Research Brief: Effect of NQF Safe Practices on Patient Outcomes

Led by Richard Lindrooth and John Welton, an interdisciplinary team at the Medical University of South Carolina examined how adoption of the National Quality Forum safe practices affects nursing sensitive patient safety outcomes. Barriers to adoption of these practices were also explored. This team took a step beyond existing literature by testing whether the implementation of safe practices leads to more effective use of nurses, and whether this leads to better performance on patient safety outcomes.

Access the research brief.

Histogram of Adoption of Safe Practices, 2004-2006

This post is part of a series to provide the public with research briefs on INQRI-funded projects across a range of interests.

Massachusetts Hospital Quality & Patient Safety Issue Brief Series

In 2004, the National Quality Forum endorsed a set of nursing sensitive measures, with the goal to provide hospitals, the public and purchasers with comparative measures that accurately reflect nursing performance. Massachusetts and Maine were among the first states to adopt statewide initiatives for the public reporting of nursing performance through the use of nurse sensitive measures. An INQRI team, led by Pat Noga and Barry Kitch, conducted a hospital leadership survey, including interviews with key stakeholders and hospital case studies to analyze these states' experiences implementing the initiatives. The team found that reaching agreement on the measures was a substantial and lengthy undertaking, and that while hospital leaders believed that public reporting of nurse sensitive measures was likely to have a positive impact both on the quality of nursing care and patient outcomes, they also found the initiatives to be burdensome. However, in both states, most believed that a public mandatory program would work best to improve quality of nursing care. Respondents were concerned about the accuracy and consistency of data collection and reporting across hospitals and wondered if the reports would be useful to the general public. Based on the experiences in Maine and Massachusetts, the researchers believe that it is possible to publicly report measures of nursing quality and that doing so can have a positive impact on the quality of care. The team theorizes that these initiatives are likely generalizable to other quality measurement initiatives not focused on nurse sensitive measures. The work of Noga and Kitch suggests that despite the perceived burden of implementing hospital reporting programs, public mandatory reporting may be viewed as a substantial impetus for improving the quality of nursing care.

Since completion of their study in 2008, the team has continued to educate stakeholders, mainly by creating issue briefs for their member audiences, such as the Massachusetts Hospital Association and the Organization of Nurse Leaders of Massachusetts and Rhode Island, and legislators.

Briefs include:

• Summary of Trends in Selected Nursing-Sensitive Care Measures in Massachusetts Hospitals and Related Cost Savings Estimates 
• Summary of Trends in Nurse Staffing in Massachusetts Acute Care Hospitals

This research also lives on in Massachusetts through the ongoing public reporting of various nurse sensitive measures that posted on the quality and safety website PatientCareLink. This site is a joint initiative of the Massachusetts Hospital Association and the Massachusetts Organization of Nurse Executives.

NQF Webinar: What's the Easiest Way to Find and Compare NQF-Endorsed Measures?

This Friday, the National Quality Forum (NQF) will host a webinar from 1:00-2:30 p.m. ET to provide an overview of the enhanced Quality Positioning System (QPS 2.0), the most comprehensive and reliable source for finding and comparing NQF-endorsed measures. QPS 2.0 allows people to create portfolios of measures, search by inclusion in Federal reporting and payment programs, and provide feedback at any time on the measures themselves. The webinar will also discuss the new Field Guide to NQF Resources, an online tool that offers easy to understand explanations of key concepts in quality measurement and NQF’s role.

This webinar is especially relative to the work of the INQRI program. Following the 2004 publication of the NQF report, “National Voluntary Consensus Standards for Nursing-Sensitive Care: An Initial Performance Measure Set,” the Robert Wood Johnson Foundation (RWJF) convened a group of researchers and stakeholders to set priorities for the NQF-identified research agenda.  Inspired by the conversations and work of scientists and stakeholders, RWJF launched the INQRI program.  INQRI's first call for proposals was released in October 2005 and focused on measurement.

In 2006, the first round of INQRI-funded interdisciplinary teams began their research studies. These nine projects addressed three major areas: (1) investigating the link between the work of nurses and the quality of care provided in hospitals; (2) producing and validating measures that capture nurses' contributions to quality care in hospitals; and (3) evaluating the impact of innovative nurse-led initiatives on patient outcomes.

This spring, Medical Care released a special supplement which was focused entirely on the INQRI program.  Included was an article that documents INQRI's contributions to measuring nursing's impact on quality.  Click here for more details.

To learn more about some of the projects funded under that first call for proposals, check out this blog post by former INQRI National Advisory Committee member Ellen Kurtzman.

To register for the NQF webinar this Friday, please click here.

On Jumping Off a Cliff

Lori Melichar, PhD

Seven and a half years ago, I sat down at the computer to write a speech in hopes of convincing my peers to join me in jumping off a cliff.

As a program officer for the Robert Wood Johnson Foundation (RWJF), I was excited to be involved with RWJF’s work in support of the National Quality Forum (NQF). We had partnered with the Veterans’ Administration (VA) to fund NQF in their endeavor to generate a list of nursing-sensitive measures. The resulting report was the inspiration for the Interdisciplinary Nursing Quality Research Initiative (INQRI) program, an enterprise of which I am incredibly proud.

So, why the cliff?

At the time, many thought that the pursuit of research linking nursing to quality should be exclusively in the purview of nurse researchers.

