NYSPFP Presentation September 24, 2012
Achieving Sustained Improvement in Nursing Quality
2
Mary Therriault Senior Director Quality and Research Initiatives at Healthcare Association of New York State
Jack Jordan CMS, Deputy Director Partnership for Patients
Kathy Ciccone Co-Project Director New York State Partnership for Patients
Lorraine Ryan Co-Project Director New York State Partnership for Patients
Acknowledgments
3
Brandon Crosser, M.A. NDNQI Reporting Manager
Nancy Dunton, PhD, FAAN NDNQI Director Research Professor, University of Kansas School of Nursing http://nursing.kumc.edu/faculty/Bios Dunton.htm
Today’s Speakers
4
A program of the American Nurses Association Preeminent global nursing quality measurement program Largest database of nursing quality indicators http://www.measurenursingquality.org/NYSPFP
About NDNQI
5
Unit-Level Performance Reports Indicators align with Nursing Structure-Process-Outcome
measures Comparison data for hospitals & units like yours
Top-Tier User Support Quarterly webinars and newsletters Tutorials
ANA’s National Quality Conference February 6-8, 2013 – Atlanta, GA
NDNQI Products & Services
6
Data on 5 of 10 Outcome PfP Measures 1. Catheter-associated urinary tract infections*
2. Central line-associated blood stream infections*
3. Injuries from falls (and immobility)*
4. Hospital-acquired pressure ulcers
5. Ventilator-associated pneumonia* * Endorsed by
NDNQI Supports Partnership for Patient Goals
7
Using Reports for Quality Improvement
1. Understand Structure & Process Measures
2. Interpret Reports & Statistics
3. Develop Your QI Plan
Learning Objectives
Understanding Structure &
Process Measures
9
Risk assessment
Prevention protocol in place
Process Nurse staffing levels
% RN hours
Education
Certification
Structure
Structure & Process Measures
10
Critical care Step down Medical & surgical Rehabilitation Pediatric & NICU Psychiatric
Unit Types
Size Teaching status Magnet status State Metro/Rural
Hospital Characteristics
NDNQI Comparison Groups
Interpreting Reports and Statistics
12
Formulate your questions
Understand the tables
Review statistics
Using NDNQI Reports
13
NDNQI Report / Unassisted Falls
14
Mean & standard deviation
Median & percentiles
Rates—percentages & ratios
Statistics in Reports
15
Mean or average = sum of all “observations” divided by the number of events Example: (1 + 1 + 1 + 3 + 4) ÷ 5 = 10 ÷ 5 = 2
Standard Deviation or average distance of observations from the mean (dispersion)
Confidence Intervals Mean ± 1.96 standard deviations
Mean & Standard Deviation
16
Median is middle observation (50% percentile) 1 1 1 3 4
Percentiles:
Order all observations from low to high and count the number of observations
Divide the observations into groups (e.g., top 10%, bottom 25%)
Median & Percentiles
17
Median for Skewed Distributions
Mean for Normal Distributions
When to Use Mean or Media
18
# Events/Standardized Population Fall Rate # Falls*1000/ Patient Days 7*1,000/500=14
Ratios
(# Events/# Observations)*100 Pressure Ulcer Rate (# Ulcers/# Patients)*100 (25/100) = .25 .25*100 = 25%
Percentages
Rates
Developing Your QI Plan
20
1. How does our unit compare to other, similar units?
2. Are we getting better or worse?
3. What improvement goal should we set? Be in the best 25% of peer units?
Should there be zero tolerance for the outcome?
QI Questions
21
NDNQI Report / Total Falls
22
Gain a better understanding of each problem and its causes Examine related nursing workforce measures
Examine related process measures
Drill Down
23
Total Falls
Prior Risk Assessment
83.9%
At Risk 79.1%
Protocol in Place 91.7%
No Protocol in Place 8.3%
Not at Risk 20.9%
No Prior Risk Assessment
16.1%
Look at all Of those, what x% Of those at risk, what patients who fell were assessed at x% had a prevention
fall risk protocol in place at the time of the fall
Could the Fall Prevention Process Be Improved?
Rush-Copley Medical Center
25
ID Problem in NDNQI Reports Inconsistent performance Periodic reductions attributed to chance
Set Goals To be in top 25% Reduce σ2 in risk assessment & intervention
Situation / Problem
26
Rapid-cycle PDSA Involve top leadership Engage staff – “No Falls Will Happen” Evidence based practice Staff accountability within “Just Culture”
QI Plan
27
No Falls with Major Injury in 616 Days Continue to sustain improvements, monitor and maintain
Result
28
Comparison data <100 beds & Critical Access Hospitals
Mixed acuity unit types
Staffing data for Emergency, PeriNatal, & PeriOp units in 2013
No special IT requirements
Benefits of NDNQI Participation for Small & Rural Hospitals
29
243 units in 51 hospitals located in rural areas
1180 units in 168 hospitals located in cities of between 10,000 and 50,000 people
Reports for hospitals <100 beds based on 2017 units in 482 hospitals
52 Critical Access Hospitals with 142 units
Comparison Data for Small Hospitals
NDNQI Enhancements Coming in 2013
31
New Dashboard Reporting System Intuitive Navigation and Interactivity
32
More Efficient and Visually Pleasing Information Display
33
Visit this site created for NYSPFP Watch short videos with nurses sharing how their hospitals are using NDNQI Download a Fall Prevention Case Study based on NDNQI data
Learn More http://www.measurenursingquality.org/NYSPFP
34
To learn more about how NDNQI can support your efforts to improve nursing quality at your facility, contact Michael Grove at ANA:
301-628-5042 [email protected]
or visit http://www.measurenursingquality.org/NYSPFP
For More Information