Embed Size (px)
Citation preview
Nurses in Imaging Saturday 6 June 2009
Professor Dame June Clark
Professor Emeritus
Swansea University Wales UKjclarkswanseaacuk
Nursing Metrics
What Why and How
What are ldquonursing metricsrdquo
You wonrsquot find the word ldquometricsrdquo defined as a noun in the Concise Oxford Dictionary or Collins English Dictionary
If you enter ldquodefinition of metricsrdquo into Google you will find
Metrics the study of poetic meter and the art of versification
Metrics is a property of a route in computer networking consisting of any value used by routing algorithms to determine whether one route should perform better than another (the route with the lowest metric is the preferred route)
Metric is a Canadian New Waveindie rock band Originally formed in 1998 in New York City they are currently based in Toronto Ontario
Google contdhellip
Quantitative measures of performance or production used to indicate progress or achievement against strategic goals
metric - A standard for measurement
metric - A measure for something a means of deriving a quantitative measurement or approximation for otherwise qualitative phenomena
A new word for an old chestnut measuring the quality of nursing care
But this timeStill part of performance managementStill a top-down management initiativeFocus on outcome as opposed to structure
or processIncreased emphasis on patient perceptionsThree dimensions Safety Effectiveness
Compassion
Enter Darzihellip
ldquoHigh quality care for all NHS Next Stage Review final reportrdquo hellip
ldquoThe Next Stage Review makes a commitment to develop an indicative set of metrics for nursing that comprises of indicators of quality reflecting the issues of safety effectiveness and compassionhellip
Griffiths P Jones S Maben J Murrells T (2008) State of the art metrics for nursing a rapid appraisal London National Nursing Research Unit Kings College London
ldquoThe group was tasked with finding measures of ldquonurse-delivered outcomes and patient experiencerdquo We take this to mean measures that directly reflect nursingrsquos end result in terms of impact upon patientsrdquo
State of the Art Metrics for Nursing p1
ldquoThis paper explores potential nursing-sensitive indicators from published literature and indicator sets currently in use The requirements of a good set of indicators are explored and evidence for indicatorsrsquo validity is considered through an examination of evidence linking nursing contributions and patient outcomes The conclusion assesses the current state of the art in nursing-sensitive indicatorsrdquo
Indicators most commonly currently used elsewhere
Pressure ulcersldquoFailure to rescuerdquoStaffing levels (nurseshours per patient)FallsHospital Associated Infections (pneumonia)Staff satisfaction and wellbeingHospital Associated Infections (UTIs)Staffingskill mixMedication administration errors
Front runners in the indicator stakes Safety Effectiveness Compassion
Safety Failure to rescue
Healthcare associated pneumonia
Healthcare associated infection
Pressure ulcers
Falls
Effectiveness Staffing levels and skill mix
Staff satisfaction
Staff perception of the practice environment
CompassionExperience of care (patient reported)
Communication (patient reported)
State of the Art Metrics for Nursing Box 5 p19
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Search Results (nursing) Quality stroke care (outcome reduction in stroke
related mortality and disability) Percentage of women who have seen a midwife or
an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
Indicators proposed by Department of Health
Issues for us
Q1 How will these indicators demonstrate the contribution or quality of nursing care
Q2 How will we get the data
14
ldquoAt present individual health providers and institutionshelliplack the basic information of knowing the quality of care that they provided in daily practice Such data are not collected and there is thus no feedback in a systematic way to the individual physicians or nurseshelliprdquo
WHO 1997
Q1How will these indicators demonstrate the contribution or
quality of nursing care
Q2 How will we get the data
Specially collected data eg a form to be filled in for every fall or pressure ulcer
Secondary use of existing data Audit (manual extraction of data from
patient records) By data mining electronic patient
records
Nursing Core Standard Respect and dignityStandard Every patient has their privacy and dignity respected at all times
Element Environment Source Yes No Instruction
Patient privacy is maintained by the use of curtains and appropriate clothing
Ask patientObserve
Ask 6 patients All 6 must report compliance
Permission is obtained by staff before entering any private area ie curtains bathrooms side rooms
Ask patientObserve
Ask 6 patients All 6 must report compliance
Element Care
Dignity and modesty is maintained for those patients moving between care settings
Ask patientObserve
Ask 6 patients observe
Patients are called by their preferred name Ask patientAsk 6 patients observe
Do all the call bell systems workObserveAsk staff
Ask 3 staff All must be aware
Element Leadership
Do staff know how to contact the interpreting translation service
Ask staff Ask 3All must be aware
Do all staff adhere to the uniform policy ObserveLook for jewellery watches and hair length
Do staff treat patients with dignity and respect ObserveGeneral feel over time on ward
Nursing Quality Assessment Tool Royal Devon and Exeter NHS Foundation Trust
17
ldquoA major strategy for improving quality in healthcare must therefore
be to establish information systems at clinical level that give feedback to
individual providers on the outcomes of the care they give for their
patientsrdquo
WHO 1997
An alternative approach retrospective analysis of electronic
patient records
Where will you find details of patient falls
Incident reports (special forms completed by nurses)
Clinical audit of patientsrsquo (paper) recordsNursing documentation about the
individual patient
Nursing documentation should include
Assessment (including Morse tool)Nursing diagnosis (Risk for falls)Intervention focused on the nursing
diagnosis (actions taken to prevent falls)Outcome (fallno fall)
Retrospective analysis of electronic patient records
Clinical data can be aggregated to provide management and policy information (Information governance is essential)
Information for management and planning should be collected as a by-product of core operational processes
ldquoCollect once use many times for multiple purposesrdquo
But this can only happen ifhellip
The relevant data is recorded in the EPR (Nursing data as well as medical data)
And stored In such a way that the relevant items can be
found (ie structured)And expressed in standardised terminology to
enable comparison (analysed in such a way as to show patterns)
This is not yet happening in nursing but it is required for electronic patient records
Layer 4Aggregated data
(N) MDSnational
international
Management decisions
Clinical decisions
Structuralcharacteristicsservice items
etc
Standardised nursing
terminology
Policy decisions
Layer 3Aggregated data
NMDS (local)
Layer 2 Nursing interpretationsNursing diagnoses
Nursing interventionsNursing outcomes
Layer 1 Facts- Demographic data
- Observations signs and symptoms
The Nursing Information Reference Model - Epping and Goosen 1997
One way traffic Bottom up not top down
Nursing documentation
The only reason for putting data in (ie documenting anything) is so that someone can get it out
But you can only get out what someone has put in (so we need agreed minimum data sets)
And they have to be able to find it (so it has to be structured - no more unstructured narratives)
And they have to be able to understand it (so we need standardised terminology)
What are nurses in other countries doing ICN
BelgiumCanadaUSANorthern Nurses Federation (Denmark Sweden
Norway Finland Iceland)
AustraliaSloveniaAnd several others
We should learn from other countries instead of re-inventing the (square) wheel
ICN project The International Nursing Minimum Data Set (i-NMDS)
ldquoa minimum set of items of information with uniform definitions and categories concerning the specific dimension of nursingrdquo
Werley and Lang 1988
Essential nursing items includebull nursing diagnosis (nursing problem)bull nursing intervention (what the nurse did)bull nursing outcome (the result of the intervention)
Belgium Nursing Minimum Data Set
Compulsory since 1988All Belgian acute hospitalsContent
Patient demographics 23 nursing interventions (recently increased to 79) Nurse staffing data (FTE nurses qualification level)
Sample 15 days 3 months19 Million data items recorded since 1988Largest Nursing Dataset in the world
Canadian Nurses Association C-HOBIC project
(Canadian Health Outcomes for Better Information and Care)
Collection of patient outcome information related to nursing care in the electronic health records of four provinces
ldquoIn addition to providing real time information to nurses about how patients are benefiting from care the collection of nursing-related outcomes can provide valuable information to administrators in understanding how well their organisation is managing outcomesrdquo
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
USA Partnership of three organisations
American Nurses Association (NDNQI)California Nurses Association (CalNOC)Veterans Administration (VANOD)
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
What are ldquonursing metricsrdquo
You wonrsquot find the word ldquometricsrdquo defined as a noun in the Concise Oxford Dictionary or Collins English Dictionary
If you enter ldquodefinition of metricsrdquo into Google you will find
Metrics the study of poetic meter and the art of versification
Metrics is a property of a route in computer networking consisting of any value used by routing algorithms to determine whether one route should perform better than another (the route with the lowest metric is the preferred route)
Metric is a Canadian New Waveindie rock band Originally formed in 1998 in New York City they are currently based in Toronto Ontario
Google contdhellip
Quantitative measures of performance or production used to indicate progress or achievement against strategic goals
metric - A standard for measurement
metric - A measure for something a means of deriving a quantitative measurement or approximation for otherwise qualitative phenomena
A new word for an old chestnut measuring the quality of nursing care
But this timeStill part of performance managementStill a top-down management initiativeFocus on outcome as opposed to structure
or processIncreased emphasis on patient perceptionsThree dimensions Safety Effectiveness
Compassion
Enter Darzihellip
ldquoHigh quality care for all NHS Next Stage Review final reportrdquo hellip
ldquoThe Next Stage Review makes a commitment to develop an indicative set of metrics for nursing that comprises of indicators of quality reflecting the issues of safety effectiveness and compassionhellip
Griffiths P Jones S Maben J Murrells T (2008) State of the art metrics for nursing a rapid appraisal London National Nursing Research Unit Kings College London
ldquoThe group was tasked with finding measures of ldquonurse-delivered outcomes and patient experiencerdquo We take this to mean measures that directly reflect nursingrsquos end result in terms of impact upon patientsrdquo
State of the Art Metrics for Nursing p1
ldquoThis paper explores potential nursing-sensitive indicators from published literature and indicator sets currently in use The requirements of a good set of indicators are explored and evidence for indicatorsrsquo validity is considered through an examination of evidence linking nursing contributions and patient outcomes The conclusion assesses the current state of the art in nursing-sensitive indicatorsrdquo
Indicators most commonly currently used elsewhere
Pressure ulcersldquoFailure to rescuerdquoStaffing levels (nurseshours per patient)FallsHospital Associated Infections (pneumonia)Staff satisfaction and wellbeingHospital Associated Infections (UTIs)Staffingskill mixMedication administration errors
Front runners in the indicator stakes Safety Effectiveness Compassion
Safety Failure to rescue
Healthcare associated pneumonia
Healthcare associated infection
Pressure ulcers
Falls
Effectiveness Staffing levels and skill mix
Staff satisfaction
Staff perception of the practice environment
CompassionExperience of care (patient reported)
Communication (patient reported)
State of the Art Metrics for Nursing Box 5 p19
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Search Results (nursing) Quality stroke care (outcome reduction in stroke
related mortality and disability) Percentage of women who have seen a midwife or
an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
Indicators proposed by Department of Health
Issues for us
Q1 How will these indicators demonstrate the contribution or quality of nursing care
Q2 How will we get the data
14
ldquoAt present individual health providers and institutionshelliplack the basic information of knowing the quality of care that they provided in daily practice Such data are not collected and there is thus no feedback in a systematic way to the individual physicians or nurseshelliprdquo
WHO 1997
Q1How will these indicators demonstrate the contribution or
quality of nursing care
Q2 How will we get the data
Specially collected data eg a form to be filled in for every fall or pressure ulcer
Secondary use of existing data Audit (manual extraction of data from
patient records) By data mining electronic patient
records
Nursing Core Standard Respect and dignityStandard Every patient has their privacy and dignity respected at all times
Element Environment Source Yes No Instruction
Patient privacy is maintained by the use of curtains and appropriate clothing
Ask patientObserve
Ask 6 patients All 6 must report compliance
Permission is obtained by staff before entering any private area ie curtains bathrooms side rooms
Ask patientObserve
Ask 6 patients All 6 must report compliance
Element Care
Dignity and modesty is maintained for those patients moving between care settings
Ask patientObserve
Ask 6 patients observe
Patients are called by their preferred name Ask patientAsk 6 patients observe
Do all the call bell systems workObserveAsk staff
Ask 3 staff All must be aware
Element Leadership
Do staff know how to contact the interpreting translation service
Ask staff Ask 3All must be aware
Do all staff adhere to the uniform policy ObserveLook for jewellery watches and hair length
Do staff treat patients with dignity and respect ObserveGeneral feel over time on ward
Nursing Quality Assessment Tool Royal Devon and Exeter NHS Foundation Trust
17
ldquoA major strategy for improving quality in healthcare must therefore
be to establish information systems at clinical level that give feedback to
individual providers on the outcomes of the care they give for their
patientsrdquo
WHO 1997
An alternative approach retrospective analysis of electronic
patient records
Where will you find details of patient falls
Incident reports (special forms completed by nurses)
Clinical audit of patientsrsquo (paper) recordsNursing documentation about the
individual patient
Nursing documentation should include
Assessment (including Morse tool)Nursing diagnosis (Risk for falls)Intervention focused on the nursing
diagnosis (actions taken to prevent falls)Outcome (fallno fall)
Retrospective analysis of electronic patient records
Clinical data can be aggregated to provide management and policy information (Information governance is essential)
Information for management and planning should be collected as a by-product of core operational processes
ldquoCollect once use many times for multiple purposesrdquo
But this can only happen ifhellip
The relevant data is recorded in the EPR (Nursing data as well as medical data)
And stored In such a way that the relevant items can be
found (ie structured)And expressed in standardised terminology to
enable comparison (analysed in such a way as to show patterns)
This is not yet happening in nursing but it is required for electronic patient records
Layer 4Aggregated data
(N) MDSnational
international
Management decisions
Clinical decisions
Structuralcharacteristicsservice items
etc
Standardised nursing
terminology
Policy decisions
Layer 3Aggregated data
NMDS (local)
Layer 2 Nursing interpretationsNursing diagnoses
Nursing interventionsNursing outcomes
Layer 1 Facts- Demographic data
- Observations signs and symptoms
The Nursing Information Reference Model - Epping and Goosen 1997
One way traffic Bottom up not top down
Nursing documentation
The only reason for putting data in (ie documenting anything) is so that someone can get it out
But you can only get out what someone has put in (so we need agreed minimum data sets)
And they have to be able to find it (so it has to be structured - no more unstructured narratives)
And they have to be able to understand it (so we need standardised terminology)
What are nurses in other countries doing ICN
BelgiumCanadaUSANorthern Nurses Federation (Denmark Sweden
Norway Finland Iceland)
AustraliaSloveniaAnd several others
We should learn from other countries instead of re-inventing the (square) wheel
ICN project The International Nursing Minimum Data Set (i-NMDS)
ldquoa minimum set of items of information with uniform definitions and categories concerning the specific dimension of nursingrdquo
Werley and Lang 1988
Essential nursing items includebull nursing diagnosis (nursing problem)bull nursing intervention (what the nurse did)bull nursing outcome (the result of the intervention)
Belgium Nursing Minimum Data Set
Compulsory since 1988All Belgian acute hospitalsContent
Patient demographics 23 nursing interventions (recently increased to 79) Nurse staffing data (FTE nurses qualification level)
Sample 15 days 3 months19 Million data items recorded since 1988Largest Nursing Dataset in the world
Canadian Nurses Association C-HOBIC project
(Canadian Health Outcomes for Better Information and Care)
Collection of patient outcome information related to nursing care in the electronic health records of four provinces
ldquoIn addition to providing real time information to nurses about how patients are benefiting from care the collection of nursing-related outcomes can provide valuable information to administrators in understanding how well their organisation is managing outcomesrdquo
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
USA Partnership of three organisations
American Nurses Association (NDNQI)California Nurses Association (CalNOC)Veterans Administration (VANOD)
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
If you enter ldquodefinition of metricsrdquo into Google you will find
Metrics the study of poetic meter and the art of versification
Metrics is a property of a route in computer networking consisting of any value used by routing algorithms to determine whether one route should perform better than another (the route with the lowest metric is the preferred route)
