...Agency for Healthcare Research and Quality: Inpatient Quality Indicators xxxxxxxx xxxxxxxxxxxxxxxxxxxxx March 2, 2015 Agency for Healthcare Research and Quality: Inpatient Quality Indicators The purpose of this capstone paper is to discuss the Agency for Healthcare Research and Quality's (AHRQ) approach to quality and safety as this pertains to inpatient quality indicators. This will assist with better understanding what efforts are being taken within the contemporary healthcare system and by contemporary healthcare organizations in order to maximize the quality of care delivered to patients. The discussion within the essay will have three main parts. The first part will explain and analyze the significance of the topic under consideration here for clinical nursing practice. The second part will discuss information from the selected topic that can be applied in order to improve professional nursing practice and complex client care. The third part will evaluate the potential outcomes that may result from the application of the information from the topic to nursing practice. Before shifting into the body of the main discussion, though, it may be appropriate to discuss the AHRQ itself in greater detail. In the AHRQ's (2015a) own words, the organization's mission "is to produce evidence to make health care safer, higher quality, more accessible, equitable, affordable, and to work within the U.S. Department of Health and Human...
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...Organizational Systems and Quality Leadership Organizational Systems and Quality Leadership Task 1 A. Nursing Sensitive Indicators Nurses are integral key players in multidisciplinary teams caring for patients in complex healthcare systems. Hospitals, a primary care delivery portal within the health system, are inundated with patients requiring higher acuity care. Nurses must be prepared to recognize patients’ health care needs and provide quality patient care outcomes. The knowledge of nursing sensitive indicators can be helpful in providing the care which meets quality standards. Nursing sensitive indicators rely on evidence-based practice. The American Nurses Association created a repository for implementing, developing, and storing nursing sensitive indicators in the National Database of Nursing Quality Indicators, or NDNQI. The nursing sensitive indicators are a set of standardized performance measures intended to help hospitals assess the extent to which nursing interventions have an impact on patient safety, quality, and the professional work environment (Erickson, J. 2011). Nurses directly impact these measures and when evidence-based practices are adopted, patient care improves as shown in historical outcomes data. In the scenario of Mr. J there were multiple failures to recognize and use nursing procedural sensitive measures to improve his safety, quality of care, and patient satisfaction. Although Mr. J had mild dementia, he was appropriately responsive...
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...Organizational Systems and Quality Leadership RTT Task 1 Nursing-sensitive Indicators Nursing- sensitive indicators are defined as those outcomes that improve in the presence of greater quantity(higher staffing ratios) or quality(educational levels and competence of nursing staff) of nursing care (www.nursingworld.org). These nursing-sensitive measures help healthcare organizations to analyze the quality and quantity of nursing care services. (www.americansentinel.edu )Nursing sensitive-indicators (NSIs) are characterized by measures that are in the realm of nurses to improve and control. According to the website www.nursingworld.org , in 1998, the National Database of Nursing Quality Indicators was established by the ANA so that nurses would have a national benchmark to reach they can compare the outcomes. This has given the profession of nursing a solid core of benchmark capital nursing sensitive indicators that are totally nursing care dependent. This database provides benchmark performance with which the individual healthcare institution can compare its performance to similar institutions across the nation. These nursing sensitive indicators result in patient outcomes that are influenced by nursing care decisions and actions. Research has indicated that patient outcomes improve, complications and mortality are reduced, costs can be reduced, and patient and professional nurse satisfaction can be enhanced with strong performance on nursing-sensitive indicators. These patient outcomes...
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...ORGANIZATIONAL SYSTEMS & QUALITY LEADERSHIP Nursing Sensitive Indicators Nursing sensitive indicators are define as those indicators that capture nursing care or its outcomes most affected by nursing care (Medscape). These indicators have been defined due to the necessity for data to show proven links between nursing interventions performed, nurse staffing levels and patient outcomes. These nursing sensitive indicators help to identify the structures of care and care processes to which both influence and have major impacts on patient outcomes (Nursing). Nursing sensitive indicators are specific to the nursing process. Some examples are Patient satisfaction, Nurse Satisfaction, and quality of care (Medscape). The structure of nursing care can be reflected by the nurse/patient ratio and staffing needs and also by the education of that nursing staff. Process indicators are those such as nursing assessment, those interventions set into play as well as how satisfied an RN is with his/her job. Nursing sensitive patient outcomes are those that improve because of a higher quality of nursing care (Nursing). There are many ways in which an understanding of nursing sensitive indicators could assist the nurses in this scenario. Firstly, I believe education to be the main issue. Everyone who provides patient care must be aware of all nursing sensitive indicators and what impact it can have on patient outcomes. If the CNA was aware of the risk of pressure ulcers with the use of restraints...
