Brandi Miller, BS, RN, PCCN Kimber Sprik, BSN, RN, AE-C Yvonne Jackson, BSN, RN, CCRN Mariah Lab, BS, RN Kelli Benson, BSN, RN, RNC-MNN Nursing-Sensitive Indicators & the Hospital National Patient Safety Goals Ferris State University NURS 541 Quality Improvement and Safety Colley, 2015

Objectives Explore nursing-sensitive indicators (NSIs) Analyze performance data and nursing research relating to select NSIs Discuss the Hospital National Patient Safety Goals (NPSGs) Examine evidence supporting the effectiveness of NPSGs Colley, 2015

Nursing-Sensitive Indicators NSIs reflect the quality and quantity of nursing care Classified using the structure/process/outcome framework Measures must be reliable and valid Risk adjusted based on patient population Several national sets of NSIs Focus on the National Voluntary Consensus Standards for Nursing-Sensitive Care Sherwood & Barnsteiner, 2012

Overview of Safety Initiative The Joint Commission’s 2015 Hospital National Patient Safety Goals Expert panel develops goals with input from many groups NPSGs apply to several service areas Seven goals apply to hospitals The Joint Commission (TJC), 2015a & 2015b

Improving Safety & Quality in Surgical Care Brandi Miller, BS, RN, PCCN Nursing-sensitive indicators Restraint prevalence Death among surgical inpatients with treatable, serious complications (failure to rescue) Hospital National Patient Safety Goals Prevent mistakes in surgery TJC, 2015c

Restraint Prevalence Included in: National Voluntary Consensus Standards for Nursing-Sensitive Care National Database of Nursing Quality Indicators Restraints associated with increased injuries Definition and calculation of measure: Nursing care is key to reducing restraint use Restraint prevalence = Number of patients in vest and/or limb restraints Total number of patients surveyed American Nurses Association (ANA), 2012 & 2015 National Quality Forum (NQF), 2004 & 2015b TJC, 2009

Restraint Prevalence Nursing initiative decreases restraint use in a multi-hospital health system “Compare” websites Medicare, n.d.c Cosper, Morelock, & Provine, 2015 Restraint usage not dependent on quantity of nursing care Healthy work environment promotes higher quality nursing care and lower restraint prevalence Heeren et al., 2014 Hallman, O’Connor, Hasenou, & Brady, 2014

Failure to Rescue Included in National Voluntary Consensus Standards for Nursing-Sensitive Care Definition: Denominator: Total surgical discharges that have a treatable complication Numerator: Number of deaths among cases meeting denominator inclusion/exclusion criteria Key nursing functions that impact measure NQF, 2015a TJC, 2009

Failure to Rescue Magnet hospitals have lower odds of failure to rescue Hospital Compare Medicare, n.d.b McHugh et al., 2013 Analytical decision making enhances nurses’ use of rapid response teams Nursing clinical peer review committee reduces risk-adjusted mortality Parker, 2014 Thielan, 2014

Prevent Mistakes in Surgery Based on the universal protocol Three sub-goals Conduct a pre-procedure verification process Mark the procedure site Perform a time-out prior to starting procedure Elements of performance for each sub-goal TJC, 2015c

Prevent Mistakes in Surgery Preventing wrong site/ procedure/patient surgery identified by nurses as top priority safety issue Hospital Compare Medicare, n.d.a Steelman, Graling, & Perkhounkova, 2013 Minnesota initiative reduces wrong site surgeries by 23% Wrong site surgery project reduced number of surgical cases with risks Rydrych, Apold, & Harder, 2012 Knudson, 2013