Metric is a Canadian New Waveindie rock band Originally formed in 1998 in New York City they are currently based in Toronto Ontario
Google contdhellip
Quantitative measures of performance or production used to indicate progress or achievement against strategic goals
metric - A standard for measurement
metric - A measure for something a means of deriving a quantitative measurement or approximation for otherwise qualitative phenomena
A new word for an old chestnut measuring the quality of nursing care
But this timeStill part of performance managementStill a top-down management initiativeFocus on outcome as opposed to structure
or processIncreased emphasis on patient perceptionsThree dimensions Safety Effectiveness
Compassion
Enter Darzihellip
ldquoHigh quality care for all NHS Next Stage Review final reportrdquo hellip
ldquoThe Next Stage Review makes a commitment to develop an indicative set of metrics for nursing that comprises of indicators of quality reflecting the issues of safety effectiveness and compassionhellip
Griffiths P Jones S Maben J Murrells T (2008) State of the art metrics for nursing a rapid appraisal London National Nursing Research Unit Kings College London
ldquoThe group was tasked with finding measures of ldquonurse-delivered outcomes and patient experiencerdquo We take this to mean measures that directly reflect nursingrsquos end result in terms of impact upon patientsrdquo
State of the Art Metrics for Nursing p1
ldquoThis paper explores potential nursing-sensitive indicators from published literature and indicator sets currently in use The requirements of a good set of indicators are explored and evidence for indicatorsrsquo validity is considered through an examination of evidence linking nursing contributions and patient outcomes The conclusion assesses the current state of the art in nursing-sensitive indicatorsrdquo
Indicators most commonly currently used elsewhere
Pressure ulcersldquoFailure to rescuerdquoStaffing levels (nurseshours per patient)FallsHospital Associated Infections (pneumonia)Staff satisfaction and wellbeingHospital Associated Infections (UTIs)Staffingskill mixMedication administration errors
Front runners in the indicator stakes Safety Effectiveness Compassion
Safety Failure to rescue
Healthcare associated pneumonia
Healthcare associated infection
Pressure ulcers
Falls
Effectiveness Staffing levels and skill mix
Staff satisfaction
Staff perception of the practice environment
CompassionExperience of care (patient reported)
Communication (patient reported)
State of the Art Metrics for Nursing Box 5 p19
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Search Results (nursing) Quality stroke care (outcome reduction in stroke
related mortality and disability) Percentage of women who have seen a midwife or
an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
Indicators proposed by Department of Health
Issues for us
Q1 How will these indicators demonstrate the contribution or quality of nursing care
Q2 How will we get the data
14
ldquoAt present individual health providers and institutionshelliplack the basic information of knowing the quality of care that they provided in daily practice Such data are not collected and there is thus no feedback in a systematic way to the individual physicians or nurseshelliprdquo
WHO 1997
Q1How will these indicators demonstrate the contribution or
quality of nursing care
Q2 How will we get the data
Specially collected data eg a form to be filled in for every fall or pressure ulcer
Secondary use of existing data Audit (manual extraction of data from
patient records) By data mining electronic patient
records
Nursing Core Standard Respect and dignityStandard Every patient has their privacy and dignity respected at all times
Element Environment Source Yes No Instruction
Patient privacy is maintained by the use of curtains and appropriate clothing
Ask patientObserve
Ask 6 patients All 6 must report compliance
Permission is obtained by staff before entering any private area ie curtains bathrooms side rooms
Ask patientObserve
Ask 6 patients All 6 must report compliance
Element Care
Dignity and modesty is maintained for those patients moving between care settings
Ask patientObserve
Ask 6 patients observe
Patients are called by their preferred name Ask patientAsk 6 patients observe
Do all the call bell systems workObserveAsk staff
Ask 3 staff All must be aware
Element Leadership
Do staff know how to contact the interpreting translation service
Ask staff Ask 3All must be aware
Do all staff adhere to the uniform policy ObserveLook for jewellery watches and hair length
Do staff treat patients with dignity and respect ObserveGeneral feel over time on ward
Nursing Quality Assessment Tool Royal Devon and Exeter NHS Foundation Trust
17
ldquoA major strategy for improving quality in healthcare must therefore
be to establish information systems at clinical level that give feedback to
individual providers on the outcomes of the care they give for their
patientsrdquo
WHO 1997
An alternative approach retrospective analysis of electronic
patient records
Where will you find details of patient falls
Incident reports (special forms completed by nurses)
Clinical audit of patientsrsquo (paper) recordsNursing documentation about the
individual patient
Nursing documentation should include
Assessment (including Morse tool)Nursing diagnosis (Risk for falls)Intervention focused on the nursing
diagnosis (actions taken to prevent falls)Outcome (fallno fall)
Retrospective analysis of electronic patient records
Clinical data can be aggregated to provide management and policy information (Information governance is essential)
Information for management and planning should be collected as a by-product of core operational processes
ldquoCollect once use many times for multiple purposesrdquo
But this can only happen ifhellip
The relevant data is recorded in the EPR (Nursing data as well as medical data)
And stored In such a way that the relevant items can be
found (ie structured)And expressed in standardised terminology to
enable comparison (analysed in such a way as to show patterns)
This is not yet happening in nursing but it is required for electronic patient records
Layer 4Aggregated data
(N) MDSnational
international
Management decisions
Clinical decisions
Structuralcharacteristicsservice items
etc
Standardised nursing
terminology
Policy decisions
Layer 3Aggregated data
NMDS (local)
Layer 2 Nursing interpretationsNursing diagnoses
Nursing interventionsNursing outcomes
Layer 1 Facts- Demographic data
- Observations signs and symptoms
The Nursing Information Reference Model - Epping and Goosen 1997
One way traffic Bottom up not top down
Nursing documentation
The only reason for putting data in (ie documenting anything) is so that someone can get it out
But you can only get out what someone has put in (so we need agreed minimum data sets)
And they have to be able to find it (so it has to be structured - no more unstructured narratives)
And they have to be able to understand it (so we need standardised terminology)
What are nurses in other countries doing ICN
BelgiumCanadaUSANorthern Nurses Federation (Denmark Sweden
Norway Finland Iceland)
AustraliaSloveniaAnd several others
We should learn from other countries instead of re-inventing the (square) wheel
ICN project The International Nursing Minimum Data Set (i-NMDS)
ldquoa minimum set of items of information with uniform definitions and categories concerning the specific dimension of nursingrdquo
Werley and Lang 1988
Essential nursing items includebull nursing diagnosis (nursing problem)bull nursing intervention (what the nurse did)bull nursing outcome (the result of the intervention)
Belgium Nursing Minimum Data Set
Compulsory since 1988All Belgian acute hospitalsContent
Patient demographics 23 nursing interventions (recently increased to 79) Nurse staffing data (FTE nurses qualification level)
Sample 15 days 3 months19 Million data items recorded since 1988Largest Nursing Dataset in the world
Canadian Nurses Association C-HOBIC project
(Canadian Health Outcomes for Better Information and Care)
Collection of patient outcome information related to nursing care in the electronic health records of four provinces
ldquoIn addition to providing real time information to nurses about how patients are benefiting from care the collection of nursing-related outcomes can provide valuable information to administrators in understanding how well their organisation is managing outcomesrdquo
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
USA Partnership of three organisations
American Nurses Association (NDNQI)California Nurses Association (CalNOC)Veterans Administration (VANOD)
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
Google contdhellip
Quantitative measures of performance or production used to indicate progress or achievement against strategic goals
metric - A standard for measurement
metric - A measure for something a means of deriving a quantitative measurement or approximation for otherwise qualitative phenomena
A new word for an old chestnut measuring the quality of nursing care
But this timeStill part of performance managementStill a top-down management initiativeFocus on outcome as opposed to structure
or processIncreased emphasis on patient perceptionsThree dimensions Safety Effectiveness
Compassion
Enter Darzihellip
ldquoHigh quality care for all NHS Next Stage Review final reportrdquo hellip
ldquoThe Next Stage Review makes a commitment to develop an indicative set of metrics for nursing that comprises of indicators of quality reflecting the issues of safety effectiveness and compassionhellip
Griffiths P Jones S Maben J Murrells T (2008) State of the art metrics for nursing a rapid appraisal London National Nursing Research Unit Kings College London
ldquoThe group was tasked with finding measures of ldquonurse-delivered outcomes and patient experiencerdquo We take this to mean measures that directly reflect nursingrsquos end result in terms of impact upon patientsrdquo
State of the Art Metrics for Nursing p1
ldquoThis paper explores potential nursing-sensitive indicators from published literature and indicator sets currently in use The requirements of a good set of indicators are explored and evidence for indicatorsrsquo validity is considered through an examination of evidence linking nursing contributions and patient outcomes The conclusion assesses the current state of the art in nursing-sensitive indicatorsrdquo
Indicators most commonly currently used elsewhere
Pressure ulcersldquoFailure to rescuerdquoStaffing levels (nurseshours per patient)FallsHospital Associated Infections (pneumonia)Staff satisfaction and wellbeingHospital Associated Infections (UTIs)Staffingskill mixMedication administration errors
Front runners in the indicator stakes Safety Effectiveness Compassion
Safety Failure to rescue
Healthcare associated pneumonia
Healthcare associated infection
Pressure ulcers
Falls
Effectiveness Staffing levels and skill mix
Staff satisfaction
Staff perception of the practice environment
CompassionExperience of care (patient reported)
Communication (patient reported)
State of the Art Metrics for Nursing Box 5 p19
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Search Results (nursing) Quality stroke care (outcome reduction in stroke
related mortality and disability) Percentage of women who have seen a midwife or
an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
Indicators proposed by Department of Health
Issues for us
Q1 How will these indicators demonstrate the contribution or quality of nursing care
Q2 How will we get the data
14
ldquoAt present individual health providers and institutionshelliplack the basic information of knowing the quality of care that they provided in daily practice Such data are not collected and there is thus no feedback in a systematic way to the individual physicians or nurseshelliprdquo
WHO 1997
Q1How will these indicators demonstrate the contribution or
quality of nursing care
Q2 How will we get the data
Specially collected data eg a form to be filled in for every fall or pressure ulcer
Secondary use of existing data Audit (manual extraction of data from
patient records) By data mining electronic patient
records
Nursing Core Standard Respect and dignityStandard Every patient has their privacy and dignity respected at all times
Element Environment Source Yes No Instruction
Patient privacy is maintained by the use of curtains and appropriate clothing
Ask patientObserve
Ask 6 patients All 6 must report compliance
Permission is obtained by staff before entering any private area ie curtains bathrooms side rooms
Ask patientObserve
Ask 6 patients All 6 must report compliance
Element Care
Dignity and modesty is maintained for those patients moving between care settings
Ask patientObserve
Ask 6 patients observe
Patients are called by their preferred name Ask patientAsk 6 patients observe
Do all the call bell systems workObserveAsk staff
Ask 3 staff All must be aware
Element Leadership
Do staff know how to contact the interpreting translation service
Ask staff Ask 3All must be aware
Do all staff adhere to the uniform policy ObserveLook for jewellery watches and hair length
Do staff treat patients with dignity and respect ObserveGeneral feel over time on ward
Nursing Quality Assessment Tool Royal Devon and Exeter NHS Foundation Trust
17
ldquoA major strategy for improving quality in healthcare must therefore
be to establish information systems at clinical level that give feedback to
individual providers on the outcomes of the care they give for their
patientsrdquo
WHO 1997
An alternative approach retrospective analysis of electronic
patient records
Where will you find details of patient falls
Incident reports (special forms completed by nurses)
Clinical audit of patientsrsquo (paper) recordsNursing documentation about the
individual patient
Nursing documentation should include
Assessment (including Morse tool)Nursing diagnosis (Risk for falls)Intervention focused on the nursing
diagnosis (actions taken to prevent falls)Outcome (fallno fall)
Retrospective analysis of electronic patient records
Clinical data can be aggregated to provide management and policy information (Information governance is essential)
Information for management and planning should be collected as a by-product of core operational processes
ldquoCollect once use many times for multiple purposesrdquo
But this can only happen ifhellip
The relevant data is recorded in the EPR (Nursing data as well as medical data)
And stored In such a way that the relevant items can be
found (ie structured)And expressed in standardised terminology to
enable comparison (analysed in such a way as to show patterns)
This is not yet happening in nursing but it is required for electronic patient records
Layer 4Aggregated data
(N) MDSnational
international
Management decisions
Clinical decisions
Structuralcharacteristicsservice items
etc
Standardised nursing
terminology
Policy decisions
Layer 3Aggregated data
NMDS (local)
Layer 2 Nursing interpretationsNursing diagnoses
Nursing interventionsNursing outcomes
Layer 1 Facts- Demographic data
- Observations signs and symptoms
The Nursing Information Reference Model - Epping and Goosen 1997
One way traffic Bottom up not top down
Nursing documentation
The only reason for putting data in (ie documenting anything) is so that someone can get it out
But you can only get out what someone has put in (so we need agreed minimum data sets)
And they have to be able to find it (so it has to be structured - no more unstructured narratives)
And they have to be able to understand it (so we need standardised terminology)
What are nurses in other countries doing ICN
BelgiumCanadaUSANorthern Nurses Federation (Denmark Sweden
Norway Finland Iceland)
AustraliaSloveniaAnd several others
We should learn from other countries instead of re-inventing the (square) wheel
ICN project The International Nursing Minimum Data Set (i-NMDS)
ldquoa minimum set of items of information with uniform definitions and categories concerning the specific dimension of nursingrdquo
Werley and Lang 1988
Essential nursing items includebull nursing diagnosis (nursing problem)bull nursing intervention (what the nurse did)bull nursing outcome (the result of the intervention)
Belgium Nursing Minimum Data Set
Compulsory since 1988All Belgian acute hospitalsContent
Patient demographics 23 nursing interventions (recently increased to 79) Nurse staffing data (FTE nurses qualification level)
Sample 15 days 3 months19 Million data items recorded since 1988Largest Nursing Dataset in the world
Canadian Nurses Association C-HOBIC project
(Canadian Health Outcomes for Better Information and Care)
Collection of patient outcome information related to nursing care in the electronic health records of four provinces
ldquoIn addition to providing real time information to nurses about how patients are benefiting from care the collection of nursing-related outcomes can provide valuable information to administrators in understanding how well their organisation is managing outcomesrdquo
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
USA Partnership of three organisations
American Nurses Association (NDNQI)California Nurses Association (CalNOC)Veterans Administration (VANOD)
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
A new word for an old chestnut measuring the quality of nursing care
But this timeStill part of performance managementStill a top-down management initiativeFocus on outcome as opposed to structure
or processIncreased emphasis on patient perceptionsThree dimensions Safety Effectiveness
Compassion
Enter Darzihellip
ldquoHigh quality care for all NHS Next Stage Review final reportrdquo hellip
ldquoThe Next Stage Review makes a commitment to develop an indicative set of metrics for nursing that comprises of indicators of quality reflecting the issues of safety effectiveness and compassionhellip
Griffiths P Jones S Maben J Murrells T (2008) State of the art metrics for nursing a rapid appraisal London National Nursing Research Unit Kings College London
ldquoThe group was tasked with finding measures of ldquonurse-delivered outcomes and patient experiencerdquo We take this to mean measures that directly reflect nursingrsquos end result in terms of impact upon patientsrdquo
State of the Art Metrics for Nursing p1
ldquoThis paper explores potential nursing-sensitive indicators from published literature and indicator sets currently in use The requirements of a good set of indicators are explored and evidence for indicatorsrsquo validity is considered through an examination of evidence linking nursing contributions and patient outcomes The conclusion assesses the current state of the art in nursing-sensitive indicatorsrdquo
Indicators most commonly currently used elsewhere
Pressure ulcersldquoFailure to rescuerdquoStaffing levels (nurseshours per patient)FallsHospital Associated Infections (pneumonia)Staff satisfaction and wellbeingHospital Associated Infections (UTIs)Staffingskill mixMedication administration errors
