomy, defined as “freedom in the workplace to make important decisions” were comparable to other institutions, nurse leaders were surprised they were not higher. Because nurses in the clinic work very independently and participate in developing standard operating procedures (SOPs) and meet regularly with the multidisciplinary team, the results were unexpected. In an effort to gain greater understanding of nurses' perceptions and opinions, quarterly autonomy rounds were established. The intent of the rounds with leaders was to provide a platform to discuss practice and operational issues that were satisfiers and dissatisfies. Bringing leaders of both areas and staff together was also a venue for resolving issues, refining processes and surfacing other concerns. Through autonomy rounds, issues such as repeated double and triple booking of appointments, resulting in long waits for the patients, and nurses feeling “caught in the middle”, began to surface and could be addressed. The outcome of this ongoing process has been positive. The Chairman and Medical Directors of both units have asked the nurses to participate with multidisciplinary teams to develop best practices. Nurses will also be involved in tracking variances of SOPs, trending them, providing that feedback to the team, and participating in necessary revisions. Leaders are looking forward to the next NDNQI Nurse Satisfaction survey results as another measure of expected success of the process.

A systematic review of the effectiveness of delegation interventions by the registered nurse to the unlicensed assistive personnel and their impact on quality of care, patient satisfaction, and RN staff satisfaction.

Review questions/objectives The objective of this systematic review is to synthesise the best available evidence on the impact of the effectiveness of delegation interventions by the registered nurse (RN) to the unlicensed assistive personnel (UAP) and their impact on quality of care, patient satisfaction, and RN staff satisfaction. Inclusion criteria Types of participants The review will consider studies that include RNs and unlicensed assistive personnel in any patient care setting where delegation by the RN to the UAP occurs. For the purposes of this systematic review we will use the following definitions: Registered nurse: A person that has graduated from a nursing program and has been licensed to practice. Unlicensed assistive personnel: Persons that are in a position to assist the RN under the registered nurse’s direct supervision. Activities are generally restricted to patient care activities delegated to them by the RN based on the nursing process. Types of interventions This review will consider studies that evaluate the effectiveness of delegation interventions by the RN to the UAP and their impact on quality of care, patient satisfaction, and RN staff satisfaction. For the purposes of this systematic review we will use the following definition: RN-UAP delegation: “Entrusting the performance of a selected nursing task to an individual who is qualified, competent, and able to perform such tasks. The nurse retains the accountability for the total nursing care of the individual”. Comparator The comparator is to that of usual nursing cares delivery. Types of outcomes The outcomes to be examined are quality of care, patient satisfaction, and RN staff satisfaction measured by validated and reliable tools. Validated and reliable measurement tools are considered measurement tools that have been previously tested and found to have acceptable psychometric properties. TRUNCATED AT 350 WORDS

Reliability Testing of the National Database of Nursing Quality Indicators Pressure Ulcer Indicator

A criterion-referenced Web-based test was designed and administered to 256 individuals at 48 randomly sampled National Database of Nursing Quality Indicators (NDNQI) member hospitals to determine the reliability of the NDNQI pressure ulcer indicator. Overall κ values for pressure ulcer identification, staging, and sourcing indicate moderate to near perfect reliability. Findings suggest that nurses can accurately differentiate pressure ulcers from other ulcerous wounds in Web-based photographs, reliably stage pressure ulcers, and reliably identify community versus nosocomial pressure ulcers.

Innovations in Communication: Team Building on a Labor and Delivery Unit Increases RN Satisfaction

Clear communication among the care providers in the labor and delivery setting has always been crucial for providing a safe environment for the patient. Developing a team training program to enhance patient safety led to an epiphany: team training innovations increased nurse satisfaction as evidenced by annual National Database of Nursing Quality Indicators (NDNQI) Survey Scores.

Midnight census revisited: Reliability of patient day measurements in US hospital units

