MEASUREMENT TOOLS

APPLYING MEASUREMENT TOOLS TO A PRACTICE PROBLEM

Conduct a collaboration interview with two or three key leaders in your practice setting to determine the measures for your practice problem and associated challenges impacting measurement for your practice problem (include confidentiality, anonymity, access issues, etc.). Perform an existing evidence review on your practice problem and search for evidence that demonstrates how your practice problem is measured across the country.

Resources

· Spath, P. (2018). 
Introduction to healthcare quality management (3rd ed.). Health Administration Press.

· Chapter 3, “Measuring Performance” (pp. 35-78)

· Chapter 4, “Evaluating Performance” (pp. 79-118)

· Yoder-Wise, P. S. (2019).
 Leading and managing in nursing (7th ed.). Mosby.

· Chapter 23, “Managing Quality and Risk” (pp. 406-427)

· Chapter 24, “Translating Research Into Practice” (pp. 427-449)

· Perla, R. J., Provost, L. P., & Murray, S. K. (2011). 

The run chart: A simple analytical tool for learning from variation in healthcare processesLinks to an external site.
. 
BMJ Quality and Safety, 20(1), 46–51. http://doi.org/10.1136/bmjqs.2009.037895

Post a description of the measures identified from the interviews, the challenges to obtaining the data that were discussed, and a summary of how this quality indicator is measured in the literature. Discuss any gaps in the data that were identified and additional sources that might be needed to obtain this data. Be sure to support your practice problem with the literature that indicates the relevance of this problem for nursing practice. Provide evidence from practice and data that is available.

Read and respond to two or more of your colleagues’ postings from the Discussion question. Provide feedback on the quality of data that was obtained and recommendations on where additional sources of data might be found. As a member of a community of practice, help each other refine and clarify the patient-centered Practice Experience Project.

Patrick Pizarro

YesterdayJun 7 at 6:26am

Manage Discussion Entry

Practice Experience – Week 2

For this week’s post, this writer conducted a brief informal interview with the Anson Correctional Institution’s Nursing Supervisor and the Lead Nurse (also serving as this writer’s preceptor for the duration of this course). The topic discussed was access to care: specifically, the typical wait times for offenders at said institution requesting basic medical attention, or as it is termed a “sick call”.

The basic yardstick for measuring how the organization is doing in regard to timely access to care consists of the offender herself initiating a request by completing, dating, and submitting a sick call request form and placing it in her respective housing unit’s mail box. Medical staff, once daily, conduct a “mail pick up” collecting the forms and bringing them back to the medical records department where they are scanned and scheduled.

The time it takes between the initial form submission and the day in which the offender is seen for their sick call appointment varies widely and is subject to several variables, but it would seem a key indicator of timely access to care in the facility. Surprisingly, this metric is not measured. Instead, the facility focuses on the backlog as a whole – how many sick calls have not been completed at any given time. For example, the Lead Nurse shared with me that a backlog number of 50 to 75 sick calls is optimal (the facility has seen backlogs of 200 or more in the recent past).

This writer would seek to achieve this abovementioned measurement – days from submission to sick call appointment as a reliable descriptor of timely access to care. Although this number is not actively measured, it can be easily obtained by this writer as the EHR system employed by the facility records a scanned copy of the sick call request and then the scheduled appointment date.

Thankfully, a review of the research literature reveals a wealth of articles on the topic designed to improve wait times for appointments and as a result, timely access to care.

Ansell, D., Crispo, J. A. G., Simard, B., & Bjerre, L. M. (2017). Interventions to reduce wait times for primary care appointments: a systematic review. 
BMC health services research, 
17(1), 295. 

https://doi.org/10.1186/s12913-017-2219-yLinks to an external site.

Ansell, D., Crispo, J.A.G., Simard, B. 
et al. Interventions to reduce wait times for primary care appointments: a systematic review. 
BMC Health Serv Res 
17, 295 (2017). 

https://doi.org/10.1186/s12913-017-2219-yLinks to an external site.

Grot, M., Kugai, S., Degen, L., Wiemer, I., Werners, B., & Weltermann, B. M. (2023). Small Changes in Patient Arrival and Consultation Times Have Large Effects on Patients’ Waiting Times: Simulation Analyses for Primary Care. 
International journal of environmental research and public health, 
20(3), 1767. 

https://doi.org/10.3390/ijerph20031767Links to an external site.

Griffiths, P., Saville, C., Ball, J., Jones, J., Pattison, N., Monks, T., & Safer Nursing Care Study Group (2020). Nursing workload, nurse staffing methodologies and tools: A systematic scoping review and discussion. 
International journal of nursing studies, 
103, 103487. 

https://doi.org/10.1016/j.ijnurstu.2019.103487Links to an external site.

Chiara Dall’Ora, Christina Saville, Bruna Rubbo, Lesley Turner, Jeremy Jones, Peter Griffiths, (2022) Nurse staffing levels and patient outcomes: A systematic review of longitudinal studies. International Journal of Nursing Studies, Volume 134,2022, 104311. https://doi.org/10.1016/j.ijnurstu.2022.104311.

Micah Mackenzie Watson

The previous six year I  have been spent working with ages 18 and up. Since I’ve been working with a large variety of patients, I’ve realized that falls are a major issue among all ages. My unit experienced 26 falls in 2022, however none of them resulted in injuries. In the past, a few falls have left patients hurt and forced longer admission to the critical care floor; one patient was even transported to another hospital. Thankfully, there haven’t been any injuries caused by recent falls.

The facility has been having trouble preventing falls, according to the director of nursing, who told me that once high-risk fallers are identified, there seems to be a breakdown in communication between the multidisciplinary team (IDT) and the front line nursing staff.

Patients who are at a high risk of falling are identified by the facility using a fall risk assessment, but he has discovered that the information is not always shared with the following shifts.

Every fall is reported to the nurse managers, and an electronic database verge incident report is filled up. For patients who have fallen more than once, daily risk meetings are held.

Unfortunately, the nursing staff is not often given access to the meeting’s findings, which could assist prevent more falls. In addition, the nurses are required to record each shift while continuously monitoring the patients after any falls.

In order to find out if they think falls are an issue in the institution and what efforts they take to prevent them, I also spoke with four nurses working the day and nighttime shifts. Responses from the nurses’ interviews were inconsistent. Some people were not aware that there were so many falls in 2022. 

Although they were unaware of the patients’ most recent fall risk scores, they were able to identify a handful of the individuals they thought were at a higher risk. They added that due to the busy workday, they are frequently unable to round on their patients who are at a higher risk and significantly rely on the milieu therapists.

The safety of the patient is seriously threatened by falls. There has to be more contact between the IDT and the nurses who work directly with patients, it was agreed upon during my discussion with the director of nursing and the nurses. This is crucial because everyone affected by falls bears a heavy financial price. According to the literature, patient falls can be decreased by having a formalized fall protocol in place and hourly staff rounds (Goldsack, Bergey, Mascioli, & Cunningham, 2015).

The q15 minute safety checks must also be patient-focused and uniquely adapted to the needs of the population. Avanecean, Calliste, Contreras, Lim, and Fitzpatrick (2017) concluded that fall prevention is the duty of all employees and that communication among healthcare team members also plays a key role in preventing falls.