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VeHU Class 247 VA Nursing Outcomes Database (VANOD): Surviving the Process. HOUSE KEEPING. This is 1.5 Hours Lecture class Restrooms are located… Cell Phones Please turn off or change to vibrate If you must answer a call, please leave the room. HOUSE KEEPING. Please,

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vehu class 247 va nursing outcomes database vanod surviving the process
VeHU Class 247

VA Nursing Outcomes Database (VANOD): Surviving the Process

Office of Nursing Services - VA Nursing Outcomes Database

house keeping
HOUSE KEEPING

This is 1.5 Hours Lecture class

Restrooms are located…

Cell Phones

Please turn off or change to vibrate

If you must answer a call, please leave the room.

Office of Nursing Services - VA Nursing Outcomes Database

house keeping3
HOUSE KEEPING

Please,

No questions during the presentation.

Questions written on the 3X5 card will be answered at the conclusion of the presentation.

For questions not answered,

the question and the answer will be available on the web.

Office of Nursing Services - VA Nursing Outcomes Database

vehu class 247
VeHU Class 247
  • Segment 1: Overview, Data & Projects in Development
    • Bonny Collins, PA-C, MPA, VANOD Program Manager
  • Segment 2: Patient Fall Risk Assessment Template
    • Alicia Levin, RN, MS, VANOD Implementation Coordinator
  • Segment 3: Facility Experiences – Validation & Application of VANOD Data
    • Michelle Ernzen, RN, MSN, CCRN, Patient Safety Manager, Durham VAMC
    • Toni Phillips, RN,MSN, C, Nursing Informatics Coordinator,North Florida & South Georgia HCS
  • Segment 4: Summary andQuestions and Answers

Office of Nursing Services - VA Nursing Outcomes Database

slide5
Segment 1: Overview, Data, and Projects in Development

Bonny Collins, PA-C, MPA,

VANOD Program Manager

Office of Nursing Services - VA Nursing Outcomes Database

presentation objectives
Presentation Objectives
  • Describe the current status of VANOD and the new indictors available
  • Describe the significant features of the VANOD
  • Describe a facility level approach to VANOD data validation
  • Describe a facility level approach to using VANOD data

Office of Nursing Services - VA Nursing Outcomes Database

simplified version of the mission of vanod
Simplified Version of the Mission of VANOD
  • Provide stakeholders with tools/data to:
    • Manage nursingresources
    • Understand clinical processes that are sensitive to nursing practices
    • Influence patient outcomes

Office of Nursing Services - VA Nursing Outcomes Database

vanod data goals
VANOD Data Goals
  • Scope of Data
    • Structures, Processes, Outcomes
    • Full Continuum of Care
    • All Nursing Personnel, Skill Mix, Role
    • Administrative, Clinical, Safety, Satisfaction (Staff and Patient) Indicators/Reports
  • Granularity of the Data
    • Unit/Clinic, Specialty, VAMC, Complexity Group, VISN, VHA
    • Shift, Day of Week, Pay Period, Month, Qtr, FY

Office of Nursing Services - VA Nursing Outcomes Database

business rules
Business Rules
  • Manual data collection only as a last resort
    • Provide front line staff the tools they need to document the good care they are providing
    • Extract the data from nursing point of care documentation
  • Standardize terms, data & indicators to allow for comparison across the VA and with non-VA facilities
  • Provide facilities the tools they need to understand and validate their data

Office of Nursing Services - VA Nursing Outcomes Database

nursing staff data currently available sample of key indicators
Nursing Staff Data Currently Available(Sample of Key Indicators)
  • Distribution of Resources - % of hours worked that were in (Role):
    • Administration
    • Direct Care
    • Consultative (Hospital Support)
    • Advance Practice
  • Staff Evidence Based Demographics
    • % of Direct Care (DC) staff that are RNs
    • % of DC RNs that have at least a Bachelors degree
  • Financial: hours and dollars for PAID, e.g. Annual Leave (AL), Sick Leave (SL), Leave With Out Pay (LWOP), Comp Time Earned (CTO), etc.
    • % of Hrs worked accrued from Overtime or Comp Time Earned (OT/CTE)
  • Nursing Staff Turnover Rates (all reasons, voluntary)
  • Staff Injury
  • RN Satisfaction
  • Nursing Staff Retirement Eligibility

