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

2. 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

3. 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

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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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