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 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. Refinement of a quality improvement plan includes adjusting processes as needed (Seidel & Newhouse, 2012). Rogers change model is appropriate for implementing change in a fall prevention program. Sullivan (2013) states the first step is assessing knowledge related to fall risk and prevention. Secondly, persuasion is utilized to convince staff of a need for fall prevention focus and prevention program. Senior leadership must support the fall prevention initiative for success and sustainability of quality improvement projects (Sullivan, 2013). The third step in Roger’s change model is decision-making. Decisions must be made regarding how implementation will occur.
Implementation and confirmation follow. National Guideline Clearinghouse (2012) suggests successful fall prevention programs are supported by organizational leadership and include interdisciplinary team members to oversee the program. Reliable risk assessments, as well as communication of the assessment and plan, are imperative to the success of a fall prevention program. Clinical staff and interdisciplinary team members must receive fall prevention education. Patients, family members, and non-clinical staff must also receive fall prevention education. Organizational leadership must foster a culture of safety that includes on-going analysis of fall rates and injuries sustained, as well as effectiveness of fall prevention measures (National Guideline Clearinghouse, Prevention of falls, 2012).
Shared leadership is a leadership style that incorporates principles of participative and transformational leadership to empower staff to make changes in health care (Sullivan, 2013). Complex problem resolution require solutions that more than one individual may be capable of providing. Including a panel of experts or a team approach to problem resolution may be most beneficial in implementing a fall prevention program. Nurse Managers must encourage and create a culture of safety and quality. Providing open discussion and brainstorming sessions to uncover how, when and why patient falls occur will assist in formulating a fall prevention plan.Very good plan This type of open communication also encourages a “just culture.” Sullivan (2013) explains a “just cultures” allow reporting of errors in an environment where staff does not fear retribution for reporting errors or near misses (Sullivan, 2013).
Nurses have an ethical responsibility to protect patients from harm (Fowler, 2008). Patient falls remain one of the most frequently occurring safety incidents in hospitals (Johnson et al., 2011). Nurse leaders must identify problems in safety and quality through data collection, communication with staff and multidisciplinary departments. Numerous evidence-based strategies are available to improve nursing practice and patient safety. Creating a culture of safety culture is accomplished through shared leadership. Utilizing quality improvement processes and change management strategies discussed in this paper will provide greatest success and sustainability of change necessary to protect patients from harm.
Diers, D., Hendrickson, K., Rimar, J., & Donovan, D. (2013). Understanding nursing units with data and theory. Nursing Economics, 31(3), 110-117. Fowler, M. D., & American Nurses Association. (2008). Guide to the code of ethics for nurses: Interpretation and application. Silver Spring, MD: American Nurses Association. 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. Laureate Education, Inc. Patient Falls Data (Excel). (n.d.) Retrieved from https://class.waldenu.edu National Guideline Clearinghouse, Prevention of falls (acute care). (2012). http://www.guideline.gov 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.
Grading Rubric NURS 4020 Week 5 Application
Introduction to overview of paper. The last sentence in this paragraph is a sentence that begins “The purpose of this paper is to . . .” 20 points
Well-written, the reader knows what to expect – 20
Data over view – describe some possible interpretations of the data related to the patient fall rate on the telemetry unit. Summarize the statistics and demographics of your patients. 20 points The data analysis and interpretation is accurate. The importance of the medication and the environment needed to be included in the analysis – 19 points Quality improvement plan – discuss the quality management process you would follow to improve patient fall rates on the unit.
Also, discuss the change management strategies you would incorporate in your quality improvement plan. 20 points DMAIC and Rogers change theory were accurately explained and applied to the scenario. Including the national clinical practice guideline recommendations was very effective in supporting the analysis. – 20 Leadership characteristics – explain the leadership characteristics needed to assist in improving the patient fall rates. 20 points
These are explained very well – 20 points
Summary – end the paper with a 1-paragraph summary of the importance of a solution to the identified practice-based problem that is based on evidence and a 1-paragraph summary of the main points of the paper. 20 points The key points discussed in the paper are included in the summary – 20 points Grammar and format (indicate if any points are taken off for these errors. Up to 40 points may be deducted if needed). A minimum of three references are required. No issues – the paper is well-written and the required areas are included. Please see my comments. Total points possible – 100