Describe nurses’ and the interdisciplinary team’s role in informatics with a focus on electronic health information and patient care technology to support decision making.
#4 Informatics And Nursing Sensitive Quality Indicators
As you begin to prepare this assessment you are encouraged to complete the Conabedian Quality Assessment Framework activity. Quality healthcare delivery requires systematic action. Completion of this will help you succeed with the assessment as you consider how the triad of structure (such as the hospital, clinic, provider qualifications/organizational characteristics) and process (such as the delivery/coordination/education/protocols/practice style or standard of care) may be modified to achieve quality outcomes.
The American Nursing Association (ANA) established the National Database of Nursing Quality Indicators (NDNQI®) in 1998 to track and report on quality indicators heavily influenced by nursing action.
NDNQI® was established as a standardized approach to evaluating nursing performance in relation to patient outcomes. It provides a database and quality measurement program to track clinical performance and to compare nursing quality measures against other hospital data at the national, regional, and state levels. Nursing-sensitive quality indicators help establish evidence-based practice guidelines in the inpatient and outpatient settings to enhance quality care outcomes and initiate quality improvement educational programs, outreach, and protocol development.
The quality indicators the NDNQI® monitors are organized into three categories: structure, process, and outcome. Theorist Avedis Donabedian first identified these categories. Donabedian’s theory of quality health care focused on the links between quality outcomes and the structures and processes of care (Grove, Gray, Jay, Jay, & Burns, 2015).
Nurses must be knowledgeable about the indicators their workplaces monitor. Some nurses deliver direct patient care that leads to a monitored outcome. Other nurses may be involved in data collection and analysis. In addition, monitoring organizations, including managed care entities, exist to gather data from individual organizations to analyze overall industry quality. All of these roles are important to advance quality and safety outcomes.
The focus of Assessment 4 is on how informatics support monitoring of nursing-sensitive quality indicator data. You will develop an 8–10 minute audio (or video) training module to orient new nurses in a workplace to a single nursing-sensitive quality indicator critical to the organization. Your recording will address how data are collected and disseminated across the organization along with the nurses’ role in supporting accurate reporting and high quality results.
Reference
Grove, S. K., Gray, J. R., Jay, G.W., Jay, H. M., & Burns, N. (2015). Understanding nursing research: Building an evidence-based practice (6th ed.). St. Louis, MO: Elsevier.
Demonstration of Proficiency
By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:
- Competency 1: Describe nurses’ and the interdisciplinary team’s role in informatics with a focus on electronic health information and patient care technology to support decision making.
- Describe the interdisciplinary team’s role in collecting and reporting quality indicator data to enhance patient safety, patient care outcomes, and organizational performance reports.
- Competency 3: Evaluate the impact of patient care technologies on desired outcomes.
- Explain how a health care organization uses nursing-sensitive quality indicators to enhance patient safety, patient care outcomes, and organizational performance reports.
- Competency 4: Recommend the use of a technology to enhance quality and safety standards for patients.
- Justify how a nursing-sensitive quality indicator establishes evidence-based practice guidelines for nurses to follow when using patient care technologies to enhance patient safety, satisfaction, and outcomes.
- Competency 5: Apply professional, scholarly communication to facilitate use of health information and patient care technologies.
- Deliver a professional and effective audio tutorial on a selected quality indicator that engages new nurses and motivates them to accurately report quality data in a timely fashion.
- Follow APA style and formatting guidelines for citations and references.
Preparation
This assessment requires you to prepare a 4-5 page paper on the importance of nursing-sensitive quality indicators. To successfully prepare for your assessment, you will need to complete the following preparatory activities:
- Select a single nursing-sensitive quality indicator that you see as important to a selected type of health care system.
- Conduct independent research on the most current information about the selected nursing-sensitive quality indicator.
- Interview a professional colleague or contact who is familiar with quality monitoring and how technology can help to collect and report quality indicator data. You do not need to submit the transcript of your conversation, but do integrate what you learned from the interview into the audio tutorial. Consider these questions for your interview:
- What is your experience with collecting data and entering it into a database?
