A clinical nurse specialist is often the individual consulted when organizations want to identify the best risk assessment tools to use in a clinical setting. Understanding how to determine which risk assessment tools are best for a specific organization or a specific patient population is not always clear. Often, the risk assessment tools used most often are selected because of a belief that if a tool was valid or useful in one population at one point in time, it will be valid and reliable in another population at another point in time. However, in health care, patient populations are rapidly changing; and a risk assessment tool that was useful five years ago, may no longer be useful today Aranda-Gallardo, et al. 2013). Thus, clinical nurse …show more content…
specialists must possess skills needed to evaluate risk assessment tools prior to making evidence-based recommendations for their use. There are many factors to consider when deciding which risk assessment tool is best for a specific population or organization.
However, when selecting a risk assessment tool, it may be more appropriate to use different tools or at least different cutoff scores because of different characteristics in the groups being assessed. Further, a combination of methods or risk assessment tools may be best. For example, combining a risk assessment score with a nursing judgment score may be more accurate in identifying risk of an adverse event than either score alone. The validity of any risk assessment tool is not static and should be assessed for each population in which it will be used (Aranda-Gallardo, et al. 2013; Lalkhen & McCluskey, 2008). The only way to really determine the best risk assessment tool for a specific purpose and population is to test the tool or tools and calculate sensitivity, specificity, prevalence, and predictive values, so a decision can be made based upon current and relevant evidence, specific to the needs of the unit or organization. The purposes of this paper are to describe how to assess the validity of risk assessment tools using several easy-to-follow formulas and to demonstrate using calculations and methodology to compare risk assessment screening tools. Since some of the terminology may not be familiar, definitions are provided so the reader can refer to them while practicing the calculations (Textbox 1). [INSERT TEXTBOX …show more content…
1] Understanding Validity Validity of a risk assessment screening tool is more than simple content or construct validity.
Since the purpose of a risk assessment screening tool is to accurately predict the future development of some event or issue of interest to nurses and their patients, risk assessment (Parikh, Mathai, Parikh, Sekhar, & Thomas, 2008). For example, health care organizations may wish to predict who will fall, develop a pressure ulcer, or develop an infection so that preventive interventions can be implemented to minimize some negative event or issue during hospitalization. Since the validity of many risk assessment tools varies widely, it has been suggested that potential users should test the tool or compare tools prior to adoption. A valid risk assessment tool should accurately identify those at risk (high sensitivity) and those not at risk (high specificity). An ideal risk assessment tool would have 100% sensitivity and 100% specificity; but in most cases, higher sensitivity results in lower specificity and vice versa (Lalkhen & McCluskey, 2008). To determine the validity of a risk assessment tool or to compare two or more risk assessment tools, the clinical nurse specialist will need to calculate sensitivity, specificity, and predictive
values. Sensitivity Sensitivity is the percentage of individuals correctly identified as at risk. Using a fictitious sample of 100 patients who fell, if 100 were assessed with a fall risk tool and 59 of these patients scored positive for a fall risk (True Positives) then the sensitivity of this tool would be 59%. However, this also means that 41 of the patients who fell were not identified as at risk (False Negatives) but fell anyhow. Sensitivity is calculated by dividing the number of True Positives (TP) by the sum of the True Positives and False Negatives (FN) and then multiplying by 100. Specificity Specificity is the number of individuals who are correctly identified as not being at risk (True Negatives). Using another fictitious sample of 100 patients who did not fall, if 75 patients scored negative for a fall risk, then the specificity of the risk tool would be 75%. As with the previous example this also means that 25 individuals would have been incorrectly identified as at risk (False Positives). Specificity if calculated by dividing the number of True Negatives (TN) by the sum of the number of True Negatives and False Positives (FP) and multiplying by 100. .Cutoff Scores Sensitivity and specificity are affected by the cutoff score of the risk assessment tool being used. The clinical nurse specialist needs to be able to assess cutoff scores that best identifies risk in their population. Cutoff scores may need to be modified over time to maximize the overall accuracy of the scale. To assess cutoff scores, sensitivity (calculated on a sample of individuals who had the event under investigation) is determined for each possible score. Then specificity (calculated on a sample of individuals who did not have the event under investigation) is determined for each possible score. For example, assume that a risk assessment tool is developed to determine patients at risk for a surgical infection, and scores can range from 0 to 10. To determine the best cutoff score for this tool a sample of 100 patients who developed an infection and 100 patients who did not develop an infection is used. Sensitivity and specificity is calculated for each of the 11 possible cutoff scores (Table 1). Note that as specificity increases, sensitivity decreases. The optimal score is the one where sensitivity and specificity are both optimized. In the example provided (Table 1) a cutoff score of 7 would identify 93% of the patients at risk for infection correctly. At the same time only 20% (1 – specificity) of patients who are not at risk would have been identified as at risk. Using a higher cutoff score would increase specificity, but at the expense of sensitivity. In general, sensitivity is preferred over specificity.
This assignment aims to discuss the justification, limitations, benefits and outcomes of using the Braden risk assessment tool within an allocated community scenario.
