Nurses in Imaging Saturday 6 June 2009 - PowerPoint PPT Presentation

Loading...

PPT – Nurses in Imaging Saturday 6 June 2009 PowerPoint presentation | free to download - id: 3bb9d5-MGY4Z



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Nurses in Imaging Saturday 6 June 2009

Description:

Nurses in Imaging Saturday 6 June 2009 Nursing Metrics: What, Why and How Professor Dame June Clark Professor Emeritus Swansea University, Wales UK – PowerPoint PPT presentation

Number of Views:61
Avg rating:3.0/5.0
Slides: 49
Provided by: rcnOrgU
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Nurses in Imaging Saturday 6 June 2009


1
Nurses in Imaging Saturday 6 June 2009
Nursing Metrics What, Why and How
  • Professor Dame June Clark
  • Professor Emeritus
  • Swansea University, Wales UK
  • j.clark_at_swansea.ac.uk

2
(No Transcript)
3
What are nursing metrics?
  • You wont find the word metrics defined as a
    noun in the Concise Oxford Dictionary or Collins
    English Dictionary

4
If you enter definition of metrics into Google
you will find
  • Metrics the study of poetic meter and the art of
    versification
  • Metrics is a property of a route in computer
    networking, consisting of any value used by
    routing algorithms to determine whether one route
    should perform better than another (the route
    with the lowest metric is the preferred route)
  • Metric is a Canadian New Wave/indie rock band.
    Originally formed in 1998 in New York City, they
    are currently based in Toronto, Ontario.

5
Google contd..
  • Quantitative measures of performance or
    production used to indicate progress or
    achievement against strategic goals.
  • metric - A standard for measurement.
  • metric - A measure for something a means of
    deriving a quantitative measurement or
    approximation for otherwise qualitative phenomena

6
A new word for an old chestnut measuring the
quality of nursing care
  • But this time
  • Still part of performance management
  • Still a top-down management initiative
  • Focus on outcome as opposed to structure or
    process
  • Increased emphasis on patient perceptions
  • Three dimensions Safety, Effectiveness,
    Compassion

7
Enter Darzi
  • High quality care for all NHS Next Stage Review
    final report .

The Next Stage Review makes a commitment to
develop an indicative set of metrics for nursing
that comprises of indicators of quality
reflecting the issues of safety, effectiveness
and compassion.
8
  • Griffiths P, Jones S, Maben J, Murrells T (2008)
    State of the art metrics for nursing a rapid
    appraisal. London. National Nursing Research
    Unit, Kings College London.

9
  • The group was tasked with finding measures of
    nurse-delivered outcomes and patient
    experience. We take this to mean measures that
    directly reflect nursings end result in terms of
    impact upon patients

This paper explores potential nursing-sensitive
indicators from published literature and
indicator sets currently in use. The requirements
of a good set of indicators are explored and
evidence for indicators validity is considered
through an examination of evidence linking
nursing contributions and patient outcomes. The
conclusion assesses the current state of the art
in nursing-sensitive indicators
State of the Art Metrics for Nursing p1.
10
Indicators most commonly currently used elsewhere
  • Pressure ulcers
  • Failure to rescue
  • Staffing levels (nurses/hours per patient)
  • Falls
  • Hospital Associated Infections (pneumonia)
  • Staff satisfaction and wellbeing
  • Hospital Associated Infections (UTIs)
  • Staffing/skill mix
  • Medication administration errors

11
Front runners in the indicator stakes Safety,
Effectiveness, Compassion
  • Safety Failure to rescue
  • Healthcare associated
    pneumonia
  • Healthcare associated
    infection
  • Pressure ulcers
  • Falls
  • Effectiveness Staffing levels and skill mix
  • Staff satisfaction
  • Staff perception of the
    practice environment
  • CompassionExperience of care (patient
    reported)
  • Communication (patient
    reported)