Background Patient days are widely used in nurse staffing research and for nursing quality measurement. Nursing hours per patient day (NHPPD) and fall rates incorporate patient days in the denominator and are endorsed by the US National Quality Forum (NQF) as nursing sensitive consensus measures. Measurement error introduced by patient days would affect the accuracy of these nursing quality indicators. Objectives The aim of this study was to assess the reliability of five patient day reporting methods accepted by the National Database of Nursing Quality Indicators (NDNQI). The specific aims were (1) to investigate the agreement of five patient day measurements with a defined quasi-gold standard, (2) to explore method bias by investigating the association of potential confounding variables with the differences between the routine measurements and the quasi-gold standard, and (3) to extrapolate the potential effect of bias of the patient day methods on nursing quality indicators. Design A multiple census study with a national convenience sample of hospital units in the US was conducted. Setting 260 out of 282 units (92%) from 54 hospitals sent bi-hourly patient census data for seven randomly selected days in September 2008. Methods The multiple census data comprised the quasi-gold standard and was compared with data routinely submitted to the database. Intraclass correlations were calculated for an agreement analysis. A Bayesian regression analysis was conducted to explore the impact of different data collection methods and the degree of short stay patients. Results Overall agreement between routine data and the quasi-gold standard was excellent (ICC [95% CI]: 0.967 [0.958–0.974]). A Bayesian regression analysis identified that two methods underestimated patient days and an interaction between the degrees of short stay patients and one of the data collection methods also affected patient day measurement by up to 7.6%.

Pressure ulcer prevention as an indicator of nursing care quality: A comment on Jull and Griffiths (2010)

In their editorial Jull and Griffiths (2010) discuss pressure ulcer prevention as an indicator of nursing care quality. The cautionary note includes remarks on pressure ulcer risk assessment tools, pressure ulcer prevention strategies and the application of pressure ulcer rates as a quality indicator. The authorsmake a number of important remarks. However we would like to add our view on these issues which is based on our experience in developing, collecting, reporting and conducting research with nursing quality data – including pressure ulcers – for the National Database of Nursing Quality Indicators (NDNQI) in the US.

A Multilevel Confirmatory Factor Analysis of the Practice Environment Scale

Practice Environment Scale (PES) data are collected from RNs in nursing units in hospitals that are members of the National Database of Nursing Quality Indicators (NDNQI). Patient and RN information are collected to aid in quality improvement and research at the nursing unit level. The data were collected from the individual RN, but items are worded so that analyses can be conducted at the individual, unit, or hospital level. There is a need to examine the validity of the PES at both the individual and the unit level. To describe multilevel confirmatory factor analysis via a case study for investigating the validity of the PES, a measure of the nursing practice environment. The PES was administered to 72,889 RNs from 4,783 nursing units (16 unit types; e.g., critical care and obstetric) in 2007. The PES has 31 items in five different domains. A multilevel confirmatory factor analytic model was fit with a structure on the basis of the five domains. From this model, an estimate was sought between unit loadings and within unit loadings to investigate factorial, convergent, and discriminant validity at both the unit and the RN levels. To investigate criterion-related validity, the five PES domains were correlated with the seven job enjoyment items adapted from the National Database of Nursing Quality Indicators at the unit and RN levels (also using a multilevel model). The multilevel factor analysis provides evidence of factorial, convergent, discriminant, and criterion-related validity at both the unit and the RN levels. The PES is a valid instrument for use in quality improvement and research both at the unit and individual RN levels.

Measuring And Addressing Distress In The Stem Cell Patient

Patients undergoing Stem Cell Transplant and Cellular Therapy (SCTCT) may experience prolonged length of stay and the potential for increased distress. While a needs assessment is completed on admission, there is no formal tool implemented for ongoing measurement of patients' concerns and distress. Data from the National Database of Nursing Quality Indicators (NDNQI) survey completed by patients upon discharge revealed a gap in patient satisfaction with nursing assessment of patient distress. In response to this data a literature search was performed by members of a nursing-based Patient Satisfaction Committee (PSC) to determine what interventions would be appropriate for assessing distress in the transplant inpatient setting.

Lessons Learned From a Lateral Violence and Team-Building Intervention

Lateral violence is likely to exist in settings characterized by poor leadership and lack of clearly articulated roles, expectations, and processes that guide behavior. The purposes of this process improvement project were to (1) identify and improve baseline levels of nurse satisfaction and group cohesion through planned unit-based interventions, (2) determine the effect of a team-building intervention on factors that impact cohesive team functioning, and (3) determine the effect of lateral violence training and communication style differences in improving team cohesion. The sample consisted of registered nurses (RNs) from 4 diverse patient care areas, chosen on the basis of low scores on the National Database of Nursing Quality Indicators (NDNQI) RN-RN interaction subscale. A quasi-experimental pre-post intervention design without a control group was employed. The intervention focused on lateral violence and team building. A qualitative component focused on the impact of the intervention on overall group dynamics and processes. RN scores on the Group Cohesion Scale (P = .037) and the RN-RN interaction scores improved postintervention. Group sessions focused on building trust, identifying and clarifying roles, engaging staff in decision making, role-modeling positive interactions, and holding each other accountable. Key to a cohesive environment is an effective nurse manager able to drive and sustain change.