References American Nurses Association [ANA]. (2012). Position statements: Reduction of patient restraint and seclusion in health care settings. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Ethics-Position-Statements/Reduction-of-Patient-Restraint-and-Seclusion-in-Health-Care-Settings.pdf American Nurses Association [ANA]. (2015). Nursing-sensitive indicators. Retrieved from http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/PatientSafetyQuality/Research-Measurement/The-National-Database/Nursing-Sensitive-Indicators_1 Colley, S. L. (2015). Syllabus for NURS541: Quality improvement and safety. (Available from the Ferris State University School of Nursing, 200 Ferris Drive, Big Rapids, MI 49307) Cosper, P., Morelock, V., & Provine, B. (2015). Please release me: Restraint reduction initiative in a health care system. Journal of Nursing Care Quality, 30, 16-23. doi:10.1097/NCQ.0000000000000074 Hallman, I. S., O’Connor, N., Hasenau, S., & Brady, S. (2014). Improving the culture of safety on a high-acuity inpatient child/adolescent psychiatric unit by mindfulness-based stress reduction training of staff. Journal of Child and Adolescent Psychiatric Nursing, 27, 183-189. doi: 10.1111/jcap.12091 Heeren, P., Van de Water, G., De Paepe, L., Boonen, S., Vleugels, A., & Milisen, K. (2014). Staffing levels and the use of physical restraints in nursing homes: A multicenter study. Journal of Gerontological Nursing, 40, 48-50. doi:10.3928/00989134-20140407-03 Knudson, L. (2013). Time out remains key weapon in fight against wrong-site surgeries. AORN Connections, 97(6), C5-C6. doi:10.1016/S0001-2092(13)00500-0

References McHugh, M. D., Kelly, L. A., Smith, H. L., Wu, E. S., Vanak, J. M. & Aiken, L. H. (2013). Lower mortality in Magnet hospitals. Medical Care, 51, 382-388. Medicare. (n.d.a). Hospital compare: General information. Retrieved from http://www.medicare.gov/hospitalcompare/compare.html#cmprTab=0&cmprID=230038%2C230059%2C230236&cmprDist=1.1%2C4.9%2C9.5&dist=50&loc=49503&lat=42.9616689&lng=-85.6588999 Medicare. (n.d.b). Hospital compare: Readmissions, complications, and deaths. Retrieved from http://www.medicare.gov/hospitalcompare/compare.html#cmprTab=3&cmprID=230038%2C230059%2C230236&cmprDist=1.1%2C4.9%2C9.5&dist=50&loc=49503&lat=42.9616689&lng=-85.6588999 Medicare. (n.d.c). Nursing home compare: Quality measures. Retrieved from http://www.medicare.gov/NursingHomeCompare/compare.html#cmprTab=3&cmprID=235075%2C235035&cmprDist=1.7%2C6.9&loc=49503&lat=42.9616689&lng=-85.6588999 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