State of the Art Metrics for Nursing Box 5 p19.
12
Finding the indicators is easy. You can search
common terms in the box below or click through
the tree structure.
Indicators proposed by Department of Health
  • Search Results (nursing)
  • Quality stroke care (outcome reduction in stroke
    related mortality and disability)
  • Percentage of women who have seen a midwife or an
    obstetrician for health and social care
    assessment of needs and risks by 12 weeks of
    their pregnancy.
  • Pressure ulcer incidence per 10,000 patients

13
Issues for us
  • Q1 How will these indicators demonstrate the
    contribution or quality of nursing care?
  • Q2 How will we get the data?

14
Q1How will these indicators demonstrate the
contribution or quality of nursing care?
  • At present, individual health providers and
    institutionslack the basic information of
    knowing the quality of care that they provided in
    daily practice. Such data are not collected and
    there is thus no feedback in a systematic way to
    the individual physicians or nurses
  • WHO 1997

15
Q2 How will we get the data?
  • Specially collected data eg a form to be filled
    in for every fall or pressure ulcer
  • Secondary use of existing data
  • Audit (manual extraction of data from patient
    records)
  • By data mining electronic patient records

16
Nursing Quality Assessment Tool
Royal Devon and Exeter NHS Foundation Trust
17
A major strategy for improving quality in
healthcare must therefore be to establish
information systems at clinical level that give
feedback to individual providers on the outcomes
of the care they give for their patients WHO
1997
18
An alternative approach retrospective analysis
of electronic patient records
19
Where will you find details of patient falls?
  • Incident reports (special forms completed by
    nurses)
  • Clinical audit of patients (paper) records
  • Nursing documentation about the individual patient

20
Nursing documentation should include
  • Assessment (including Morse tool?)
  • Nursing diagnosis (Risk for falls?)
  • Intervention focused on the nursing diagnosis
    (actions taken to prevent falls)
  • Outcome (fall/no fall)

21
Retrospective analysis of electronic patient
records
  • Clinical data can be aggregated to provide
    management and policy information (Information
    governance is essential)
  • Information for management and planning should be
    collected as a by-product of core operational
    processes
  • Collect once, use many times, for multiple
    purposes

22
But this can only happen if
  • The relevant data is recorded in the EPR (Nursing
    data as well as medical data)
  • And stored
  • In such a way that the relevant items can be
    found (ie structured)
  • And expressed in standardised terminology to
    enable comparison (analysed in such a way as to
    show patterns)

This is not yet happening in nursing, but it is
required for electronic patient records
23
The Nursing Information Reference Model - Epping
and Goosen 1997
One way traffic Bottom up not top down
24
Nursing documentation
  • The only reason for putting data in (ie
    documenting anything) is so that someone can get
    it out.
  • But you can only get out what someone has put in
    (so we need agreed minimum data sets).
  • And they have to be able to find it (so it has to
    be structured - no more unstructured narratives).
  • And they have to be able to understand it (so we
    need standardised terminology).

25
What are nurses in other countries doing?
  • ICN
  • Belgium
  • Canada
  • USA
  • Northern Nurses Federation (Denmark, Sweden,
    Norway, Finland, Iceland)
  • Australia
  • Slovenia
  • And several others

We should learn from other countries instead of
re-inventing the (square) wheel
26
ICN project The International Nursing Minimum
Data Set (i-NMDS)
  • a minimum set of items of information with
    uniform definitions and categories concerning the
    specific dimension of nursing
    Werley and Lang 1988
  • Essential nursing items include
  • nursing diagnosis (nursing problem)
  • nursing intervention (what the nurse did)
  • nursing outcome (the result of the intervention)

27
Belgium Nursing Minimum Data Set
  • Compulsory since 1988
  • All Belgian acute hospitals
  • Content
  • Patient demographics
  • 23 nursing interventions (recently increased to
    79)
  • Nurse staffing data (FTE nurses / qualification
    level)
  • Sample 15 days / 3 months
  • 19 Million data items recorded since 1988
  • Largest Nursing Dataset in the world

