NUR 621 Identify two quality metrics used in your clinical workplace

NUR 621 Identify two quality metrics used in your clinical workplace

NUR 621 Identify two quality metrics used in your clinical workplace

There are several quality measures used in healthcare. The measures used to assess and compare the quality of health care organizations are classified as either a structure, process, or outcome measure. “Structural measures give consumers a sense of a health care provider’s capacity, systems, and processes to provide high-quality care. Process measures indicate what a provider does to maintain or improve health, either for healthy people or for those diagnosed with a health care condition. These measures typically reflect generally accepted recommendations for clinical practice. Outcome measures reflect the impact of the health care service or intervention on the health status of patients.” (Agency for Healthcare Quality and Research, 2021)

One quality metrics used in the VA is Mission Act Quality Standards comparison data. This allows consumers to examine VA and regional community provider performance on key clinical quality and experience metrics. This metric aids patients in understanding the quality of care available in their geographic region. The metrics included indicators of inpatient, outpatient, and patient experience performance that align with three central tenants of VA care. “Effective care is based on scientific knowledge of what is likely to provide benefit to veterans, Safe Care that avoids harm from the care that is intended to help veterans, and veteran -centered care that anticipates and responds to Veterans and their caregivers.” (United States Department of Veterans Affairs, 2021). The quality metrics are measured by surveys and evaluation of weekly incident reports. The information is shared with nurses via the monthly townhall meetings, electronic mail, and weekly news letters.

Another quality metric used at the VA is catheter associated urinary tract infection rates. The number of patients who contract UTI’s during their inpatient stay that have indwelling catheters is measured daily. The system keeps track of everyone in the facility that has a catheter and charts are audited daily to see if CHG baths were performed. Cultures and labs are consistently drawn to evaluate the range of WBC’s and possible signs of infection. The results are shared with staff on a monthly basis via e-mail and in monthly town hall meetings.

Overall, I think that having quality metrics is a benefit to the VA system. Quality metrics helps to keep us aware of areas of improvement as well as areas that are doing well. It is important to consistently perform evaluations to maintain a high level of quality service.

Mission Act Quality Standards. (2021). United States Department of Veterans Affairs. http//:accesstocare.va.gov

Types of Healthcare Quality Measures. (2021). Agency for Healthcare Quality and Researchhttp://ahrq.gov

The two-quality metrics used in my workplace are the length of stay and readmission rates. Length of stay measures the amount of time a patient spends in the hospital from the time of admission to time of discharge. The length of stay metric is often traced over weeks and months and in annual quarters. The data collected is important because it provides sufficient evidence on the hospital’s level of care efficiency. Care efficiency contributes significantly to how long a patient stays in the hospital. High care efficiency leads to short hospital stays, while inadequate care efficiency extends the length of patient stay. When patients stay in the hospital for too long, they are at risk for hospital-acquired infections (Baek et al., 2018). The length of stay metric results are shared with the nursing staff. The purpose of sharing the results is to encourage nurses to improve care efficiency to enable short hospital stays.

Readmission rates show the number of patients admitted into the same facility or a different facility within thirty days of being discharged for the same condition. It also tracks a patient’s readmission due to a complication related to the original condition of care. The readmission rate metric measures the quality of care given to patients (Fische et al., 2014). When the number of readmitted patients is high, it indicates that the health professionals are delivering low-quality care to patients, ignoring complications or relevant patient information. Conversely, a small number of readmission cases shows the hospital provides high quality of care.

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The results of the readmission rate metric are not shared with the nurses. However, I think that these results should be shared because nurses can help reduce the rate of readmission. Nurses can improve on the quality of care they provide to patients. Moreover, they can carry out patient education on proper scheduling of medication and common illnesses that lead to readmission (Nelson & Rosenthal, 2015). They can also enhance communication with patients to determine whether they need further care to prevent readmission.

References

Baek, H., Cho, M., Kim, S., Hwang, H., Song, M., & Yoo, S. (2017). Analysis of length of hospital stay using electronic health records: A statistical and data mining approach. Plos One12(4), e0195901. https://doi.org/10.1371/journal.pone.0195911

Fischer, C., Lingsma, H. F., Marang-van de Mheen, P. J., Kringos, D. S., Klazinga, N. S., & Steyerberg, E. W. (2014). Is the readmission rate a valid quality indicator? A review of the evidence. Plos One9(11), e112282.

