Nurse-Sensitive Indicators In Nursing

As defined by the American of Nurses Association (ANA, 2002), “Nursing-Sensitive Indicators are those indicators that capture care or its outcomes most affected by nursing care.” The ANA uses the National Database of Nursing Quality Indicators (NDNQI) to statistically test the relationships between nursing interventions, staffing levels, and positive patient outcomes (Nursing Quality - NDNQI, 2016). These indicators utilize unit specific data enabling action planning and intervention according to the unit if improvement is needed (Nursing Quality – NDNQI, 2016). The purpose of this paper is to show how Good Samaritan Medical Center’s 5th floor, pavilion 2, Medical Surgical/Oncology unit uses nurse sensitive indicators such as pain management,

CLABSI prevention, CAUTI prevention, and responsiveness of staff to achieve the highest levels of nursing performance and patient safety while increasing patient outcomes.
How do hospitals and nurses make sure that they are adequately monitoring, scoring and attempting to control a patient’s pain? It can be very difficult because every patient handles and understands their pain in a different way. One person’s score of an 8/10 pain may be quite different than another patient’s. But we can’t not give them pain medications or non-pharmacological interventions because we perceive their pain to be different from their stated pain level. Why? It’s because pain is very subjective in nature.
The nurses at Good Samaritan Medical Center (GSMC) do their best utilizing standardized pain scales and trying to keep on top of a patient’s pain to help control it. Something that stood out about Good Samaritan was their emphasis on asking a patient what a goal pain level was and asking a patient, “If we can’t take your pain away completely, let’s work on getting it to a controllable level. What would be a goal level of pain for you?” It not only can affect and create positive pain outcomes but it also shows relationship based care in the aspect that nurses are partnering with their patients for better outcomes. According to Medicare.gov’s (2016) hospital compare tool, 69% of patients reported that their pain was “always” well controlled. Colorado’s average and the national average were both at 71%. This coincides with the information from GSMC’s fifth floor, pavilion 2, Med/Surg Unit shown below in table 1 and figure 1. The 69% from Medicare.gov (2016) is hospital wide whereas in the table and figure it is showing unit specific information. With the year to date pain management at 69.2%, it is slightly under the target achievement goal of 71% (Good Samaritan Medical Center, 2016). From observing and spending time on that particular unit, I believe that target goal could be reached just by making sure to stay on top of a patient’s pain and working towards a pain goal that is achievable and comfortable for the patient.
Table 1
Threshold Achievement Target Achievement Maximum Achievement
Pain Management 70.70% 71.00% 72.80
Source: Good Samaritan Medical Center, 2016
Figure 1

Source: Good Samaritan Medical Center, 2016
While central line-associated blood stream infections (CLABSI) have decreased in U.S. hospitals in the past couple of years, they are still occurring in ICU’s and regular units of acute care facilities (Center for Disease Control, 2016). CLABSI’s are serious infections that can be prevented by proper insertion techniques and if managed correctly, can prevent prolonged hospital stays, increased costs, and an increased risk of mortality (Center for Disease Control, 2016). Figure 2 shows the rates for CLABSI’s and Table 2 shows the target numbers for the Med/Surg unit at GSMC. With the information given for three months but without an available national comparison, so far GSMC is within their target range (Good Samaritan Hospital, 2016). GSMC knows the value of proper aseptic technique as well as proper management of central lines and how education on both can decrease the chance of infections.
Figure 2

Source: Good Samaritan Medical Center, 2016
Table 2
MEG CAUTI Target 2016 0.451-0.500
MEG CLABSI Target 2016 0.370 – 0.414
Source: Good Samaritan Medical Center, 2016
Urinary tract infections are the fourth most common health-care associated infection and most hospital-acquired urinary infections are caused by catheter insertion (Center for Disease Control, 2016). Catheter-associated urinary tract infections can lead to many health complications including death and can also complications such as prolonged hospital stay and increased hospital costs (Center for Disease Control, 2016). Figure 2 and Table 2 above show GSMC’s rates of CAUTIs and with the limited data given, show they are within and actually better than the target range (Good Samaritan Medical Center, 2016). Frequent monitoring, sterile insertion techniques, and cutting down on the number of days the catheter is left in, as well as many others, all play a part in GSMC’s goal of CAUTI prevention.
The HCAHP score that determines how a patient felt about the response of hospital staff can be very good, or very bad, depending which lens you are looking through.

From the patient’s standpoint, when they push their call button, they are hoping to get a response very quickly and get understandably upset when they are not immediately taken care of. From the staff standpoint, if a nurse or a nurse aide is already busy with something that can’t wait, the other patient is stuck waiting. There is only so much the staff can do. Below shows the unit specific information provided by GSMC on the responsiveness of hospital staff. They are slightly below the target rating for the year to date but are above their threshold achievement percentage (Good Samaritan Medical Center, 2016). With a conscious effort to get to the call lights as fast as possible and not waiting for someone else to do it, those numbers have the potential to

increase.
Table 3
2016 Target Rating 2106 Feb MEG YTD
Response of Hospital Staff 64 62.3 63
Source: Good Samaritan Medical Center, 2016
Table 4
Responsiveness of Staff
Threshold Achievement % 62
Target Achievement % 64
Maximum Achievement % 66.84
Source: Good Samaritan Medical Center, 2016
Good Samaritan Medical Center is a wonderful hospital that delivers high quality and safe care and utilizes nurse sensitive indicators to improve patient outcomes, including those indicators related to pain management, CAUTIs, CLABSIs, and responsiveness of staff.

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

for.
References
American Nurses Association. (2002). Nursing-sensitive indicators for community-based non-