Transition to Practice Study: Outcomes Data National Council of State Boards of Nursing Mary Blegen, PhD, RN, FAAN April 27, 2011

Research Study: Determine the effects of the TTP intervention Must have valid data for comparison across hospitals and across time Across hospitals – experimental and control Across time – before and after the study Valid means accurate, measuring what we intend to measure, and comparable across hospitals and time Measures should be the same in all hospitals [surveys will be the same, outcomes data may not] Data collected using the same definitions and care This is the focus of this presentation

Obtaining valid comparable data is a major challenge BUT – we will benefit from the work of the National Database of Nursing Quality Indicators (NDNQI) Hospitals participating include 82 from Illinois 53 from North Carolina 96 from Ohio

Evaluation Data Surveys of new graduates Surveys of preceptors and unit managers Hospital Data Nurse Staffing Nurse Retention Patient Satisfaction Patient Outcomes

Hospital Data: Nursing Nurse staffing Has major influence on patient outcomes Need to control when comparing patient outcomes and nurse retention Hours of care on each unit for specific time period RNs, LPNs, NAs Regular, Contract, Float Calculate hours per patient day (HPPD) Patient days of care on each unit for the same time period Source of data Unit Manager #1 or Payroll or Human Resources

Hospital Data: Nursing Vacancy Rates (positions available but unfilled) In the unit In the hospital All Nurse Retention (turnover) New graduates in our study New Graduate Retention at 6 months Retention at 12 months Reason for Leaving

Hospital Data: Patients Patient Satisfaction – Hospital Survey Data as the hospital collects and reports Year before our study and the year of the study This survey may be different from one hospital to the next Comparison must be with previous patient satisfaction results in that hospital Unit level - if hospital aggregates it that way Hospital level also

Hospital Data: Patients Patient Outcomes – Unit Level Medication errors (per patient day from previous) *Patient falls with and without injury (per patient day) *Hospital acquired pressure ulcers *Catheter associated Urinary Tract Infections *Central line associated blood stream infections *Ventilator associated pneumonia *NDNQI (Nat'l Database Nursing Quality Indicators) Need to know the type of unit

Hospital Data: Patients Use existing data You do not have to do chart reviews to collect these data Use definitions from the NDNQI Manual will be provided Explanations/definitions if different from NDNQI Collect by month if possible By quarter is OK

Patient Outcomes: Definitions Medication Administration Errors Number of adverse incidents from medication error reported / divided by patient days of care This outcome measure is not collected by NDNQI but should be available from each hospital By month if possible, by quarter if necessary

Patient Outcomes: Definitions Patient Falls – per patient days, per month (quarter if necessary) Total falls Injury falls (minor, moderate, major, death) Patient Fall is: an unplanned descent to the floor, with or without injury to the patient, that occurred on the nursing care unit Include patient falls due to all reasons: Physiologic (fainting) Environment (slippery floors) Assisted falls

Patient Outcomes: Definitions Hospital Acquired Pressure Ulcers Localized injury to the skin or underlying tissue, usually over a bony prominence, as a result of pressure or pressure in combination with shear Stages I to IV or unstageable Best detected by quarterly rounds with inspection of all patients (NDNQI) Rate: number of patients with HAPU divided by number of patients inspected Some hospitals “measure” with incident reports, others from “wound care” nurses documentation

Patient Outcomes: Definitions Infections Catheter Associated Urinary Tract Infections Central Line associated blood stream infections Ventilator Associated Pneumonia Data from NDNQI liaison or Unit Manager or Infection Control Department