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‘‘A SAFE PATIENT’’. Dr J Edem-Hotah Dean – Faculty of Nursing' College of Medicine and Allied Health Sciences University of Sierra Leone. What do RNs do?. What you see Health teaching Integration Supervision Emotional support Physiologic therapy Compensate for loss of function .

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A safe patient l.jpg

‘‘A SAFE PATIENT’’

Dr J Edem-Hotah

Dean – Faculty of Nursing' College of Medicine and Allied Health Sciences University of Sierra Leone


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What do RNs do?

  • What you see

    • Health teaching

    • Integration

    • Supervision

    • Emotional support

    • Physiologic therapy

    • Compensate for loss of function


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What do RNs do? / 2

  • What you don’t see

    • Surveillance

      • Assessment

      • Nursing diagnosis

      • Planning interventions

      • Identifying desired outcomes


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Quantifying Nursing Value

  • Research and quantification: late 1980s

    • Prompted by changes in the health care environment

      • Downsizing

      • Decreased reimbursement

      • Decreased length of stay

      • Emergence of managed care


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Quantifying Nursing Value / 2

  • In 1994, Aitken et al, notes 4.6 lower mortality rates in Magnet Hospital vs Non-Magnet Hospitals

  • ANA requested the study of the impact of restructuring on patient care (1994)


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Quantifying Nursing Value / 3

  • In 1995, ‘‘Nursing Care Report for Acute Care’’ is published by ANA

    • 21 nursing sensitive indicators identified

  • National Database of Nursing Quality Indicators (NDNQI) is born

    • National Centre for Nursing Quality and University of Kansas School of Nursing


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Nursing Indicators

  • Defined as variable patient, family or caregiver state, condition, or perception responsive to nursing intervention

  • Indicators capture health care or outcomes most affected by nursing


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Nursing Indicators / 2

  • Patient-focused outcome indicators:

    • Mortality rate

    • Length of stay

    • Adverse events: falls*, medication errors

    • Complications: UTI, decubitus, pneumonia

    • Patient satisfaction

    • Readmission rates


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Nursing Indicators / 3

  • Process of care indicators:

    • Nurse satisfaction

    • Pain management

    • Patient education

    • Discharge planning

    • Appropriate use of restraints

    • Assessment and implementation of patient care requirements


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Nursing Indicators / 4

  • Structure of care indicators:

    • Ratio of nursing staff to patients

    • Staff education and experience

    • Total nursing hour per patient

    • Staff continuity

    • Overtime

    • Staff injury rates


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What the Research Shows

  • RN staffing and mortality, length of stay

  • High nurse ratios in ICU (1:3 or more), increased ICU days by 49%: similar high nurse patient ratios on the evening shift resulted in 20% increase in length of stay


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What the Research Shows / 2

  • RN staffing and mortality / failure to rescue:

    • Each additional patient per nurse results in 7% increase in the likelihood of dying within 30 of admission

    • Each additional patient per nurse results in a 7% increase in the odds of failure to rescue


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What the Research Shows / 3

  • RN staffing and health care costs:

    • Hepatic resection patients in ICU’s with nurse/patient ratio of 1:3 or more incurred a 14% increase in hospital costs

    • The same patients were a increase risk of re-intubation


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What the Research Shows / 4

  • Staffing levels and sentinel events:

    • Staffing levels have been a factor in 24% of the 1609 sentinel events-unanticipated events that result in death, injury or permanent loss of function-that have been reported to the Joint Commission as of March 2002


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What the Research Shows / 5

  • RN staffing and patient outcomes:

    • Hours of care delivered by RN’s was inversely related to unit rates of medication errors, decubitis, and patient complaints

    • Among medical patients, more RNs hours of care result in decreased LOS, UTI, and GI bleeds

    • Among surgical patients, more RNs hours of care result in decreased rates of pneumonia, Shocks or cardiac arrest, failure to rescue


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What the Research Shows / 6

  • RN staffing and patient outcomes:

    • Higher rates of RN staffing associated with a 3-12% reduction on adverse outcomes

    • Higher staffing at all levels associated with a 2-25% reduction on adverse outcomes

    • RN hours of care, not skill mix, impact level of adverse patient events

    • There is a greater incidence of nearly all adverse events in hospitals with fewer licensed nurses


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What the Research Shows / 7

  • Nursing staffing and hepatitis C transmission

  • Higher nurse/patient ratios resulted in significantly higher HCV prevalence and seroconversion rates per year

  • 2:1 (26.8%, 5.3%), 3:1 (43.6%, 8.6%), 4:1 (71.8%, 14.4%)


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What the Research Shows / 8

  • RN staffing and operational costs:

    • A 1% increase in RN FTEs increased operating expenses by 0.25% but had no effect on profit margins

    • Higher levels of non-nurse staffing resulted in both higher operating expenses and lower profits


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Additional Research

  • Positive nurse-physician communication related to improved patient outcomes and decreased incidents of failure to rescue

  • Educational levels of nurses may have some impact on patient outcomes


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‘‘A safe patient’’

  • RNs are the essential part of the safety equation



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Bibliography

  • Aitken et al (2002) Hospital Nurse-Staffing and Patient Mortality, Nurse Burnout and Job Dissatisfaction

  • Blegen et al (1998) Nurse Staffing and Patient Outcomes

  • Dimick et al (2001) Effects of Nurse-Patient Ratios in ICU on Pulmonary Complications and Resource Use After Hepatectomy

  • JCAHO (2002) Health Care at the Cross-roads: Strategies for addressing the Evolving Nursing Crisis

  • JCAHO (2002) Patient Safety Goal , 2005: reduce the Risk of Patient Harm Resulting from Falls

  • IOM (2004) Keeping Patients Safe: Transforming the Work Environment of Nurses

  • McCue et al (2003) Nurse Staffing, Quality and Financial Performance

  • Needleman et al (2002) Nurse Staffing Levels and Quality of Care in Hospitals

  • Pronovost et al (1999) Organisational Characteristics of Intensive Care Units Related to Outcomes of Abdominal Aortic Surgery

  • Saxena et al (2004) The Impact of Nurse Understanding on the Transmission of Hepatitis C Virus in a Hospital-Based Haemodialysis Unit

  • Unruh (2003) Licensed Nurse Staffing and Adverse Events in Hospitals


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