28
Canadian Nurses Association C-HOBIC project
(Canadian Health Outcomes for Better Information
and Care)
  • Collection of patient outcome information related
    to nursing care in the electronic health records
    of four provinces
  • In addition to providing real time information
    to nurses about how patients are benefiting from
    care, the collection of nursing-related outcomes
    can provide valuable information to
    administrators in understanding how well their
    organisation is managing outcomes

29
Objectives of C-HOBIC project
  • Standardise assessment and documentation of
    patient outcomes into EHRs by nurses
  • Foster uptake of EHRs by nurses
  • Provide EHR content that is of use in nursing
    practice
  • Develop consistent methodology that will
    contribute to provincial patient outcomes data
  • Standardise the language used by C-HOBIC to ICNP
  • Capture and store patient outcomes data related
    to patient care across four sectors (acute,
    complex care, long term care, and home care) of
    the health system

30
USA Partnership of three organisations
  • American Nurses Association (NDNQI)
  • California Nurses Association (CalNOC)
  • Veterans Administration (VANOD)

31
American Nurses Association (ANA)
  • ANA began work on nursing quality and standards
    in the early 1970s. The RCN used this work to
    develop DySSI
  • ANA has worked on standardised nursing
    terminology and clinical information systems
    since the 1980s
  • In 1994, the American Nurses Association (ANA)
    launched the Safety Quality Initiative to
    explore and identify the empirical linkages
    between nursing care and patient outcomes. The
    Nursing Care Report Card for Acute Care (ANA,
    1995) proposed 21 measures of hospital
    performance with an established or theoretical
    link to the availability and quality of nursing
    services in acute care settings. In 1997, ANA
    issued a call for organizations to submit
    proposals to develop and maintain the National
    Database of Nursing Quality Indicators. From 1997
    - 2000, a series of pilot studies were funded by
    ANA to test selected indicators definitions,
    data collection methodology and instrument
    development.

32
NDNQI (National Database of Nursing Quality
Indicators)
  • The National Database of Nursing Quality
    Indicators (NDNQI) is a system developed by ANA
    to enable hospitals to collect and evaluate
    nursing-sensitive indicators.
  • All indicator data are collected and reported at
    the nursing unit level.
  • NDNQIs nursing-sensitive indicators reflect the
    structure, process, and outcomes of nursing care.
  • Currently, NDNQI has over 1,200 participating
    U.S. hospitals that are actively aided in
    improving patient safety and quality of patient
    care by using NDNQI comparative data.
  • NDNQIs mission is to aid the nursing provider in
    patient safety and quality
  • improvement efforts by providing research-based
    national comparative data on nursing care and the
    relationship to patient outcomes.

33
CalNOC (Collaborative Alliance for Nursing
Outcomes)
  • CALNOC is a collaborative Project of ANA
    California, the Association of California Nurse
    Leaders, and the CALNOC Steering Committee. Its
    mission is to advance improvements in patient
    care by
  • Building sustaining a valid and reliable
    statewide outcomes database.
  • Conducting research to advance evidence-based
    interventions to achieve quality.
  • Synthesizing disseminating data to shape public
    policy, practice, education.

34
Veterans AdministrationVANOD
Patient Care
Individual Clinical Reminders
35
Northern Nurses Federation
  • The Northern Nurses' Federation (NNF/SSN) has
    met the challenge of the ICN's Congress in
    Durban, South Africa in June/July of 2009
    (www.icn.ch/congress2009) and submitted a
    proposal for a symposium that now has been
    accepted. The symposium will be on
    nursing-sensitive quality indicators at the
    Nordic level based on international and national
    research. The focus of the presentations will be
    the Nordic experience and how it has inspired
    solutions relevant to public health and the
    promotion of the nursing profession.

