1、Annual Review of Nursing Services Staffing Plan,Sample Outcome MetricsNH Nurse Staffing Toolkit 2010,Annual Review,Core principles mandate at least a yearly review by the hospital-wide nursing staffing committee: Ensure the most current nursing services staffing plan does all of the following: Impro
2、ve inpatient care outcomes; Positively affects clinical management; Facilitates cost-effective quality nursing care Remains consistent with acceptable and prevailing standards of safe nursing care and evidenced-based guidelines established by national nursing organizations. Make recommendations, bas
3、ed on the most recent review conducted, regarding how the most current nursing services staffing plan should be revised, if at all.,Dont Reinvent the Wheel,Use data you have that is consistent with what you require for credible metrics and adds value to the analysisAssess data that is currently coll
4、ected for required reporting, voluntary reporting or internal quality (outcome and process) purposes,Inpatient Care Outcomes / Clinical Management / Cost Effective Care,NDNQI metrics Patient falls Pressure ulcer prevalence NHPPD Nurse satisfaction Other metrics Medication errors, adverse drug events
5、 and near misses Care events Patient satisfaction (HCHAPS nursing questions),Patient complaints / grievances Turnover rate Vacancy rate Overtime usage Agency/traveler usage ALOS Costs/UOS Costs/discharge MD satisfaction Staff satisfaction TJC Core Measures,Evidence Based Outcomes,Needleman & Buerhau
6、s et al. (2001) Strong consistent relationships between nurse staffing and UTI, pneumonia, LOS, UGI bleeds shock. In major surgical patients failure to rescue was also related to nurse staffing.,Cho et al. (2003) An increase of 1 HPPD was associated with 8.9% decrease in odds of pneumonia, 10% incre
7、ase in RN proportion was associated with 9.5% decrease in odds of pneumonia, increased nursing HPPD higher probability of pressure ulcers,Evidence Based Outcomes,Aiken et al. (2002) Each additional patient cared for by a nurse was associated with a 7% increase likelihood of dying within 30 days of a
8、dmission, and a 7% increase in failure to rescue rates, a 23% increase in nurse burnout a 15% increase in job dissatisfaction.,Rogers et al. (2004) Errors and near errors more likely to occur when nurses work 12 hours.,Evidence Based Outcomes,2007 AHRQ Report Increased RN to Patient Ratios was assoc
9、iated with decreased hospital mortality, LOS, failure to rescue (but not necessarily causal) For every increase 1 RN FTE per patient day, decrease in mortality in ICU by 9% and in surgical patients by 16%. For Every additional patient per RN per shift 7% increase risk of hospital acquired pneumonia
10、45% increased risk of unplanned extubation 17% increased risk of medical complications,Evidence Based Outcomes,2007 AHRQ Report An increase of 1 RN FTE per day in ICU 28% decrease in risk of CPR, 51% decrease in risk of unplanned extubation, 60% decrease risk of pulmonary failure 30% decreased risk
11、of hospital acquired pneumonia An increase of 1 RN FTE per day in Surgery patients 16% decreased risk of failure to rescue, 30% decreased risk of nosocomial blood stream infections,Evidence Based Outcomes,2007 AHRQ Report Death rate decreased by 1.98% for every additional total nurse hour per day. N
12、urse satisfaction and autonomy was associated with reduction of risk of death. Increased nurse turnover was associated with a 0.2% increase in falls. No research on the effect of agency or temporary staff or international nurses in staffing.,Required Measures,Required Measures,Required Measures,Requ
13、ired Measures,Required Measures,Required Measures,Measures on the Horizon,Required Measures HCAHPS Hospital Consumer Assessment of Healthcare Providers and Systems,Communication with nurses Communication with doctors Responsiveness of staff Pain management,Communication about medication Cleanliness
14、of hospital Discharge information Overall rating Willingness to recommend,CMS Hospital Acquired Conditions (never events),CABG Mediastinitis Catheter Associated Urinary Tract Infection Pressure Ulcers Vascular Catheter-Association Infection Object Left in Surgery,Hospital Acquired Injuries (i.e. fal
15、ls/burns/fractures, etc) Air Embolism Blood Transfusion Incompatibility,TJC Proposed Nurse Sensitive Measures,Patient-centered Outcome Measures: Death among surgical inpatients with treatable serious complications (failure to rescue): The percentage of major surgical inpatients who experience a hosp
16、ital-acquired complication and die. Pressure ulcer prevalence: Percentage of inpatients who have a hospital acquired pressure ulcer. Falls prevalence: Number of inpatient falls per inpatient days. Falls with injury: Number of inpatient falls with injuries per inpatient days. Restraint prevalence: Pe
17、rcentage of inpatients who have a vest or limb restraint.,TJC Proposed Nurse Sensitive Measures,Patient-centered Outcome Measures: Urinary catheter-associated urinary tract infection for intensive care unit (ICU) patients: Rate of urinary track infections associated with use of urinary catheters for
18、 ICU patients. Central line catheter-associated blood stream infection rate for ICU and high-risk nursery patients: Rate of blood stream infections associated with use of central line catheters for ICU and high-risk nursery patients. Ventilator-associated pneumonia for ICU and high-risk nursery pati
19、ents: Rate of pneumonia associated with use of ventilators for ICU and high-risk nursery patients.,TJC Proposed Nurse Sensitive Measures,Nursing-centered Intervention Measures: Smoking cessation counseling for acute myocardial infarction. Smoking cessation counseling for heart failure. Smoking cessa
20、tion counseling for pneumonia. Each measures the percentage of patients with a history of smoking within the past year who received smoking cessation advice or counseling during hospitalization.,TJC Proposed Nurse Sensitive Measures,System-centered Measures: Skill mix: Percentage of registered nurse
21、, licensed vocational/practical nurse, unlicensed assistive personnel, and contracted nurse care hours to total nursing care hours. Nursing care hours per patient day: Number of registered nurses per patient day and number of nursing staff hours (registered nurse, licensed vocational/practical nurse
22、, and unlicensed assistive personnel) per patient day.,TJC Proposed Nurse Sensitive Measures,System-centered Measures: Practice Environment Scale Nursing Work Index: Composite score and scores for five subscales: nurse participation in hospital affairs; nursing foundations for quality of care; nurse
23、 manager ability, leadership and support of nurses; staffing and resource adequacy; and collegiality of nurse-physician relations. Voluntary turnover: Number of voluntary uncontrolled separations during the month by category (RNs, APNs, LVN/LPNs, NAs).,Dont Reinvent the Wheel,Use data you have that
24、is consistent with what the statute requires and adds value to the analysisAssess data that is currently collected for required reporting, voluntary reporting or internal quality (outcome and process) purposes As new measures of performance are added/required consider incorporating them into the annual review process,Questions?,