Front runners in the indicator stakes Safety Effectiveness Compassion
Safety Failure to rescue
Healthcare associated pneumonia
Healthcare associated infection
Pressure ulcers
Falls
Effectiveness Staffing levels and skill mix
Staff satisfaction
Staff perception of the practice environment
CompassionExperience of care (patient reported)
Communication (patient reported)
State of the Art Metrics for Nursing Box 5 p19
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Search Results (nursing) Quality stroke care (outcome reduction in stroke
related mortality and disability) Percentage of women who have seen a midwife or
an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
Indicators proposed by Department of Health
Issues for us
Q1 How will these indicators demonstrate the contribution or quality of nursing care
Q2 How will we get the data
14
ldquoAt present individual health providers and institutionshelliplack the basic information of knowing the quality of care that they provided in daily practice Such data are not collected and there is thus no feedback in a systematic way to the individual physicians or nurseshelliprdquo
WHO 1997
Q1How will these indicators demonstrate the contribution or
quality of nursing care
Q2 How will we get the data
Specially collected data eg a form to be filled in for every fall or pressure ulcer
Secondary use of existing data Audit (manual extraction of data from
patient records) By data mining electronic patient
records
Nursing Core Standard Respect and dignityStandard Every patient has their privacy and dignity respected at all times
Element Environment Source Yes No Instruction
Patient privacy is maintained by the use of curtains and appropriate clothing
Ask patientObserve
Ask 6 patients All 6 must report compliance
Permission is obtained by staff before entering any private area ie curtains bathrooms side rooms
Ask patientObserve
Ask 6 patients All 6 must report compliance
Element Care
Dignity and modesty is maintained for those patients moving between care settings
Ask patientObserve
Ask 6 patients observe
Patients are called by their preferred name Ask patientAsk 6 patients observe
Do all the call bell systems workObserveAsk staff
Ask 3 staff All must be aware
Element Leadership
Do staff know how to contact the interpreting translation service
Ask staff Ask 3All must be aware
Do all staff adhere to the uniform policy ObserveLook for jewellery watches and hair length
Do staff treat patients with dignity and respect ObserveGeneral feel over time on ward
Nursing Quality Assessment Tool Royal Devon and Exeter NHS Foundation Trust
17
ldquoA major strategy for improving quality in healthcare must therefore
be to establish information systems at clinical level that give feedback to
individual providers on the outcomes of the care they give for their
patientsrdquo
WHO 1997
An alternative approach retrospective analysis of electronic
patient records
Where will you find details of patient falls
Incident reports (special forms completed by nurses)
Clinical audit of patientsrsquo (paper) recordsNursing documentation about the
individual patient
Nursing documentation should include
Assessment (including Morse tool)Nursing diagnosis (Risk for falls)Intervention focused on the nursing
diagnosis (actions taken to prevent falls)Outcome (fallno fall)
Retrospective analysis of electronic patient records
Clinical data can be aggregated to provide management and policy information (Information governance is essential)
Information for management and planning should be collected as a by-product of core operational processes
ldquoCollect once use many times for multiple purposesrdquo
But this can only happen ifhellip
The relevant data is recorded in the EPR (Nursing data as well as medical data)
And stored In such a way that the relevant items can be
found (ie structured)And expressed in standardised terminology to
enable comparison (analysed in such a way as to show patterns)
This is not yet happening in nursing but it is required for electronic patient records
Layer 4Aggregated data
(N) MDSnational
international
Management decisions
Clinical decisions
Structuralcharacteristicsservice items
etc
Standardised nursing
terminology
Policy decisions
Layer 3Aggregated data
NMDS (local)
Layer 2 Nursing interpretationsNursing diagnoses
Nursing interventionsNursing outcomes
Layer 1 Facts- Demographic data
- Observations signs and symptoms
The Nursing Information Reference Model - Epping and Goosen 1997
One way traffic Bottom up not top down
Nursing documentation
The only reason for putting data in (ie documenting anything) is so that someone can get it out
But you can only get out what someone has put in (so we need agreed minimum data sets)
And they have to be able to find it (so it has to be structured - no more unstructured narratives)
And they have to be able to understand it (so we need standardised terminology)
What are nurses in other countries doing ICN
BelgiumCanadaUSANorthern Nurses Federation (Denmark Sweden
Norway Finland Iceland)
AustraliaSloveniaAnd several others
We should learn from other countries instead of re-inventing the (square) wheel
ICN project The International Nursing Minimum Data Set (i-NMDS)
ldquoa minimum set of items of information with uniform definitions and categories concerning the specific dimension of nursingrdquo
Werley and Lang 1988
Essential nursing items includebull nursing diagnosis (nursing problem)bull nursing intervention (what the nurse did)bull nursing outcome (the result of the intervention)
Belgium Nursing Minimum Data Set
Compulsory since 1988All Belgian acute hospitalsContent
Patient demographics 23 nursing interventions (recently increased to 79) Nurse staffing data (FTE nurses qualification level)
Sample 15 days 3 months19 Million data items recorded since 1988Largest Nursing Dataset in the world
Canadian Nurses Association C-HOBIC project
(Canadian Health Outcomes for Better Information and Care)
Collection of patient outcome information related to nursing care in the electronic health records of four provinces
ldquoIn addition to providing real time information to nurses about how patients are benefiting from care the collection of nursing-related outcomes can provide valuable information to administrators in understanding how well their organisation is managing outcomesrdquo
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
USA Partnership of three organisations
American Nurses Association (NDNQI)California Nurses Association (CalNOC)Veterans Administration (VANOD)
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
Enter Darzihellip
ldquoHigh quality care for all NHS Next Stage Review final reportrdquo hellip
ldquoThe Next Stage Review makes a commitment to develop an indicative set of metrics for nursing that comprises of indicators of quality reflecting the issues of safety effectiveness and compassionhellip
Griffiths P Jones S Maben J Murrells T (2008) State of the art metrics for nursing a rapid appraisal London National Nursing Research Unit Kings College London
ldquoThe group was tasked with finding measures of ldquonurse-delivered outcomes and patient experiencerdquo We take this to mean measures that directly reflect nursingrsquos end result in terms of impact upon patientsrdquo
State of the Art Metrics for Nursing p1
ldquoThis paper explores potential nursing-sensitive indicators from published literature and indicator sets currently in use The requirements of a good set of indicators are explored and evidence for indicatorsrsquo validity is considered through an examination of evidence linking nursing contributions and patient outcomes The conclusion assesses the current state of the art in nursing-sensitive indicatorsrdquo
Indicators most commonly currently used elsewhere
Pressure ulcersldquoFailure to rescuerdquoStaffing levels (nurseshours per patient)FallsHospital Associated Infections (pneumonia)Staff satisfaction and wellbeingHospital Associated Infections (UTIs)Staffingskill mixMedication administration errors
Front runners in the indicator stakes Safety Effectiveness Compassion
Safety Failure to rescue
Healthcare associated pneumonia
Healthcare associated infection
Pressure ulcers
Falls
Effectiveness Staffing levels and skill mix
Staff satisfaction
Staff perception of the practice environment
CompassionExperience of care (patient reported)
Communication (patient reported)
State of the Art Metrics for Nursing Box 5 p19
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Search Results (nursing) Quality stroke care (outcome reduction in stroke
related mortality and disability) Percentage of women who have seen a midwife or
an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
Indicators proposed by Department of Health
Issues for us
Q1 How will these indicators demonstrate the contribution or quality of nursing care
Q2 How will we get the data
14
ldquoAt present individual health providers and institutionshelliplack the basic information of knowing the quality of care that they provided in daily practice Such data are not collected and there is thus no feedback in a systematic way to the individual physicians or nurseshelliprdquo
WHO 1997
Q1How will these indicators demonstrate the contribution or
quality of nursing care
Q2 How will we get the data
Specially collected data eg a form to be filled in for every fall or pressure ulcer
Secondary use of existing data Audit (manual extraction of data from
patient records) By data mining electronic patient
records
Nursing Core Standard Respect and dignityStandard Every patient has their privacy and dignity respected at all times
Element Environment Source Yes No Instruction
Patient privacy is maintained by the use of curtains and appropriate clothing
Ask patientObserve
Ask 6 patients All 6 must report compliance
Permission is obtained by staff before entering any private area ie curtains bathrooms side rooms
Ask patientObserve
Ask 6 patients All 6 must report compliance
Element Care
Dignity and modesty is maintained for those patients moving between care settings
Ask patientObserve
Ask 6 patients observe
Patients are called by their preferred name Ask patientAsk 6 patients observe
Do all the call bell systems workObserveAsk staff
Ask 3 staff All must be aware
Element Leadership
Do staff know how to contact the interpreting translation service
Ask staff Ask 3All must be aware
Do all staff adhere to the uniform policy ObserveLook for jewellery watches and hair length
Do staff treat patients with dignity and respect ObserveGeneral feel over time on ward
Nursing Quality Assessment Tool Royal Devon and Exeter NHS Foundation Trust
17
ldquoA major strategy for improving quality in healthcare must therefore
be to establish information systems at clinical level that give feedback to
individual providers on the outcomes of the care they give for their
patientsrdquo
WHO 1997
An alternative approach retrospective analysis of electronic
patient records
Where will you find details of patient falls
Incident reports (special forms completed by nurses)
Clinical audit of patientsrsquo (paper) recordsNursing documentation about the
individual patient
Nursing documentation should include
Assessment (including Morse tool)Nursing diagnosis (Risk for falls)Intervention focused on the nursing
diagnosis (actions taken to prevent falls)Outcome (fallno fall)
Retrospective analysis of electronic patient records
Clinical data can be aggregated to provide management and policy information (Information governance is essential)
Information for management and planning should be collected as a by-product of core operational processes
ldquoCollect once use many times for multiple purposesrdquo
But this can only happen ifhellip
The relevant data is recorded in the EPR (Nursing data as well as medical data)
And stored In such a way that the relevant items can be
found (ie structured)And expressed in standardised terminology to
enable comparison (analysed in such a way as to show patterns)
This is not yet happening in nursing but it is required for electronic patient records
Layer 4Aggregated data
(N) MDSnational
international
Management decisions
Clinical decisions
Structuralcharacteristicsservice items
etc
Standardised nursing
terminology
Policy decisions
Layer 3Aggregated data
NMDS (local)
Layer 2 Nursing interpretationsNursing diagnoses
Nursing interventionsNursing outcomes
Layer 1 Facts- Demographic data
- Observations signs and symptoms
The Nursing Information Reference Model - Epping and Goosen 1997
One way traffic Bottom up not top down
Nursing documentation
The only reason for putting data in (ie documenting anything) is so that someone can get it out
But you can only get out what someone has put in (so we need agreed minimum data sets)
And they have to be able to find it (so it has to be structured - no more unstructured narratives)
And they have to be able to understand it (so we need standardised terminology)
What are nurses in other countries doing ICN
BelgiumCanadaUSANorthern Nurses Federation (Denmark Sweden
Norway Finland Iceland)
AustraliaSloveniaAnd several others
We should learn from other countries instead of re-inventing the (square) wheel
ICN project The International Nursing Minimum Data Set (i-NMDS)
ldquoa minimum set of items of information with uniform definitions and categories concerning the specific dimension of nursingrdquo
Werley and Lang 1988
Essential nursing items includebull nursing diagnosis (nursing problem)bull nursing intervention (what the nurse did)bull nursing outcome (the result of the intervention)
Belgium Nursing Minimum Data Set
Compulsory since 1988All Belgian acute hospitalsContent
Patient demographics 23 nursing interventions (recently increased to 79) Nurse staffing data (FTE nurses qualification level)
Sample 15 days 3 months19 Million data items recorded since 1988Largest Nursing Dataset in the world
Canadian Nurses Association C-HOBIC project
(Canadian Health Outcomes for Better Information and Care)
Collection of patient outcome information related to nursing care in the electronic health records of four provinces
ldquoIn addition to providing real time information to nurses about how patients are benefiting from care the collection of nursing-related outcomes can provide valuable information to administrators in understanding how well their organisation is managing outcomesrdquo
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
USA Partnership of three organisations
American Nurses Association (NDNQI)California Nurses Association (CalNOC)Veterans Administration (VANOD)
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
Griffiths P Jones S Maben J Murrells T (2008) State of the art metrics for nursing a rapid appraisal London National Nursing Research Unit Kings College London
ldquoThe group was tasked with finding measures of ldquonurse-delivered outcomes and patient experiencerdquo We take this to mean measures that directly reflect nursingrsquos end result in terms of impact upon patientsrdquo
State of the Art Metrics for Nursing p1
ldquoThis paper explores potential nursing-sensitive indicators from published literature and indicator sets currently in use The requirements of a good set of indicators are explored and evidence for indicatorsrsquo validity is considered through an examination of evidence linking nursing contributions and patient outcomes The conclusion assesses the current state of the art in nursing-sensitive indicatorsrdquo
Indicators most commonly currently used elsewhere
Pressure ulcersldquoFailure to rescuerdquoStaffing levels (nurseshours per patient)FallsHospital Associated Infections (pneumonia)Staff satisfaction and wellbeingHospital Associated Infections (UTIs)Staffingskill mixMedication administration errors
Front runners in the indicator stakes Safety Effectiveness Compassion
Safety Failure to rescue
Healthcare associated pneumonia
Healthcare associated infection
Pressure ulcers
Falls
Effectiveness Staffing levels and skill mix
Staff satisfaction
Staff perception of the practice environment
CompassionExperience of care (patient reported)
Communication (patient reported)
State of the Art Metrics for Nursing Box 5 p19
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Search Results (nursing) Quality stroke care (outcome reduction in stroke
related mortality and disability) Percentage of women who have seen a midwife or
an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
Indicators proposed by Department of Health
Issues for us
Q1 How will these indicators demonstrate the contribution or quality of nursing care
Q2 How will we get the data
14
ldquoAt present individual health providers and institutionshelliplack the basic information of knowing the quality of care that they provided in daily practice Such data are not collected and there is thus no feedback in a systematic way to the individual physicians or nurseshelliprdquo
WHO 1997
Q1How will these indicators demonstrate the contribution or
quality of nursing care
Q2 How will we get the data
Specially collected data eg a form to be filled in for every fall or pressure ulcer
Secondary use of existing data Audit (manual extraction of data from
patient records) By data mining electronic patient
records
Nursing Core Standard Respect and dignityStandard Every patient has their privacy and dignity respected at all times
Element Environment Source Yes No Instruction
Patient privacy is maintained by the use of curtains and appropriate clothing
Ask patientObserve
Ask 6 patients All 6 must report compliance
Permission is obtained by staff before entering any private area ie curtains bathrooms side rooms
Ask patientObserve
Ask 6 patients All 6 must report compliance
Element Care
Dignity and modesty is maintained for those patients moving between care settings
Ask patientObserve
Ask 6 patients observe
Patients are called by their preferred name Ask patientAsk 6 patients observe
Do all the call bell systems workObserveAsk staff
Ask 3 staff All must be aware
Element Leadership
Do staff know how to contact the interpreting translation service
Ask staff Ask 3All must be aware
Do all staff adhere to the uniform policy ObserveLook for jewellery watches and hair length
Do staff treat patients with dignity and respect ObserveGeneral feel over time on ward
Nursing Quality Assessment Tool Royal Devon and Exeter NHS Foundation Trust
17
ldquoA major strategy for improving quality in healthcare must therefore
be to establish information systems at clinical level that give feedback to
individual providers on the outcomes of the care they give for their
patientsrdquo
WHO 1997
An alternative approach retrospective analysis of electronic
patient records
Where will you find details of patient falls
Incident reports (special forms completed by nurses)
Clinical audit of patientsrsquo (paper) recordsNursing documentation about the
individual patient
Nursing documentation should include
Assessment (including Morse tool)Nursing diagnosis (Risk for falls)Intervention focused on the nursing
diagnosis (actions taken to prevent falls)Outcome (fallno fall)