Office of Nursing Services - VA Nursing Outcomes Database

understanding our work force vha staff demographics fy2007
Understanding Our Work ForceVHA Staff Demographics(FY2007)
  • Direct Care Nursing Staff:** 62,268
    • % of Direct Care Staff who are RNs 60%
    • % of Direct Care RNs with least a Bachelors Degree 58%
    • % of Direct Care RNs eligible to retire 28%
  • Voluntary Loss Rate of RNs leaving the VA: 6.3%
  • RNs in the VA less than 5 years 33%

**RN, LPN, Unlicensed Assistive Personnel (UAP) with direct patient care assignments – Inpatient or Outpatient.

** RN, LPN, Unlicensed Assistive Personnel (UAP) with direct patient care assignments – Inpatient or Outpatient

Office of Nursing Services - VA Nursing Outcomes Database

how much can you trust the data
How Much Can You Trust the Data?
  • Trustworthy - Data used for Payroll
    • Administrative indicators for skill mix, hours and dollars
      • Reports assigned T&L Unit - won’t capture float off T&L (Unit)
  • Need Data Validation for ‘less used’ data
    • Assignment code (used to determine roles)
    • Education level – from PAID/HR
    • Built in to new products: New DSS and VANOD Skin Assessment/Reassessment
  • Data has to be corrected locally
    • Local Validation tools available (Class III VistA reports):
      • Active NURS Staff file report
      • NURS Staff Education report

Office of Nursing Services - VA Nursing Outcomes Database

nurse staff turnover rate
Nurse Staff Turnover Rate
  • Segment by:
    • All reasons for departure, e.g. retirement, death, etc.
    • Voluntary departure – JCAHO Nursing Sensitive Indicator, “quit”, “regrettable loss”
  • Data from HR – current limitations
    • Only at the facility level
    • Can’t segment out Advance Practice Nurses (NPs & CNSs) from other RNs (Only HR Codes)
  • VANOD is working to add:
    • T&L Unit granularity
    • Tenure in VA, VAMC, Time &Leave (T&L) Unit
    • Ability to segment NPs & CNSs from other RNs (Budget Object Codes)
    • Nursing Role, e.g. Direct Care, Admin, Consultative, Advance Practice

Office of Nursing Services - VA Nursing Outcomes Database

slide14

FY07 Voluntary Quit Rate by Occupation Name, by VISN

RN: Avg 6.3%

Range 3.8% to 9.5%

Nursing Assistant

LPN

Office of Nursing Services - VA Nursing Outcomes Database

percent of hours worked that were overtime or comp time earned
Percent of Hours Worked That Were Overtime or Comp Time Earned

Which skill mix has the highest percent of worked hours acquired through overtime or comp time earned?

  • RN
  • NP
  • CNS
  • LPN, LVN
  • Nursing Assistant

Office of Nursing Services - VA Nursing Outcomes Database

percent of hours worked that were overtime or comp time earned16

Scale 0% to 5%

Nursing

Assistant

RN

LPN

NP

CNS

FY08 Qtr 1 & Qtr 2

Percent of Hours Worked That Were Overtime or Comp Time Earned

Office of Nursing Services - VA Nursing Outcomes Database

nursing assistant overtime or comp time earned trend fy04 thru april 12 2008

3.8%

3.8%

3.5%

3.8%

4.6%

4.7%

FY04

FY04

FY05

FY06

FY07

FY08

Q1 & Q2

Nursing Assistant Overtime or Comp Time Earned, TrendFY04 - thru April 12, 2008

Office of Nursing Services - VA Nursing Outcomes Database

nurse staff injuries
Nurse Staff Injuries
  • Types of injuries
  • Types of staff
  • Numbers and rates
  • Staff demographics

Stop by and see the POSTER &

Hands-on training Class 250

Office of Nursing Services - VA Nursing Outcomes Database

current vanod projects in development
Current VANOD Projects in Development
  • Facility Alert Profile
    • Deputy Under Secretary for Operations and Management (DUSHOM 10N)
    • Nursing Indicators - Data from Decision Support Service (DSS)
  • Comprehensive Patient Assessment

