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Organizational Systems and Quality Leadership – C TASK 1 Western Governors University Organizational Systems and Quality Leadership Task 1 A. Understanding of Nursing Quality Indicators For the task assigned I will be using nursing quality indicators (NQI) to help identify potential issues that may affect Mr. J’s care. Nursing quality indicators include using outcome, structure, and processes to reflect on parts of nursing care. In the case involving Mr, J., NQI’s could have been assessed to help guide the staff’s behavior in three ways. Those ways include prevention of pressure ulcers, use of restraints, and following cultural beliefs regarding food choices. According to Montalvo et al., 2007, these standards are part of national standards set to evaluate nursing quality care. In the situation of Mr. J’s care, the staff had placed Mr. J in restraints. When a patient is in restraints, they have limited range of motion and ability to reposition themselves in bed. The inability to adjust the pressure on bony prominences can irritate and increases the risk of skin breakdown. Once Mr. J’s daughter pointed out to the staff that there was a reddened depressed area on his lower back over a bony prominence that should have been a red flag to staff that there is the potential for a pressure ulcer to develop. The development of a pressure ulcer adds additional complications to Mr. J’s care. A pressure ulcer opens the door for an increased risk of infection. Additionally, a hospital-acquired pressure ulcer means that the
hospital would be responsible for payment for the patient’s hospital stay. Wound care would now need to be involved in the patient’s care. Wound care is a great resource that provides direction for the best ways to care for a pressure ulcer. Pressure ulcers are easily preventable by frequently repositioning patients that are unable to move around frequently. A better understanding of the NQI’s by the nursing staff could help in the prevention of negative patient outcomes, in this case, the prolonged stay and potential repeat hospitalizations for the care of a pressure ulcer. B. Advancing Quality Patient Care To determine the efficacy of a quality indicator there must be a collection of data. The development of The National Database of Nursing Quality Indications (NDNQI) allows for information to be objectively collected into a single database. The NDNQI allows hospitals to view past and current data to assist in the adjustment of structures of care that build the foundation for better patient care and outcomes (Montalvo, 2007). The ability to analyze the data found in the NDNQI database allows hospitals the opportunity for increased education to nurses and nursing staff in the areas that show a significant need for improvement. Hospitals can use data obtained from the nursing staff to help set goals to assist in improving patient care. The hospital can encourage staff to come up with ideas to improve numbers in categories where the hospital scores lower than the desired level. Frequent education that reflects the most up to date information will also help the nursing staff be able to provide the best patient education. Data from the NDNQI has gone a long way to improving patient outcomes in regards to central line-associated bloodstream infections (CLABSI). In the way of foley catheters, the indicators have shown frequent assessment of the site, proper foley care, and hand hygiene have significantly reduced infections in patients. This
the registered nurse (RN) which should have prompted the RN to complete a skin reassessment. This would have allowed the RN to address the problem right away. The RN could have implemented repositioning of the patient as well as placed a consult to wound care. The RN could even apply a foam dressing to protect the site until wound care could evaluate the patient limiting additional injury to the skin. As a nursing supervisor in the situation making sure that the staff has adequate education and resources available is important. Once alerted to the potential development of a pressure ulcer there should be a review of events. Then it’s important to take that information and figure out areas where changes could have been made to prevent the current situation. I would then sit down with the entire nursing staff for that department and go over the data collected. I would make sure that the meeting was educational and not a finger-pointing situation. I would also reach out to the education coordinator to see about additional education opportunities to make sure the staff is comfortable with the signs of pressure ulcers and ways to prevent the development of pressure ulcers. Wound care would be a great additional resource. They can provide education on proper care for pressure ulcers both old and new. Then as the supervisor, I would sit down and speak with Mr. J and his daughter and offer a sincere apology. I would answer any questions they have as well as explain the plan of care for Mr. J for the remainder of his hospitalization. If additional ethical issues arose that required additional assistance, I would reach out to the hospital’s ethics committee for additional guidance. References Bergquist-Beringer, S., Davidson, J., Agosto, C., Linde, N. K., Abel, M., Spurling, K., … Christopher, A. (2009). Evaluation of the National Database of Nursing Quality
Indicators (NDNQI) Training Program on Pressure Ulcers. The Journal of Continuing Education in Nursing, 40(6), 252–258. doi: 10.3928/00220124-20090522- Cherry, B., & Jacob, S. (2019). Contemporary nursing: Issues, trends, and management (8th ed.). St. Louis: Mosby Elsevier. ISBN: 978- Milliken, A., (January 31, 2018) "Ethical Awareness: What It Is and Why It Matters" OJIN: The Online Journal of Issues in Nursing Vol. 23, No. 1, Manuscript 1. Montalvo, I., (September 30, 2007) "The National Database of Nursing Quality IndicatorsTM (NDNQI®)" OJIN: The Online Journal of Issues in Nursing. Vol. 12 No. 3, Manuscript
- doi: 10.3912/OJIN.Vol12No03Man Sauls, K. (Producer). (2013, November 18). Nursing sensitive indicators [video file]. Retrieved from https://srm.my.salesforce.com/apex/PanoptoVideo?VideoID=b9767cd8-e22b-4b84- b22b-7b94acd643a
