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Sample Application Letter for Staff Nurse

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					National Database of Nursing
Quality Indicators®- NDNQI®:
     Taking Your Quality
   Improvement Data to the
        National Level

        Database Overview
          October 2010

                               1
                  Objectives

1) Describe history and purpose of NDNQI
2) Identify NDNQI core measures
3) Suggest uses for NDNQI reports
4) Enrollment & web entry overview




                                           2
             ANA’s 1994 Initiative

• To investigate the impact of healthcare
  restructuring on safety and quality of
  patient care related to
  – Reduction in direct care RNs
  – Unlicensed staff replaced RNs
  – Decreased length of patient stay
  – Cost-cutting measures

                                            3
               Nursing-Sensitive
                  Indicators

• To demonstrate that RNs make a critical
  difference in providing safe, high-quality
  patient care

• To capture patient care outcomes most
  affected by nursing


                                               4
      State Nurses Associations

• 7 SNAs assisted with initial pilot
  studies on nursing-sensitive
  indicators for acute care settings in
  60 hospitals
  – Arizona          − Ohio
  – California       − Texas
  – Minnesota        − Virginia
  – North Dakota
                                          5
                   Birth of NDNQI

• Established in 1998 as part of ANA’s Safety
  and Quality Initiative

• ANA funded the development of a national
  database to house nursing-sensitive quality
  indicators
• Database is located at Kansas University
  Medical Center (KUMC) School of Nursing
  – ANA Contract

                                                6
              Twin Goals of NDNQI


• Provide participant       • Develop national data
  hospitals with national     on the relationships
  comparative unit level      between nurse
  data for use in quality     staffing and patient
  improvement                 outcomes
  activities



                                                      7
                 NDNQI Participants
• Acute Care Hospitals
  – All 50 states and DC
  – International
• Voluntary membership
• All hospital types
  – 6 - >500 beds
  – Academic, teaching, non-teaching
  – General, pediatric, rehab, psych, specialty
  – Not-for-profit, government, for-profit
  – Metro, non-metro                              8
Membership Map




                 9
Participant Characteristics




                          10
                   Participant Growth
                                    # Reports
1600
                                                                          1388
1400
                                                                   1278
                                                            1173
1200
                                                      992
1000
                                                852
 800
                                         646
 600
                              483

 400
                        272
                  210
 200        113
       36
   0




                                                                                 11
            Reasons for Participation

• Data are being collected internally
• Seeking national level data for…
  – Quality initiatives
  – Magnet application
  – RN retention/recruitment
• Satisfies CMS’ reporting requirement...
  – For participation in a nursing-sensitive
    database registry
                                               12
            Supporting Participants
• On-line tutorial training on collecting
  standardized data
• Data Collection Guideline Manual
• Quarterly newsletter
• Quarterly teleconferences

• Annual conference
• Technical assistance via email/phone
                                            13
                      Confidentiality
• Facility Participation
  – Disclosed only if authorized
• Data
  – Secure web entry
  – HIPAA compliance
     • Protected Health Information (PHI) not collected
• Reports
  – Suppress data if <5 units reporting

                                                          14
Core Measures




                15
                  Primary Focus
• Data collected/submitted at UNIT level
  – Where nursing occurs
• Nurses who provide Direct Patient Care
• Nursing-sensitive Outcomes
• Reports by Unit Type




                                           16
                       Unit Types

Adult & Pediatric        Neonatal
–   Critical Care        Psychiatric
–   Step Down            Rehab
–   Medical              ED
–   Surgical             OB
–   Medical/Surgical     Peri-op
    Combined             Ambulatory Care
                         Interventional



                                           17
                       Original Indicators
                             (1998)
• Nursing Hours per Patient Day*
• Skill Mix*
• Hospital/Unit Acquired Pressure Ulcers*
• Falls/Injury Falls*

*Aligned with National Quality Forum (NQF) definitions




                                                         18
                Additional Collected
                        Data
• Contract/Agency Nurse Hours
• RN Education and Certification
• Pressure Ulcer & Fall Processes
  – Risk Assessment
  – Prevention Protocols
  – Severity
• Hospital Characteristics
  – Staffed Beds
  – Magnet Status
  – Teaching Status

                                       19
                          Indicators Added
• RN Satisfaction Survey – 2002
• Cycle of Pain Assessment – 4Q04
• Peripheral IV Infiltration – 4Q04
• Physical/Sexual Assaults – 1Q05
• Restraint Prevalence* – 4Q06
• Nurse Staff Turnover* – 3Q07
     *Aligned with National Quality Forum (NQF) definitions


                                                              20
                   Indicators Added Cont
• Healthcare Acquired Infections -
  4Q07
  – Ventilator-associated pneumonia (VAP)*
  – Catheter associated urinary tract infections
    (CAUTI)*
  – Central line-associated bloodstream
    infections (CLABSI)*
  *Aligned with National Quality Forum (NQF) definitions



                                                           21
                          RN Survey
•   Annual Survey
•   Web-based data collection
•   Choice of 6 available months
•   3 week data collection period
•   All nursing units may participate
    – Not limited to in-patient units




