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Informatics and Nursing Sensitive Quality Indicators

Introduction

High-quality care and patient safety are the primary objectives that healthcare providers, especially nursing staff and hospital administration, should strive to provide. In this regard, the American Nurses Association (ANA) established the National Database of Nursing Quality Indicators (NDNQI) which reports unit-level performance data quarterly and annually to help medical facilities assess their nursing care delivery. Therefore, this paper aims to examine the significance of a single nursing-sensitive quality indicator (NSI), namely, Nosocomial Infections, for patient safety, patient care outcomes, and organizational performance. The paper will also discuss the nurses’ role in supporting accurate reporting and high-quality results and how nursing-sensitive quality indicator data is collected and disseminated across healthcare organizations.

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Nursing Quality Indicators

The NDNQI is principally directed at collecting and measuring the healthcare-related process, structure, and outcome indicators to allow nursing leadership and staff to review and evaluate their performance regarding patient outcomes. In particular, process indicators determine techniques of nursing interventions and patient assessment, such as nursing job satisfaction or Pediatric Pain Assessment, Intervention, Reassessment (AIR) Cycle. Structural indicators comprise the nursing staff supply and the nursing staff’s education, skill, and certification levels. Outcome indicators represent patient results that are considered to be nursing-sensitive due to their dependence on the quality and quantity of nursing care; for example, they include falls and pressure ulcers. The nosocomial infections rate will be under examination in the given paper since it reflects the medical quality and patient safety in hospitals.

Nosocomial Infection Indicator

Nosocomial infections, better known as Healthcare-associated infections (HCAIs), have become a severe public health problem globally because of their adverse effect on mortality and morbidity among hospitalized patients. In the USA, the Centers for Disease Control and Prevention has identified that approximately 1.7 million cases of Healthcare-Acquired infections occur, which totally results in over 98,000 deaths each year (Haque, 2018). Besides, patients who become infected through surgery spend an average of 6.5 additional days in the hospital (“Healthcare-Acquired Infections,” n.d.). It is also worth noting that with the outbreak of the COVID-19 pandemic, the given issue has acquired critical importance for patient outcomes and safety.

Herewith, one of the most critical concerns caused by infection is that many germs can be resilient to most antibiotics. For example, approximately 50 percent of surgical-associated infections, especially Staphylococcus aureus and gram-negative bacilli, are antibiotic-resistant (“Infection prevention and control,” n.d.). Catheter-associated urinary tract infection (CAUTI), Surgical Site Infection (SSI), Central Line-Associated Blood Stream Infection (CLABSI), and Ventilator-Associated Pneumonia (VAP) are the most prevalent among HCAIs. Being at the forefront of delivering care for patients, nursing staff directly contribute to reducing infection transmission. In this regard, nurses should follow essential prevention procedures, such as hand hygiene, surface sanitation, sterilization, and protective personnel equipment, including masks and gloves.

The Data Collection on the Quality Indicator

Due to the variety and number of errors caused by the human factor, medical personnel needs not only wised-developed policies but also reliable support related to advanced technology. Health Information System (HIS) is an advanced documentation tool specifically designed to manage, collect, store, transmit healthcare data to facilitate clinical workflow. These systems typically include a patient’s electronic medical record (EMR), Practice Management Software, Clinical decision support systems (CDSS), and others. In particular, EMR replaces the traditional paper-based methods of a patient’s medical history, containing individuals’ test results and treatments conducted previously and other patient-specific information. Besides, electronic health records can exchange data with each other, which assists healthcare providers in evaluating patients’ conditions. Likewise, CDSS is a specifically designed instrument that provides staff, clinicians, or patients with health-related information, clinical guidelines and summaries, and intelligently filtered diagnostic support to promote decision-making.

Concerning patient safety and quality of care, HIS gathers data related to the previous cases of patients’ hospitalization in the form of reports from reliable healthcare databases. It considerably contributes to documentation accuracy since it aggregates information from different sources and allows for avoiding and correcting errors in patients’ data. Secondly, the system can select the required tests for diagnosis, which decreases the time waste and effort and enhances the healthcare service productivity and the treatment overall. For example, when nurses are continuously aware of a patient’s set of allergies, they know which medications and food should be avoided and which medical adhesive plaster and gloves should be used.

