Healthcare professionals and leaders need to regularly track the quality of performance and interpret statistical data from various resources to determine the areas requiring clinical practice transformations. Since its creation in 1994, the National Database of Nursing Quality Indicators (NDNQI) helps healthcare professionals and facilities to translate nurse-sensitive data into a meaningful form and promote accountability in nursing (Laureate Education, 2009). Quartile dashboards demonstrate the relationships between the values in the data set and might be utilized to monitor key metrics determining healthcare quality and patient safety (Brown et al., 2008). The comparison of the scores facilitates the assessment of the performance results against the goals and might indicate the need for a change. The purposes of the following paper are to provide the analysis of the Sample Dashboard, identify the main area for performance improvements, and offer the nursing plan proposing relevant best practices.
The data from the Dashboard demonstrates that there are certain strong and weak performance areas that should be considered and improved. The document contains the facility’s performance scores and NDNQI benchmarks, or percentile rankings, from multiple hospitals nationwide (Laureate Education, 2009). The Dashboard consists of four quarters (from Q2 FY09 to Q1 FY10) representing 3-month periods, and each section contains mean (NDNQI), target, actual, and variance data. The main assessment areas are NDNQI original, nurse-sensitive serviceline, nurse-sensitive general, and nurse-sensitive patient satisfaction survey indicators.
Dashboard performance reporting is one of the evidence-based strategies that nurses and healthcare facilities can implement to enhance patient experience and quality of care (Finkelman, 2020). One of the weakest areas of the Inpatient Rehab Unit is the percentage of patients with pressure ulcers. The area was selected because there are no signs of improvement over the quarters and the end of the fiscal year shows the negative statistics reflecting the increase in the percentage of pressure ulcer patients. Moreover, pressure ulcer prevalence is one of the original nursing quality indicators endorsed by the American Nursing Association (ANA), which represent the critical concerns in the hospital setting (Montalvo, 2007). The Dashboard does not indicate whether the problem is community-, hospital-, or unit-acquired and displays the general percentage of patients with pressure ulcers.
When the benchmarks are not met, and the Dashboard demonstrates that certain areas need improvements, an appropriate action plan should be developed by the nurse supported by the interprofessional team or advice from colleagues. Based on the scores and the Dashboard analysis, it is evident that the percentage of patients with pressure ulcers is the area requiring immediate critical attention. Pressure ulcers represent a serious concern in the nursing community, so NDNQI staff developed a platform for sharing the experience with the issue and best practices from high-performing facilities.
The first best practice that might be included in the teaching plan is the nurses’ collaboration with wound specialists. The nursing units with frequent cases of pressure ulcers need to improve skin assessment regime (Montalvo, 2007). Comprehensive skin assessment requires the nurse to inspect and palpate the patient’s skin to determine the presence or absence of abnormalities by assessing the color, temperature, turgor, dryness, and integrity. The measure can improve the surveillance of the at-risk patients, detect the early symptoms (skin discoloration, pain, itchiness), and eventually decrease the percentage of patients with pressure ulcers.
The second recommendation for pressure ulcer prophylaxis is the standardization of risk assessment procedures to minimize clinical variation. The guidelines proposed by the Agency for Healthcare Research and Quality (AHRQ) (2021) describe the measure as the critical component of nursing response. Standardized procedures, such as the use of assessment scales, help nurses identify patients’ pressure ulcer risk levels and understand whether preventive interventions are needed based on the results of the assessment. The Norton Scale might be utilized to determine the patient’s physical and mental condition, activity/mobility levels, and incontinence, while the Braden Scale refers to sensory response, nutrition, activity/mobility, skin moisture, and friction (AHRQ, 2021). The measure can decrease the percentage of pressure ulcer cases, as it facilitates the clinical decision-making process, ensures a personalized approach to each patient, and enables efficient communication between medical professionals.
The third best practice option is care planning involving relevant interventions targeting the risk areas. Care planning should be conducted considering assessment results, the patient’s preferences/needs, and evidence-based approaches to pressure ulcer prophylaxis (AHRQ, 2021). Care planning is the translation of pressure ulcer risk data from the assessment and patient information sources into the plan of action. The method may significantly impact the number of patients suffering from pressure ulcers via timely prevention and response. If the patient is at low risk of developing pressure ulcers, the individual should still be monitored because there is no guarantee that he/she does not develop the condition during the hospital stay. However, risk assessment-based care planning may help to distribute healthcare resources more economically via prioritization of high-risk cases. Overall, the nurse-sensitive indicator may improve when an appropriate treatment plan is designed and implemented to decrease the percentage of pressure ulcer cases.
References
Agency for Healthcare Research and Quality. (2021). Preventing Pressure Ulcers in Hospitals. AHRQ. Web.
Brown, D. S., Aydin, C. E., & Donaldson, N. (2008). Quartile dashboards: Translating large data sets into performance improvement properties. Journal of Healthcare Quality, 30(6), 18–30. Web.
Finkelman, A. (2020). Quality improvement: A guide for integration in nursing. Jones & Bartlett Learning.
Laureate Education (Producer). (2009). Topics in clinical nursing: Accountability and nursing practice [Video]. Author.
Montalvo, I. (2007). The national database of nursing quality indicators. The Online Journal of Issues in Nursing, 12(3). Web.