NURS 8302 Discussion Quality Indicators

NURS 8302 Discussion Quality Indicators

Quality of care is measured by the degree in which services rendered achieve desired health outcomes (Quality of Care, 2021).  Nursing has been at the forefront of health care quality and patient safety for many years.  Nurse-sensitive indicators (NSI) are measurable patient related outcomes that are directly affected by nursing care (Burston, Chaboyer, & Gillespie, 2014).  When considering which NSI’s to measure to be effective the DNP-prepared nurse must carefully select NSI’s relative to the clinical context, identify how the NSI data will be reported and used, and consider how the NSI will be embedded into clinical practice (Burston et al., 2014).  Two specific NSI’s are patient falls and pressure ulcer prevention (Montalvo, 2007).

According to Burston, et al. (2014), studies show patient outcomes are affected by both nursing structural and process variables.  Structural variable include nurse-to-patient ratios, nursing hours per patient day, nursing education level, and nursing experience (Burston, et al., 2014).  Process variables include specific nursing interventions provided and process care delivery (Burston, et al., 2014).  Burston, et al., (2014) cautioned that data collection and analyzation approaches can cause inconsistencies.  For example, analysis at the hospital level does not allow for shift-to-shift variations that would be better identified at the unit level (Burston, et al., 2014).  The DNP-prepared nurse must analyze data and consider both structural and process variables to develop process changes at the unit level and organization level to improve quality.

Pressure injuries (PIs) are defined as an insult to the skin and underlying soft tissue usually over a bony prominence that may cause and open wound and cause pain (Hoedl, Eglseer, & Lohrmann, 2019).  Hospital acquired PI prevalence rates in the United States range from 1.4% to as high as 49% (Hoedl, et al., 2019). One quality model utilized to evaluate PI prevention is the Donabedian Model of Healthcare Organizations. It is composed of three quality indicators: structure, process, and outcomes. According to Hoedl, et al. (2019), a systematic mapping review using the Donabedian Model identified 146 quality indicators for PI prevention and care, noting 17.6% were structural-level indicators, 48.6% process-level indicators, and 33.6% were outcome-level indicators.  The researchers utilized the Nursing Quality Measurement 2.0 Survey to further identify specific structure, process, and outcome indicators that could be addressed in the quality improvement project to improve PI injury prevention and care (Hoedl, et al., 2019).  These measures could be utilized by the DNP-prepared nurse to address local quality improvement initiatives for PI prevention and care.

Patient falls are a common cause of patient injury during hospitalizations. Morgan, Flynn, Robertson, New, Forde-Johnston, & McCulloch (2017), discussed a staff-led quality improvement intervention which consisted of engagement and communication activities, teamwork and systems improvement training, support and coaching and iterative Plan-Do-Check-Act cycles in an effort to decrease falls.  Intentional rounding was implemented and evaluated using process (hourly rounding by staff) and outcome (patient falls).  There was 50% reduction in falls noted on the units and researchers concluded that integrating teamwork training and staff-led systems redesign resulted in effective change and improvement (Morgan, et al., 2017).  The DNP-prepared nurse is uniquely aligned as a nurse leader and educator to foster staff-led quality improvement initiatives in the clinical setting.

References

Burston, S., Chaboyer, W., & Gillespie, B. (2014). Nurse sensitive indicators suitable to reflect nursing care quality: a review and discussion of issues. Journal of Clinical Nursing, 23(13-14), 1785–1795. https://doi.org/ezp.waldenulibrary.org/10.1111/jocn.12337

Hoedl, M., Eglseer, D., & Lohrmann, C. (2019). Structure, process, and quality indicators for pressure injury prevention and care in Austrian hospitals: A quality improvement project. Journal of Wound, Ostomy, and Continence Nursing, 46(6), 479–484. https://doi.org/10.1097/WON.0000000000000586