Retrospective analysis of electronic patient records
Clinical data can be aggregated to provide management and policy information (Information governance is essential)
Information for management and planning should be collected as a by-product of core operational processes
ldquoCollect once use many times for multiple purposesrdquo
But this can only happen ifhellip
The relevant data is recorded in the EPR (Nursing data as well as medical data)
And stored In such a way that the relevant items can be
found (ie structured)And expressed in standardised terminology to
enable comparison (analysed in such a way as to show patterns)
This is not yet happening in nursing but it is required for electronic patient records
Layer 4Aggregated data
(N) MDSnational
international
Management decisions
Clinical decisions
Structuralcharacteristicsservice items
etc
Standardised nursing
terminology
Policy decisions
Layer 3Aggregated data
NMDS (local)
Layer 2 Nursing interpretationsNursing diagnoses
Nursing interventionsNursing outcomes
Layer 1 Facts- Demographic data
- Observations signs and symptoms
The Nursing Information Reference Model - Epping and Goosen 1997
One way traffic Bottom up not top down
Nursing documentation
The only reason for putting data in (ie documenting anything) is so that someone can get it out
But you can only get out what someone has put in (so we need agreed minimum data sets)
And they have to be able to find it (so it has to be structured - no more unstructured narratives)
And they have to be able to understand it (so we need standardised terminology)
What are nurses in other countries doing ICN
BelgiumCanadaUSANorthern Nurses Federation (Denmark Sweden
Norway Finland Iceland)
AustraliaSloveniaAnd several others
We should learn from other countries instead of re-inventing the (square) wheel
ICN project The International Nursing Minimum Data Set (i-NMDS)
ldquoa minimum set of items of information with uniform definitions and categories concerning the specific dimension of nursingrdquo
Werley and Lang 1988
Essential nursing items includebull nursing diagnosis (nursing problem)bull nursing intervention (what the nurse did)bull nursing outcome (the result of the intervention)
Belgium Nursing Minimum Data Set
Compulsory since 1988All Belgian acute hospitalsContent
Patient demographics 23 nursing interventions (recently increased to 79) Nurse staffing data (FTE nurses qualification level)
Sample 15 days 3 months19 Million data items recorded since 1988Largest Nursing Dataset in the world
Canadian Nurses Association C-HOBIC project
(Canadian Health Outcomes for Better Information and Care)
Collection of patient outcome information related to nursing care in the electronic health records of four provinces
ldquoIn addition to providing real time information to nurses about how patients are benefiting from care the collection of nursing-related outcomes can provide valuable information to administrators in understanding how well their organisation is managing outcomesrdquo
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
USA Partnership of three organisations
American Nurses Association (NDNQI)California Nurses Association (CalNOC)Veterans Administration (VANOD)
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
ldquoThe group was tasked with finding measures of ldquonurse-delivered outcomes and patient experiencerdquo We take this to mean measures that directly reflect nursingrsquos end result in terms of impact upon patientsrdquo
State of the Art Metrics for Nursing p1
ldquoThis paper explores potential nursing-sensitive indicators from published literature and indicator sets currently in use The requirements of a good set of indicators are explored and evidence for indicatorsrsquo validity is considered through an examination of evidence linking nursing contributions and patient outcomes The conclusion assesses the current state of the art in nursing-sensitive indicatorsrdquo
Indicators most commonly currently used elsewhere
Pressure ulcersldquoFailure to rescuerdquoStaffing levels (nurseshours per patient)FallsHospital Associated Infections (pneumonia)Staff satisfaction and wellbeingHospital Associated Infections (UTIs)Staffingskill mixMedication administration errors
Front runners in the indicator stakes Safety Effectiveness Compassion
Safety Failure to rescue
Healthcare associated pneumonia
Healthcare associated infection
Pressure ulcers
Falls
Effectiveness Staffing levels and skill mix
Staff satisfaction
Staff perception of the practice environment
CompassionExperience of care (patient reported)
Communication (patient reported)
State of the Art Metrics for Nursing Box 5 p19
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Search Results (nursing) Quality stroke care (outcome reduction in stroke
related mortality and disability) Percentage of women who have seen a midwife or
an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
Indicators proposed by Department of Health
Issues for us
Q1 How will these indicators demonstrate the contribution or quality of nursing care
Q2 How will we get the data
14
ldquoAt present individual health providers and institutionshelliplack the basic information of knowing the quality of care that they provided in daily practice Such data are not collected and there is thus no feedback in a systematic way to the individual physicians or nurseshelliprdquo
WHO 1997
Q1How will these indicators demonstrate the contribution or
quality of nursing care
Q2 How will we get the data
Specially collected data eg a form to be filled in for every fall or pressure ulcer
Secondary use of existing data Audit (manual extraction of data from
patient records) By data mining electronic patient
records
Nursing Core Standard Respect and dignityStandard Every patient has their privacy and dignity respected at all times
Element Environment Source Yes No Instruction
Patient privacy is maintained by the use of curtains and appropriate clothing
Ask patientObserve
Ask 6 patients All 6 must report compliance
Permission is obtained by staff before entering any private area ie curtains bathrooms side rooms
Ask patientObserve
Ask 6 patients All 6 must report compliance
Element Care
Dignity and modesty is maintained for those patients moving between care settings
Ask patientObserve
Ask 6 patients observe
Patients are called by their preferred name Ask patientAsk 6 patients observe
Do all the call bell systems workObserveAsk staff
Ask 3 staff All must be aware
Element Leadership
Do staff know how to contact the interpreting translation service
Ask staff Ask 3All must be aware
Do all staff adhere to the uniform policy ObserveLook for jewellery watches and hair length
Do staff treat patients with dignity and respect ObserveGeneral feel over time on ward
Nursing Quality Assessment Tool Royal Devon and Exeter NHS Foundation Trust
17
ldquoA major strategy for improving quality in healthcare must therefore
be to establish information systems at clinical level that give feedback to
individual providers on the outcomes of the care they give for their
patientsrdquo
WHO 1997
An alternative approach retrospective analysis of electronic
patient records
Where will you find details of patient falls
Incident reports (special forms completed by nurses)
Clinical audit of patientsrsquo (paper) recordsNursing documentation about the
individual patient
Nursing documentation should include
Assessment (including Morse tool)Nursing diagnosis (Risk for falls)Intervention focused on the nursing
diagnosis (actions taken to prevent falls)Outcome (fallno fall)
Retrospective analysis of electronic patient records
Clinical data can be aggregated to provide management and policy information (Information governance is essential)
Information for management and planning should be collected as a by-product of core operational processes
ldquoCollect once use many times for multiple purposesrdquo
But this can only happen ifhellip
The relevant data is recorded in the EPR (Nursing data as well as medical data)
And stored In such a way that the relevant items can be
found (ie structured)And expressed in standardised terminology to
enable comparison (analysed in such a way as to show patterns)
This is not yet happening in nursing but it is required for electronic patient records
Layer 4Aggregated data
(N) MDSnational
international
Management decisions
Clinical decisions
Structuralcharacteristicsservice items
etc
Standardised nursing
terminology
Policy decisions
Layer 3Aggregated data
NMDS (local)
Layer 2 Nursing interpretationsNursing diagnoses
Nursing interventionsNursing outcomes
Layer 1 Facts- Demographic data
- Observations signs and symptoms
The Nursing Information Reference Model - Epping and Goosen 1997
One way traffic Bottom up not top down
Nursing documentation
The only reason for putting data in (ie documenting anything) is so that someone can get it out
But you can only get out what someone has put in (so we need agreed minimum data sets)
And they have to be able to find it (so it has to be structured - no more unstructured narratives)
And they have to be able to understand it (so we need standardised terminology)
What are nurses in other countries doing ICN
BelgiumCanadaUSANorthern Nurses Federation (Denmark Sweden
Norway Finland Iceland)
AustraliaSloveniaAnd several others
We should learn from other countries instead of re-inventing the (square) wheel
ICN project The International Nursing Minimum Data Set (i-NMDS)
ldquoa minimum set of items of information with uniform definitions and categories concerning the specific dimension of nursingrdquo
Werley and Lang 1988
Essential nursing items includebull nursing diagnosis (nursing problem)bull nursing intervention (what the nurse did)bull nursing outcome (the result of the intervention)
Belgium Nursing Minimum Data Set
Compulsory since 1988All Belgian acute hospitalsContent
Patient demographics 23 nursing interventions (recently increased to 79) Nurse staffing data (FTE nurses qualification level)
Sample 15 days 3 months19 Million data items recorded since 1988Largest Nursing Dataset in the world
Canadian Nurses Association C-HOBIC project
(Canadian Health Outcomes for Better Information and Care)
Collection of patient outcome information related to nursing care in the electronic health records of four provinces
ldquoIn addition to providing real time information to nurses about how patients are benefiting from care the collection of nursing-related outcomes can provide valuable information to administrators in understanding how well their organisation is managing outcomesrdquo
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
USA Partnership of three organisations
American Nurses Association (NDNQI)California Nurses Association (CalNOC)Veterans Administration (VANOD)
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
Indicators most commonly currently used elsewhere
Pressure ulcersldquoFailure to rescuerdquoStaffing levels (nurseshours per patient)FallsHospital Associated Infections (pneumonia)Staff satisfaction and wellbeingHospital Associated Infections (UTIs)Staffingskill mixMedication administration errors
Front runners in the indicator stakes Safety Effectiveness Compassion
Safety Failure to rescue
Healthcare associated pneumonia
Healthcare associated infection
Pressure ulcers
Falls
Effectiveness Staffing levels and skill mix
Staff satisfaction
Staff perception of the practice environment
CompassionExperience of care (patient reported)
Communication (patient reported)
State of the Art Metrics for Nursing Box 5 p19
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Search Results (nursing) Quality stroke care (outcome reduction in stroke
related mortality and disability) Percentage of women who have seen a midwife or
an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
Indicators proposed by Department of Health
Issues for us
Q1 How will these indicators demonstrate the contribution or quality of nursing care
Q2 How will we get the data
14
ldquoAt present individual health providers and institutionshelliplack the basic information of knowing the quality of care that they provided in daily practice Such data are not collected and there is thus no feedback in a systematic way to the individual physicians or nurseshelliprdquo
WHO 1997
Q1How will these indicators demonstrate the contribution or
quality of nursing care
Q2 How will we get the data
Specially collected data eg a form to be filled in for every fall or pressure ulcer
Secondary use of existing data Audit (manual extraction of data from
patient records) By data mining electronic patient
records
Nursing Core Standard Respect and dignityStandard Every patient has their privacy and dignity respected at all times
Element Environment Source Yes No Instruction
Patient privacy is maintained by the use of curtains and appropriate clothing
Ask patientObserve
Ask 6 patients All 6 must report compliance
Permission is obtained by staff before entering any private area ie curtains bathrooms side rooms
Ask patientObserve
Ask 6 patients All 6 must report compliance
Element Care
Dignity and modesty is maintained for those patients moving between care settings
Ask patientObserve
Ask 6 patients observe
Patients are called by their preferred name Ask patientAsk 6 patients observe
Do all the call bell systems workObserveAsk staff
Ask 3 staff All must be aware
Element Leadership
Do staff know how to contact the interpreting translation service
Ask staff Ask 3All must be aware
Do all staff adhere to the uniform policy ObserveLook for jewellery watches and hair length
Do staff treat patients with dignity and respect ObserveGeneral feel over time on ward
Nursing Quality Assessment Tool Royal Devon and Exeter NHS Foundation Trust
17
ldquoA major strategy for improving quality in healthcare must therefore
be to establish information systems at clinical level that give feedback to
individual providers on the outcomes of the care they give for their
patientsrdquo
WHO 1997
An alternative approach retrospective analysis of electronic
patient records
Where will you find details of patient falls
Incident reports (special forms completed by nurses)
Clinical audit of patientsrsquo (paper) recordsNursing documentation about the
individual patient
Nursing documentation should include
Assessment (including Morse tool)Nursing diagnosis (Risk for falls)Intervention focused on the nursing
diagnosis (actions taken to prevent falls)Outcome (fallno fall)
Retrospective analysis of electronic patient records
Clinical data can be aggregated to provide management and policy information (Information governance is essential)
Information for management and planning should be collected as a by-product of core operational processes
ldquoCollect once use many times for multiple purposesrdquo
But this can only happen ifhellip
The relevant data is recorded in the EPR (Nursing data as well as medical data)
And stored In such a way that the relevant items can be
found (ie structured)And expressed in standardised terminology to
enable comparison (analysed in such a way as to show patterns)
This is not yet happening in nursing but it is required for electronic patient records
Layer 4Aggregated data
(N) MDSnational
international
Management decisions
Clinical decisions
Structuralcharacteristicsservice items
etc
Standardised nursing
terminology
Policy decisions
Layer 3Aggregated data
NMDS (local)
Layer 2 Nursing interpretationsNursing diagnoses
Nursing interventionsNursing outcomes
Layer 1 Facts- Demographic data
- Observations signs and symptoms
The Nursing Information Reference Model - Epping and Goosen 1997
One way traffic Bottom up not top down
Nursing documentation
The only reason for putting data in (ie documenting anything) is so that someone can get it out
But you can only get out what someone has put in (so we need agreed minimum data sets)
And they have to be able to find it (so it has to be structured - no more unstructured narratives)
And they have to be able to understand it (so we need standardised terminology)
What are nurses in other countries doing ICN
BelgiumCanadaUSANorthern Nurses Federation (Denmark Sweden
Norway Finland Iceland)
AustraliaSloveniaAnd several others
We should learn from other countries instead of re-inventing the (square) wheel
ICN project The International Nursing Minimum Data Set (i-NMDS)
ldquoa minimum set of items of information with uniform definitions and categories concerning the specific dimension of nursingrdquo
Werley and Lang 1988
Essential nursing items includebull nursing diagnosis (nursing problem)bull nursing intervention (what the nurse did)bull nursing outcome (the result of the intervention)
Belgium Nursing Minimum Data Set
Compulsory since 1988All Belgian acute hospitalsContent
Patient demographics 23 nursing interventions (recently increased to 79) Nurse staffing data (FTE nurses qualification level)
Sample 15 days 3 months19 Million data items recorded since 1988Largest Nursing Dataset in the world
Canadian Nurses Association C-HOBIC project
(Canadian Health Outcomes for Better Information and Care)
Collection of patient outcome information related to nursing care in the electronic health records of four provinces
ldquoIn addition to providing real time information to nurses about how patients are benefiting from care the collection of nursing-related outcomes can provide valuable information to administrators in understanding how well their organisation is managing outcomesrdquo
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
USA Partnership of three organisations
American Nurses Association (NDNQI)California Nurses Association (CalNOC)Veterans Administration (VANOD)
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
Front runners in the indicator stakes Safety Effectiveness Compassion
Safety Failure to rescue
Healthcare associated pneumonia
Healthcare associated infection
Pressure ulcers
Falls
Effectiveness Staffing levels and skill mix
Staff satisfaction
Staff perception of the practice environment
CompassionExperience of care (patient reported)
Communication (patient reported)
State of the Art Metrics for Nursing Box 5 p19
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Search Results (nursing) Quality stroke care (outcome reduction in stroke
related mortality and disability) Percentage of women who have seen a midwife or
an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
Indicators proposed by Department of Health
Issues for us
Q1 How will these indicators demonstrate the contribution or quality of nursing care
Q2 How will we get the data
14
ldquoAt present individual health providers and institutionshelliplack the basic information of knowing the quality of care that they provided in daily practice Such data are not collected and there is thus no feedback in a systematic way to the individual physicians or nurseshelliprdquo
WHO 1997
Q1How will these indicators demonstrate the contribution or
quality of nursing care
Q2 How will we get the data
Specially collected data eg a form to be filled in for every fall or pressure ulcer