36
England (Department of Health)
Nursing Times 19 May 2009
NHS quality indicators go live A set of
national quality indicators that can be used to
measure the performance of NHS nurses has been
published by the government. The Department of
Health has revealed a list of over 200 indicators
or metrics that are intended to measure the
performance of clinical teams the development
of which was first outlined in the NHS Next Stage
Review. The government has whittled its list of
232 down from more than 400 possible indicators
suggested in a consultation document, launched in
November. The final metrics fall into in three
main categories patient experience, safety,
effectiveness.
37
England (Department of Health)
Finding the indicators is easy. You can search
common terms in the box below or click through
the tree structure.
  • Search Results (nursing)
  • Quality stroke care (outcome reduction in stroke
    related mortality and disability)
  • Percentage of women who have seen a midwife or an
    obstetrician for health and social care
    assessment of needs and risks by 12 weeks of
    their pregnancy.
  • Pressure ulcer incidence per 10,000 patients

38
Scotland (NHS Scotland)
  • Aim of the Project
  • Develop a core set of Clinical Quality Indicators
    (CQI's) for Nursing and Midwifery developed and
    agreed in collaboration with NHSScotland and
    NHSQIS. Clinical Quality Indicators integrated
    into national clinical data sets to assess and
    support the delivery of safe and effective
    nursing and midwifery practice.
  • What does the project aim to achieve?
  • The objectives of the project are
  • Build on 'The Impact of Nursing on Patient
    Clinical Outcomes' working to develop a robust
    and interpretable metric of indicators
    demonstrating the nursing contribution to care
    that is safe, effective, efficient,
    patient-centred, timely and equitable.
  • Develop electronic data capture and analysis
    systems to enable monitoring of CQI's in NHS
    Board areas for the purpose of informing
    continuous quality improvement and performance
    management.
  • Utilise the agreed indicator set in the pilot
    phase of the Senior Charge Nurse/Ward Sister
    Review.
  • Achieve sustainability by ensuring existing and
    newly qualified nurses and midwives are suitably
    prepared and supported to take forward project
    outcomes.
  • Develop a model to ensure continuous review and
    development of the CQI's, considering the
    development of 'Centres of Responsibility' as set
    out in Recommendation 4 of 'The Impact of Nursing
    on Patient Clinical Outcomes'.

39
Scotland (NHS Scotland)
  •   Four initial clinical quality indicators have
    been developed which are supported by a national
    electronic quality improvement programme.  This
    is linked into the patient safety alliance work
    which you may have heard about. The first
    indicators are
  • pressure ulcer prevention,
  • falls prevention,
  • food fluid and nutrition,
  • and monitoring and observation.

40
UK RCN
  • Keyword search
  • Search results
  • Your search for nursing metrics in title,
    description and keywords returned 2 results.
  • You are on page 1 of 1
  • Nurses to lead the campaign to drive up quality
    in the NHS
  • Commenting on the release of the Kings College
    London reports, Nurses in Society Starting the
    Debate and State of the Art Metrics for Nursing
    A Rapid Appraisal, Dr Peter Carter, Chief
    Executive General Secretary of the Royal
    College of Nursing (RCN), today said
  • Location News, Events, Campaigns Press
    releases uk wide
  • Published 15 Oct 2008
  • State of the art metrics for nursing a rapid
    appraisal
  • Format PDF
  • Published 13 Nov 2008
  • You are on page 1 of 1