Office of Nursing Services - VA Nursing Outcomes Database

facility alert profile nursing inpatients
Facility Alert Profile: Nursing - Inpatients

1. Hours Per Patient Day of Care (HPPD): all direct care nursing staff

2. Hours Per Patient Day of Care (HPPD): RNs

    • HPPD reported in six areas:

Critical Care, Medical, Surgical, Mixed Med/Surg, Mental Health, and

Community Living Center (NHCU) units

3. % of Direct Care Hours by RN

  • Data are from DSS – nurse staff mapping is critical
  • Lowest time granularity is “Month”

Office of Nursing Services - VA Nursing Outcomes Database

facility alerts profile nursing outpatients
Facility Alerts Profile: Nursing - Outpatients

4. Average # hours per encounter for all support nursing staff (RN,LPN,UAP, excludes CNS, NP) by clinic type

5. % of ambulatory care support nursing staff who are RNs by clinic type

Clinic type:

  • Mental Health
  • Primary Care
  • Procedures Clinics, e.g. GI Endoscopy, etc.
  • SCI/Rehab Clinics
  • Specialty Clinics, e.g. HTN, DM, etc.

Office of Nursing Services - VA Nursing Outcomes Database

facility alert profile
Facility Alert Profile
  • What is the ‘threshold’ for being noted as an “Alert”?
    • To be developed

Office of Nursing Services - VA Nursing Outcomes Database

nationally standardized comprehensive patient assessment project
Nationally Standardized Comprehensive Patient Assessment Project
  • Opportunity to move locally developed Class III software patient assessment to Class I (National Release and ongoing support)
  • When released, the assessment will be required for ‘at least’ acute Medical and Surgical Units

Office of Nursing Services - VA Nursing Outcomes Database

development team
Development Team

36 members from 17 VISNs and 26 VA Medical Centers chartered March 9, 2008 representing stakeholders including:

  • Content and Work Flow Experts: Front line staff, Nurse Managers, CNSs, CNLs, NPs
  • Clinical Settings in ICU, Med/Surg, MH, SCI&D
  • Informatics: CACs, Clinical Informatics Subgroup, BCMA Coordinators, Taxonomy/Data Standardization
  • Research: Nurse Researchers
  • Administration: Nurse Executive,Magnet Coordinators
  • OI&T: Programmers and OIFO Patient Safety
  • VANOD Team, Field Advisory Council and Site Coordinators

Office of Nursing Services - VA Nursing Outcomes Database

software specifications functionality
Software Specifications & Functionality
  • Reviewed and validated a list of 64 specifications or functionality items
  • Highest Priority – provide optimal work flow support for front line nurses (reduce fragmentation, disruption, redundancy)
  • Save partially completed data

Office of Nursing Services - VA Nursing Outcomes Database

software specifications functionality26
Software Specifications & Functionality
  • Combination of structured point and click and free text
  • Data pulled from other sources to make available for review
  • Production of local reports

Office of Nursing Services - VA Nursing Outcomes Database

slide27

Local Reports

Examples: Summary & Detail Display of Patients with:

1. MRSA Swabs

2. Admission Assessment done within X hrs

3. High risk for skin break down

4. Fall risk assessment done within 24 hrs

5. List of patients at risk for .....??

Vision

Patient Assessment (including fall risk)

Extracted Data for National Reports

Reassessment (Shift Note)

Identify Key Data Terms from Patient Assessment, Reassessment & Care Plans

Embed terms in Files: Clinical Observations (CLiO), Health Factors, Vital Signs

End of Shift Report

Care Plan

Office of Nursing Services - VA Nursing Outcomes Database

contacts
Contacts
  • Chief Nursing Officer: Cathy Rick
  • VANOD Program Manager: Bonny Collins
  • VANOD Implementation Coordinator: Alicia Levin
  • VANOD Education Coordinator: Mimi Haberfelde
  • VANOD Informatics: Diane Bedecarre
  • Analyst: Becky Kellen

