Role of the Nurse Leader in Evaluating Data to Improve Quality and Safety Leadership Competencies in Nursing and Healthcare
Role of the Nurse Leader in Evaluating Data to Improve Quality and Safety Recent nursing literature indicates it is critical that nurse leaders construct a culture of safety to develop and maintain a successful fall prevention program (Johnson et al., 2011). Data exists readily in healthcare systems that nursing leaders may use to understand nursing performance and improve patient outcomes (Diers, Hendrickson, Rimar, & Donovan, 2013). The purpose of this paper is to discuss the importance of nursing leadership’s use of data to improve patient quality and safety. Data Overview
Data provided in the NURS 4020 course [lecture notes] (“Evaluating Data”, n.d.) and the Patient Fall Data (Excel, n.d.) document indicate patient fall rates have increased over the last four months to an unacceptable level on a telemetry unit (Laureate Education, Inc., n.d.). Patient population data indicates the majority (68%) of patients is arewomen, all have a cardiac diagnosis, and the average age is 72.4 years. The majority of patients receive diuretic therapy (94%), and 12% have a secondary diagnosis of disorientation or confusion. Additionally, one full-time employee has been removed from the night shift (11p-7a) to the evening shift (3p-11p). “Data hold the key to risk reduction – to understanding not only what happened but why – and point the way toward solutions” (Siegal & Ruoff, 2015, p. 25). Analyzing the data in the patient fall data set (Excel, n.d.) reveals that 59% of falls occur over a weekend, and 62% of falls occur between 3a-11a. Staffing on weekends and especially between 3a-11a may not be appropriate to manage tasks and safeguard patients from falls. (Williams, Szekendi, & Thomas, 2013). A high number of falls occur two hours after mealtime. Assessing patient needs every one or two hours has been reported helpful to prevent patient falls (Williams, Szekendi, & Thomas, 2013). The average age of patients on the telemetry unit is 72.4 years of age (“Evaluating Data”, n.d.). Twelve percent of patients have secondary diagnoses of confusion or disorientation. William et al., (2013) state patients exhibiting confusion and disorientation have an increased risk of falls. The National Guideline Clearinghouse (National Guideline Clearinghouse, Prevention of falls, 2012) recommends assessment of all adults over age 65 upon admission for dementia and delirium. Patients with delirium and dementia are at a much higher risk of falls. Why? How do the cardiac medications influence the fall rate? What about the layout of the unit? Quality Improvement Plan
The DMAIC method of Six Sigma is a process improvement method whereby nurse leaders develop quantitative data to implement a quality management program. The first step in the DMAIC process is to identify what measure will indicate success (Sullivan, 2013). A baseline measurement must include what fall prevention strategies are in place presently. An assessment of staff knowledge of fall prevention strategies is necessary to determine deficits. In the example provided, 47 patient falls have occurred in 4 months. An appropriate goal is patient falls are reduced by 50% in the next quarter or four months. The second step in the DAMIC process is to provide a baseline of performance. The patient fall data set (Excel, n.d.), provides this baseline data. Accurate data must be utilized to create a successful quality improvement plan (Siegal & Ruoff, 2015). The next three steps consist of analyzing the data set to determine appropriate interventions, improving performance through interventions, and last control and sustain improvements (Sullivan, 2013). Implementation of an evidence-based plan to improve patient falls include asking the right questions, acquiring and appraising evidence, and applying evidence to practice....
References: Diers, D., Hendrickson, K., Rimar, J., & Donovan, D. (2013). Understanding nursing units with data and theory. Nursing Economics, 31(3), 110-117.
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Johnson, J. E., Veneziano, T., Green, J., Howarth, E., Malast, T., Mastro, K., ... Smith, A. (2011, December). Breaking the fall. The Journal of Nursing Administration, 41, 538-545.
Seidel, K. L., & Newhouse, R. P. (2012, June). The intersection of evidence-based practice with 5 quality improvement methodologies. Journal of Nursing Administration, 42(6), 299-304.
Siegal, B., & Ruoff, G. (2015). Data as a catalyst for change: Stories from the frontlines. JOURNAL OF HEALTHCARE RISK MANAGEMENT, VOLUME 34(3), 18-25.
Sullivan, E. J. (2013). Effective leadership and management in nursing (8th ed. ed.). Upper Saddle River: Pearson Prentice Hall.
Williams, T., Szekendi, M., & Thomas, S. (2013). An analysis of patient falls and fall prevention programs across academic medical centers. Journal of Nursing Care Quality, 29(1), 19-29.
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