Nelson, J. M., & Rosenthal, L. (2015). How nurses can help reduce hospital readmissions: learn how to help mitigate readmission risk starting from the time of admission. American Nurse Today10(5), S18-S18.

There are a number of reasons why hospitals or other healthcare institutions choose to use a particular metrics for staffing. Some may want to prioritize financial performance, others may want to prioritize patient care, but most organization choose a particular metric system so that they can adequately distribute their resources all over the hospital, so that they can function more effectively. There are different forms of metrics that are used in different healthcare institutions, but the two that are use in the hospital that I work at is the average hospital stay and bed occupancy rate. The average hospital stay bases its metrics on the average time patients stay in the hospital while the bed occupancy rate monitors the availability of hospital beds (Ramsey et al., 2018). The reason why the hospital uses this form of metrics is because it is a government funded institution and making profit like other private hospitals is not high among its priority list like other private hospitals. Its not uncommon to find patients staying for more than two hundred days in an acute mental health unit something which would be unfathomable in the private world. The metrics should be shared with staff, so that they can know if they are short at the beginning of a shift and be able to adjust their assignment accordingly i.e., they can assign patients among each other according to the level of their acuity.

Reference:

Ramsey, Z., Palter, J. S., Hardwick, J., Moskoff, J., Christian, E. L., & Bailitz, J. (2018). Decreased Nursing Staffing Adversely Affects Emergency Department Throughput Metrics. Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, 19(3), 496–500. https://doi.org/10.5811/westjem.2018.1.36327

Metrics are used to measure a specific level or value (Penner, 2016, p. 102). In healthcare, metrics are used to identify abnormal values, progress of the organization, or financial health (Penner, 2016, p. 102). There are many metrics that units use in order to identify issues and areas that could use improvement. One quality metric that the nursing unit uses a lot are the rates of catheter associated urinary tract infections (CAUTIs). This is a pretty common quality measure that is tracked for most nursing units inpatient. Many nursing interventions are geared at preventing CAUTIs as these make hospital stays longer and cause unnecessary use of antibiotics. These results are shared with staff which is important because it can show how well your nursing interventions and preventative protocols are working. If there was a constant increase in cases there would need to be an investigation into the why and how to decrease rates again. Another quality metric used is the rate of barcode scanning. We use barcodes for medication administration, patient identification, and for sending specimens to the lab. Using the scanner helps to make sure we have the right patient, the right medication, and right lab specimen. This helps to reduce errors to improve quality of care and patient outcomes. This is reported and shared also which I believe is important as well. It helps to hold everyone accountable to use the tools in place to reduce errors. Our patients deserve the best care and potential for improving their overall health. We can see everyone’s individual scanning rate and then have a unit goal that we must maintain.

Penner, S. J., RN, , MN, , MPA, , DrPH, , & CNL, . (2016). Economics and financial management for nurses and nurse leaders (3rd ed.). Springer Publishing Company.

According to Penner, Nursing quality metrics are quantifiable measures of nursing care that is delivered to the patients (2012). This is used to identify and support the nurse’s contribution to high quality and safe care delivered to them. Our hospital uses a variety of metrics such as obtaining consent for care, medication administration, nursing care plans, risk assessment, safety, restraints and education. Quality care and patient safety are paramount quality metrics used in our hospital. These are ongoing and have continual assessments. It is essential to provide high quality care and to note is care is dropping due to factors within the system such as unit acuity, staffing issues or supplies. There is an obligatory standard of care in the unit I work which mandates assessments every two hours, medications to be given within an hour prior or after the dose time, and all patients are monitored for safety on an ongoing basis. One of the ways that leadership ensures that the setting for providing quality care happens is to look at the staffing resources for each shift, the acuity level of the patients, determine if there is enough support for the team and if not, staff with per diem, floats or vary assignments to lighten certain nursing responsibilities. As for safety, staffing also plays a role in this, unit cameras, alarms on beds and bedside chairs. Interdisciplinary teams also help with these quality indicators. Case management rounds, discusses needs with the patients and their family members as well. PT/OT make assessments based on the patient needs and note are they safe to ambulate alone? Do they need durable medical equipment such as a walker or staff? (Penner, 2016). The data is a collaborative effort and noted in EPIC for all involved to see in order to provide the highest level of care that is delivered in a safe and efficient manner.  

