One Hundred Nurses Partner for Exemplary Nursing Sensitive Quality Indicators

Purpose:
A freestanding children's hospital with Magnet re-designation established nursing sensitive quality indicator (NSQI)teams to engage nursing staff, parents, and interdisciplinary staff in efforts to sustain a culture of safety. The teams' goal was to achieve exemplary quality outcomes for 7 NSQI.

Significance:
Clinical nursing practice has a direct impact on NSQI outcomes. NSQI have serious implications for patient outcomes, cost of healthcare, reimbursement for care, and recognition of quality nursing care. Nurses benefit from mentoring in evidence-based practice (EBP) and quality improvement (QI).

Strategy and Implementation:
In 2011, the organization's nursing shared governance core assembly formed NSQI teams to focus on NSQI most relevant to inpatient units; patient falls, facility-acquired pressure ulcers, central line associated blood stream infections, peripheral intravenous catheter infiltration, restraint use, catheter associated urinary tract infection, and the pain assessment – intervention – reassessment cycle. A charter guided scope of work. The teams applied an EBP model for planned change in practice. Team members received mentoring by clinical and professional practice experts through workshop, webinars, and work meetings. Shared governance councils provided additional guidance. Teams implemented organization-wide staff education on EBP changes, policy revisions, and patient/family education materials. Tracking, trending, and analyzing NSQI data determines the effectiveness of sustaining the practice changes.

Evaluation:
The teams improved 7 NSQI outcomes as compared to natioal benchmark statistics. The organization received 2 awards for low CLA-BSI rate. Team members serve on national advisory panels. The organization has been re-designated as a Magnet Hospital with 11 exemplars for outcomes.

Implications for Practice:
The model for sustained change requires involvement of key stakeholders for buy-in. The team approach was effective with the right mix of member expertise and experience and parent perspective. Staff took ownership of outcome data. Continued success requires nursing leadership and staff commitment.