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...Nursing Sensitive Indicators (NSIs) and Hospital Consumer Assessment and Healthcare Providers and Systems (HCAHPS) are at the forefront of patient care. These quality measures of nursing care are evaluated in hospital settings. These indicators and survey scores allow nurses and their administrators to assess how the care they are providing is following evidence-based practices, and how they can improve their practices towards a better patient outcome. The American Nurses Association (in promoting these indicators as the definitive standards for patient care and quality ANA) has made steps improvement. The purpose of this paper will define NSIs, HCAHPS and include examples of each from Good Samaritan Medical Center, the outcomes and interventions...
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...TASK 1 RTT1 TASK 1 A. Discuss how an understanding of nursing-sensitive indicators could assist the nurses in this case in identifying issues that may interfere with patient care. Nursing-sensitive indicators are determinations used to delineate the excellence of nursing interventions and positive patient outcomes. This is not a new concept. In the 1800’s, Florence Nightingale, a promoter of outcomes, revealed such indicators when she revealed her statistical findings of soldier’s mortality rate associated to environmental conditions during the Crimean War (Fee & Garofalo, 2010). Over the past decades, various studies world-wide have been conducted on the connection of nursing quality indicators and their outcomes. The American Nurses Association (ANA) recognized these studies were an important focus in evidenced-based practice among the nursing profession; and in 1998, they established a program for implementing, developing and storing these nursing-sensitive indicators, known as the National Database of Nursing Quality Indicators (NDNQI) (ANA, 2014). The NDNQI serves as a valuable resource for hospitals nationwide at the acute level for administrators and nurses alike to compare various indicators and outcomes with that of other facilities to determine best practices for patients and staff. In the case of Mr. J, it is clear the nurse caring for this patient had little or no knowledge of indicators of restraint prevalence. However, my initial concern after...
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...maximum productivity in different sectors, displaying perfect performance culminates in the increase of client for any given organization. In the area of health, various institutions strive to improve service care through highlighting different methods that can be incorporated to improve the particular sector. This has subsequently led to the idea of outcome management being included in various health institutions. In equal measure, the proper outlining of the above-mentioned aspect about the nursing profession plays an imperative role in factoring the patient who in turn helps substantiate this particular perception. It also proves essential to take note that outcome management also provides evidence-based information which is used in evaluating its current progress which in turn helps different institutions come up with better strategies that will help improve the quality of services offered. The patient The term patient refers to the individual that receives medical services from healthcare providers. Typically, multiple patients have a wide array of expectations and preferences during the process of being treated. Outcome management creates an environment upon which several patients can have a platform that they can use to give information which in turn is used to measure progress. Information gathered from patients in different healthcare facilities is acquired through studies such as Hospital Customer Assessment of Healthcare Providers and Systems. Additionally, questionnaires...
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...Organizational Systems and Quality Leadership Task 1 Western Governors University Organizational Systems and Quality Leadership RTT1 Task 1 Organizational Systems and Quality Leadership Task 1 A. Nursing-Sensitive Indicators Nursing-sensitive indicators reflect the structure, process and outcomes of nursing care. The structure of nursing care is indicated by the supply of nursing staff, the skill level of the nursing staff, and the education/certification of nursing staff. Process indicators measure aspects of nursing care such as assessment, intervention, and RN job satisfaction. Patient outcomes that are determined to be nursing sensitive are those that improve if there is a greater quantity or quality of nursing care (e.g., pressure ulcers, falls, and intravenous infiltrations). (Nursing, 2014, para. 1) In the instance of Mr. J’s hospitalization there are many areas for improvement as it applies to nursing-sensitive indicators. Some of these areas can be improved by implementing new protocols or by simply educating the staff about specific indicators. Other areas that need improvement such as staff communication as well as attitudes may be a little more difficult to correct. Patient restraints can be an effective intervention to promote patient safety only if used when appropriate. Restraints can have a negative effect on patient safety, morbidity, and mortality if used inappropriately. The story of Mr. J isn’t really clear on the rationale for the restraints...
