One organization enhances care by exposing nurses to quality improvement information
The pressure for healthcare organizations to participate in a variety of quality improvement initiatives is increasing. And with the demand come two major challenges:
1. Engaging nursing staff members
2. Disseminating data
To stay on top of quality improvement expectations, The University of Kansas Hospital in Kansas City—an ANCC Magnet Recognition Program® recipient in 2006—identified ways to successfully collect and disseminate data and engage nursing staff members to improve patient outcomes.
“There’s tons of data obtained from conducting quality improvement activities, and you have to funnel it down to what is appropriate, applicable, and meaningful to nurses,” says Lila Martin, RN, MSN, director of quality and safety at The University of Kansas Hospital. “You have to put the data into terms that they can relate to.”
The University of Kansas Hospital has several nurses who aid in the process of collecting quality improvement data and also work as quality outcomes coordinators. These coordinators work with data regarding specimen mislabeling, restraint use, critical care outcomes, and sepsis, as well as data from the American Nurses Association National Database of Nursing Quality Indicators, which collects and evaluates unit-specific, nurse-sensitive information in the United States. Each quality outcomes coordinator oversees data collection, analysis, interpretation, and benchmarking of internal and external indicators to identify improvement opportunities, says Martin. Coordinators share those data with departmental councils (risk management, quality, nursing, clinical laboratory, etc.).
“You need people as resources because you have to have somebody that can collect the data and then do something with the data,” says Martin. “Our coordinators actively engage multidisciplinary groups to look at data and decide what kind of interventions they are going to put in place.”
Not all nurses understand statistics like an incidence of 1.29 falls per 1,000 patient days, says Martin. “They want to know three patients fell on my unit last month, and five fell the month before, so we are getting better,” she says. “Sometimes they just need raw data.”
To help staff members see the raw data, the quality department uses a variety of approaches to expose staff nurses to the data collected on the following quality improvement initiatives:
Patient satisfaction data. These data are collected weekly, so the hospital knows where it stands “week by week, instead of waiting for a quarter’s worth of data that’s three months old,” says Martin. The patient satisfaction data are pushed out to all nurse managers weekly through e-mail. Once nurse managers receive the data, they are expected to share the results with their staff.
Falls data. Nurse directors and managers receive falls data through e-mail on a weekly basis from risk management. The e-mail lists the patients who have fallen in the last week and the number of days since the last fall on each unit. This allows units to track their falls by using dry-erase or bulletin boards, says Martin.
Contaminated blood cultures data. Nursing leadership receives weekly e-mail reports on contaminated blood cultures from the clinical laboratory. Reports include the unit, collection day and time, and patient identification and site, so nurse leaders can immediately identify the nurse who drew the samples. A nursing leader reviews each incident and then individually follows up with the nurse. Each month, units post the actual number of contaminated cultures for staff members to see.
“Having real-time and meaningful data is necessary for improvement,” says Amanda Gartner, RN, BSN, CCRN, unit coordinator and chair of the nursing quality council at the facility.
Once results are distributed, the unit nursing practice councils examine the data on quality improvement initiatives during their monthly meetings. Each nursing unit is expected to conduct at least one quality improvement project of their choice each year.
“We kind of hold their feet to the fire in the sense that we have a reporting schedule of when they have to report to the quality council,” says Martin. “Each year, we hold an annual nursing staff meeting and encourage the units to display posters of their quality improvement projects.”
Sharing data organizationwide
A nursing quality forum is held for managers, directors, and nurses, but the entire organization is welcome to attend.
At the forum, information about the overall performance for all quality improvement indicators is presented, including nurse-sensitive quality indicators. A scorecard (see “Patient satisfaction scorecard” below) is presented to show the hospital’s trends regarding the indicators.
The scorecard is an immediate visual aid for nurses to see whether they are improving, says Martin.
“The open forum gives staff organizationwide an opportunity to see data,” says Martin. “Some nurses might never see patients that have [methicillin-resistant Staphylococcus aureus], but they get to see the overall trends taking place during this forum. Everyone who attends sees the bigger picture—something they should be proud of.”
Martin says she believes that keeping the data in front of the nurses is the reason University of Kansas’ specimen labeling has improved, nurses can identify the last time a patient fell, and pressure ulcers have been reduced to about 4% facilitywide.
“I don’t think you can tie one certain intervention to a particular outcome, but I would like to think one of the reasons for change is because we show nurses data,” says Martin.