Thirdly, the tool facilitates clinical workflow by providing better retrieval, collection, and display of complete, available, and accurate information. Lastly, it can have a beneficial impact on the staff’s expertise and computer literacy mainly through continued access to necessary resources and active interaction with the electronic system. Namely, CDSS continuously equips nurses with guidelines and reminders, promoting the right execution of clinical procedures and preparation actions, including HCAI-associated. It also improves pediatrics service by delivering information about what vaccines have already been given and what vaccines are planned to be provided. Thus, healthcare facilities or organizations can develop a comprehensive picture concerning potential problem areas and provide excellent service by monitoring and obtaining information about the occurrence of nosocomial infections, including CAUTI, CLABSI, VAP, and SSI, in the facility.

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Nevertheless, medical staff can face particular challenges while using HIS, which is primarily connected with its usability, interoperability, and scalability. In particular, occasionally, users may have considerable difficulties in understanding the CDSS software design, which can cause errors and substantial setbacks in the workflow. However, contemporary CDSS models have been developed as user-friendly systems with an understandable display (Sutton et al., 2020). Regarding interoperability, when HIS is designed as a stand-alone system, it cannot exchange, process, and represent the data gained from other software systems adequately. Finally, sometimes, HIS lacks scalability, which leads to its impotence to manage an ever-increasing amount of incoming information regarding patients’ history, recommendations, and research findings. Besides, there may be nurses’ resistance to HIS’s implementation, thereby increasing the capital required for its installation.

Nurse’s Role in Supporting Accurate Reporting and High-Quality Results

An interdisciplinary team is a group of clinical professionals from diverse competency fields who closely and actively cooperate to attain specific healthcare goals that improve their clients’ wellbeing. This team mostly consists of patients and their families or caregivers, hospital administration and policymakers, nursing personnel, public health workers, and other medical providers (Oliver, 2019). The first group of critical stakeholders includes nurses, physicians, pediatricians, and clinical pharmacists since the accurate collection and reporting of NSI significantly depends on input information obtained from them. In this regard, healthcare providers should provide the right details referring to patients’ histories, guidelines, protocols, and clinical requirements. In particular, nurses should report to the client’s attending physician about all adverse reactions to medications and suspicious changes in patients’ conditions during and after medical procedures and diagnostic tests. They should also enter all relevant and received data about interventions or examinations into patients’ electronic medical records and sometimes review their accuracy.

Another stakeholder is office staff and managers because they are accountable for collecting billing, contact, monetary and demographic information of all the admitted patients. Office staff can obtain, gather, and categorize information received from other disciplines, that is, clinicians and nurses. Moreover, managers should hold a comprehensive vision of an organization’s needs and potential challenges that may occur during HIS implementation and data collection. The last stakeholders are patients and their families, which are also liable for giving correct information. Additionally, they should track any changes that happened in their histories to identify mistakes and report them to a responsible person.

In summary, the paper has explored the importance of data collection and reporting of a nursing-sensitive quality indicator, namely, Nosocomial Infections, for patient safety, patient care outcomes, and organizational performance. HCAIs have become a burning public health problem globally because of their adverse effect on mortality and morbidity among hospitalized patients and their ability to resist many antibiotics. In these circumstances, Health Information System, as an advanced documentation tool specifically designed to manage, collect, store, transmit healthcare data to facilitate clinical workflow, gains a primary priority to enhance patients’ results and safety. In particular, the system substantially promotes documentation accuracy since it gathers information from different sources and ensures avoiding and correcting errors in patients’ data. Furthermore, HIS, especially CDSS, unceasingly supplies nurses with reminders and guidelines, promoting the appropriate execution of clinical procedures and preparation actions, including HCAI-associated. Regarding the interdisciplinary role, nurses should report to the client’s attending physician about all adverse reactions to medicines and suspect changes in patients’ condition during and after medical procedures and diagnostic tests.

References

Haque, M., Sartelli, M., McKimm, J., & Bakar, M. A. (2018). Health care-associated infections–an overview. Infection and Drug Resistance, 11, 2321-2333.

Healthcare-Acquired Infections (HAIs). (n.d.). PatientCareLink.

Infection prevention and control (n.d.). WHO.

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Oliver, M. (2019). Communication devices and electronic aids to activities of daily living (5th ed.). In Atlas of Orthoses and Assistive Devices (pp. 403-417). Elsevier.

Sutton, R. T., Pincock, D., Baumgart, D. C., Sadowski, D. C., Fedorak, R. N., & Kroeker, K. I. (2020). An overview of clinical decision support systems: Benefits, risks, and strategies for success. NPJ Digital Medicine, 3(1), 1-10.

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