                                        22
               3 Instrument Options
• RN Survey with Practice Environment
  Scale *
• RN Survey with Job Satisfaction
• RN Survey with Job Satisfaction – Short
  Form

    *Endorsed by NQF




                                            23
                     Survey Contents
• Scales
    – Practice Environment or
    – Job Satisfaction
•   Job Enjoyment Scale
•   Work Context Items
•   Job Plans
•   RN Characteristics


                                       24
            Practice Environment
                   Scales
• Nurse Participation in Hospital Affairs
• Nursing Foundations for Quality of Care
• Nurse Manager Ability, Leadership, and
  Support of Nurses
• Staffing and Resource Adequacy
• Collegial Nurse-Physician Relations


                                            25
                      Job Satisfaction Scales
•   Nurse-Nurse Interaction
•   Nurse-Physician Interaction
•   Decision-Making **
•   Autonomy
•   Task **
•   Professional Status
•   Professional Development
•   Supportive Nurse Management
•   Nursing Administration
•   Pay
    ** On short form version


                                                26
         Survey Eligibility Criteria

• RN and advanced practice RN
• Spend >50% time in direct patient care
  activities
• Employed a minimum of 3 months on unit




                                           27
              Survey Participation
                    Growth
       Year      # of RNs   # of Hospitals

2002             17,805          64
2003             41,524         131
2004             75,877         206
2005             144,207        382
2006             176,842        494
2007             219,428        553
2008             234,588        696
2009             271,751        773


                                             28
NDNQI Reports




                29
                            Two Reports
• Quarterly Indicator Reports
   – Hospital Unit Data
   – Dashboards & User-specified Graphics
   – National Summary Statistics*
• Annual RN Survey Reports
   – Hospital Unit Data
   – Dashboards & User-specified Graphics
   – National Comparison Data*
*Comparison data owned by ANA, hospitals cannot publish
                                                          30
                 Quarterly Indicator
                      Reports
• Section for each Unit Type
• Each section has multiple tables
• Within each table
  – Individual unit information
  – Hospital unit type summary
  – National comparative information for like
    facilities
  – Mean, standard deviation, percentiles
                                                31
Sample Report




                32
Dashboard Examples
Custom Web Charts

              Your choice of
              benchmark group
                     RN Survey Reports

• Comparison Data
  • Summarized across all units in all hospitals
  • Summarized by unit type
  • Statistics
     • Mean or T-score, standard deviation, percentiles
• Individual Hospital Data
  • Summarized for all units in hospital
  • Summarized by units
     • Not provided if individuals identifiable


                                                          35
Sample Report




                36
Dashboard Examples




                     37
              Uses for NDNQI Reports

 Satisfy Reporting Requirements
 Quality Improvement
     Track staffing and patient trends over time
    Nursing Administration (i.e., resource planning)
    Patient Recruitment
    RN Retention Efforts
    RN Recruitment
    Staff Education
    Research
    Risk Management
                                                        38
                    Internal Stakeholders

 Marketing                                             CEO
Recruitment                                      Board of Directors
                              CNO
Research
 Council                                                 Management
                                      Practice             Council
              Quality
              Council                 Council
                            Risk
                         Management


                                                     Unit
                                                    Manager
                          Staff
                        Education

                                        Staff
                                        Nurse
                                                                      39
            Unique Database for
             Policy Research
• National coverage

• Data at unit level — where interventions
  can best be planned & implemented

• Contains data on both nurse staffing and
  patient outcomes

                                             40
Enrollment & Web Entry




                         41
                   Joining NDNQI

• See web site for enrollment materials
• First steps
  – Identify site coordinator (primary contact)
  – Complete and return Membership Application
• Next steps
  – Sign Database Agreement (contract)
  – Pay invoice (stratified pricing system based
    on staffed bed size)
                                                   42
           Before Data Submission

Site Coordinator:
1. Receives from NDNQI
  – Letter with ID code
  – Link to set up password
2. Completes web-based tutorial
3. Verifies hospital demographic
   information on-line
4. Enrolls hospital units
                                    43
Website Main Menu




                    44
                    Tutorial...more

• All data entry staff must complete tutorial
  – Includes instructions on how to collect
    standardized data
  – Demonstrates data entry on web screens
  – Each indicator has a module quiz
• Separate Reports On-line Training
  – Optional

                                                45
46
            Quarterly Data Process

• Follow data entry instructions for each
  indicator
• Data are extracted 45 days after the close
  of the quarter for analysis
• Reports posted on website for download
     PDF or Excel



                                               47
                 RN Survey Process

• Registration
  – On-line
  – Opens August for following year
  – Limited first-come, first-serve basis
• RN Survey Coordinator
  – Guided by standardized Data Collection
    Protocol
• Report posted on website
  – PDF and Excel
                                             48
On-line Registration for
        Survey




                           49
National Database of Nursing
     Quality Indicators


   We invite your facility to
   participate

   Contact us:
   ndnqi@kumc.edu
   www.nursingquality.org
   913-588-1691




                                50

				
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