Penner, S.J., & Spencer, M.D. (2012). Acute care utilization, staffing and financial indicators. In K.T. Waxman (Ed.). Financial & Business management for the doctor of nursing practice. New York, NY: Springer Publishing Company.

Penner, S. J., RN, , MN, , MPA, , DrPH, , & CNL, . (2016). Economics and financial management for nurses and nurse leaders (3rd ed.). Springer Publishing Company. 

Quality measures are widely used in healthcare organizations to ensure quality health care and patient safety. “Quality measures are tools that help measure and quantify healthcare processes, outcomes, patient perceptions, and organizational structures and systems that are associated with the ability to provide high-quality health care and relate to one or more quality goals for healthcare” (CMS, n.d.). The Centers for Medicare and Medicaid Services uses quality measures for quality improvement, public reporting, and pay-for-reporting programs for specific providers (CMS, n.d.). Quality measures are crucial for healthcare organizations to thrive.

Patient satisfaction is a care quality measure that healthcare providers and organizations use to measure how happy patients are with their care, giving feedback and insights into how effective, efficient, and safe care is and the areas for improvements. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a patient satisfaction survey that has three main goals, which are to produce data about patient’s perspective of care, create new incentives for hospitals with public reporting of survey results, and increase accountability through transparency of healthcare delivery (CMS, 2021). This writer’s clinical workplace uses patient experience as one of its quality measure tools. Reports are usually communicated to staff in monthly staff meetings and unit huddles regarding low and high scores for strengths and weaknesses. Unit manager encourages and communicates ways to address areas showing low scores and commends and motivates staff to maintain high scores.

Healthcare-associated infections (HAIs) are another quality measurement tool used by this writer’s clinical institution. HAIs include central line-associated bloodstream infections, catheter-associated urinary tract infections, and ventilated-associated pneumonia. HAIs are serious threats to patient safety and well-being; the Centers for Disease Control and Prevention (CDC) helps monitor and prevent these infections (CDC, n.d.). This writer’s clinical unit reports in morning huddles which patients have central lines and foleys with the nurse’s responsibility to follow up with the medical team regarding reviewing status for discontinuation. The results of quality metrics should be shared with staff because it is a shared responsibility to keep care up to standards and keep patients safe. Quality measures save lives daily.

References

Centers for Disease Control and Prevention. (n.d.). Healthcare-associated infections (HAIs). https://www.cdc.gov/hai/infectiontypes.html

Centers for Medicare and Medicaid Services. (2021). Quality measures. https://www.cms.gov/Medicare/Quality-initiatives-Patient-Assessment-Instruments/QualityMeasures

There are several quality metrics used in my clinical workplace (Penner, 2016). The MCO (Managed Care Organization) that I work for conducts quality metrics for Healthcare Effectiveness Data and Information Set (HEDIS) measures. HEDIS measures for diabetic members we assess adults 18 to 75 years of age with diabetes (type 1 and type 2) who had each of the following: 

  • Hemoglobin A1c (HbA1c) testing. 
  • HbA1c poor control (>9.0%). 
  • HbA1c control (<8.0%). 
  • Eye exam (retinal) performed. 
  • Medical attention for nephropathy.  
  • BP (Blood Pressure) control (<140/90 mm Hg) (https://www.ahrq.gov). 

We also assess for Follow-Up After Hospitalization for Mental Illness (FUH). Our MCO assesses the percentage of inpatient discharges for a diagnosis of mental illness (MH) or intentional self-harm among patients aged 6 years and older that resulted in follow-up care with a MH provider within 7- and 30-days post discharge (https://www.ahrq.gov). 

The assessments are done telephonically by LCSW (Licensed Clinical Social Workers) and RN (Registered Nurses). The results are shared with staff as well as upper management and with Louisiana Department of Health and Hospitals (LDHH). The results help us improve access to care for diabetes as well as post discharge follow up for members recently discharged from an inpatient facility for mental/behavioral illness treatment (https://www.ahrq.gov). 

Reference 

https://www.ahrq.gov/talkingquality/measures/setting/health-plan/examples.html

Penner, S. J., RN, , MN, , MPA, , DrPH, , & CNL, . (2016). Economics and financial management for nurses and nurse leaders (3rd ed.). Springer Publishing Company.