But, I’m not a nurse researcher. I’m not even a nurse; I’m a labor economist who, way back in the fall of 2005, was relatively new to the field. However, as my work with RWJF and NQF evolved, I began to appreciate not only the plethora of gaps in what we knew about nursing, but also the role of nurses as valued team members.

When I began collaborating with Mary Naylor and Mark Pauly on brainstorming ideas for what would ultimately become the INQRI program, we settled on one thing at the outset: INQRI would not fund research that was solely conducted by nurses. We believed then and we believe now that interdisciplinary research allows researchers to break out of their siloes, develop new ideas, test old assumptions, and pursue an understanding of the issues facing us with strong methodological fervor.

INQRI Study: RN Staffing Linked To Safe Practices Adoption

Last week, nurse.com, reported that an INQRI supported study found more nurse-hours per patient and larger percentages of RNs on staff as factors in higher adoption levels of safe practices. The publication, co-authored by Dr. Jayani Jayawardhana and INQRI grantees Drs. Richard Lindrooth & John Welton, examined the higher likelihood of designated Magnet hospitals, when compared with non-Magnet hospitals, to adopt National Quality Forum Safe Practices.

Click here to read the article.

Click here to access the journal article published in the Journal of Nursing Administration (subscription required).

Quality Measures and Nursing

Despite the $2.3 trillion spent on U.S. health care, public and private payers still have a hard time measuring whether the kind of care they are paying for is of the highest value and produces the best outcomes. Nurses represent the largest group of health care professionals in the United States and have a direct affect on patient care, yet quality measures historically have focused on treatment of conditions or diseases, not on the care delivered by nurses. That changed in 2004, when the National Quality Forum (NQF) endorsed the first set of nationally standardized performance measures to assess the quality of care provided by nurses who work in hospitals.

By focusing on patient centered outcome measures such as prevalence of pressure ulcers and falls, as well as restraint use and frequency of catheter-associated infections, the NQF began to examine the link between what nurses do and the quality of care they provide. INQRI has played an important role in adding to the evidence about the utility of the NQF-endorsed Nursing Sensitive Measures by promoting the development and testing of new measures designed to both improve care and nursing performance, as well as reduce costs.
 
Click here to download a research synthesis on this topic.

Interested in Weighing in on a New NQF Committee?

The National Quality Forum is seeking to identify and endorse additional measures of outpatient care addressing emergency department and/or urgent care for public reporting and quality improvement. The Additional Outpatient Measures 2010 14-day review of the proposed roster for submitted nominees is now open through Monday, March 22, at 6:00 pm ET. Members and the public can provide comments on the proposed roster and potential vacancies in expertise.

INQRI is very interested in the work of the National Quality Forum (NQF).  Our first call for proposals (CFP) focused on measurement, with a specific interest in testing the effects of implementing the nursing sensitive performance measures endorsed by NQF. Click here to learn about the nine teams funded via our first CFP.

NQF's Safe Practice 18 - A Call to Action

"Pharmacy leaders should have an active role on the administrative leadership team that reflects their authority and accountability for medication management systems performance across the organization."

- Pharmacist Leadership Structures and Systems - Safe Practice 18, from the National Quality Forum's 2009 Update to their Safe Practices for Better Healthcare Report

The American Society of Health-System Pharmacists recently published an article focusing on the growth opportunities available to the field of pharmacy by the endorsement of Safe Practice 18.  Hayley Burgess, Pharm.D., BCPP, one of the writers of the standard, believes that this is a "call to action" for pharmacists to take on larger leadership roles.

INQRI agrees that pharmacists have an important role to play in ensuring effective medication management.  In 2007, we funded a nurse-pharmacist team to conduct a project at Johns Hopkins Hospital.  In their project, "Nursing-Pharmacy Collaboration on Medication Reconciliation: A Novel Approach to Information Management,"  Drs. Linda Costa (a nurse) and Robert Feroli (a pharmacist) examined how to economically support direct care providers in medication reconciliation in order to facilitate safe transition to and from hospital and community.  Costa and Feroli believe that deficits in communication across the continuum of care in regards to medication use can place patients at serious risk for harm. The team evaluated the effectiveness of a nurse-pharmacist clinical information coordination team in improving drug information management on admission and discharge, quantified potential harm due to reconciliation failures, and determined cost-benefit related to averted harm.

Check out a recent webinar presented by Dr. Costa about this collaboration.

National Quality Forum Measures

Last week, Modern Healthcare reported that "The National Quality Forum is endorsing 70 performance measures that combine data from various electronic sources—such as administrative claims, pharmacy and laboratory systems, and registries—in order to advance the use of electronic data platforms to measure, report and improve quality."

Click here to read the article.

In February 2003, the National Quality Forum undertook a 14-month project to study the relationship between nursing personnel and quality, and the degree to which national voluntary consensus standards for nursing-sensitive care could be established.  The 15 indicators of nurse-sensitive care endorsed by NQF represented the first set of nationally standardized performance measures designed to assess how nurses in acute care hospitals contribute to health care quality, patient safety, and a professional and safe work environment.

This work greatly informed the development of the first INQRI call for proposals in 2005 which focused on measurement.  The teams selected via that call began their work in August 2006 and completed their work in fall 2008. The nine research projects covered three major areas: (1) investigating the link between the work of nurses and the quality of care provided in hospitals; (2) producing and validating measures that capture nurses' contributions to quality care in hospitals; and (3) evaluating the impact of innovative nurse-led initiatives on patient outcomes.

To read more about the nine teams in INQRI's first cohort, please click here.