1. Nursing-Sensitive Quality Indicators And Safety Initiatives
Group A, Part ***
Rebecca Joostens

2. Ambulatory Care Nursing
Development of Ambulatory Care NSI’s has lagged that of acute care settings
Recent Legislation Changes
Complex patients/ population
Reimbursement Changes
Demand for high quality, lower cost healthcare
Pay for Performance Initiatives

3. Nursing-Sensitive Indicators in Ambulatory Care
Possible that Acute Care NSIs are applicable
Common themes arising
RN Visibility in high acuity patients
Readmissions
Transitions management
Care Coordination
Disease Specific Indicators (BP, A1C, lipids)
Multidisciplinary Team / Staff mix
RN Triage
Shared Governance
Quality Improvement Committee
in-patient NSIs are general enough to apply to any setting:
Role of RN with economic benefit:
My original article (jan 2015):

4. Readmissions Description
Readmission within 30 days National Rate Primary Care Sensitive admissions
The individual student identifies at least 2 NSIs and provides a thorough description of each that postulates how the quality or quantity of nursing care impacts outcomes related to same. How quality or quantity of nursing care impacts outcomes of high acuity patients

5. Readmission Data Adams, 1997 Community Health Centers
RN care manager
Fewer hospitalizations
Fewer emergency room visits.
Hamner, 2005 Heart Failure Clinics RN managed clinic
Telephone or technology based RN intervention
demonstrated reduction in hospital admissions and emergency room visits, decreased mortality, improved self-care and quality of life.
Improved patient satisfaction
decrease in emergency room visits.
Data and research is provided that strongly support the identified NSIs as being positively impacted by nursing care quality or quantity. The literature support is scholarly and two or more nursing research studies are included by the individual student.
3rd option rehospitalization

6. Spectrum Health Pilot Readmission Data

7. Disease Indicators Description
Self Management
Symptom Management
A1c reduction
BP management
Cholesterol Management
Improved Communication

8. Disease Indicators Data
Piette et al., 2000 Diabetes Care
Automated calls with RN
Fewer symptoms of depression
greater selfefficacy to perform selfcare activities; fewer days in bed because of illness;
greater satisfaction with their health care overall, quality of their health outcomes,
greater satisfaction with continuity of care and communications with providers.
Philis-Tsimikas & Walker, 2001/ Philis-Tsimikas et al., 2004
High-Risk Diabetics Multicomponent RN-led outreach and education, recruitment, screening, diagnosis, clinical care
Significant beneficial effect, HgbA1c, blood pressure, total cholesterol, and LDL are decreased significantly.
The individual student identifies at least 2 NSIs and provides a thorough description of each that postulates how the quality or quantity of nursing care impacts outcomes related to same.
Data and research is provided that strongly support the identified NSIs as being positively impacted by nursing care quality or quantity. The literature support is scholarly and two or more nursing research studies are included by the individual student.

9. Group Safety Initiative
QSEN

10. QSEN: Informatics Knowledge Skills Attitude
Understand benefits, limitations, strengths and barriers
Support Patient Care
Support Communication
Interoperability
Knowledge Systems
Skills
Select, design, implement
Pilot, evaluate, teach team members
Communication Technologies
Clinical decision support
Anticipate challenges
Attitude
Value information and communication technologies in patient care
Collaboration
Appreciate the effort needed to make technology an effective tool in patient care
Definition: “use information and technology to communicate, manage knowledge, mitigate error, and support decision making” (QSEN 2014)
A key safety initiative and/or regulation is identified and clearly explained. A knowledgeable discussion of the impact of this initiative on the healthcare environment, and the role of nursing in the initiative is shared.(The group focus is on one major initiative, but individual students will address a different component of the initiative in their portion of the presentation.)
Data and research is provided that strongly support the identified safety initiative as being effective in improving safety. The literature support is scholarly and two or more nursing research studies are included by the individual student.

11. Informatics Data and Research
Systematic Review of Randomized Controlled Trials
Goals:
Identify impact of information technology on the following aspects of patient-centered care
Health care processes
Clinical outcomes
Intermediate outcomes
Responsiveness to needs and preferences of patients
Shared decision making
Patient-client communication
Access to information
Identify barriers to utilizing IT for patient centered care.
Results
Substantial evidence confirms IT has a positive outcome in health
Barriers identified
Lack of usability
Problems with access to applications due to older age, income, education, cognitive impairment
Low computer literacy
Insufficient training in applications
Workflow issues
Facilitators of use
Ease of use
Perceived usefulness
Efficiency of use
Availability of support
Comfort in use
Enabling Patient-Centered Care Through Health Information Technology
184 articles
Systematic review:
strong evidence supporting
Medication safety and time documenting:

12. QSEN: Quality Improvement
Knowledge
Strategies for improving outcomes
Describe benefits and limitations of data sources
Analyze Ethical issues
Skills
Use a variety of sources to assess outcomes of care
Design and use databases
Root Cause analysis
Change Management
Attitudes
Appreciate continuous quality improvement
Appreciate value of data
Value good measurement and the role it has in patient care
Appreciate the value of individual teams.
A key safety initiative and/or regulation is identified and clearly explained. A knowledgeable discussion of the impact of this initiative on the healthcare environment, and the role of nursing in the initiative is shared.(The group focus is on one major initiative, but individual students will address a different component of the initiative in their portion of the presentation.)
Data and research is provided that strongly support the identified safety initiative as being effective in improving safety. The literature support is scholarly and two or more nursing research studies are included by the individual student.

13. Quality Improvement Data and Research
US department of health and human services
Successful reduction in CAUTI
Using this outcome and lessons learned to spread throughout 50 states
Using this outcome to improve other conditions: falls, DVTs
Components
Coordinated effort to disseminate information
Data collection based on clear definitions and approaches
Focus on technical practices
Emphasis on socioadaptive challenges
Partnership with agencies that specialize in relevant subjects
CAUTI

14. References