1. 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)

2. 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)

3. 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)

4. 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)

5. “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., )

6. 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)

7. 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)

8. 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)

9. 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)

10. 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

11. 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), doi: /j x
The Joint Commission (2013). National patient safety goals effective January 1, Retrieved from:
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
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), doi: /NEJMsa
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), doi: /intqhc/mzr049
Riley-Lawless, K. (2009). Family-identified barriers to medication reconciliation. Journal for Specialists In Pediatric Nursing, 14(2), doi: /j x
Staggs, V. S. & He, J. (2013). Recent Trends in Hospital Nurse Staffing in the United States. Journal Of Nursing Administration, 43(7/8), doi: /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), doi: /j.ijnurstu

12. 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.