Quality & Research
Over the past two years, the Center for Nursing Research and Quality Outcomes (the Center) has taken an active role in quality management. With the increasing integration of research methods with QI projects, the Center represents the interests of more than 1,500 nurses within the Department of Nursing. The objective is to create a culture of safe patient and family centered care driven by leadership and clinical staff nurses. The Center supports innovative approaches to measure nursing quality and monitor patient outcomes. The following are examples of the activities and initiatives.
The Clinical Scholar Mentoring Program
The success of the Evidence-Based Workshops/Clinical Scholar Program is due in large part to the dedication and passion of the Research Mentors at Maine Medical Center. Nurses who are experienced researchers have been invited to act as research mentors to EBP Workshop/Clinical Scholar Program participants. These nurses have also provided the lecture content and presentations at the workshops. The mentors have worked with clinical specialty groups during the workshops and have continued to work with their protégées after the workshops have concluded.
Mentoring is critical to the success of EBP, research and QI projects and the foundation on which a progressive culture is based. Interestingly, though, current literature describes research mentoring almost exclusively in the context of academic institutions. This observation initiated a project at the Center in which Deb Palmer R.N., M.S. is developing a Research Mentoring Model to further enhance the Clinical Scholar Program.
The Center provides the technology, infrastructure, customized tools for data collection and standardized processes to measure practices for the evaluation of optimal quality performance. Some of our accomplishments to date are:
- Collaborated with wound care specialists and unit skin care representatives to establish a consistent, decentralized data collection process for pressure ulcer prevalence studies. The electronic Pressure Ulcer Database was developed to facilitate immediate access to the data with automatically calculated findings following the monthly prevalence studies. A preliminary report from this Excel database communicates the findings in a timelier period to leadership and clinical staff. The Pressure Ulcer Database has enabled earlier identification of patients at risk and earlier implementation of prevention and intervention protocols.
- Guided the development of a Chart Audit Tool utilizing scanning technology. This new approach has helped to standardize the data collection for chart audits. The collected data is quick and easy to analyze and the findings can be reported systematically and similarly to units.
- Originated and developed the Raw Data Bank to collect and store unit-specific quality data in a central repository. This has increased both access to the data as well as its visibility and utilization by nursing staff, administration and other departments at MMC. The availability of data in the bank has improved satisfaction among its users with shortened turnaround times for data retrieving and reporting.
- Guided the development and accessibility of the icon "Nursing" on all clinical workstations and nursing managers' PCs. This has allowed all campuses to provide staff nurse’s direct access to unit-specific quality monitors.
- Supported and encouraged the utilization of the Incident Reporting (IR) system, which notifies risk management of all types of errors, incidents, injuries, near misses, and other patient safety concerns. The robust IR system provides nurses and other disciplines with numerous data elements to conduct more in-depth analysis of patient events to improve processes.
The Center has established Quality Monitoring Processes that are emphasized as priorities according to Regulatory Standards of Practice, National Patient Safety Goals, and MMC’s Strategic Plan.
Nursing Sensitive Indicators
Nursing Sensitive Indicators have been reported by the Center since 2003 to the National Database of Nursing Quality Indicators (NDNQI), and since 2006 to the Maine Quality Forum (MQF). NDNQI provides its members with comparison data from other organizations to explore relationships between nursing care and patient outcomes. MQF is currently creating an informative resource for the citizens of Maine to access meaningful health information that also describes and compares the quality of heath care services specific to Maine healthcare organizations. The Center coordinates all of the data collection, data entry, communications with NDNQI and MQF, and reporting of the findings back at MMC.
Nurse Satisfaction Survey of Work Satisfaction and Job Enjoyment
The Center coordinated the house-wide Nurse Satisfaction Survey of Work Satisfaction and Job Enjoyment in 2005 and 2006. The organization of the satisfaction surveys has required systematic and careful planning for marketing, pre-enrollment of the survey units and identification of all eligible R.N.s. It also required coordination of designated computers for the Web-based survey questionnaire so that all nurses in various patient care areas could participate. Extensive recruitment activities are developed with administrative support to ensure a high response rate. A variety of communication strategies are utilized to publicize the survey, including weekly reminder emails to all R.N.s. Unit response rates are monitored closely and used to target recruitment efforts. The success of the surveys has been excellent and is reflected by the response rates of 70% and 60% in respective years.
Prioritization of Performance Indicators
The Center coordinated the prioritization of performance indicators for monitoring, analysis of trends and process improvements to promote patient safety and ensure quality of care Indicators include: dangerous abbreviations, labeling medications, medication reconciliation, nursing assessment of falls, pain and skin integrity, patient teaching, and restraints. This approach has enabled nursing leadership and staff to focus on high-risk, problem-prone patient care needs in a health care environment that is fast-paced with increasing demands on resources and productivity while preserving patient safety.
The Center provides consultation and assistance to nurses for QI projects. This can include crystallization of study design; proposal and IRB application writing; data collection, entry and analysis; and interpretation and utilization of the findings. This helps to ensure meaningful results from the quality initiatives.