KU School of Nursing faculty keep a close watch on nursing quality across the nation

February 29, 2012

By Bridget Koan

Nurse Leasa Clemons demonstrates how she asseses pain for infants in the Neonatal Intensive Care Unit at The University of Kansas Hospital. Infant pain is one measure of quality, according to the National Database of Nursing Quality Indicators®.

Though it's not widely known, experts at the University of Kansas School of Nursing have spent more than a decade analyzing crucial information that ensures hospitals throughout the United States meet the highest quality of standards for nursing care.

In 1994, the American Nurses Association (ANA) launched the Patient Safety & Quality Initiative to identify the links between nursing care and patient outcomes. The following year, the organization issued the Nursing Care Report Card for Acute Care, proposing 21 measures of hospital performance, such as patient falls, pressure ulcers, and hospital-acquired infections. The ANA proceeded to fund a series of pilot studies to create and test definitions of these measures and data collection methodologies.

Recognizing the need to keep track of hospital performance, in 1997, the ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators®  (NDNQI®). The KU School of Nursing and the Midwest Research Institute (MRI) were selected to take on this task because of their expertise in database programming and outcomes research.

The database was first housed with Midwest Research Institute in Kansas City, Mo., lead by Nancy Dunton, PhD, FAAN, who is now a research professor in the KU School of Nursing. The MRI information technology team created the database, with less than one full-time employee working on the program and 30 hospitals participating. When MRI changed focus in 2001, Dunton approached the KU School of Nursing's Roma Lee Taunton, RN, PhD, FAAN, and Dean Karen L. Miller, RN, PhD, FAAN, about taking on the program.

"Within three weeks, NDNQI was brought to the KU School of Nursing," Dunton said.

Today, NDNQI has more than 1,800 hospitals participating and collects data on the following indicators: Patient falls, patient falls with injury, pressure ulcers, pediatric pain assessment cycle, pediatric IV infiltration rate, psychiatric patient assault rate, restraint prevalence, nurse turnover, healthcare-associated infections (ventilator-associated pneumonia, central line-associated blood stream infection, catheter-associated urinary tract infections), skill mix or the percent of nursing care hours supplied by RNs, nursing hours per patient day, RN Surveys (job satisfaction, practice environment scale), RN education and certification. The number of participating hospitals grows weekly, tracked on a map at the ANA's website www.nursingworld.org.

Administered by the University of Kansas School of Nursing under contract to ANA, NDNQI is the only national nursing quality measurement program that provides hospitals with unit-level performance comparisons based on a variety of hospital characteristics including size, teaching status, Magnet status and geography. NDNQI is transforming research data into improved quality of patient care by improving nursing processes, nurse staffing and skill level.

NDNQI provides quarterly information that includes national, regional and state comparison data for hospitals. The NDNQI data allows staff nurses and nursing leaders to evaluate nursing performance relative to similar units in peer hospitals. Facilities can use the information to establish organizational goals for improvement and mark progress

"We process quarterly and survey data for nearly 19,000 units," Dunton said. NDNQI has nearly 40 full time employees who have a wide range of backgrounds. Nurses are employed to provide technical assistance to hospitals. Statistical analysts, sociologists, psychologists, statisticians and people with social science backgrounds are employed with NDNQI to collect, analyze, and report on the data. They also work with the KUMC Department of Biostatistics and KU Center for Health Informatics on statistical methods development and publications.

NDNQI also is a primary resource for nursing quality indicator data used by hospitals pursuing Magnet recognition, a program of the American Nurses Credentialing Center that recognizes heath care organizations for excellence in nursing, the nursing work environment, and patient outcomes. "As we develop new indicators we call on hospitals to volunteer for pilot testing," Dunton said. Many hospitals like this opportunity because they can show they are engaged in research, which is required for Magnet recognition.

A unique aspect of NDNQI is the RN Job Satisfaction Survey. "The nurse satisfaction survey can help prepare nurse managers and leaders in practice and education for the coming increased competition for specialists and clinical staff," Miller said. "New care delivery models, built on valid data, are already emerging."

"We're the only nursing outcomes database that is national in scope, that has the RN Satisfaction Survey and a focus on nursing care at the unit level rather than for the hospital as a whole," Dunton said. "Hospitals really want to retain nurses so they are very interested in RN job satisfaction."

Since 1999, when the National Institute of Medicine recognized that 100,000 people die each year from hospital-acquired conditions, there has been a proliferation of measures of health care quality. Over the last seven years, NDNQI has submitted nursing-related definitions of quality indicators to the National Quality Forum, a public-private partnership that recognizes certain measures as national standards for assessing the quality of health care.

NDNQI also offers pressure ulcer training under the guidance of Sandra Bergquist-Berringer, RN, PhD, KU School of Nursing researcher. The web-based tutorial trains nurses to identify pressure ulcers. To date, approximately 220,000 nurses have taken the tutorial for continuing education credit.

The data collected and analyzed at KU has also provided patient outcome data to researchers at other institutions. To date, six investigators from other universities have used NDNQI data in funded projects and more are in the application process. Their work has contributed to the state of knowledge in patient falls, pressure ulcers, and pain care quality; the influence of electronic health records on nursing; and the effectiveness of federal policies in promoting safer patient care.

"The ultimate goal is to provide better patient care and outcomes, which is the essence of nursing practice," Miller said. "NDNQI is a method to evaluate nursing's impact on a continuum of care that involves multiple health professionals. It is crucial that the indicators help us achieve a clinical practice that is as robust and as relevant as possible."

Last modified: Mar 27, 2012