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...RTT Task 1 WGU Nursing –Sensitive Indicators In the case of Mr. J, a 72-year-old retired rabbi with a diagnosis of mild dementia, the nursing sensitive indicators include restraint use, hospital acquired pressure ulcers, and patient-family satisfaction with nursing and overall care. Not understanding and identifying nursing-sensitive indicators contributed to adverse outcomes, which included the development of a pressure ulcer and the likely unnecessary use of restraints. Lastly, family dissatisfaction with care was evidenced when the daughter called the patient’s physician to complain that her father had not received the ordered kosher meals. If the hospital nursing staff had understood and identified nursing-sensitive indicators, the negative outcomes cited above may have been avoided. The nurses would know that through data collection, measurement, and evaluation of nursing practice it has been recognized that nursing care has a direct impact on specific patient outcomes. Because of this research, the profession has been able to elevate the quality of nursing care by developing and implementing evidence based practice, which has been demonstrated to improve patient outcomes (American Sentinel University, 2014). Quality Patient Care Collecting hospital data from each unit on specific nursing-sensitive indicators could advance quality patient care throughout the hospital. Staffing levels and the mix of nursing personnel (RN, LPN’s, and CNA’s) on a unit can have a...
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...Nursing-Sensitive Indicators Frances Westlake WGU Nursing-Sensitive Indicators Having knowledge and understanding of nursing-sensitive indicators assist the nurse with providing quality, ethical and safe care to the patient. In Mr, J’s case, the plan of care was not evidence based; otherwise they would not have applied restraints. The restraints only impeded his care by restricting movement which resulted in him having a pressure ulcer. By Mr.J being drowsy and having some dementia he was a high fall risk. The nurses could have used a bed alarm or staffed a sitter at his bedside. The nurse providing care to Mr. J should have immediately provided him the correct diet according to his religious beliefs. Family involvement also increases better outcomes for the patient; however, the Mr. J’s daughter was not included in the plan of care or notified of the use of restraints or the change in his diet. The nursing-sensitive indicators analyze the quality and patient outcomes of nursing care provided to patients. The information can be used to look at the nursing practice and processes, as well as how changes have influenced patient care and outcomes throughout the hospital. The measures are used for quality improvement in areas that have scored high or that could become potential issues. For example, if the pressure ulcer rate was high throughout the hospital, a pressure ulcer prevention program would be implemented. Staff would be educated on the program, and then nurse managers...
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...A. Nurse sensitive indicators are factors that are directly impacted by nursing. There indicators fall into three categories; structure, process and outcomes of nursing care. The structure indicators are the organizational piece of nursing care. These relates to the amount of staff on duty at a given time, how many RN's are on duty and experience level of the staff. For example, evidence indicates institutions with a higher number of RN’s possessing a Bachelor Degree in nursing result in improved patient outcomes. The process indicators measure nursing care such as patient assessment, patient care and intervention. These are the organizational policies and procedures of nursing. The patient outcomes are indicators directly related to nursing care and quality of care provided. Patient satisfaction, pain management or infections rates are some examples of patient outcome indicators. In the case provided, knowledge of nursing sensitive indicators would have assisted the nurses in several ways to provide a positive patient outcome. First, if the nursing assistant had knowledge of pressure ulcer prevention, sign and symptoms and treatment of pressure ulcers, the pressure ulcer on the patient’s sacrum may have been prevented. In this case, the nurse assistant did not recognize the patient had the first stages of a pressure ulcer developing. When the assistant got the patient up for toileting she should have checked his bottom and upon seeing the red area on his sacrum, she should...