Secondary use of existing data Audit (manual extraction of data from
patient records) By data mining electronic patient
records
Nursing Core Standard Respect and dignityStandard Every patient has their privacy and dignity respected at all times
Element Environment Source Yes No Instruction
Patient privacy is maintained by the use of curtains and appropriate clothing
Ask patientObserve
Ask 6 patients All 6 must report compliance
Permission is obtained by staff before entering any private area ie curtains bathrooms side rooms
Ask patientObserve
Ask 6 patients All 6 must report compliance
Element Care
Dignity and modesty is maintained for those patients moving between care settings
Ask patientObserve
Ask 6 patients observe
Patients are called by their preferred name Ask patientAsk 6 patients observe
Do all the call bell systems workObserveAsk staff
Ask 3 staff All must be aware
Element Leadership
Do staff know how to contact the interpreting translation service
Ask staff Ask 3All must be aware
Do all staff adhere to the uniform policy ObserveLook for jewellery watches and hair length
Do staff treat patients with dignity and respect ObserveGeneral feel over time on ward
Nursing Quality Assessment Tool Royal Devon and Exeter NHS Foundation Trust
17
ldquoA major strategy for improving quality in healthcare must therefore
be to establish information systems at clinical level that give feedback to
individual providers on the outcomes of the care they give for their
patientsrdquo
WHO 1997
An alternative approach retrospective analysis of electronic
patient records
Where will you find details of patient falls
Incident reports (special forms completed by nurses)
Clinical audit of patientsrsquo (paper) recordsNursing documentation about the
individual patient
Nursing documentation should include
Assessment (including Morse tool)Nursing diagnosis (Risk for falls)Intervention focused on the nursing
diagnosis (actions taken to prevent falls)Outcome (fallno fall)
Retrospective analysis of electronic patient records
Clinical data can be aggregated to provide management and policy information (Information governance is essential)
Information for management and planning should be collected as a by-product of core operational processes
ldquoCollect once use many times for multiple purposesrdquo
But this can only happen ifhellip
The relevant data is recorded in the EPR (Nursing data as well as medical data)
And stored In such a way that the relevant items can be
found (ie structured)And expressed in standardised terminology to
enable comparison (analysed in such a way as to show patterns)
This is not yet happening in nursing but it is required for electronic patient records
Layer 4Aggregated data
(N) MDSnational
international
Management decisions
Clinical decisions
Structuralcharacteristicsservice items
etc
Standardised nursing
terminology
Policy decisions
Layer 3Aggregated data
NMDS (local)
Layer 2 Nursing interpretationsNursing diagnoses
Nursing interventionsNursing outcomes
Layer 1 Facts- Demographic data
- Observations signs and symptoms
The Nursing Information Reference Model - Epping and Goosen 1997
One way traffic Bottom up not top down
Nursing documentation
The only reason for putting data in (ie documenting anything) is so that someone can get it out
But you can only get out what someone has put in (so we need agreed minimum data sets)
And they have to be able to find it (so it has to be structured - no more unstructured narratives)
And they have to be able to understand it (so we need standardised terminology)
What are nurses in other countries doing ICN
BelgiumCanadaUSANorthern Nurses Federation (Denmark Sweden
Norway Finland Iceland)
AustraliaSloveniaAnd several others
We should learn from other countries instead of re-inventing the (square) wheel
ICN project The International Nursing Minimum Data Set (i-NMDS)
ldquoa minimum set of items of information with uniform definitions and categories concerning the specific dimension of nursingrdquo
Werley and Lang 1988
Essential nursing items includebull nursing diagnosis (nursing problem)bull nursing intervention (what the nurse did)bull nursing outcome (the result of the intervention)
Belgium Nursing Minimum Data Set
Compulsory since 1988All Belgian acute hospitalsContent
Patient demographics 23 nursing interventions (recently increased to 79) Nurse staffing data (FTE nurses qualification level)
Sample 15 days 3 months19 Million data items recorded since 1988Largest Nursing Dataset in the world
Canadian Nurses Association C-HOBIC project
(Canadian Health Outcomes for Better Information and Care)
Collection of patient outcome information related to nursing care in the electronic health records of four provinces
ldquoIn addition to providing real time information to nurses about how patients are benefiting from care the collection of nursing-related outcomes can provide valuable information to administrators in understanding how well their organisation is managing outcomesrdquo
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
USA Partnership of three organisations
American Nurses Association (NDNQI)California Nurses Association (CalNOC)Veterans Administration (VANOD)
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Search Results (nursing) Quality stroke care (outcome reduction in stroke
related mortality and disability) Percentage of women who have seen a midwife or
an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
Indicators proposed by Department of Health
Issues for us
Q1 How will these indicators demonstrate the contribution or quality of nursing care
Q2 How will we get the data
14
ldquoAt present individual health providers and institutionshelliplack the basic information of knowing the quality of care that they provided in daily practice Such data are not collected and there is thus no feedback in a systematic way to the individual physicians or nurseshelliprdquo
WHO 1997
Q1How will these indicators demonstrate the contribution or
quality of nursing care
Q2 How will we get the data
Specially collected data eg a form to be filled in for every fall or pressure ulcer
Secondary use of existing data Audit (manual extraction of data from
patient records) By data mining electronic patient
records
Nursing Core Standard Respect and dignityStandard Every patient has their privacy and dignity respected at all times
Element Environment Source Yes No Instruction
Patient privacy is maintained by the use of curtains and appropriate clothing
Ask patientObserve
Ask 6 patients All 6 must report compliance
Permission is obtained by staff before entering any private area ie curtains bathrooms side rooms
Ask patientObserve
Ask 6 patients All 6 must report compliance
Element Care
Dignity and modesty is maintained for those patients moving between care settings
Ask patientObserve
Ask 6 patients observe
Patients are called by their preferred name Ask patientAsk 6 patients observe
Do all the call bell systems workObserveAsk staff
Ask 3 staff All must be aware
Element Leadership
Do staff know how to contact the interpreting translation service
Ask staff Ask 3All must be aware
Do all staff adhere to the uniform policy ObserveLook for jewellery watches and hair length
Do staff treat patients with dignity and respect ObserveGeneral feel over time on ward
Nursing Quality Assessment Tool Royal Devon and Exeter NHS Foundation Trust
17
ldquoA major strategy for improving quality in healthcare must therefore
be to establish information systems at clinical level that give feedback to
individual providers on the outcomes of the care they give for their
patientsrdquo
WHO 1997
An alternative approach retrospective analysis of electronic
patient records
Where will you find details of patient falls
Incident reports (special forms completed by nurses)
Clinical audit of patientsrsquo (paper) recordsNursing documentation about the
individual patient
Nursing documentation should include
Assessment (including Morse tool)Nursing diagnosis (Risk for falls)Intervention focused on the nursing
diagnosis (actions taken to prevent falls)Outcome (fallno fall)
Retrospective analysis of electronic patient records
Clinical data can be aggregated to provide management and policy information (Information governance is essential)
Information for management and planning should be collected as a by-product of core operational processes
ldquoCollect once use many times for multiple purposesrdquo
But this can only happen ifhellip
The relevant data is recorded in the EPR (Nursing data as well as medical data)
And stored In such a way that the relevant items can be
found (ie structured)And expressed in standardised terminology to
enable comparison (analysed in such a way as to show patterns)
This is not yet happening in nursing but it is required for electronic patient records
Layer 4Aggregated data
(N) MDSnational
international
Management decisions
Clinical decisions
Structuralcharacteristicsservice items
etc
Standardised nursing
terminology
Policy decisions
Layer 3Aggregated data
NMDS (local)
Layer 2 Nursing interpretationsNursing diagnoses
Nursing interventionsNursing outcomes
Layer 1 Facts- Demographic data
- Observations signs and symptoms
The Nursing Information Reference Model - Epping and Goosen 1997
One way traffic Bottom up not top down
Nursing documentation
The only reason for putting data in (ie documenting anything) is so that someone can get it out
But you can only get out what someone has put in (so we need agreed minimum data sets)
And they have to be able to find it (so it has to be structured - no more unstructured narratives)
And they have to be able to understand it (so we need standardised terminology)
What are nurses in other countries doing ICN
BelgiumCanadaUSANorthern Nurses Federation (Denmark Sweden
Norway Finland Iceland)
AustraliaSloveniaAnd several others
We should learn from other countries instead of re-inventing the (square) wheel
ICN project The International Nursing Minimum Data Set (i-NMDS)
ldquoa minimum set of items of information with uniform definitions and categories concerning the specific dimension of nursingrdquo
Werley and Lang 1988
Essential nursing items includebull nursing diagnosis (nursing problem)bull nursing intervention (what the nurse did)bull nursing outcome (the result of the intervention)
Belgium Nursing Minimum Data Set
Compulsory since 1988All Belgian acute hospitalsContent
Patient demographics 23 nursing interventions (recently increased to 79) Nurse staffing data (FTE nurses qualification level)
Sample 15 days 3 months19 Million data items recorded since 1988Largest Nursing Dataset in the world
Canadian Nurses Association C-HOBIC project
(Canadian Health Outcomes for Better Information and Care)
Collection of patient outcome information related to nursing care in the electronic health records of four provinces
ldquoIn addition to providing real time information to nurses about how patients are benefiting from care the collection of nursing-related outcomes can provide valuable information to administrators in understanding how well their organisation is managing outcomesrdquo
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
USA Partnership of three organisations
American Nurses Association (NDNQI)California Nurses Association (CalNOC)Veterans Administration (VANOD)
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
Issues for us
Q1 How will these indicators demonstrate the contribution or quality of nursing care
Q2 How will we get the data
14
ldquoAt present individual health providers and institutionshelliplack the basic information of knowing the quality of care that they provided in daily practice Such data are not collected and there is thus no feedback in a systematic way to the individual physicians or nurseshelliprdquo
WHO 1997
Q1How will these indicators demonstrate the contribution or
quality of nursing care
Q2 How will we get the data
Specially collected data eg a form to be filled in for every fall or pressure ulcer
Secondary use of existing data Audit (manual extraction of data from
patient records) By data mining electronic patient
records
Nursing Core Standard Respect and dignityStandard Every patient has their privacy and dignity respected at all times
Element Environment Source Yes No Instruction
Patient privacy is maintained by the use of curtains and appropriate clothing
Ask patientObserve
Ask 6 patients All 6 must report compliance
Permission is obtained by staff before entering any private area ie curtains bathrooms side rooms
Ask patientObserve
Ask 6 patients All 6 must report compliance
Element Care
Dignity and modesty is maintained for those patients moving between care settings
Ask patientObserve
Ask 6 patients observe
Patients are called by their preferred name Ask patientAsk 6 patients observe
Do all the call bell systems workObserveAsk staff
Ask 3 staff All must be aware
Element Leadership
Do staff know how to contact the interpreting translation service
Ask staff Ask 3All must be aware
Do all staff adhere to the uniform policy ObserveLook for jewellery watches and hair length
Do staff treat patients with dignity and respect ObserveGeneral feel over time on ward
Nursing Quality Assessment Tool Royal Devon and Exeter NHS Foundation Trust
17
ldquoA major strategy for improving quality in healthcare must therefore
be to establish information systems at clinical level that give feedback to
individual providers on the outcomes of the care they give for their
patientsrdquo
WHO 1997
An alternative approach retrospective analysis of electronic
patient records
Where will you find details of patient falls
Incident reports (special forms completed by nurses)
Clinical audit of patientsrsquo (paper) recordsNursing documentation about the
individual patient
Nursing documentation should include
Assessment (including Morse tool)Nursing diagnosis (Risk for falls)Intervention focused on the nursing
diagnosis (actions taken to prevent falls)Outcome (fallno fall)
Retrospective analysis of electronic patient records
Clinical data can be aggregated to provide management and policy information (Information governance is essential)
Information for management and planning should be collected as a by-product of core operational processes
ldquoCollect once use many times for multiple purposesrdquo
But this can only happen ifhellip
The relevant data is recorded in the EPR (Nursing data as well as medical data)
And stored In such a way that the relevant items can be
found (ie structured)And expressed in standardised terminology to
enable comparison (analysed in such a way as to show patterns)
This is not yet happening in nursing but it is required for electronic patient records
Layer 4Aggregated data
(N) MDSnational
international
Management decisions
Clinical decisions
Structuralcharacteristicsservice items
etc
Standardised nursing
terminology
Policy decisions
Layer 3Aggregated data
NMDS (local)
Layer 2 Nursing interpretationsNursing diagnoses
Nursing interventionsNursing outcomes
Layer 1 Facts- Demographic data
- Observations signs and symptoms
The Nursing Information Reference Model - Epping and Goosen 1997
One way traffic Bottom up not top down
Nursing documentation
The only reason for putting data in (ie documenting anything) is so that someone can get it out
But you can only get out what someone has put in (so we need agreed minimum data sets)
And they have to be able to find it (so it has to be structured - no more unstructured narratives)
And they have to be able to understand it (so we need standardised terminology)
What are nurses in other countries doing ICN
BelgiumCanadaUSANorthern Nurses Federation (Denmark Sweden
Norway Finland Iceland)
AustraliaSloveniaAnd several others
We should learn from other countries instead of re-inventing the (square) wheel
ICN project The International Nursing Minimum Data Set (i-NMDS)
ldquoa minimum set of items of information with uniform definitions and categories concerning the specific dimension of nursingrdquo
Werley and Lang 1988
Essential nursing items includebull nursing diagnosis (nursing problem)bull nursing intervention (what the nurse did)bull nursing outcome (the result of the intervention)
Belgium Nursing Minimum Data Set
Compulsory since 1988All Belgian acute hospitalsContent
Patient demographics 23 nursing interventions (recently increased to 79) Nurse staffing data (FTE nurses qualification level)
Sample 15 days 3 months19 Million data items recorded since 1988Largest Nursing Dataset in the world
Canadian Nurses Association C-HOBIC project
(Canadian Health Outcomes for Better Information and Care)
Collection of patient outcome information related to nursing care in the electronic health records of four provinces
ldquoIn addition to providing real time information to nurses about how patients are benefiting from care the collection of nursing-related outcomes can provide valuable information to administrators in understanding how well their organisation is managing outcomesrdquo
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
USA Partnership of three organisations
American Nurses Association (NDNQI)California Nurses Association (CalNOC)Veterans Administration (VANOD)
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
14
ldquoAt present individual health providers and institutionshelliplack the basic information of knowing the quality of care that they provided in daily practice Such data are not collected and there is thus no feedback in a systematic way to the individual physicians or nurseshelliprdquo
WHO 1997
Q1How will these indicators demonstrate the contribution or
quality of nursing care
Q2 How will we get the data
Specially collected data eg a form to be filled in for every fall or pressure ulcer
Secondary use of existing data Audit (manual extraction of data from
patient records) By data mining electronic patient
records
Nursing Core Standard Respect and dignityStandard Every patient has their privacy and dignity respected at all times
Element Environment Source Yes No Instruction
Patient privacy is maintained by the use of curtains and appropriate clothing
Ask patientObserve
Ask 6 patients All 6 must report compliance
Permission is obtained by staff before entering any private area ie curtains bathrooms side rooms
Ask patientObserve
Ask 6 patients All 6 must report compliance
Element Care
Dignity and modesty is maintained for those patients moving between care settings
Ask patientObserve
Ask 6 patients observe
Patients are called by their preferred name Ask patientAsk 6 patients observe
Do all the call bell systems workObserveAsk staff
Ask 3 staff All must be aware
Element Leadership
Do staff know how to contact the interpreting translation service
Ask staff Ask 3All must be aware
Do all staff adhere to the uniform policy ObserveLook for jewellery watches and hair length
Do staff treat patients with dignity and respect ObserveGeneral feel over time on ward
Nursing Quality Assessment Tool Royal Devon and Exeter NHS Foundation Trust
17
ldquoA major strategy for improving quality in healthcare must therefore
be to establish information systems at clinical level that give feedback to