Safety competency is essential for high-quality care in the medical field. Nurses play an important role in setting the bar for quality healthcare services through patient safety mediation and strategies. The QSEN definition of safety is that it “minimizes risk of harm to patients and providers through both system effectiveness and individual performance.” This papers primary purpose is to review and better understand the importance of safety knowledge, skills, and attitude within nursing education, nursing practice, and nursing research. It will provide essential information that links health care quality to overall patient safety.
Beaumont, K., & Russell, J. (2012). Standardising for reliability: the contribution of tools and checklists. Nursing Standard, 26(34), 35-39.
All these tools are useful in assessing the risk of a patient, it is easy to assess a person for risk, but the problem is how to prioritize what risk is greater. The only way that we can prioritize their safety is when the risk of them coming to harm is greater than their ability to manage the risk (Lloyd 2010). These tools are very good to risk assess Julie’s for any violence problems, once these assessments are completed it will help nurse's come up with a plan to help reduce the risk
This is directly related to my nursing major and current practice as an RN. I have a personal interest in making sure I am practicing in a way that is safe for my patients. What exactly is the problem? The problem, as defined in my argument research paper, is that to cut costs, hospitals have been steadily increasing the number of patients nurses must care for. In many areas, it's not uncommon for one nurse to have to assess, give medications to, and manage the care of as many as 12 patients.
With the help of NDNQI’s research and testing, hospitals have more successful patient outcomes and give a higher quality and safe care. Having been on the patient side as well as the medical professional side, it has shown how effective nurse sensitive indicators and HCAHPS are for both sides of the coin to standardize things for nurses as well as making sure our patients are properly and safely cared
Shekelle, P. (2013). Nurse-patient ratios as a patient safety strategy. 158, 404-409. Retrieved from http://eds.b.ebscohost.com
I enjoyed taking this class. I did not know what to expect at first, but this class has proven to be challenging and very informative. I have learned a lot about the pharmacological principle of different drugs, which I will use in my practice as a family nurse practitioner. Each week we were given different case study, which we had to find a differential diagnosis based on our patient’s sign and symptoms and also choose the correct pharmacological agent to treat our patient. This was a time-consuming process to come up with the correct diagnosis and treatment. I learned about different pharmacological agents to treat different diseases. I also learned about different medication dosage, side effect and the mechanism of action for different drugs. I was introduced to a different database, such as Epocrates and Micromedex to look up different drugs. The case scenarios gave me the practice that I needed to become familiar with different medications, their action, dosage, side effect, adverse effect and their mechanism of action. By taking this class I am better prepared to meet the MSN program outcome.
O’Daniel, M., & A.H., R. (2008). Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville: Agency for Healthcare Research and Quality. Retrieved from: http://www.ncbi.nlm.nih.gov/books/NBK2637/
Each year this panel of experts put a microscope on patient safety across the board. They decide where upmost attention needs to be paid. Sometimes items leave the list because there are been strides take to improve in that area and sometimes it continues to stay on the list because they believe the relevance and importance is growing. Healthcare is evolving b...
Safety is focused on reducing the chance of harm to staff and patients. The 2016 National Patient Safety Goals for Hospitals includes criteria such as using two forms of identification when caring for a patient to ensure the right patient is being treated, proper hand washing techniques to prevent nosocomial infections and reporting critical information promptly (Joint Commission, 2015). It is important that nurses follow standards and protocols intending to patients to decrease adverse
Hospitalizations affect a large number of the population in the United States (US). A large number of those Americans are hospitalized due to a surgical procedure that needs to be performed. Many people may suffer from postoperative complications while in the hospital that can be extremely serious or even cause death. The Agency for Healthcare Research and Quality (AHRQ) has established Quality Indicators (QIs) called Patient Safety Indicators (PSIs). The PSIs are used with hospital inpatient data to reflect quality of care and patient safety, primarily focusing on potential avoidable complications. The purpose of this paper is to define the purpose of the PSIs-90 and role in healthcare today. Discuss
The profession of nursing is always regarded as complex, dynamic and noble. The nursing profession requires many things such as hard work, vast knowledge, excellent communication skills, and a passion for the noble profession. All these qualities are needed to be an effective nurse. Today, nurses are living in a world of ever changing field of medicine. The present patient statistics pose, nurses are expected to take responsibility of accomplishing the requirements.
In order to provide the best quality of care, and concurrently making it cost effective, nursing institutions nationwide must ensure that their products are well-equipped with the competencies needed to be a safe nurse. The Nurse of the Future (NOF) Core Competencies are: Patient-centered care, Professionalism, Informatics and technology, Evidence-based practice, Leadership, System-based practice, Safety, Communication, Teamwork and Collaboration, and Quality improvement. This paper will evaluate my core competencies and point out areas that need improvement.
(https://elearning.ucd.ie/bbcswebdav/pid-1161313-dt-content-rid-4081345_1/courses/NMHS32380/Patient%20Safety%20Definitions.pdf) There are many things that nurses must do to assure that this is being executed while preforming care to each patient. The main concern when addressing patient safety would be the proper use of adequate staff and newest evidence based practice. While it is imperative that each nurse and all other staff are performing safe practice with each and every patient, it is also important that there are enough educated and qualified nurses and other staff using the most up to date proper approach to patient