Office of Nursing Services - VA Nursing Outcomes Database

alicia levin rn ms vanod implementation coordinator

Segment 2:

Patient Fall Risk Assessment Templates

Alicia Levin RN, MS

VANOD Implementation Coordinator

Office of Nursing Services - VA Nursing Outcomes Database

slide30
Tackling Another Patient Safety Issue

Preventing and Tracking Falls

Office of Nursing Services - VA Nursing Outcomes Database

rationale
Rationale
  • Estimate is that by the year 2020 in the U.S., there will be 17,293,000 falls resulting in injury. A projected cost of $85.37 billion. (this includes community as well as healthcare settings)*
  • Falls are the leading cause of injury-related death for individuals 65 and older**
  • Thus the need to apply current best evidence to reduce fall risk is clear

*Poe, S.S. et. al., An Evidence-based Approach to Fall Risk Assessment, Prevention and Management; Lessons Learned, Journal of Nursing Care Quality, Vo. 20, , No 2, pp 107 – 116, 2005

**National Center for Patient Safety

Office of Nursing Services - VA Nursing Outcomes Database

vanod approach to addressing patient falls
VANOD Approach to Addressing Patient Falls

Creation of two nationally standardized nursing documentation templates:

  • Fall Risk Assessment
  • Post Fall Note

Office of Nursing Services - VA Nursing Outcomes Database

fall risk assessment template
Fall Risk Assessment Template

Assessment – Fall risk identification (Morse Fall Scale)

  • All patients are assumed to be at risk of falling in acute care settings

Fall prevention strategies (evidence-based review of current measures)

  • Basic interventions for universal application are put into place for all patients

Office of Nursing Services - VA Nursing Outcomes Database

fall risk assessment definitions
Fall Risk Assessment Definitions
  • Fall: a unplanned decent to the floor, either with or without injury to the patient
    • Assisted fall counts as a fall
  • Injury: a disruption of structure or function of some part of the body as a result of an unplanned event

Office of Nursing Services - VA Nursing Outcomes Database

fall risk assessment indicators to be tracked
Fall Risk Assessment Indicators to be Tracked
  • Rate at which patients fall during the course of their hospital stay
  • Rate at which patient fall and incur physical injury during the course of their hospital stay
  • Rate of repeat patient falls (for current episode of care)

Office of Nursing Services - VA Nursing Outcomes Database

fall risk assessment indicators to be tracked36
Fall Risk Assessment Indicators to be Tracked

4. % of admitted patients who had a fall risk assessment using the Morse Fall Scale within the first 24 hours.

5. % of patients who had a fall risk assessment and then fell and were injured

6. % of moderate or high risk patients who had fall prevention protocols in place

Office of Nursing Services - VA Nursing Outcomes Database

slide37

Instructions for use of the template

General information on conducting the Morse Scale can be viewed.

Office of Nursing Services - VA Nursing Outcomes Database

slide39

Breakdown of “History of Falling” questions

Office of Nursing Services - VA Nursing Outcomes Database

slide40

Breakdown of “Secondary Diagnosis questions

Office of Nursing Services - VA Nursing Outcomes Database

slide41

Universal Fall Precautions are put into place on for all hospitalized patients

Office of Nursing Services - VA Nursing Outcomes Database

slide42

Interventions are selected based on assessment findings from Morse Scale

Office of Nursing Services - VA Nursing Outcomes Database

slide43

Interventions offered for a positive response to “History of Falling” question

Office of Nursing Services - VA Nursing Outcomes Database

slide44

Interventions offered for a positive response to “Secondary Diagnosis” question

Office of Nursing Services - VA Nursing Outcomes Database

slide45

Interventions offered for a positive response to “Gait or Transferring Problems” question

Office of Nursing Services - VA Nursing Outcomes Database

slide46

Clinical Judgment Interventions Content box opens when selected

Links to ordering therapies

Office of Nursing Services - VA Nursing Outcomes Database

post fall note
Post Fall Note
  • A standardized national template to track occurrence of falls along with some levels of injury which may occur as result of the fall.
  • Short term goal is to collect information that will be similar to or the same as data collected in patient incident reports (patient event reports)
  • Long term goal is to have the information from the post fall note link to an electronic incident report so that duplicate entry will not be required

Office of Nursing Services - VA Nursing Outcomes Database

slide48

Ward list –

sites are able to edit

Office of Nursing Services - VA Nursing Outcomes Database

slide50

Information is recorded on the fact that a patient is/is not in restraints

Office of Nursing Services - VA Nursing Outcomes Database

slide51

Patient medications

Office of Nursing Services - VA Nursing Outcomes Database

slide52

The patient is asked what happened

The nurse records what he/she observed on arrival at scene.