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...Quality Improvement Plan Part One—Consumerism HCS.588 Facilitator: Patricia Wolcott September 23, 2013 Quality Improvement Plan--Consumerism The Institute of Medicine’s widespread reports, To Err Is Human (2000) and Crossing the Quality Chasm, revealed widespread incidence of medical errors in U.S. hospitals, there has been a great deal of effort to measure and improve the quality of hospital care (Institute of Medicine, 2000). Progressive input have been made in establishing quality indicators and risk adjustment components to compare quality across organizations, and in analyzing processes and cultures in high-performing hospitals. There is a vast amount of knowledge to learn about the infrastructure of hospital performance. Health care organizations performance measures may include, which hospitals are improving (or deteriorating) over time and how they accomplish and provide for that improvement. This paper will seek to develop a quality improvement plan for St. Joseph Medical Center, the difference between performance measurement and quality improvement, examine quality indicators, and explain stakeholder feedback is used in the quality improvement process. Type of care Provided St. Joseph Medical Center has provided health care to the Kansas City metropolitan area since 1874. According to St. Joseph Medical Center (2013), “It is a joint accredited, 310-bed hospital offering a full array of acute care, outpatient and extended care services with a reputation for...
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...THE CASE FOR A MODEL OF CARE Contemporary health care systems are constantly challenged to revise traditional methods of health care delivery. These challenges are multifaceted and stem from: 1. novel pharmacological and non-pharmacological treatments; 2. changes in consumer demands and expectations; 3. fiscal and resource constraints; 4. changes in societal demographics in particular the ageing of society; 5. an increasing burden of chronic disease; 6. documentation of limitations in traditional health care delivery; 7. an increasing emphasis on transparency and accountability, 8. evidence based practice (EBP) and clinical governance structures; and 9. the increasing cultural diversity of the community. These challenges provoke discussion of the necessity of developing services around a model of care. What do we mean by a model of care? Ambiguity exists in the literature, with the terms, model of care, nursing model, philosophy, paradigm, framework and theory often used interchangeably, despite referring to diverse, yet parallel concepts (Tierney 1998). In their recent review of the literature, the Queensland Government (Australia) reported that they found no consistent definition of ‘model of care’ (Queensland Health 2000). They concluded that a model of care is a multidimensional concept that defines the way in which health care services are delivered (Queensland Health 2000). More specifically, Davidson and Elliott...
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...Increasing changes in diversity puts a demand on healthcare professionals. Changes in healthcare have popularized empirical and evidence-based research in the field of nursing research (Hung, Chang,Chen, 2010) New roles that are emerging are tele-conferencing, providing nursing care over the phone triage style nurses need to be effective leaders and managers to meet the new challenges, advocate for policies that contribute to the health of populations, to sustainable development, and to the security and just treatment of nurses and health care professionals (NSNA,2011). Health care evolving at a fast rate and as provider’s nurses will need to adapt by meeting the needs and demands of individuals. The elderly are increasing and have been at a steady rate, and we need the professionals to be available to take care of the elder generation. The acuity on my floor are seeing more and more elderly’s coming in with stroke and fractures. Hung, H., Wang, H., Chang, Y., & Chen, C. (2010). [Nursing knowledge: the evolution of scientific philosophies and paradigm trends]. Hu Li Za Zhi The Journal Of Nursing, 57(1), 64-70. Retrieved from EBSCOhost. NSNA (2011) Meeting Today’s Global Health Care Challenges retrieved from http://www.nsna.org/Portals/0/Skins/NSNA/pdf/Imprint_Feb04_Hancock.pdf patterns of health events in populations characterizes health outcomes in terms of what, who, where, when, and why: What is the outcome? Who is affected? Where are they? When do events occur...
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...Organizational Systems Task 1 Western Governors University Task 1 A. Nursing-sensitive indicators By understanding nursing sensitive indicators, the nurses in this case could improve the structure, process, and outcomes of their nursing care. The structure of nursing care is indicated by the supply of nursing staff and the skill level of the nursing staff. By the nurses having increased knowledge of the issues hip fracture patients are prone to having, such as decrease mobility, increase need for surgical intervention, and increase risk of falls, could help improve the quality of patient care. A patient with decrease mobility is at higher risk for pressure sores. The nurses in this case may have prevented the one by proper padding and repositioning every 2 hours. The nurses in this case should aim to prevent surgical complications and infection (Sauls, 2013). With proper knowledge of dementia, fall prevention, restraint prevalence could lead to improved patient safety and satisfaction. Maybe with an understanding of dementia the patient could have been reoriented, medicated, moved to a room across from the nurses desk, or had a CNA sit with the patient to prevent the need for restraints. If the patient was drowsy there is a good chance the restraints in this case were not medically indicated. Dementia patients are more prone to weight loss and inadequate nutrition which could lead to other risk. In this case the staff should have offered a variety of foods the...
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