individual providers on the outcomes of the care they give for their
patientsrdquo
WHO 1997
An alternative approach retrospective analysis of electronic
patient records
Where will you find details of patient falls
Incident reports (special forms completed by nurses)
Clinical audit of patientsrsquo (paper) recordsNursing documentation about the
individual patient
Nursing documentation should include
Assessment (including Morse tool)Nursing diagnosis (Risk for falls)Intervention focused on the nursing
diagnosis (actions taken to prevent falls)Outcome (fallno fall)
Retrospective analysis of electronic patient records
Clinical data can be aggregated to provide management and policy information (Information governance is essential)
Information for management and planning should be collected as a by-product of core operational processes
ldquoCollect once use many times for multiple purposesrdquo
But this can only happen ifhellip
The relevant data is recorded in the EPR (Nursing data as well as medical data)
And stored In such a way that the relevant items can be
found (ie structured)And expressed in standardised terminology to
enable comparison (analysed in such a way as to show patterns)
This is not yet happening in nursing but it is required for electronic patient records
Layer 4Aggregated data
(N) MDSnational
international
Management decisions
Clinical decisions
Structuralcharacteristicsservice items
etc
Standardised nursing
terminology
Policy decisions
Layer 3Aggregated data
NMDS (local)
Layer 2 Nursing interpretationsNursing diagnoses
Nursing interventionsNursing outcomes
Layer 1 Facts- Demographic data
- Observations signs and symptoms
The Nursing Information Reference Model - Epping and Goosen 1997
One way traffic Bottom up not top down
Nursing documentation
The only reason for putting data in (ie documenting anything) is so that someone can get it out
But you can only get out what someone has put in (so we need agreed minimum data sets)
And they have to be able to find it (so it has to be structured - no more unstructured narratives)
And they have to be able to understand it (so we need standardised terminology)
What are nurses in other countries doing ICN
BelgiumCanadaUSANorthern Nurses Federation (Denmark Sweden
Norway Finland Iceland)
AustraliaSloveniaAnd several others
We should learn from other countries instead of re-inventing the (square) wheel
ICN project The International Nursing Minimum Data Set (i-NMDS)
ldquoa minimum set of items of information with uniform definitions and categories concerning the specific dimension of nursingrdquo
Werley and Lang 1988
Essential nursing items includebull nursing diagnosis (nursing problem)bull nursing intervention (what the nurse did)bull nursing outcome (the result of the intervention)
Belgium Nursing Minimum Data Set
Compulsory since 1988All Belgian acute hospitalsContent
Patient demographics 23 nursing interventions (recently increased to 79) Nurse staffing data (FTE nurses qualification level)
Sample 15 days 3 months19 Million data items recorded since 1988Largest Nursing Dataset in the world
Canadian Nurses Association C-HOBIC project
(Canadian Health Outcomes for Better Information and Care)
Collection of patient outcome information related to nursing care in the electronic health records of four provinces
ldquoIn addition to providing real time information to nurses about how patients are benefiting from care the collection of nursing-related outcomes can provide valuable information to administrators in understanding how well their organisation is managing outcomesrdquo
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
USA Partnership of three organisations
American Nurses Association (NDNQI)California Nurses Association (CalNOC)Veterans Administration (VANOD)
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
Q2 How will we get the data
Specially collected data eg a form to be filled in for every fall or pressure ulcer
Secondary use of existing data Audit (manual extraction of data from
patient records) By data mining electronic patient
records
Nursing Core Standard Respect and dignityStandard Every patient has their privacy and dignity respected at all times
Element Environment Source Yes No Instruction
Patient privacy is maintained by the use of curtains and appropriate clothing
Ask patientObserve
Ask 6 patients All 6 must report compliance
Permission is obtained by staff before entering any private area ie curtains bathrooms side rooms
Ask patientObserve
Ask 6 patients All 6 must report compliance
Element Care
Dignity and modesty is maintained for those patients moving between care settings
Ask patientObserve
Ask 6 patients observe
Patients are called by their preferred name Ask patientAsk 6 patients observe
Do all the call bell systems workObserveAsk staff
Ask 3 staff All must be aware
Element Leadership
Do staff know how to contact the interpreting translation service
Ask staff Ask 3All must be aware
Do all staff adhere to the uniform policy ObserveLook for jewellery watches and hair length
Do staff treat patients with dignity and respect ObserveGeneral feel over time on ward
Nursing Quality Assessment Tool Royal Devon and Exeter NHS Foundation Trust
17
ldquoA major strategy for improving quality in healthcare must therefore
be to establish information systems at clinical level that give feedback to
individual providers on the outcomes of the care they give for their
patientsrdquo
WHO 1997
An alternative approach retrospective analysis of electronic
patient records
Where will you find details of patient falls
Incident reports (special forms completed by nurses)
Clinical audit of patientsrsquo (paper) recordsNursing documentation about the
individual patient
Nursing documentation should include
Assessment (including Morse tool)Nursing diagnosis (Risk for falls)Intervention focused on the nursing
diagnosis (actions taken to prevent falls)Outcome (fallno fall)
Retrospective analysis of electronic patient records
Clinical data can be aggregated to provide management and policy information (Information governance is essential)
Information for management and planning should be collected as a by-product of core operational processes
ldquoCollect once use many times for multiple purposesrdquo
But this can only happen ifhellip
The relevant data is recorded in the EPR (Nursing data as well as medical data)
And stored In such a way that the relevant items can be
found (ie structured)And expressed in standardised terminology to
enable comparison (analysed in such a way as to show patterns)
This is not yet happening in nursing but it is required for electronic patient records
Layer 4Aggregated data
(N) MDSnational
international
Management decisions
Clinical decisions
Structuralcharacteristicsservice items
etc
Standardised nursing
terminology
Policy decisions
Layer 3Aggregated data
NMDS (local)
Layer 2 Nursing interpretationsNursing diagnoses
Nursing interventionsNursing outcomes
Layer 1 Facts- Demographic data
- Observations signs and symptoms
The Nursing Information Reference Model - Epping and Goosen 1997
One way traffic Bottom up not top down
Nursing documentation
The only reason for putting data in (ie documenting anything) is so that someone can get it out
But you can only get out what someone has put in (so we need agreed minimum data sets)
And they have to be able to find it (so it has to be structured - no more unstructured narratives)
And they have to be able to understand it (so we need standardised terminology)
What are nurses in other countries doing ICN
BelgiumCanadaUSANorthern Nurses Federation (Denmark Sweden
Norway Finland Iceland)
AustraliaSloveniaAnd several others
We should learn from other countries instead of re-inventing the (square) wheel
ICN project The International Nursing Minimum Data Set (i-NMDS)
ldquoa minimum set of items of information with uniform definitions and categories concerning the specific dimension of nursingrdquo
Werley and Lang 1988
Essential nursing items includebull nursing diagnosis (nursing problem)bull nursing intervention (what the nurse did)bull nursing outcome (the result of the intervention)
Belgium Nursing Minimum Data Set
Compulsory since 1988All Belgian acute hospitalsContent
Patient demographics 23 nursing interventions (recently increased to 79) Nurse staffing data (FTE nurses qualification level)
Sample 15 days 3 months19 Million data items recorded since 1988Largest Nursing Dataset in the world
Canadian Nurses Association C-HOBIC project
(Canadian Health Outcomes for Better Information and Care)
Collection of patient outcome information related to nursing care in the electronic health records of four provinces
ldquoIn addition to providing real time information to nurses about how patients are benefiting from care the collection of nursing-related outcomes can provide valuable information to administrators in understanding how well their organisation is managing outcomesrdquo
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
USA Partnership of three organisations
American Nurses Association (NDNQI)California Nurses Association (CalNOC)Veterans Administration (VANOD)
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
Nursing Core Standard Respect and dignityStandard Every patient has their privacy and dignity respected at all times
Element Environment Source Yes No Instruction
Patient privacy is maintained by the use of curtains and appropriate clothing
Ask patientObserve
Ask 6 patients All 6 must report compliance
Permission is obtained by staff before entering any private area ie curtains bathrooms side rooms
Ask patientObserve
Ask 6 patients All 6 must report compliance
Element Care
Dignity and modesty is maintained for those patients moving between care settings
Ask patientObserve
Ask 6 patients observe
Patients are called by their preferred name Ask patientAsk 6 patients observe
Do all the call bell systems workObserveAsk staff
Ask 3 staff All must be aware
Element Leadership
Do staff know how to contact the interpreting translation service
Ask staff Ask 3All must be aware
Do all staff adhere to the uniform policy ObserveLook for jewellery watches and hair length
Do staff treat patients with dignity and respect ObserveGeneral feel over time on ward
Nursing Quality Assessment Tool Royal Devon and Exeter NHS Foundation Trust
17
ldquoA major strategy for improving quality in healthcare must therefore
be to establish information systems at clinical level that give feedback to
individual providers on the outcomes of the care they give for their
patientsrdquo
WHO 1997
An alternative approach retrospective analysis of electronic
patient records
Where will you find details of patient falls
Incident reports (special forms completed by nurses)
Clinical audit of patientsrsquo (paper) recordsNursing documentation about the
individual patient
Nursing documentation should include
Assessment (including Morse tool)Nursing diagnosis (Risk for falls)Intervention focused on the nursing
diagnosis (actions taken to prevent falls)Outcome (fallno fall)
Retrospective analysis of electronic patient records
Clinical data can be aggregated to provide management and policy information (Information governance is essential)
Information for management and planning should be collected as a by-product of core operational processes
ldquoCollect once use many times for multiple purposesrdquo
But this can only happen ifhellip
The relevant data is recorded in the EPR (Nursing data as well as medical data)
And stored In such a way that the relevant items can be
found (ie structured)And expressed in standardised terminology to
enable comparison (analysed in such a way as to show patterns)
This is not yet happening in nursing but it is required for electronic patient records
Layer 4Aggregated data
(N) MDSnational
international
Management decisions
Clinical decisions
Structuralcharacteristicsservice items
etc
Standardised nursing
terminology
Policy decisions
Layer 3Aggregated data
NMDS (local)
Layer 2 Nursing interpretationsNursing diagnoses
Nursing interventionsNursing outcomes
Layer 1 Facts- Demographic data
- Observations signs and symptoms
The Nursing Information Reference Model - Epping and Goosen 1997
One way traffic Bottom up not top down
Nursing documentation
The only reason for putting data in (ie documenting anything) is so that someone can get it out
But you can only get out what someone has put in (so we need agreed minimum data sets)
And they have to be able to find it (so it has to be structured - no more unstructured narratives)
And they have to be able to understand it (so we need standardised terminology)
What are nurses in other countries doing ICN
BelgiumCanadaUSANorthern Nurses Federation (Denmark Sweden
Norway Finland Iceland)
AustraliaSloveniaAnd several others
We should learn from other countries instead of re-inventing the (square) wheel
ICN project The International Nursing Minimum Data Set (i-NMDS)
ldquoa minimum set of items of information with uniform definitions and categories concerning the specific dimension of nursingrdquo
Werley and Lang 1988
Essential nursing items includebull nursing diagnosis (nursing problem)bull nursing intervention (what the nurse did)bull nursing outcome (the result of the intervention)
Belgium Nursing Minimum Data Set
Compulsory since 1988All Belgian acute hospitalsContent
Patient demographics 23 nursing interventions (recently increased to 79) Nurse staffing data (FTE nurses qualification level)
Sample 15 days 3 months19 Million data items recorded since 1988Largest Nursing Dataset in the world
Canadian Nurses Association C-HOBIC project
(Canadian Health Outcomes for Better Information and Care)
Collection of patient outcome information related to nursing care in the electronic health records of four provinces
ldquoIn addition to providing real time information to nurses about how patients are benefiting from care the collection of nursing-related outcomes can provide valuable information to administrators in understanding how well their organisation is managing outcomesrdquo
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
USA Partnership of three organisations
American Nurses Association (NDNQI)California Nurses Association (CalNOC)Veterans Administration (VANOD)
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
17
ldquoA major strategy for improving quality in healthcare must therefore
be to establish information systems at clinical level that give feedback to
individual providers on the outcomes of the care they give for their
patientsrdquo
WHO 1997
An alternative approach retrospective analysis of electronic
patient records
Where will you find details of patient falls
Incident reports (special forms completed by nurses)
Clinical audit of patientsrsquo (paper) recordsNursing documentation about the
individual patient
Nursing documentation should include
Assessment (including Morse tool)Nursing diagnosis (Risk for falls)Intervention focused on the nursing
diagnosis (actions taken to prevent falls)Outcome (fallno fall)
Retrospective analysis of electronic patient records
Clinical data can be aggregated to provide management and policy information (Information governance is essential)
Information for management and planning should be collected as a by-product of core operational processes
ldquoCollect once use many times for multiple purposesrdquo
But this can only happen ifhellip
The relevant data is recorded in the EPR (Nursing data as well as medical data)
And stored In such a way that the relevant items can be
found (ie structured)And expressed in standardised terminology to
enable comparison (analysed in such a way as to show patterns)
This is not yet happening in nursing but it is required for electronic patient records
Layer 4Aggregated data
(N) MDSnational
international
Management decisions
Clinical decisions
Structuralcharacteristicsservice items
etc
Standardised nursing
terminology
Policy decisions
Layer 3Aggregated data
NMDS (local)
Layer 2 Nursing interpretationsNursing diagnoses
Nursing interventionsNursing outcomes
Layer 1 Facts- Demographic data
- Observations signs and symptoms
The Nursing Information Reference Model - Epping and Goosen 1997
One way traffic Bottom up not top down
Nursing documentation
The only reason for putting data in (ie documenting anything) is so that someone can get it out
But you can only get out what someone has put in (so we need agreed minimum data sets)
And they have to be able to find it (so it has to be structured - no more unstructured narratives)
And they have to be able to understand it (so we need standardised terminology)
What are nurses in other countries doing ICN
BelgiumCanadaUSANorthern Nurses Federation (Denmark Sweden
Norway Finland Iceland)
AustraliaSloveniaAnd several others
We should learn from other countries instead of re-inventing the (square) wheel
ICN project The International Nursing Minimum Data Set (i-NMDS)
ldquoa minimum set of items of information with uniform definitions and categories concerning the specific dimension of nursingrdquo
Werley and Lang 1988
Essential nursing items includebull nursing diagnosis (nursing problem)bull nursing intervention (what the nurse did)bull nursing outcome (the result of the intervention)
Belgium Nursing Minimum Data Set
Compulsory since 1988All Belgian acute hospitalsContent
Patient demographics 23 nursing interventions (recently increased to 79) Nurse staffing data (FTE nurses qualification level)
Sample 15 days 3 months19 Million data items recorded since 1988Largest Nursing Dataset in the world
Canadian Nurses Association C-HOBIC project
(Canadian Health Outcomes for Better Information and Care)
Collection of patient outcome information related to nursing care in the electronic health records of four provinces
ldquoIn addition to providing real time information to nurses about how patients are benefiting from care the collection of nursing-related outcomes can provide valuable information to administrators in understanding how well their organisation is managing outcomesrdquo
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
USA Partnership of three organisations
American Nurses Association (NDNQI)California Nurses Association (CalNOC)Veterans Administration (VANOD)
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
An alternative approach retrospective analysis of electronic
patient records
Where will you find details of patient falls
Incident reports (special forms completed by nurses)
Clinical audit of patientsrsquo (paper) recordsNursing documentation about the
individual patient
Nursing documentation should include
Assessment (including Morse tool)Nursing diagnosis (Risk for falls)Intervention focused on the nursing
diagnosis (actions taken to prevent falls)Outcome (fallno fall)
Retrospective analysis of electronic patient records
Clinical data can be aggregated to provide management and policy information (Information governance is essential)
Information for management and planning should be collected as a by-product of core operational processes
