Nursing Sensitive Indicator: RN Hours Per Patient Day (NHPPD)

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Presentation transcript:

Nursing Sensitive Indicator: RN Hours Per Patient Day (NHPPD) Nurse staffing impacts patient mortality Short by one nurse for an eight hour shift Increased patient mortality Significant correlation (Needleman et al., 2011)

NHPPD as a Method for Staffing Unit specific, accounts for complexities in care Patient turnover Acuity Type of care provided Leads to increased number of nurses Improves patient outcomes (Twigg, Duffield, Bremmer, Rapley, & Finn, 2011)

Evidence of the Success of NHPPD Increase in total NHPP NDNQI and non-NDNQI facilities Biggest increase in RN hours (compared to the increase in hours by other nursing positions) Increasing in staffing concurrent with improvement in outcomes such as number of inpatient falls and hospital acquired pressure ulcers. Coincidence or cause and effect? (Staggs & He, 2013)

Nursing Sensitive Indicator: Ventilator Associated Pneumonia (VAP) Lung infection that develops while a patient is mechanically ventilated A leading cause of death among healthcare associated infections (HAIs) (Needleman, et al., 2011)

“Vent Bundle” for the prevention of VAP Cluster of interventions to be implemented on all intubated patients Includes interventions that are specifically respiratory and other supportive measures Evidence of success only when implemented consistently and completely (Needleman, et al., 2011)

Keystone ICU in Michigan, an example of reducing VAP Raised awareness in Michigan Promotes the implementation of Vent Bundle Number of VAPs in participating hospitals: 2004: 497 2012: 197 Sixty percent reduction! (MHA Keystone Center, 2013)

Patient Safety Initiative: Communicating Information About Patients’ Medications It’s important because… Crucial for safe and effective medication management Often multiple providers prescribing/ordering meds Prevents Omission of necessary drugs Unexpected interactions between drugs Duplication of drugs or drug classes (The Joint Commission, 2014)

Elements of Medication Information Reconciliation Obtain accurate med history Compare history with current orders Complete, written information at discharge TEACH pt to carry med information Pt provides med information to all providers (The Joint Commission, 2014)

Challenges to Med Reconciliation Polypharmacy Level of activity at patient transition times Depend on patient/family for information Don’t know complete info (especially doses) Don’t recall instructions to provide list or actual meds (Riley-Lawless, 2009)

Nurses can fill the gap! Study by Balon & Thomas (2011) Meds lists from all sources are often inaccurate Suggest that nurses educate patients to accept greater accountability for managing own med information

Balon, J., & Thomas, S. A. (2011). Comparison of hospital admission medication lists with primary care physician and outpatient pharmacy lists. Journal of Nursing Scholarship, 43(3), 292-300. doi:10.1111/j.1547-5069.2011.01409.x The Joint Commission (2013). National patient safety goals effective January 1, 2014. Retrieved from: http://www.jointcommission.org/assets/1/6/HAP_NPSG_Chapter_2014.pdf Michigan Health and Human Services (MHA) Keystone Center (2013). Patient safety and quality report 2013, Michigan hospitals: A decade of making care safer. Retrieved from http://www.mhakeystonecenter.org/documents/2013_psqreport.pdf Needleman, J., Buerhaus, P., Pankratz, V. S., Leibson, C.L., Stevens, S.R., & Harris, M. (2011). Nurse staffing and inpatient hospital mortality. New England Journal of Medicine, 364(11), 1037-1045. doi: 10.1056/NEJMsa1001025 Pogorzelska, M., Stone, P., Furuya, Y., Perencevich, E. N., Larson, E. L., Goldmann, D., & Dick, A. (2011) Impact of the ventilator bundle on ventilator-associated pneumonia in intensive care unit. International Journal for Quality in Healthcare 23(5), 538-544. doi: 10.1093/intqhc/mzr049 Riley-Lawless, K. (2009). Family-identified barriers to medication reconciliation. Journal for Specialists In Pediatric Nursing, 14(2), 94-101. doi:10.1111/j.1744-6155.2009.00182.x Staggs, V. S. & He, J. (2013). Recent Trends in Hospital Nurse Staffing in the United States. Journal Of Nursing Administration, 43(7/8), 388-393. doi:10.1097/NNA.0b013e31829d620c 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

Summary American Nurses Association supports an environment and culture of quality and safety. Nurse Sensitive Indicators are supportive of the evaluation of nursing interventions leading to outcomes. Continued awareness of safety initiatives and goals support continued work towards safe outcomes, safe practices with the ultimate goal of supporting a patients healthcare needs through patient centered care. Nursing leadership is vital in supporting evidence based practices, a culture of safety all leading to a shared vision and commitment to learning and daily practice.