Six Hospitals Leading the Way in Nursing Quality

By Debra Wood, RN, contributor

February 13, 2013 - In a healthcare system that focuses on patient outcomes, an emphasis on quality bedside care, support for frontline caregivers and the analytics to prove how well you are succeeding are all important. And when everything works, it is a cause for celebration. That was evidenced last week, as six hospitals celebrated receiving the NDNQI® Award for Outstanding Nursing Quality for demonstrating superior results and sustained improvement in patient outcomes related to nursing care and work environment factors.

“We have been working on nurse-sensitive quality indicators for a long time,” said Lisa Aurilio, RN, MSN, MBA, NEA-BC, vice president of patient services and chief nursing officer at Akron Children’s Hospital Mahoning Valley in Boardman, Ohio, which received the award in the Pediatric Hospital category.

“The award looks at outcome measures on nurse-quality indicators,” Aurilio added. “But the other half of the award is balanced on nurse satisfaction with their work environment.”

The National Database of Nursing Quality Indicators (NDNQI) is part of the American Nurses Association (ANA) National Center for Nursing Quality (NCNQ®).  It tracks a broad range of outcomes indicative of the quality of nursing service; establishes links between patient outcomes and nurse staffing characteristics, such as nursing care hours, education level, certification and turnover; and allows nursing units to compare their performance to similar units at other hospitals.

“Nurses recognize that our healthcare system is becoming more focused on performance standards and patient outcomes,” said ANA President Karen A. Daley, PhD, RN, FAAN. “That’s how it should be, that’s how nurses approach their work, and that’s what this award is all about.”

Hospital representatives received their awards at ANA’s Nursing Quality Conference in Atlanta.

“It was very exciting for us,” Aurilio said. It’s the first time the hospital received the national quality award.

Nurses at Akron Children’s reduced by 30 percent the facility’s central-line associated bloodstream infection rate for very low-birth-weight infants by researching best practices in the literature and then uniformly following a five-step bundle for accessing lines. No babies in the NICU experienced such an infection in 2011.

“There was a lot of nursing education and holding each other accountable,” Aurilio said. “We monitored the process changes as well as the outcomes. We also are doing intermittent spot checks to see who is following the bundle and who is not and giving feedback.”

Akron Children’s NDNQI nurse satisfaction scores exceed national comparisons, something Aurilio attributed to unit huddles that empower and inform nurses and encourage creativity and foster autonomy.

Craig Hospital in Englewood, Colo., received the award in the Rehabilitation Hospital category. Nurses at Craig reduced patient falls by 16 percent after adopting a “Two to Transfer” policy for patients with traumatic brain injury. In addition, their hospital-acquired pressure ulcer scores have been below the national average for several quarters.

Six Hospitals Leading the Way in Nursing Quality
Diane Reinhard, MBA, MSCIS, BSN, RN, NE-BC, CRRN, says that Craig Hospital has invested in certified wound care training for their nurses that has already shown big returns.

Craig paid for three staff nurses to travel to other hospitals to receive the required education to become certified wound care nurses. These nurses, in turn, taught resource nurses on each unit so someone with advanced skin care knowledge would always be available. Diane Reinhard, MBA, MSCIS, BSN, RN, NE-BC, CRRN, vice president of patient care services and chief nursing officer, said the facility has already seen a return on investment. As for nursing environment, Craig scores for nurse–physician relations surpassed national means.

“We have a unique culture at Craig,” Reinhard said. “We are not afraid to admit we have an opportunity to improve. By me getting out of the way, [staff] get creative and take pride in owning the challenges we have with our patients.”

Nurses at Rose Medical Center in Denver, winner in the Teaching Hospital category, significantly reduced ventilator-associated pneumonia, from 17 cases in 2008-09 to just one case in 2011-12, by carefully following oral-care standards and implementing proven infection-reduction interventions. Rose also has reduced fall rates, adopting a communication tool to alert staff to patients’ fall risk. The hospital prizes education and innovation, and strives to implement nurses’ ideas for improving care.

Six Hospitals Leading the Way in Nursing Quality
Lynne Wagner, BSN, MHs, RN, CENP, says the nurses at Rose Medical Center reduced ventilator-associated pneumonia and fall rates by applying proven standards of care and exercising their passion for continually making things better.

“This is about nurses, not administration, about people coming forth with good ideas and being passionate about the care they deliver and always wanting to make it better,” said Lynne Wagner, BSN, MHs, RN, CENP, chief nursing officer and vice president of patient care. “We want nurses at the bedside to be satisfied with their work environment, to feel safe, have the equipment and resources they need, and have great leadership.”

Robert Wood Johnson University Hospital in New Brunswick, N.J., received the award in the Academic Medical Center category and was recognized for reducing patient falls by more than half on a cardiac unit. The staff conducted safety huddles at the start of each shift, used bed alarms and made hourly nursing rounds. Satisfaction scores of RWJUH nurses are high.

In the Community Hospital category, St. Francis Hospital – The Heart Center in Roslyn, N.Y., reduced post-op, hospital-acquired pressure ulcers and fall rates, consistently beating the national mean on both measures. St. Francis established a skin champion program, changed its fall assessment tool and began intentional rounding. Patient satisfaction stays in the 99th percentile for overall ratings of care and likelihood of the person recommending the hospital to others.

“It’s a great place to work, because people are so committed and dedicated,” said Ann Cella, MA, MEd, RN, NEA-BC, senior vice president of patient care services and chief nursing officer at St. Francis. “Always raising the bar is the norm, to do better than we did last time.”

Six Hospitals Leading the Way in Nursing Quality
Ann Cella, MA, MEd, RN, NEA-B, reports that the staff at St. Francis Hospital is committed to continuous improvement: “Always raising the bar is the norm.”

This was St. Francis Hospital’s first time winning the award. Cella said she felt humbled and honored and plans to ensure it is not the last.

Sharp Mesa Vista Hospital in San Diego, Calif., recipient in the Psychiatric Hospital category, has worked to avoid using physical restraints and scored in the top 15 percent in patient satisfaction with nursing care.

Cheryl Odell, MS, RN NEA-BC, chief nursing officer at Sharp Mesa Vista, expressed excitement and surprise upon learning the hospital received the award based on its quality metrics. She attributes much of the facility’s success to using the Recovery model, which offers patients hope, engages them in meaningful connections, and empowers them through building skills and gaining independence. Sharp has also instituted a shared-governance model.

“[The nurses’] engagement in practice moves the profession forward in our facility,” Odell said. “It takes a lot of commitment by a lot of people to invest in improving patient care. I want to thank my nurses for making that happen.”

More details:
The NDNQI award winners’ booklet, Hardwiring Quality for Superior Outcomes, provides more information on the hospitals’ nursing performance improvement strategies.

Related articles:
Creating a Great Nurse Work Environment to Improve the Bottom Line
How to Encourage Staff to Point Out Safety Flaws

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