ldquoCollect once use many times for multiple purposesrdquo
But this can only happen ifhellip
The relevant data is recorded in the EPR (Nursing data as well as medical data)
And stored In such a way that the relevant items can be
found (ie structured)And expressed in standardised terminology to
enable comparison (analysed in such a way as to show patterns)
This is not yet happening in nursing but it is required for electronic patient records
Layer 4Aggregated data
(N) MDSnational
international
Management decisions
Clinical decisions
Structuralcharacteristicsservice items
etc
Standardised nursing
terminology
Policy decisions
Layer 3Aggregated data
NMDS (local)
Layer 2 Nursing interpretationsNursing diagnoses
Nursing interventionsNursing outcomes
Layer 1 Facts- Demographic data
- Observations signs and symptoms
The Nursing Information Reference Model - Epping and Goosen 1997
One way traffic Bottom up not top down
Nursing documentation
The only reason for putting data in (ie documenting anything) is so that someone can get it out
But you can only get out what someone has put in (so we need agreed minimum data sets)
And they have to be able to find it (so it has to be structured - no more unstructured narratives)
And they have to be able to understand it (so we need standardised terminology)
What are nurses in other countries doing ICN
BelgiumCanadaUSANorthern Nurses Federation (Denmark Sweden
Norway Finland Iceland)
AustraliaSloveniaAnd several others
We should learn from other countries instead of re-inventing the (square) wheel
ICN project The International Nursing Minimum Data Set (i-NMDS)
ldquoa minimum set of items of information with uniform definitions and categories concerning the specific dimension of nursingrdquo
Werley and Lang 1988
Essential nursing items includebull nursing diagnosis (nursing problem)bull nursing intervention (what the nurse did)bull nursing outcome (the result of the intervention)
Belgium Nursing Minimum Data Set
Compulsory since 1988All Belgian acute hospitalsContent
Patient demographics 23 nursing interventions (recently increased to 79) Nurse staffing data (FTE nurses qualification level)
Sample 15 days 3 months19 Million data items recorded since 1988Largest Nursing Dataset in the world
Canadian Nurses Association C-HOBIC project
(Canadian Health Outcomes for Better Information and Care)
Collection of patient outcome information related to nursing care in the electronic health records of four provinces
ldquoIn addition to providing real time information to nurses about how patients are benefiting from care the collection of nursing-related outcomes can provide valuable information to administrators in understanding how well their organisation is managing outcomesrdquo
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
USA Partnership of three organisations
American Nurses Association (NDNQI)California Nurses Association (CalNOC)Veterans Administration (VANOD)
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
Where will you find details of patient falls
Incident reports (special forms completed by nurses)
Clinical audit of patientsrsquo (paper) recordsNursing documentation about the
individual patient
Nursing documentation should include
Assessment (including Morse tool)Nursing diagnosis (Risk for falls)Intervention focused on the nursing
diagnosis (actions taken to prevent falls)Outcome (fallno fall)
Retrospective analysis of electronic patient records
Clinical data can be aggregated to provide management and policy information (Information governance is essential)
Information for management and planning should be collected as a by-product of core operational processes
ldquoCollect once use many times for multiple purposesrdquo
But this can only happen ifhellip
The relevant data is recorded in the EPR (Nursing data as well as medical data)
And stored In such a way that the relevant items can be
found (ie structured)And expressed in standardised terminology to
enable comparison (analysed in such a way as to show patterns)
This is not yet happening in nursing but it is required for electronic patient records
Layer 4Aggregated data
(N) MDSnational
international
Management decisions
Clinical decisions
Structuralcharacteristicsservice items
etc
Standardised nursing
terminology
Policy decisions
Layer 3Aggregated data
NMDS (local)
Layer 2 Nursing interpretationsNursing diagnoses
Nursing interventionsNursing outcomes
Layer 1 Facts- Demographic data
- Observations signs and symptoms
The Nursing Information Reference Model - Epping and Goosen 1997
One way traffic Bottom up not top down
Nursing documentation
The only reason for putting data in (ie documenting anything) is so that someone can get it out
But you can only get out what someone has put in (so we need agreed minimum data sets)
And they have to be able to find it (so it has to be structured - no more unstructured narratives)
And they have to be able to understand it (so we need standardised terminology)
What are nurses in other countries doing ICN
BelgiumCanadaUSANorthern Nurses Federation (Denmark Sweden
Norway Finland Iceland)
AustraliaSloveniaAnd several others
We should learn from other countries instead of re-inventing the (square) wheel
ICN project The International Nursing Minimum Data Set (i-NMDS)
ldquoa minimum set of items of information with uniform definitions and categories concerning the specific dimension of nursingrdquo
Werley and Lang 1988
Essential nursing items includebull nursing diagnosis (nursing problem)bull nursing intervention (what the nurse did)bull nursing outcome (the result of the intervention)
Belgium Nursing Minimum Data Set
Compulsory since 1988All Belgian acute hospitalsContent
Patient demographics 23 nursing interventions (recently increased to 79) Nurse staffing data (FTE nurses qualification level)
Sample 15 days 3 months19 Million data items recorded since 1988Largest Nursing Dataset in the world
Canadian Nurses Association C-HOBIC project
(Canadian Health Outcomes for Better Information and Care)
Collection of patient outcome information related to nursing care in the electronic health records of four provinces
ldquoIn addition to providing real time information to nurses about how patients are benefiting from care the collection of nursing-related outcomes can provide valuable information to administrators in understanding how well their organisation is managing outcomesrdquo
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
USA Partnership of three organisations
American Nurses Association (NDNQI)California Nurses Association (CalNOC)Veterans Administration (VANOD)
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
Nursing documentation should include
Assessment (including Morse tool)Nursing diagnosis (Risk for falls)Intervention focused on the nursing
diagnosis (actions taken to prevent falls)Outcome (fallno fall)
Retrospective analysis of electronic patient records
Clinical data can be aggregated to provide management and policy information (Information governance is essential)
Information for management and planning should be collected as a by-product of core operational processes
ldquoCollect once use many times for multiple purposesrdquo
But this can only happen ifhellip
The relevant data is recorded in the EPR (Nursing data as well as medical data)
And stored In such a way that the relevant items can be
found (ie structured)And expressed in standardised terminology to
enable comparison (analysed in such a way as to show patterns)
This is not yet happening in nursing but it is required for electronic patient records
Layer 4Aggregated data
(N) MDSnational
international
Management decisions
Clinical decisions
Structuralcharacteristicsservice items
etc
Standardised nursing
terminology
Policy decisions
Layer 3Aggregated data
NMDS (local)
Layer 2 Nursing interpretationsNursing diagnoses
Nursing interventionsNursing outcomes
Layer 1 Facts- Demographic data
- Observations signs and symptoms
The Nursing Information Reference Model - Epping and Goosen 1997
One way traffic Bottom up not top down
Nursing documentation
The only reason for putting data in (ie documenting anything) is so that someone can get it out
But you can only get out what someone has put in (so we need agreed minimum data sets)
And they have to be able to find it (so it has to be structured - no more unstructured narratives)
And they have to be able to understand it (so we need standardised terminology)
What are nurses in other countries doing ICN
BelgiumCanadaUSANorthern Nurses Federation (Denmark Sweden
Norway Finland Iceland)
AustraliaSloveniaAnd several others
We should learn from other countries instead of re-inventing the (square) wheel
ICN project The International Nursing Minimum Data Set (i-NMDS)
ldquoa minimum set of items of information with uniform definitions and categories concerning the specific dimension of nursingrdquo
Werley and Lang 1988
Essential nursing items includebull nursing diagnosis (nursing problem)bull nursing intervention (what the nurse did)bull nursing outcome (the result of the intervention)
Belgium Nursing Minimum Data Set
Compulsory since 1988All Belgian acute hospitalsContent
Patient demographics 23 nursing interventions (recently increased to 79) Nurse staffing data (FTE nurses qualification level)
Sample 15 days 3 months19 Million data items recorded since 1988Largest Nursing Dataset in the world
Canadian Nurses Association C-HOBIC project
(Canadian Health Outcomes for Better Information and Care)
Collection of patient outcome information related to nursing care in the electronic health records of four provinces
ldquoIn addition to providing real time information to nurses about how patients are benefiting from care the collection of nursing-related outcomes can provide valuable information to administrators in understanding how well their organisation is managing outcomesrdquo
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
USA Partnership of three organisations
American Nurses Association (NDNQI)California Nurses Association (CalNOC)Veterans Administration (VANOD)
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
Retrospective analysis of electronic patient records
Clinical data can be aggregated to provide management and policy information (Information governance is essential)
Information for management and planning should be collected as a by-product of core operational processes
ldquoCollect once use many times for multiple purposesrdquo
But this can only happen ifhellip
The relevant data is recorded in the EPR (Nursing data as well as medical data)
And stored In such a way that the relevant items can be
found (ie structured)And expressed in standardised terminology to
enable comparison (analysed in such a way as to show patterns)
This is not yet happening in nursing but it is required for electronic patient records
Layer 4Aggregated data
(N) MDSnational
international
Management decisions
Clinical decisions
Structuralcharacteristicsservice items
etc
Standardised nursing
terminology
Policy decisions
Layer 3Aggregated data
NMDS (local)
Layer 2 Nursing interpretationsNursing diagnoses
Nursing interventionsNursing outcomes
Layer 1 Facts- Demographic data
- Observations signs and symptoms
The Nursing Information Reference Model - Epping and Goosen 1997
One way traffic Bottom up not top down
Nursing documentation
The only reason for putting data in (ie documenting anything) is so that someone can get it out
But you can only get out what someone has put in (so we need agreed minimum data sets)
And they have to be able to find it (so it has to be structured - no more unstructured narratives)
And they have to be able to understand it (so we need standardised terminology)
What are nurses in other countries doing ICN
BelgiumCanadaUSANorthern Nurses Federation (Denmark Sweden
Norway Finland Iceland)
AustraliaSloveniaAnd several others
We should learn from other countries instead of re-inventing the (square) wheel
ICN project The International Nursing Minimum Data Set (i-NMDS)
ldquoa minimum set of items of information with uniform definitions and categories concerning the specific dimension of nursingrdquo
Werley and Lang 1988
Essential nursing items includebull nursing diagnosis (nursing problem)bull nursing intervention (what the nurse did)bull nursing outcome (the result of the intervention)
Belgium Nursing Minimum Data Set
Compulsory since 1988All Belgian acute hospitalsContent
Patient demographics 23 nursing interventions (recently increased to 79) Nurse staffing data (FTE nurses qualification level)
Sample 15 days 3 months19 Million data items recorded since 1988Largest Nursing Dataset in the world
Canadian Nurses Association C-HOBIC project
(Canadian Health Outcomes for Better Information and Care)
Collection of patient outcome information related to nursing care in the electronic health records of four provinces
ldquoIn addition to providing real time information to nurses about how patients are benefiting from care the collection of nursing-related outcomes can provide valuable information to administrators in understanding how well their organisation is managing outcomesrdquo
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
USA Partnership of three organisations
American Nurses Association (NDNQI)California Nurses Association (CalNOC)Veterans Administration (VANOD)
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
But this can only happen ifhellip
The relevant data is recorded in the EPR (Nursing data as well as medical data)
And stored In such a way that the relevant items can be
found (ie structured)And expressed in standardised terminology to
enable comparison (analysed in such a way as to show patterns)
This is not yet happening in nursing but it is required for electronic patient records
Layer 4Aggregated data
(N) MDSnational
international
Management decisions
Clinical decisions
Structuralcharacteristicsservice items
etc
Standardised nursing
terminology
Policy decisions
Layer 3Aggregated data
NMDS (local)
Layer 2 Nursing interpretationsNursing diagnoses
Nursing interventionsNursing outcomes
Layer 1 Facts- Demographic data
- Observations signs and symptoms
The Nursing Information Reference Model - Epping and Goosen 1997
One way traffic Bottom up not top down
Nursing documentation
The only reason for putting data in (ie documenting anything) is so that someone can get it out
But you can only get out what someone has put in (so we need agreed minimum data sets)
And they have to be able to find it (so it has to be structured - no more unstructured narratives)
And they have to be able to understand it (so we need standardised terminology)
What are nurses in other countries doing ICN
BelgiumCanadaUSANorthern Nurses Federation (Denmark Sweden
Norway Finland Iceland)
AustraliaSloveniaAnd several others
We should learn from other countries instead of re-inventing the (square) wheel
ICN project The International Nursing Minimum Data Set (i-NMDS)
ldquoa minimum set of items of information with uniform definitions and categories concerning the specific dimension of nursingrdquo
Werley and Lang 1988
Essential nursing items includebull nursing diagnosis (nursing problem)bull nursing intervention (what the nurse did)bull nursing outcome (the result of the intervention)
Belgium Nursing Minimum Data Set
Compulsory since 1988All Belgian acute hospitalsContent
Patient demographics 23 nursing interventions (recently increased to 79) Nurse staffing data (FTE nurses qualification level)
Sample 15 days 3 months19 Million data items recorded since 1988Largest Nursing Dataset in the world
Canadian Nurses Association C-HOBIC project
(Canadian Health Outcomes for Better Information and Care)
Collection of patient outcome information related to nursing care in the electronic health records of four provinces
ldquoIn addition to providing real time information to nurses about how patients are benefiting from care the collection of nursing-related outcomes can provide valuable information to administrators in understanding how well their organisation is managing outcomesrdquo
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
USA Partnership of three organisations
American Nurses Association (NDNQI)California Nurses Association (CalNOC)Veterans Administration (VANOD)
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
Layer 4Aggregated data
(N) MDSnational
international
Management decisions
Clinical decisions
Structuralcharacteristicsservice items
etc
Standardised nursing
terminology
Policy decisions
Layer 3Aggregated data
NMDS (local)
Layer 2 Nursing interpretationsNursing diagnoses
Nursing interventionsNursing outcomes
Layer 1 Facts- Demographic data
- Observations signs and symptoms
The Nursing Information Reference Model - Epping and Goosen 1997
One way traffic Bottom up not top down
Nursing documentation
The only reason for putting data in (ie documenting anything) is so that someone can get it out
But you can only get out what someone has put in (so we need agreed minimum data sets)
And they have to be able to find it (so it has to be structured - no more unstructured narratives)
And they have to be able to understand it (so we need standardised terminology)
What are nurses in other countries doing ICN
BelgiumCanadaUSANorthern Nurses Federation (Denmark Sweden
Norway Finland Iceland)
AustraliaSloveniaAnd several others
We should learn from other countries instead of re-inventing the (square) wheel
ICN project The International Nursing Minimum Data Set (i-NMDS)
ldquoa minimum set of items of information with uniform definitions and categories concerning the specific dimension of nursingrdquo
Werley and Lang 1988
Essential nursing items includebull nursing diagnosis (nursing problem)bull nursing intervention (what the nurse did)bull nursing outcome (the result of the intervention)
Belgium Nursing Minimum Data Set
Compulsory since 1988All Belgian acute hospitalsContent
Patient demographics 23 nursing interventions (recently increased to 79) Nurse staffing data (FTE nurses qualification level)
Sample 15 days 3 months19 Million data items recorded since 1988Largest Nursing Dataset in the world
Canadian Nurses Association C-HOBIC project
(Canadian Health Outcomes for Better Information and Care)
Collection of patient outcome information related to nursing care in the electronic health records of four provinces
ldquoIn addition to providing real time information to nurses about how patients are benefiting from care the collection of nursing-related outcomes can provide valuable information to administrators in understanding how well their organisation is managing outcomesrdquo
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
USA Partnership of three organisations
American Nurses Association (NDNQI)California Nurses Association (CalNOC)Veterans Administration (VANOD)
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
Nursing documentation
The only reason for putting data in (ie documenting anything) is so that someone can get it out
But you can only get out what someone has put in (so we need agreed minimum data sets)