- What challenges have you experienced?
- How does your organization share with the nursing staff and other members of the health care system the quality improvement monitoring results?
- What role do bedside nurses and other frontline staff have in entering the data? For example, do staff members enter the information into an electronic medical record for extraction? Or do they enter it into another system? How effective is this process
Instructions
For this assessment, imagine you are a member of a Quality Improvement Council at any type of health care system, whether acute, ambulatory, home health, managed care, et cetera. Your Council has identified that newly hired nurses would benefit from comprehensive training on the importance of nursing-sensitive quality indicators. The Council would like the training to address how this information is collected and disseminated across the organization. It would also like the training to describe the role nurses have in accurate reporting and high-quality results.
The Council indicates a recording is preferable to a written fact sheet due to the popularity of audio blogs. In this way, new hires can listen to the tutorial on their own time using their phone or other device.
As a result of this need, you offer to create an audio tutorial orienting new hires to these topics. You know that you will need a script to guide your audio recording. You also plan to incorporate into your script the insights you learned from conducting an interview with an authority on quality monitoring and the use of technology to collect and report quality indicator data.
You determine that you will cover the following topics in your audio tutorial script:
Introduction: Nursing-Sensitive Quality Indicator
- What is the NDNQI®?
- What are nursing-sensitive quality indicators?
- Which particular quality indicator did you select to address in your tutorial?
- Why is this quality indicator important to monitor?
- Be sure to address the impact of this indicator on quality of care and patient safety.
- Why do new nurses need to be familiar with this particular quality indicator when providing patient care?
Collection and Distribution of Quality Indicator Data
- According to your interview and other resources, how does your organization collect data on this quality indicator?
- How does the organization disseminate aggregate data?
- What role do nurses play in supporting accurate reporting and high-quality results?
- As an example, consider the importance of accurately entering data regarding nursing interventions.
Additional Requirements
- References: Cite a minimum of three scholarly and/or authoritative sources.
- APA: Submit along with the recording a separate Reference page that follows APA style and formatting guidelines. For an APA refresher, consult the APA Style and Formatpage on Campus.
Nursing Informatics
Nursing informatics “is the specialty that integrates nursing science with multiple information and analytical sciences to identify, define, manage and communicate data, information, knowledge and wisdom in nursing practice.”
What are Nursing Sensitive Indicators?
Nursing Sensitive Indicators are said to reflect three aspects of nursing care: structure, process, and outcomes.
Structural indicators include the supply of nursing staff, the skill level of nursing staff, and the education and certification levels of nursing staff.
Process indicators measure methods of patient assessment and nursing interventions. Nursing job satisfaction is also considered a process indicator.
Outcome indicators reflect patient outcomes that are determined to be nursing-sensitive because they depend on the quantity or quality of nursing care. These include things like pressure ulcers and falls. Other types of patient outcomes are related to other elements of medical care and are not considered to be nursing-sensitive – these include things like hospital readmission rates and cardiac failure.
In 1999, the American Nurses Association (ANA) identified 10 critical nursing sensitive indicators for acute care settings. In 2002 the ANA added 10 others that are applicable to community-based, non-acute care settings. Since then, the lists have been refined and expanded many times, with new indicators being added annually. The ten original indicators that apply to hospital-based nursing are:
- Patient satisfaction with pain management
- Patient satisfaction with nursing care
- Patient satisfaction with overall care
- Patient satisfaction with medical information provided
- Pressure ulcers
- Patient falls
- Nurse job satisfaction
- Rates of nosocomial infections
- Total hours of nursing care per patient, per day
- Staffing mix (ratios of RNs, LPNs, and unlicensed staff)
What Do Nursing Sensitive Indicators Provide?
By identifying this first group of indicators, the ANA became a pioneer, of sorts, in evidence based practice. The next step was a literature search to identify other indicators that were potentially nurse-sensitive. Those were then reviewed and either validated as being truly nurse-sensitive, or discarded.