Office of Nursing Services - VA Nursing Outcomes Database

slide53

Orthostatic VS

Office of Nursing Services - VA Nursing Outcomes Database

slide54

For known diabetics a glucometer reading is taken and a low blood sugar reported

Office of Nursing Services - VA Nursing Outcomes Database

slide55

Visible signs of injury

Office of Nursing Services - VA Nursing Outcomes Database

slide56

Non verbal indicators suggestive of pain are described in a text box

Office of Nursing Services - VA Nursing Outcomes Database

slide57

A “Pain Rating” is recorded for each identified pain location. Pain Rating is a drop down and 0-10 has to be selected only on the location selected.

Office of Nursing Services - VA Nursing Outcomes Database

slide58

A change in range of motion following a fall is another way to assess for evidence of injury

Office of Nursing Services - VA Nursing Outcomes Database

slide59

Neurological assessment with suspected head injury. Drop down for positive response

Office of Nursing Services - VA Nursing Outcomes Database

slide60

Continued neurological assessmentwith pupillary response

Office of Nursing Services - VA Nursing Outcomes Database

slide61

Prior Morse Score pulled in

Patient reassessed with Morse Fall Scale

New interventions put into place post fall

Office of Nursing Services - VA Nursing Outcomes Database

slide62

Important notifications to document

Office of Nursing Services - VA Nursing Outcomes Database

availability to the field
Availability to the Field
  • This summer both the Post Fall Note and the Fall Risk Assessment will be sent out as national templates.
  • The Fall Risk Assessment will also be incorporated into the new nationally standardized patient admission assessment and shift reassessment templates.

Office of Nursing Services - VA Nursing Outcomes Database

segment 3 facility experiences with validation and application of data

Segment 3: Facility Experiences with Validation and Application of Data

Office of Nursing Services - VA Nursing Outcomes Database

slide65
Durham’s Approach to Data Validation and Data Usage

Michelle Ernzen, RN, MSN, CCRN

Patient Safety Manager

Office of Nursing Services - VA Nursing Outcomes Database

three prong approach
Three Prong Approach
  • Educate
  • Monitor
  • Support

Focused primarily on the Nurse Managers

Office of Nursing Services - VA Nursing Outcomes Database

educate
Educate
  • Developed learning modules using 2 different approaches
    • Briefing book
    • Creating Own views
    • Modules had screen shots with descriptions
    • Used VANOD modules as starting point
  • Offered several small “hands-on” classes
    • Learning modules also available via email and hard copy
  • Included introduction to VANOD

Office of Nursing Services - VA Nursing Outcomes Database

monitor
Monitor
  • “If you don’t use it, you lose it”
  • Assignments given each month
    • Annual leave/Sick leave (AL/SL) for the past 4 quarters for T&L
    • Retirement eligibility
    • Overtime for past 2 fiscal years for T&L
  • When AL/SL data was pulled, several Nurse Mangers found discrepancies
    • VANOD notified, already known.
    • Once fixed, data was re-pulled with more accurate results

Office of Nursing Services - VA Nursing Outcomes Database

support
Support
  • Addressed varying levels of computer competency and data analysis
  • Recommended ProClarity classes via VSSC website
  • Identified a few Nurse Managers as resources

Office of Nursing Services - VA Nursing Outcomes Database

data validation
Data Validation
  • Compare FTEE with our staffing model.
    • Staffing model data is updated weekly
    • Communicate with Human Resources (HR) and Fiscal if discrepancies are noted
  • Compare VANOD OT data with Fiscal OT data
    • VANOD data about 30 days behind Fiscal data, therefore delays in acting on data discrepancies can occur