Evaluation of the National Database of Nursing Quality Indicators (NDNQI) Training Program on Pressure Ulcers

The National Database of Nursing Quality Indicators (NDNQI) Pressure Ulcer Training Program was developed to improve nursing accuracy and reliability in identifying and staging pressure ulcers and differentiating hospital- and unit-acquired from community-acquired pressure ulcers. Of 5,200 individuals who completed the training program within 5 months of release, 937 provided written evaluation comments. Four major themes emerged from content analysis of the evaluation remarks: pressure ulcer and other wound pictures; accuracy and clarity of content; program design and technology; and the educational/informational experience. Reviewers most frequently commented on their positive learning experience. Program components that enhanced the educational experience included the array of pressure ulcer pictures at each stage and pictures of other wounds. Clarity of content, program design, and technological problems were barriers to reviewer satisfaction. Findings suggest the NDNQI Pressure Ulcer Training Program was effective for educating staff nurses on pressure ulcer identification and staging.

Using NDNQI data to manage CAUTI

ospital-acquired catheter-associated uri-nary tract infections (CAUTIs) are clas-sified as a never event by the Centersfor Medicare and Medicaid Services(CMS) and are no longer reimbursed.Never events can cause serious injuryor death to patients and result in increasedcosts from additional days in the hospital,nursing care, medical treatments, and devices.Therefore, the new rule puts forth an incentivefor hospitals to eliminate or reduce neverevents in order to avoid costs for which therewill be no reimbursement. To prepare for thisresponsibility, nurse managers must knowmore about the prevalence of never events,improve nursing assessment tools and preven-tion strategies, and identify best practices foreffective and efficient treatment of theseevents. By implementing effective practices ina sustainable manner and monitoring theimpact of those interventions, nurse managerscan reduce avoidable, nonreimbursed costs totheir facilities.The National Database of Nursing QualityIndicators (NDNQI) began collecting data onCAUTI rates for ICUs in the fourth quarter of2007. Using these data, nurse managers cancompare the CAUTI rates for their units withpeer units in similar facilities and examinetrends in their rates over time.Defining CAUTICAUTIs may be the least regarded never eventbecause they’re viewed as a minor infectioncausing less morbidity and mortality than cen-tral line-associated bloodstream infections, forexample.

Evaluation of the National Database of Nursing Quality Indicators (NDNQI) Training Program on Pressure Ulcers

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Professional Practice-Implementing a Pressure Ulcer Prevention Program

The purpose of this research study was to investigate if the use of a static air mattress overlay and static air seat cushion on all patients admitted to our surgical hospital unit would decrease the incidence of hospital-acquired pressure ulcers. We used cross-sectional data collection using the National Database of Nursing Quality Indicators (NDNQI). The target population was inpatients located on the surgical unit of our hospital and excluded any patient that was not on a static air mattress overlay during their entire inpatient hospital stay. The study compared a one-day snapshot survey of patients with standard ulcer prevention strategies before usage of static air mattress and seat cushion and a one-day snapshot survey after usage of a static air mattress overlay and static air seat cushion, education for the patient, families and nursing staff. We discovered that the percentage of our surgical patients with hospital-acquired pressure ulcers (HPU) for the quarter prior to the research study was 18.18%. The percentage of our surgical patients during the research study was 4.76%. The patients that developed a HPU during our study had been previously excluded from the research study because they were not on a mattress overlay during their entire inpatient stay. We concluded that the use of a static air mattress overlay and static air seat cushion, when used on all patients admitted to our surgical unit along with education for the patient, families and staff resulted in positive patient outcomes as demonstrated by the significant reduction in hospital-acquired pressure ulcers.

Inter‐rater reliability of pressure ulcer staging: ordinal probit Bayesian hierarchical model that allows for uncertain rater response

This article describes a method for estimating the inter-rater reliability of pressure ulcer (PU) staging (stages I-IV) from raters in National Database of Nursing Quality Indicators (NDNQI) participating hospitals. The method models ordinal spanning data utilizing an ordinal probit Bayesian hierarchical model (BHM) across several hospitals in which raters monitor patient's PUs. An ulcer that cannot be accurately assessed because the base of the wound cannot be seen is defined as unstageable. Our novel approach allows for an unstageable PU rating to be included in the analysis. We compare the ordinal probit BHM to an approximate random-effects (standard approach in the literature) model that assumes that the raw ordinal data are continuous.