And they have to be able to find it (so it has to be structured - no more unstructured narratives)
And they have to be able to understand it (so we need standardised terminology)
What are nurses in other countries doing ICN
BelgiumCanadaUSANorthern Nurses Federation (Denmark Sweden
Norway Finland Iceland)
AustraliaSloveniaAnd several others
We should learn from other countries instead of re-inventing the (square) wheel
ICN project The International Nursing Minimum Data Set (i-NMDS)
ldquoa minimum set of items of information with uniform definitions and categories concerning the specific dimension of nursingrdquo
Werley and Lang 1988
Essential nursing items includebull nursing diagnosis (nursing problem)bull nursing intervention (what the nurse did)bull nursing outcome (the result of the intervention)
Belgium Nursing Minimum Data Set
Compulsory since 1988All Belgian acute hospitalsContent
Patient demographics 23 nursing interventions (recently increased to 79) Nurse staffing data (FTE nurses qualification level)
Sample 15 days 3 months19 Million data items recorded since 1988Largest Nursing Dataset in the world
Canadian Nurses Association C-HOBIC project
(Canadian Health Outcomes for Better Information and Care)
Collection of patient outcome information related to nursing care in the electronic health records of four provinces
ldquoIn addition to providing real time information to nurses about how patients are benefiting from care the collection of nursing-related outcomes can provide valuable information to administrators in understanding how well their organisation is managing outcomesrdquo
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
USA Partnership of three organisations
American Nurses Association (NDNQI)California Nurses Association (CalNOC)Veterans Administration (VANOD)
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
What are nurses in other countries doing ICN
BelgiumCanadaUSANorthern Nurses Federation (Denmark Sweden
Norway Finland Iceland)
AustraliaSloveniaAnd several others
We should learn from other countries instead of re-inventing the (square) wheel
ICN project The International Nursing Minimum Data Set (i-NMDS)
ldquoa minimum set of items of information with uniform definitions and categories concerning the specific dimension of nursingrdquo
Werley and Lang 1988
Essential nursing items includebull nursing diagnosis (nursing problem)bull nursing intervention (what the nurse did)bull nursing outcome (the result of the intervention)
Belgium Nursing Minimum Data Set
Compulsory since 1988All Belgian acute hospitalsContent
Patient demographics 23 nursing interventions (recently increased to 79) Nurse staffing data (FTE nurses qualification level)
Sample 15 days 3 months19 Million data items recorded since 1988Largest Nursing Dataset in the world
Canadian Nurses Association C-HOBIC project
(Canadian Health Outcomes for Better Information and Care)
Collection of patient outcome information related to nursing care in the electronic health records of four provinces
ldquoIn addition to providing real time information to nurses about how patients are benefiting from care the collection of nursing-related outcomes can provide valuable information to administrators in understanding how well their organisation is managing outcomesrdquo
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
USA Partnership of three organisations
American Nurses Association (NDNQI)California Nurses Association (CalNOC)Veterans Administration (VANOD)
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
ICN project The International Nursing Minimum Data Set (i-NMDS)
ldquoa minimum set of items of information with uniform definitions and categories concerning the specific dimension of nursingrdquo
Werley and Lang 1988
Essential nursing items includebull nursing diagnosis (nursing problem)bull nursing intervention (what the nurse did)bull nursing outcome (the result of the intervention)
Belgium Nursing Minimum Data Set
Compulsory since 1988All Belgian acute hospitalsContent
Patient demographics 23 nursing interventions (recently increased to 79) Nurse staffing data (FTE nurses qualification level)
Sample 15 days 3 months19 Million data items recorded since 1988Largest Nursing Dataset in the world
Canadian Nurses Association C-HOBIC project
(Canadian Health Outcomes for Better Information and Care)
Collection of patient outcome information related to nursing care in the electronic health records of four provinces
ldquoIn addition to providing real time information to nurses about how patients are benefiting from care the collection of nursing-related outcomes can provide valuable information to administrators in understanding how well their organisation is managing outcomesrdquo
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
USA Partnership of three organisations
American Nurses Association (NDNQI)California Nurses Association (CalNOC)Veterans Administration (VANOD)
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
Belgium Nursing Minimum Data Set
Compulsory since 1988All Belgian acute hospitalsContent
Patient demographics 23 nursing interventions (recently increased to 79) Nurse staffing data (FTE nurses qualification level)
Sample 15 days 3 months19 Million data items recorded since 1988Largest Nursing Dataset in the world
Canadian Nurses Association C-HOBIC project
(Canadian Health Outcomes for Better Information and Care)
Collection of patient outcome information related to nursing care in the electronic health records of four provinces
ldquoIn addition to providing real time information to nurses about how patients are benefiting from care the collection of nursing-related outcomes can provide valuable information to administrators in understanding how well their organisation is managing outcomesrdquo
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
USA Partnership of three organisations
American Nurses Association (NDNQI)California Nurses Association (CalNOC)Veterans Administration (VANOD)
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
Canadian Nurses Association C-HOBIC project
(Canadian Health Outcomes for Better Information and Care)
Collection of patient outcome information related to nursing care in the electronic health records of four provinces
ldquoIn addition to providing real time information to nurses about how patients are benefiting from care the collection of nursing-related outcomes can provide valuable information to administrators in understanding how well their organisation is managing outcomesrdquo
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
USA Partnership of three organisations
American Nurses Association (NDNQI)California Nurses Association (CalNOC)Veterans Administration (VANOD)
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
USA Partnership of three organisations
American Nurses Association (NDNQI)California Nurses Association (CalNOC)Veterans Administration (VANOD)
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
USA Partnership of three organisations
American Nurses Association (NDNQI)California Nurses Association (CalNOC)Veterans Administration (VANOD)
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
American Nurses Association (ANA)
ANA began work on nursing quality and standards in the early 1970s The RCN used this work to develop DySSI
ANA has worked on standardised nursing terminology and clinical information systems since the 1980s
In 1994 the American Nurses Association (ANA) launched the Safety amp Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes The Nursing Care Report Card for Acute Care (ANA 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings In 1997 ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators From 1997 - 2000 a series of pilot studies were funded by ANA to test selected indicators definitions data collection methodology and instrument development
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
NDNQI (National Database of Nursing Quality Indicators)
The National Database of Nursing Quality Indicators (NDNQI) is a system developed by ANA to enable hospitals to collect and evaluate nursing-sensitive indicators
All indicator data are collected and reported at the nursing unit level
NDNQIrsquos nursing-sensitive indicators reflect the structure process and outcomes of nursing care
Currently NDNQI has over 1200 participating US hospitals that are actively aided in improving patient safety and quality of patient care by using NDNQI comparative data
NDNQIrsquos mission is to aid the nursing provider in patient safety and quality
improvement efforts by providing research-based national comparative data on nursing care and the relationship to patient outcomes
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
CalNOC (Collaborative Alliance for Nursing Outcomes)
CALNOC is a collaborative Project of ANA California the Association of California Nurse Leaders and the CALNOC Steering Committee Its mission is to advance improvements in patient care by Building amp sustaining a valid and reliable
statewide outcomes database Conducting research to advance evidence-
based interventions to achieve quality Synthesizing amp disseminating data to shape
public policy practice amp education
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
Data Into Files
Skin Risk Braden ScalePressure UlcersClinical Observations
Veterans AdministrationVANOD
EMR
Point amp Click
Patient Assessment
Template
Creates Progress Note
in EMR
Individual Clinical Reminders
Creates Population
Reportseg list of all
Pts in hosp withPressure Ulcers
Patient Care
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
Northern Nurses FederationldquoThe Northern Nurses Federation (NNFSSN)
has met the challenge of the ICNs Congress in Durban South Africa in JuneJuly of 2009 (wwwicnchcongress2009) and submitted a proposal for a symposium that now has been accepted The symposium will be on nursing-sensitive quality indicators at the Nordic level based on international and national research The focus of the presentations will be the Nordic experience and how it has inspired solutions relevant to public health and the promotion of the nursing profession ldquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
England (Department of Health)
NHS quality indicators go live
ldquoA set of national quality indicators that can be used to measure the performance of NHS nurses has been published by the governmentThe Department of Health has revealed a list of over 200 indicators or ldquometricsrdquorsquo that are intended to measure the performance of clinical teams ndash the development of which was first outlined in the NHS Next Stage ReviewThe government has whittled its list of 232 down from more than 400 possible indicators suggested in a consultation document launched in November The final metrics fall into in three main categories ndash patient experience safety effectivenesshelliprdquo
Nursing Times 19 May 2009
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
England (Department of Health)
Search Results (nursing) Quality stroke care (outcome reduction in
stroke related mortality and disability) Percentage of women who have seen a
midwife or an obstetrician for health and social care assessment of needs and risks by 12 weeks of their pregnancy
Pressure ulcer incidence per 10000 patients
ldquoFinding the indicators is easy You can search common terms in the box below or click through the tree structurerdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
Scotland (NHS Scotland)
Aim of the Project Develop a core set of Clinical Quality Indicators (CQIs) for Nursing and Midwifery
developed and agreed in collaboration with NHSScotland and NHSQIS Clinical Quality Indicators integrated into national clinical data sets to assess and support the delivery of safe and effective nursing and midwifery practice
What does the project aim to achieve The objectives of the project are Build on The Impact of Nursing on Patient Clinical Outcomes working to develop a
robust and interpretable metric of indicators demonstrating the nursing contribution to care that is safe effective efficient patient-centred timely and equitable
Develop electronic data capture and analysis systems to enable monitoring of CQIs in NHS Board areas for the purpose of informing continuous quality improvement and performance management
Utilise the agreed indicator set in the pilot phase of the Senior Charge NurseWard Sister Review
Achieve sustainability by ensuring existing and newly qualified nurses and midwives are suitably prepared and supported to take forward project outcomes
Develop a model to ensure continuous review and development of the CQIs considering the development of Centres of Responsibility as set out in Recommendation 4 of The Impact of Nursing on Patient Clinical Outcomes
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
Scotland (NHS Scotland)
Four initial clinical quality indicators have been developed which are supported by a national electronic quality improvement programme This is linked into the patient safety alliance work which you may have heard about The first indicators are
pressure ulcer prevention falls prevention food fluid and nutrition and monitoring and observation
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
UK RCN Keyword searchSearch results
Your search for nursing metrics in title description and keywords returned 2 results
You are on page 1 of 1 Nurses to lead the campaign to drive up quality in the NHS Commenting on the release of the Kingrsquos College London reports
Nurses in Society Starting the Debate and State of the Art Metrics for Nursing A Rapid Appraisal Dr Peter Carter Chief Executive amp General Secretary of the Royal College of Nursing (RCN) today said
Location News Events Campaigns Press releases uk wide
Published 15 Oct 2008 State of the art metrics for nursing a rapid appraisal Format PDF Published 13 Nov 2008 You are on page 1 of 1
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
UK RCNKeyword searchSearch resultsYour search for nursing quality indicators in title description and keywords returned
2 results You are on page 1 of 1 Senior Charge nurse review and clinical quality indicators projectsDelivering Care Enabling Health is the current Scottish strategy for nursing
midwifery and allied health professions published in 2006Location News Events Campaigns News article Scotland
Published 28 Mar 2008Standards for assessing measuring and monitoring vital signs in infants children and
young peopleFormat PDFThe assessment measurement and monitoring of vital signs are important skills for all
practitioners working with infants children and young people The vital signs covered in this publication include temperature heartpulse rate respiratory rate and effort and blood pressure Important information gained by assessing and measuring vital signs can be indicators of health and ill health
These standards provide criteria for practitioners in achieving high quality nursing care They will be of help in guiding local policies and procedures in relation to vital sign monitoring performance improvement programmes and education programmes for registered nurses nurses in training and health care assistants
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
UK RCN
Location Home Keyword searchSearch resultsYour search for policy nursing metrics in title
description and keywords returned 0 results
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
RCN eHealth Policy documents launchedLocation NewsEventsCampaignsnews articlesUK-wide Published 28 Jul 2008
RCN e-Health Programme Policy Statement
Nursing content of electronic patient client records
Published June 2008 Review date June 2009
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
If you search really hardhelliphellipSearch resultsYour search for measuring quality returned 2 results You are on page 1 of 1 Measuring for quality in health and social care An RCN position
statementFormat PDFThis information sets out the RCNrsquos position in relation to quality and its
measurement and outlines the RCNrsquos input on this issue Designed to be of value to those for whom quality and its measurement is integral to their day-to-day work it will also assist the wider health and social community to understand the contribution that nursing makes in this arena
Published 08 May 2009
Standards for assessing measuring and monitoring vital signs in infants children and young people
Format PDF
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
Measuring for quality in health and social care An RCN position statement Publication no 003 535
The RCNrsquos role and contribution in relation to measurement of quality The RCN has a major role in role to play in relation to quality and standards The main priorities identified by the RCN for indicator and metrics development are
summarised below 1048766 indicators for high riskhigh cost topics particularly pressure ulcers failure to rescue further work on falls and other front runners identified by Griffith et al(2008)
1048766 indicators for essence of care 1048766 patient reported outcomes such as patient experience and perception of patient
involvement which will provide fruitful measures for providing feedback on person-centred care
1048766 indicators for systems of care (for example continuity of care teamwork and also staffing levels) with links to patient satisfaction
In relation to measuring quality the RCN has three key purposes 1048766 engaging and informing members profession and public 1048766 representing nursing 1048766 developing the evidence base
A response to the DH (England) proposals on metrics has been submitted by the RCN setting out its position in relation to the contribution of nursing and its principles around quality and measurement
The RCN is currently moving towards establishing a quality and standards unit
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
So what do we have to do
Abandon our isolationism and learn from the rest of the nursing world
Invest massively in education to restructure the way we teach and use the nursing process
Invest massively in education to restructure our nursing documentation
Ensure appropriate nursing content in EHRs
Copy the Canadians
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
Objectives of C-HOBIC project
Standardise assessment and documentation of patient outcomes into EHRs by nurses
Foster uptake of EHRs by nursesProvide EHR content that is of use in nursing
practiceDevelop consistent methodology that will contribute
to provincial patient outcomes dataStandardise the language used by C-HOBIC to ICNPCapture and store patient outcomes data related to
patient care across four sectors (acute complex care long term care and home care) of the health system
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
As Dr Simon Jones (Senior Research Fellow at National nursing Research Unit Kings
College London) said at a recent conferencehellip
ldquoIf you donrsquot drive the development of metrics for your profession someone else will and they wonrsquot have your insightrdquo
