NYSPFP Presentation September 24, 2012

Achieving Sustained Improvement in Nursing Quality

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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

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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

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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

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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

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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

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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

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Risk assessment

Prevention protocol in place

Process Nurse staffing levels

% RN hours

Education

Certification

Structure

Structure & Process Measures

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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

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Formulate your questions

Understand the tables

Review statistics

Using NDNQI Reports

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NDNQI Report / Unassisted Falls

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Mean & standard deviation

Median & percentiles

Rates—percentages & ratios

Statistics in Reports

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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

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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

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Median for Skewed Distributions

Mean for Normal Distributions

When to Use Mean or Media

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# 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

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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

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NDNQI Report / Total Falls

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Gain a better understanding of each problem and its causes Examine related nursing workforce measures

Examine related process measures

Drill Down

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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

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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

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Rapid-cycle PDSA Involve top leadership Engage staff – “No Falls Will Happen” Evidence based practice Staff accountability within “Just Culture”

QI Plan

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No Falls with Major Injury in 616 Days Continue to sustain improvements, monitor and maintain

Result

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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

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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

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New Dashboard Reporting System Intuitive Navigation and Interactivity

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More Efficient and Visually Pleasing Information Display

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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

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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 Michael.Grove@ana.org

or visit http://www.measurenursingquality.org/NYSPFP

For More Information