References National Quality Forum [NQF]. (2015a). Death among surgical inpatients with treatable serious complications (failure to rescue). Retrieved from http://www.qualityforum.org/QPS/QPSTool.aspx#qpsPageState={%22TabType%22%3A1,%22TabContentType%22%3A2,%22SearchCriteriaForStandard%22%3A{%22TaxonomyIDs%22%3A[],%22SelectedTypeAheadFilterOption%22%3A{%22ID%22%3A32843,%22FilterOptionLabel%22%3A%22failure+to+rescue%22,%22TypeOfTypeAheadFilterOption%22%3A1,%22TaxonomyId%22%3A0},%22Keyword%22%3A%22failure+to+rescue%22,%22PageSize%22%3A%2225%22,%22OrderType%22%3A3,%22OrderBy%22%3A%22ASC%22,%22PageNo%22%3A1,%22IsExactMatch%22%3Afalse,%22QueryStringType%22%3A%22%22,%22ProjectActivityId%22%3A%220%22,%22FederalProgramYear%22%3A%220%22,%22FederalFiscalYear%22%3A%220%22,%22FilterTypes%22%3A1},%22SearchCriteriaForForPortfolio%22%3A{%22Tags%22%3A[],%22FilterTypes%22%3A0,%22PageStartIndex%22%3A1,%22PageEndIndex%22%3A25,%22PageNumber%22%3Anull,%22PageSize%22%3A%2225%22,%22SortBy%22%3A%22Title%22,%22SortOrder%22%3A%22ASC%22,%22SearchTerm%22%3A%22%22},%22ItemsToCompare%22%3A[],%22SelectedStandardIdList%22%3A[],%22StandardID%22%3A1116,%22EntityTypeID%22%3A1} National Quality Forum [NQF]. (2015b). Restraint prevalence (vest and limb). Retrieved from http://www.qualityforum.org/QPS/QPSTool.aspx#qpsPageState={%22TabType%22%3A1,%22TabContentType%22%3A2,%22SearchCriteriaForStandard%22%3A{%22TaxonomyIDs%22%3A[],%22SelectedTypeAheadFilterOption%22%3A{%22ID%22%3A20932,%22FilterOptionLabel%22%3A%22restraint%22,%22TypeOfTypeAheadFilterOption%22%3A1,%22TaxonomyId%22%3A0},%22Keyword%22%3A%22restraint%22,%22PageSize%22%3A%2225%22,%22OrderType%22%3A3,%22OrderBy%22%3A%22ASC%22,%22PageNo%22%3A1,%22IsExactMatch%22%3Afalse,%22QueryStringType%22%3A%22%22,%22ProjectActivityId%22%3A%220%22,%22FederalProgramYear%22%3A%220%22,%22FederalFiscalYear%22%3A%220%22,%22FilterTypes%22%3A1},%22SearchCriteriaForForPortfolio%22%3A{%22Tags%22%3A[],%22FilterTypes%22%3A0,%22PageStartIndex%22%3A1,%22PageEndIndex%22%3A25,%22PageNumber%22%3Anull,%22PageSize%22%3A%2225%22,%22SortBy%22%3A%22Title%22,%22SortOrder%22%3A%22ASC%22,%22SearchTerm%22%3A%22%22},%22ItemsToCompare%22%3A[],%22SelectedStandardIdList%22%3A[],%22StandardID%22%3A1120,%22EntityTypeID%22%3A1} Parker, C. G. (2014). Decision-making models used by medical-surgical nurses to activate rapid response teams. MedSurg Nursing, 23(3), 159-164.

References Rydrych, D., Apold, J., & Harder, K. (2012). Preventing wrong-site surgery in Minnesota: A 5-year journey. Patient Safety & Quality Healthcare, 9(6), 24-34. Retrieved from http://psqh.com/preventing-wrong-site-surgery-in-minnesota-a-5-year-journey Sherwood, G., & Barnsteiner, J. (Eds.). (2012). Quality and safety in nursing: A competency approach to improving outcomes. West Sussex, UK: Wiley-Blackwell. Steelman, V. M., Graling, P. R., & Perkhounkova, Y. (2013). Priority patient safety issues identified by perioperative nurses. AORN Journal, 97, 402-418. doi:10.1016/j.aorn.2012.06.016 The Joint Commission [TJC]. (2009). Implementation guide for the NQF endorsed nursing-sensitive care measure set. Retrieved from http://www.jointcommission.org/assets/1/6/NSC%20Manual.pdf The Joint Commission [TJC]. (2015a). Facts about the national patient safety goals. Retrieved from http://www.jointcommission.org/standards_information/npsgs.aspx The Joint Commission [TJC]. (2015b). National patient safety goals. Retrieved from http://www.jointcommission.org/standards_information/npsgs.aspx The Joint Commission [TJC]. (2015c). National patient safety goals effective January 1, 2015: Hospital accreditation program. Retrieved from http://www.jointcommission.org/assets/1/6/2015_NPSG_HAP.pdf Thielan, J. (2014). Failure to rescue as the conceptual basis for nursing clinical peer review. Journal of Nursing Care Quality, 29, 155-163. doi:10.1097/NCQ.0b013e3182a8df96