Office of Nursing Services - VA Nursing Outcomes Database

rn satisfaction survey
RN Satisfaction Survey
  • High response rate (82% first year)
  • VISN 6 Nurse Manager Academy
  • Validation with All Employee Survey
  • Improvement in RN satisfaction

Office of Nursing Services - VA Nursing Outcomes Database

what s next
What’s Next
  • Data validation for education and assignment codes
  • Compare VANOD HPPD with how we currently extract HPPD
  • Once new Quality Improvement Coordinator (QIC) in place, “re-educate” Nurse Managers

Office of Nursing Services - VA Nursing Outcomes Database

who else can use the data
Who Else Can Use the Data?
  • Patient Safety Manager
    • Falls
    • Pressure Ulcers
  • Joint Commission Standards
    • National Patient Safety Goals
    • Nurse Sensitive Indicators

Office of Nursing Services - VA Nursing Outcomes Database

slide74
North Florida/South Georgia’s Approach to Data Validation and Data Usage

Toni Phillips, MSN, C

Nursing Informatics Coordinator

Office of Nursing Services - VA Nursing Outcomes Database

objectives
OBJECTIVES
  • Discuss the significance of validation
  • Identify key stakeholders
  • Share learning opportunities obtained with data validation
  • Share NF/SG maintenance procedures
  • Discuss future benefits & application of validation

Office of Nursing Services - VA Nursing Outcomes Database

share nursing service strategies initiatives and measure outcomes
Share Nursing Service Strategies, Initiatives, and Measure Outcomes

TRANSFORMATION

TRANSLATION

Office of Nursing Services - VA Nursing Outcomes Database

focus on the care of the veteran
Focus on the Care of the Veteran

OFFICE OF NURSING SERVICE

Office of Nursing Services - VA Nursing Outcomes Database

north florida south georgia validation
North Florida South Georgia Validation

Office of Nursing Services - VA Nursing Outcomes Database

operationally validating data
Operationally Validating Data

HR sends Nursing Informatics an Outlook message

On day ONE of “entry on to duty” a demographic form is completed

Nursing Informatics enters staff into the Nurse Staff File or (210)

Office of Nursing Services - VA Nursing Outcomes Database

slide81

Class III Mumps Routine AKA Active Nurse Staff

Office of Nursing Services - VA Nursing Outcomes Database

measures maintenance
Measures & Maintenance
  • Nursing Informatics enters transfers and new employees into the nurse staff file (210) to maintain accuracy and historical integrity.
  • Nursing Informatics enters all new staff into the nurse staff file (210)to validate and ensure integrity within the files within the nurse staff file (210).
  • Nurse Recruitment is entering a handwritten assignment code on all 52 forms prior to sending to Human Resources.

Office of Nursing Services - VA Nursing Outcomes Database

slide83
Office of Nursing Services - VA Nursing Outcomes Database

Incident of nurse staff injury for lifting and repositioning patients in our Nursing Homes

benchmarking
Benchmarking

Office of Nursing Services - VA Nursing Outcomes Database

unexpected tangible intangible benefits
Unexpected Tangible & Intangible Benefits

VANOD Data is in Alignment with American Nurses Association’s Forces of Magnetism

#7 : Quality Improvement

#8 : Consultation & Resources

#9: Autonomy

Office of Nursing Services - VA Nursing Outcomes Database

learning opportunities
Learning Opportunities

The primary locations within Medical Administration Service , the nursing package and Decision Support Systems didn’t follow the same naming nomenclature.

Historical updating of Nurse Staff File

Corrected time cards impact the data

Office of Nursing Services - VA Nursing Outcomes Database

future changes
Future Changes

Assignment codes will become a part of VHA Form-52-118.

Current assignment codes will be approved to reflect the current roles within nursing service.

Inclusion of agency data to provide increased precision with HPPD.

Exploration of data within the DSS cubes on the VSSC.

Office of Nursing Services - VA Nursing Outcomes Database

thank you questions
Thank You ! Questions?

Office of Nursing Services - VA Nursing Outcomes Database