41
UK RCN
  • Keyword search
  • Search results
  • Your search for nursing quality indicators in
    title, description and keywords returned 2
    results.
  • You are on page 1 of 1
  • Senior Charge nurse review and clinical quality
    indicators projects
  • Delivering Care, Enabling Health is the current
    Scottish strategy for nursing, midwifery and
    allied health professions, published in 2006
  • Location News, Events, Campaigns News article
    Scotland
  • Published 28 Mar 2008
  • Standards for assessing, measuring, and
    monitoring vital signs in infants, children and
    young people
  • Format PDF
  • The assessment, measurement and monitoring of
    vital signs are important skills for all
    practitioners working with infants, children and
    young people. The vital signs covered in this
    publication include temperature, heart/pulse
    rate, respiratory rate and effort, and blood
    pressure. Important information gained by
    assessing and measuring vital signs can be
    indicators of health and ill health. These
    standards provide criteria for practitioners in
    achieving high quality nursing care. They will be
    of help in guiding local policies and procedures
    in relation to vital sign monitoring, performance
    improvement programmes and education programmes
    for registered nurses, nurses in training and
    health care assistants.

42
UK RCN
  • Location Home
  • Keyword search
  • Search results
  • Your search for policy nursing metrics in title,
    description and keywords returned 0 results.

43
RCN eHealth Policy documents launched Location
News/Events/Campaigns/news articles/UK-wide
Published 28 Jul 2008
  • RCN e-Health Programme
  • Policy Statement
  • Nursing content of electronic patient / client
    records
  • Published June 2008
  • Review date June 2009

44
If you search really hard
  • Search results
  • Your search for measuring quality returned 2
    results.
  • You are on page 1 of 1
  • Measuring for quality in health and social care.
    An RCN position statement
  • Format PDF
  • This information sets out the RCNs position in
    relation to quality and its measurement, and
    outlines the RCNs input on this issue. Designed
    to be of value to those for whom quality and its
    measurement is integral to their day-to-day work,
    it will also assist the wider health and social
    community to understand the contribution that
    nursing makes in this arena.
  • Published 08 May 2009
  • Standards for assessing, measuring and monitoring
    vital signs in infants, children and young people
  • Format PDF

45
Measuring for quality in health and social care
An RCN position statement
Publication no 003 535
  • The RCNs role and contribution in relation to
    measurement of quality
  • The RCN has a major role in role to play in
    relation to quality and standards.
  • The main priorities identified by the RCN for
    indicator and metrics development are summarised
    below
  • ?? indicators for high risk/high cost
    topics, particularly pressure ulcers, failure to
    rescue, further work on falls and other front
    runners identified by Griffith et al.(2008)
  • ?? indicators for essence of care
  • ?? patient reported outcomes, such as patient
    experience and perception of patient involvement,
    which will provide fruitful measures for
    providing feedback on person-centred care
  • ?? indicators for systems of care (for example,
    continuity of care, teamwork and also staffing
    levels) with links to patient satisfaction.
  • In relation to measuring quality the RCN has
    three key purposes
  • ?? engaging and informing members, profession and
    public
  • ?? representing nursing
  • ?? developing the evidence base.
  • A response to the DH (England) proposals on
    metrics has been submitted by the RCN, setting
    out its position in relation to the contribution
    of nursing and its principles around quality and
    measurement.
  • The RCN is currently moving towards establishing
    a quality and standards unit.

46
So what do we have to do?
  • Abandon our isolationism and learn from the rest
    of the nursing world
  • Invest massively in education to restructure the
    way we teach and use the nursing process
  • Invest massively in education to restructure our
    nursing documentation
  • Ensure appropriate nursing content in EHRs
  • Copy the Canadians

47
Objectives of C-HOBIC project
  • Standardise assessment and documentation of
    patient outcomes into EHRs by nurses
  • Foster uptake of EHRs by nurses
  • Provide EHR content that is of use in nursing
    practice
  • Develop consistent methodology that will
    contribute to provincial patient outcomes data
  • Standardise the language used by C-HOBIC to ICNP
  • Capture and store patient outcomes data related
    to patient care across four sectors (acute,
    complex care, long term care, and home care) of
    the health system

48
As Dr Simon Jones, (Senior Research Fellow at
National nursing Research Unit Kings College
London) said at a recent conference..
  • If you dont drive the development of metrics
    for your profession, someone else will and they
    wont have your insight
About PowerShow.com