Improving Safety & Quality in Staffing & Communication Kelli Benson, BSN, RN, RNC-MNN Nursing sensitive indicators Nursing care hours per patient day Voluntary turnover Hospital National Patient Safety Goals Improve staff communication

Nursing Care Hours Per Patient Day (NHPPD) RN care hours Nursing staff hours Productive hours/ inpatient days Number of nursing hours available per admitted patient National Quality Forum (NQF),2004

NHPPD Increased NHPPD Get involved S 864 HR 1602 Improved patient quality & outcomes Nurse satisfaction Cost effective Get involved S 864 National Nursing Shortage Reform and Patient Advocacy Act HR 1602 Nurse Staffing Standards for Patient Safety and Quality Care Act Mensik, 2014 National Nurses United, 2015 Twigg, Duffield, Bremmer, Rapley, & Finn, 2011 Twigg , Geelhoed, Bremmer, & Duffield, 2013

Voluntary Turnover Uncontrolled separations Exclusions Number of voluntary separations /Number of employees on last day of month Exclusions Death, illness, pregnancy, relocation, retirement, performance or discipline, cutbacks, layoffs, per diem, consultants, temporary, agency, non-salaried, students NQF,2004

Voluntary Turnover Overworked (inadequate staffing & resources) Reasons for turnover Impact of turnover Overworked (inadequate staffing & resources) No opportunities No recognition Lack of role clarity Lack of collaboration/team support Poor communication with management Decreased patient care quality Decreased patient satisfaction Increased staff cost Increased additional turnover of medical/nursing staff Increased accidents Increased absenteeism Bae, Kelly, Brewer, & Spencer,2014 Hayes, et al., 2012;Hunt, 2009

Voluntary Turnover Cost of turnover Rate of turnover Retention $10,000-$88,000 (to replace one RN) Rate of turnover 50% for RNs 27% for new grads 51.5% for CNAs Retention American Health Care Association, 2012 Hayes et al., 2012 Kovner, Brewer, Fatehi, & Jun,2014 Krsek, 2011

Improve Staff Communication Improve effectiveness of communication Report critical results Within established time frame To the responsible licensed caregiver Eliminate treatment delays Elements of performance Develop written procedures Implement procedures Evaluate timeliness of reporting TJC, 2015

Improve Staff Communication 20-62% of inpatient tests with no follow-up Critical lab values related to adverse effects Bleeding, prolonged hospital stay, cerebrovascular accident, cardiac injury, death Role of nursing Help develop new policies Educate Research Braun, 2012 Goldstein, Prosser, & Travis, 2013 University of North Carolina, 2013

References American Health Care Association. (2012). American health care association 2012 staffing report. Retrieved from http://www.ahcancal.org/research_data/staffing/Documents/2012_Staffing_Report.pdf Bae, S., Kelly, M., Brewer, C., & Spencer, A. (2014). Analysis of nurse staffing and patient outcomes using comprehensive nurse staffing characteristics in acute care nursing units. Journal of Nursing Care Quality, 29(4), 318-326. doi: 10.1097/NCQ.0000000000000057 Braun, B. (2012). Evaluating and improving the handoff process. Journal of Emergency Nursing, 38(2), 151-155. doi: 10.1016/j.jen.2010.06.015 Goldstein, R., Prosser, D., & Travis, L. (2013). Analysis of critical laboratory value nurse-to-physician follow-up calls at a community hospital. Journal of Nursing Care Quality, 28(4), 335-339. doi: 10.1097/NCQ.0b013e31829229ff Hayes, L., O’Brien-Pallas, L, Duffield, C., Shamian, J., Buchan, J., Hughes, F.,... & North, N. (2012). Nurse turnover: A literature review-an update. International Journal of Nursing Studies, 49(7), 887-905. doi: 10.1016/j.ijnurstu.2011.10.001 Hunt, S. (2009). Nursing turnover: Costs, causes, & solutions. Retrieved from http://www.nmlegis.gov/lcs/handouts/LHHS%20081312%20NursingTurnover.pdf Kovner, C., Brewer, C., Fatehi, F., & Jun, J. (2014). What does nurse turnover rate mean and what is the rate? Policy, Politics, & Nursing Practice, 15(3-4), 64-71. doi: 10.1177/1527154414547953 Krsek, C. (2011). Investing in nursing retention is a smart move in today’s economy. American Nurse Today, 6(4), online. Retrieved from http://www.americannursetoday.com/investing-in-nursing-retention-is-a-smart-move-in-todays-economy/

References Mensik, J. (2014). What every nurse should know about staffing. American Nurse Today, 9(2), online. Retrieved from http://www.americannursetoday.com/what-every-nurse-should-know-about-staffing/ National Nurses United. (2015). National campaign for safe RN-to-patient staffing ratios. Retrieved from http://www.nationalnursesunited.org/issues/entry/ratios/ National Quality Forum [NQF]. (2004). National voluntary consensus standards for nursing-sensitive care: An initial performance measure set. Retrieved from http://www.qualityforum.org/Publications/2004/10/National_Voluntary_Consensus_Standards_for_Nursing-Sensitive_Care__An_Initial_Performance_Measure_Set.aspx The Joint Commission [TJC]. (2015). National patient safety goals effective January 1, 2015. Retrieved from http://www.jointcommission.org/assets/1/6/2015_NPSG_HAP.pdf Twigg, D., Duffield, C., Bremner, A., Rapley, P., & Finn, J. (2011). The impact of the nursing hours per patient day (NHPPD) staffing method on patient outcomes: A retrospective analysis of patient and staffing data. International Journal of Nursing Studies, 48(5), 540-548. doi: 10.1016/j.ijnurstu.2010.07.013 Twigg, D., Geelhoed, E., Bremner, A., & Duffield, C. (2013). The economic benefits of increased levels of nursing care in the hospital setting. Journal of Advanced Nursing, 69(10), 2253-2261. doi: 10.1111/jan.12109 University of North Carolina. (2013). Policy on: Communications: Critical imaging findings. Retrieved from https://www.med.unc.edu/radiology/files-a/protocols/Critical%20Image%20Findings%20Call%20Back%20Protocol.pdf