Transition to Practice Study: Outcomes Data

1. Transition to Practice Study:Outcomes Data National Council of State Boards of Nursing Mary Blegen, PhD, RN, FAAN April 27, 2011

2. Research Study: Determine the effects of the TTP intervention • Must have valid data for comparison across hospitals and across time • Across hospitals – experimental and control • Across time – before and after the study • Valid means accurate, measuring what we intend to measure, and comparable across hospitals and time • Measures should be the same in all hospitals [surveys will be the same, outcomes data may not] • Data collected using the same definitions and care • This is the focus of this presentation

3. Obtaining valid comparable data is a major challenge • BUT – we will benefit from the work of the National Database of Nursing Quality Indicators (NDNQI) • Hospitals participating include • 82 from Illinois • 53 from North Carolina • 96 from Ohio

4. Evaluation Data • Surveys of new graduates • Surveys of preceptors and unit managers • Hospital Data • Nurse Staffing • Nurse Retention • Patient Satisfaction • Patient Outcomes

5. Hospital Data: Nursing • Nurse staffing • Has major influence on patient outcomes • Need to control when comparing patient outcomes and nurse retention • Hours of care on each unit for specific time period • RNs, LPNs, NAs • Regular, Contract, Float • Calculate hours per patient day (HPPD) • Patient days of care on each unit for the same time period • Source of data • Unit Manager #1 or • Payroll or • Human Resources

6. Hospital Data: Nursing • Vacancy Rates (positions available but unfilled) • In the unit • In the hospital • All Nurse Retention (turnover) • In the unit • In the hospital • New graduates in our study • New Graduate • Retention at 6 months • Retention at 12 months • Reason for Leaving

7. Hospital Data: Patients • Patient Satisfaction – Hospital Survey • Data as the hospital collects and reports • Year before our study and the year of the study • This survey may be different from one hospital to the next • Comparison must be with previous patient satisfaction results in that hospital • Unit level - if hospital aggregates it that way • Hospital level also

8. Hospital Data: Patients • Patient Outcomes – Unit Level • Medication errors (per patient day from previous) • *Patient falls with and without injury (per patient day) • *Hospital acquired pressure ulcers • *Catheter associated Urinary Tract Infections • *Central line associated blood stream infections • *Ventilator associated pneumonia *NDNQI (Nat'l Database Nursing Quality Indicators) • Need to know the type of unit

9. Hospital Data: Patients • Use existing data • You do not have to do chart reviews to collect these data • Use definitions from the NDNQI • Manual will be provided • Explanations/definitions if different from NDNQI • Collect by month if possible • By quarter is OK

10. Patient Outcomes: Definitions • Medication Administration Errors • Number of adverse incidents from medication error reported / divided by patient days of care • This outcome measure is not collected by NDNQI but should be available from each hospital • By month if possible, by quarter if necessary

11. Patient Outcomes: Definitions • Patient Falls – per patient days, per month (quarter if necessary) • Total falls • Injury falls (minor, moderate, major, death) • Patient Fall is: • an unplanned descent to the floor, with or without injury to the patient, that occurred on the nursing care unit • Include patient falls due to all reasons: • Physiologic (fainting) • Environment (slippery floors) • Assisted falls

12. Patient Outcomes: Definitions • Hospital Acquired Pressure Ulcers • Localized injury to the skin or underlying tissue, usually over a bony prominence, as a result of pressure or pressure in combination with shear • Stages I to IV or unstageable • Best detected by quarterly rounds with inspection of all patients (NDNQI) • Rate: number of patients with HAPU divided by number of patients inspected • Some hospitals “measure” with incident reports, others from “wound care” nurses documentation

13. Patient Outcomes: Definitions • Infections • Catheter Associated Urinary Tract Infections • Central Line associated blood stream infections • Ventilator Associated Pneumonia • Data from NDNQI liaison or Unit Manager or Infection Control Department