Quality Indicators & Safety Initiative Presentation Group 4

Quality Indicators & Safety Initiative: Part 1 Adam March Ferris State University MSN Program

NSI: Nursing Hours (NHPPD) What is it? A widely used indicator for acute care staffing levels (4) Endorsed by the National Quality Forum (3) How is it measured? Total Nursing hours on a given nursing care department as the numerator Total number of patient days for that department as the denominator

NSI: Nursing Hours (NHPPD) Sample Data – Includes Benchmark for comparison versus like-sized hospitals

NSI: Nursing Hours (NHPPD) What are the ramifications? Represents the adequacy of nurse staffing (7) Linked to improved patient outcomes (3) Poor staffing increases the risk for patient death (4) Poor staffing reduces nursing quality care causing medication errors and failure to rescue (3)

NSI: RN Education Background: Entry into practice through multiple avenues (8) Diploma, Associate Degree (ADN), & Bachelor Degree (BSN) Minimum degree requirements has been argued since 1965 Individual states control minimum degree requirements Faculty shortage and program availability (8)

NSI: RN Education What are the ramifications? Higher proportion of BSN Linked to improved patient outcomes (3) Lower education levels increases the risk for patient death ADN nurses report more missed care (2) What happens now? The IOM calls for 80% BSN prepared nurses by 2020 (1) Improve access to BSN programs and increase number of nursing faculty (11)

NSI: RN Education Sample Data

QSEN: Evidence Based Practice Definition: Practice based on the best available evidence that incorporates clinician judgment and expertise (6) Five Basic Steps: Inquiry Literature Search Critical Analysis & Synthesis Practice Recommendations Outcomes Evaluation

QSEN: Evidence Based Practice What are the barriers for EBP? Nurses lack basic understanding of EBP (5) Lack of mentorship for the process (10) Poor access and ability to use electronic databases (9) Break through the barriers Education of clinicians (6) Leadership support (9) Academic and clinical partnerships (6)

References 1. Institute of Medicine (2010). The future of nursing: Leading change, advancing health. Retrieved from Nursing-Leading-Change-Advancing-Health.aspx 2. Kalisch, B., Landstrom, G., & Williams, R. (2009). Missed nursing care: errors of omission. Nursing Outlook, 57(1), 3-9. doi: /j.outlook Krueger, L., Funk, C., Green, J., & Kuznar, K. (2013). Nurse- related variables associated with patient outcomes: A review of the literature 2006–2012. Teaching & Learning in Nursing, 8(4), doi: /j.teln Needleman, J., Buerhaus, P., Pankratz, V., Leibson, C., Stevens, S., & Harris, M. (2011). Nurse staffing and inpatient hospital mortality. The New England Journal of Medicine, 346(11), 1037−1045.

References 5. Rolfe, G., Segrott, J., Jordan, S. (2008). Tensions and Contradictions in Nurses’ Perspectives of Evidence-Based Practice. Journal of Nursing Management, 16, doi /j x 6. Sherwood, G. & Barnsteiner, J. (2012). Quality and Safety in Nursing: A Competency Approach to Improving Outcomes. Chichester, West Sussex: Wiley-Blackwell. 7. Simon, M., Yankovskyy, E., Klaus, S., Gajewski, B., & Dunton, N. (2011). Midnight census revisited: reliability of patient day measurements in US hospital units. International Journal of Nursing Studies, 48(1), doi: /j.ijnurstu Smith, T. (2010). A policy perspective on the entry into practice Issue. Online Journal of Issues in Nursing, 15(1), 2.

References 9. Strickland, R. J. & O'Leary-Kelley, C. (2009). Clinical nurse educators' perceptions of research utilization, barriers and facilitators to change. Journal for Nurses in Staff Development, 25(4), doi: /NND.0b013e3181ae142b 10. Wallen, G. R., Mitchell, S. A., Melnyk, B., Fineout-Overholt, E., Miller-Davis, C., Yates, J., & Hastings, C. (2010). Implementing evidence-based practice: effectiveness of a structured multifaceted mentorship programme. Journal of Advanced Nursing, 66(12), doi: /j x 11. Wakefield, M. (2010). Nurses and the Affordable Care Act: New legislation gives nurses a greater voice. American Journal of Nursing, 110(9), 11. doi: /01.NAJ f