In 1998, the ANA established the National Database of Nursing Quality Indicators™ (NDNQI®), in order to continue to build on data gained from earlier studies. There was already an established link between nurse staffing and patient outcomes, but more data and reporting was needed to evaluate other indicators of nursing quality at the unit level. The NDNQI became the very first database to gather such unit-level information. It now supplies hospitals with performance reports that allow administrators to compare their data with national averages, percentile rankings, and other important information.
Nursing sensitive quality indicators are an important part of the equation when it comes to establishing evidence-based practice guidelines. But measuring these indicators is not simply good science – it’s an ethical imperative. Nursing’s foundational principles and guidelines state that, as a profession, nursing has a responsibility to measure, evaluate, and improve the quality of nursing practice.
How Nursing Informatics Improves Patient Care
Aligning Nursing Best Practice with Clinical Workflows and Care – Nursing informatics is focussed on the best ways to achieve good patient outcomes — it is about applying the overall process and best practice to maximize patient care wherever possible. As a result, nurse informaticists are often involved in process design, clinical workflow reviews, and new diagnostics and treatment plans. They take into account the various options for providing care and use objective facts and analysis to determine the actions that will lead to the most patient-centered, value-based care.
Improving Clinical Policies, Protocols, Processes, and Procedures – Data is the lifeblood of nursing informatics. That data and information can be used to measure the success of the various protocols, processes, and procedures used in a healthcare organization. A nurse informaticist will measure and analyze how specific parts of the organization are performing, with a focus on the resulting patient outcomes.
They can then make changes to specific parts of the process to streamline activities, avoid bottlenecks, and improve care. Informaticists will see what the results are and continue making changes to enhance every part of the clinical care process.
Providing Training and Learning Based on Objective Data – One of the most valuable ways a nursing informaticist can enhance patient outcomes is through providing training to clinical staff. They can use data to identify endemic issues in a healthcare organization and consult on the best way to resolve these problems. These learnings can be integrated with onboarding new staff, ongoing in-house training, or external education and certification. Nursing informaticists can help to create highly-targeted educational programs to deal with specific gaps between ability and provider expectations.
Selecting and Testing New Medical Devices – Connected IoT medical devices can provide vast amounts of health data on patients. Nursing informaticists are ideally positioned to understand the true value of that data and provide recommendations on how it can be recorded, accessed, and used. Involving informaticists in the selection of medical devices will ensure you have additional criteria for understanding how device data can inform diagnostics, treatment plans, and ultimately patient outcomes.
Reducing Medical Errors and Costs – Nursing informaticists can reduce the chance of medical errors in a healthcare organization, together with associated costs. A combination of staff training, process improvement, and best practice will enhance the quality of care and limit patient risks. There are four main areas that drive medical errors:
- Communication doesn’t take place when it should
- Incorrect or incomplete information is communicated
- Information is shared with the wrong recipient or third party
- The message lacks critical facts or is unclear, meaning it isn’t understood correctly
Informaticists can look at how your organization communicates and collaborates around patient information. They can audit individual cases, identify gaps, and provide recommendations for avoiding errors in the future. In 2015, an analysis discovered medical errors cost healthcare providers $1.7 billion, over a five year period.
Enhancing End-to-End Treatment and Continuity of Care – A patient’s care may involve several areas, many teams, and dozens of individuals. Nursing informaticists can create protocols and processes to ensure proper communications and interactions between departments, teams, individuals, and patients. They can help healthcare employees to seek out “one view of the truth” through electronic health records, so everyone has the context and insight they need to ensure excellent continuity of care.
Three Essential Responsibilities of a Nurse Informaticist
With COVID-19 driving more data sharing, health systems have access to have even more data. However, many organizations still struggle to leverage that data to drive long-term improvements. Nurse informaticists have three essential responsibilities that help the nursing workforce document and submit accurate data and leverage it to develop evidence-based procedures for optimal care delivery.
Responsibility #1: Understand and Communicate the “Why” Behind New Processes
Knowing the why behind any process and communicating it to the nursing workforce and key stakeholders is critical for accuracy and adoption. When a nurse informaticist explains the importance of documenting specific observations and measures (e.g., height, weight, and allergies), nurses understand the long-term ramifications of incorrect or missing data on a person’s health and feel more accountable for capturing the correct data. Increased understanding also builds the nurses’ confidence in the system’s data, making them more likely to rely on that data to make decisions.
