Achieving Sustained Improvement in Nursing Quality · 3 Brandon Crosser, M.A. NDNQI Reporting...

NYSPFP Presentation September 24, 2012

Achieving Sustained Improvement in Nursing Quality

2

Mary Therriault Senior Director Quality and Research Initiatives at Healthcare Association of New York State

Jack Jordan CMS, Deputy Director Partnership for Patients

Kathy Ciccone Co-Project Director New York State Partnership for Patients

Lorraine Ryan Co-Project Director New York State Partnership for Patients

Acknowledgments

3

Brandon Crosser, M.A. NDNQI Reporting Manager

Nancy Dunton, PhD, FAAN NDNQI Director Research Professor, University of Kansas School of Nursing http://nursing.kumc.edu/faculty/Bios Dunton.htm

Today’s Speakers

4

A program of the American Nurses Association Preeminent global nursing quality measurement program Largest database of nursing quality indicators http://www.measurenursingquality.org/NYSPFP

About NDNQI

5

Unit-Level Performance Reports Indicators align with Nursing Structure-Process-Outcome

measures Comparison data for hospitals & units like yours

Top-Tier User Support Quarterly webinars and newsletters Tutorials

ANA’s National Quality Conference February 6-8, 2013 – Atlanta, GA

NDNQI Products & Services

6

Data on 5 of 10 Outcome PfP Measures 1. Catheter-associated urinary tract infections*

2. Central line-associated blood stream infections*

3. Injuries from falls (and immobility)*

4. Hospital-acquired pressure ulcers

5. Ventilator-associated pneumonia* * Endorsed by

NDNQI Supports Partnership for Patient Goals

7

Using Reports for Quality Improvement

1. Understand Structure & Process Measures

2. Interpret Reports & Statistics

3. Develop Your QI Plan

Learning Objectives

Understanding Structure &

Process Measures

9

Risk assessment

Prevention protocol in place

Process Nurse staffing levels

% RN hours

Education

Certification

Structure

Structure & Process Measures

10

Critical care Step down Medical & surgical Rehabilitation Pediatric & NICU Psychiatric

Unit Types

Size Teaching status Magnet status State Metro/Rural

Hospital Characteristics

NDNQI Comparison Groups

Interpreting Reports and Statistics

12

Formulate your questions

Understand the tables

Review statistics

Using NDNQI Reports

13

NDNQI Report / Unassisted Falls

14

Mean & standard deviation

Median & percentiles

Rates—percentages & ratios

Statistics in Reports

15

Mean or average = sum of all “observations” divided by the number of events Example: (1 + 1 + 1 + 3 + 4) ÷ 5 = 10 ÷ 5 = 2

Standard Deviation or average distance of observations from the mean (dispersion)

Confidence Intervals Mean ± 1.96 standard deviations

Mean & Standard Deviation

16

Median is middle observation (50% percentile) 1 1 1 3 4

Percentiles:

Order all observations from low to high and count the number of observations

Divide the observations into groups (e.g., top 10%, bottom 25%)

Median & Percentiles

17

Median for Skewed Distributions

Mean for Normal Distributions

When to Use Mean or Media

18

# Events/Standardized Population Fall Rate # Falls*1000/ Patient Days 7*1,000/500=14

Ratios

(# Events/# Observations)*100 Pressure Ulcer Rate (# Ulcers/# Patients)*100 (25/100) = .25 .25*100 = 25%

Percentages

Rates

Developing Your QI Plan

20

1. How does our unit compare to other, similar units?

2. Are we getting better or worse?

3. What improvement goal should we set? Be in the best 25% of peer units?

Should there be zero tolerance for the outcome?

QI Questions

21

NDNQI Report / Total Falls

22

Gain a better understanding of each problem and its causes Examine related nursing workforce measures

Examine related process measures

Drill Down

23

Total Falls

Prior Risk Assessment

83.9%

At Risk 79.1%

Protocol in Place 91.7%

No Protocol in Place 8.3%

Not at Risk 20.9%

No Prior Risk Assessment

16.1%

Look at all Of those, what x% Of those at risk, what patients who fell were assessed at x% had a prevention

fall risk protocol in place at the time of the fall

Could the Fall Prevention Process Be Improved?

Rush-Copley Medical Center

25

ID Problem in NDNQI Reports Inconsistent performance Periodic reductions attributed to chance

Set Goals To be in top 25% Reduce σ2 in risk assessment & intervention

Situation / Problem

26

Rapid-cycle PDSA Involve top leadership Engage staff – “No Falls Will Happen” Evidence based practice Staff accountability within “Just Culture”

QI Plan

27

No Falls with Major Injury in 616 Days Continue to sustain improvements, monitor and maintain

Result

28

Comparison data <100 beds & Critical Access Hospitals

Mixed acuity unit types

Staffing data for Emergency, PeriNatal, & PeriOp units in 2013

No special IT requirements

Benefits of NDNQI Participation for Small & Rural Hospitals

29

243 units in 51 hospitals located in rural areas

1180 units in 168 hospitals located in cities of between 10,000 and 50,000 people

Reports for hospitals <100 beds based on 2017 units in 482 hospitals

52 Critical Access Hospitals with 142 units

Comparison Data for Small Hospitals

NDNQI Enhancements Coming in 2013

31

New Dashboard Reporting System Intuitive Navigation and Interactivity

32

More Efficient and Visually Pleasing Information Display

33

Visit this site created for NYSPFP Watch short videos with nurses sharing how their hospitals are using NDNQI Download a Fall Prevention Case Study based on NDNQI data

Learn More http://www.measurenursingquality.org/NYSPFP

34

To learn more about how NDNQI can support your efforts to improve nursing quality at your facility, contact Michael Grove at ANA:

301-628-5042 Michael.Grove@ana.org

or visit http://www.measurenursingquality.org/NYSPFP

For More Information