For example, an EHR could require documenting a patient’s height and weight and allergies during the admission assessment before a team member can enter new orders into the system. An estimated height and weight or missing documentation of allergies has downstream impacts for determining correct medications and dosages as well as avoiding a potential adverse event. A crucial part of a nurse informaticist’s job is to educate the workforce about the reasons behind these EHR requirements and their far-reaching effects. This insight helps the care team understand how specific data play an important role throughout the care process and decision making.
Responsibility #2: Implement New Technology and Processes
Any type of new electronic implementation (e.g., an EHR or patient portal) means a change in the clinical process. The clinical team will evaluate and adapt current processes in the context of the new technology and then implement it. With greater data access, health systems can identify additional care gaps and improvement opportunities, making a nurse informaticist’s role in new process education and implementation even more critical.
New processes bring improvement opportunities, but they also bring pain points and learning curves that can discourage team members. Without proper training and implementation, new technologies can flounder, fail to gain adoption, or even lead to unsafe workarounds, resulting in compromised patient safety and team member frustration. An effective nurse informaticist guides a new process implementation from beginning to end, setting team members up for success.
For example, an ICU nurse needs to use a new module in the EHR to capture the physiological (e.g., hemodynamic) monitoring of a patient. The new module requires capturing the data directly from the monitoring device and verifying it versus manually entering it in an electronic format or historically documenting it in a paper-based flow sheet. Logging the hemodynamic monitoring electronically focuses on real-time data capture. With a manual entry process, the nurse may delay data entry until a break or at the end of his/her shift, meaning that notes (or data) wouldn’t be available until later. The problem is that waiting to capture the data (the hemodynamic monitoring information) informs how other care team members will execute their care delivery and planning. If the latest data isn’t available, providers make care decisions based on incomplete information.
This change in the process means the nurse has to electronically submit information throughout a shift instead of during a break. A nurse informaticist, understanding the complex nature of nursing and the challenges of disrupting a routine, would provide education about the new process before implementation, ensure testing completion and provide hands-on training within the EHR, and a thorough explanation of the new approach’s benefits compared to the old method.
Responsibility #3: Validating Data with the Three Vs
The nursing informaticist role is expanding to encompass greater responsibility with data and analytics. To promote a data-driven decision making in clinical practice through effective data utilization and adoption.
Volume: Health systems have access to (what seems like) unlimited data. A nurse informaticist realizes the actual volume of data (e.g., clinical notes, admission assessments, vital signs medications, and lab results) and various data sources the organization can leverage to support data-driven decision making. The informaticist role is emerging to include data stewardship and data validation in support of an organization enterprise-wide data strategy.
Velocity: Data sharing is critical for health systems to deliver comprehensive care based on complete patient information. This means the velocity, or the speed at which data travels, is also critical. Delayed access to data can lead to postponed decision making or decisions based on incomplete data. Part of understanding data velocity is also communicating what data will be available and when to enable decisions (e.g., near real-time versus retrospective analysis). For example, real-time clinical data supporting analysis of possible and/or actual Hospital Acquired Conditions (HAC) enables the care team to take timely actions that impact patient safety versus using that same data retrospectively to identify trends over time. For population health, both clinical data and claims data are included in care coordination and closing care gaps; however, the velocity of claims data is currently less frequent than clinical systems and EHR data.
Variety: Validating data requires the informaticist to understand the different data sources and how they do—or do not—come together. Today’s electronic environment is comprised of discrete data, unstructured data, images, and connected device data (to name a few) that need to be validated. Nurse informaticists understand the variety of data sources and how to evaluate the data to tell a cohesive story about the patient and the population. For example, a nurse informaticist might discover that missing data sets could be a result of data not integrated into the EHR. The ability to dig deeper into data variety and then adjust processes to harmonize the data is critical to delivering care based on complete data sets.
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