Nurse-Sensitive Indicator Quality Improvement Toolkit

Abstract

Background: Existing best practices to monitor and prevent health care–associated infections (HAIs) were ineffective during the COVID-19 pandemic due to increased patient susceptibility toward infections, reduced resources, and increased use of agency nurses. Problem: A review of the US hospitals revealed a 60% increase in central line–associate bloodstream infections (CLABSIs) and a 43% increase in catheter-associated urinary tract infections (CAUTIs) in 2020. A large, academic, level 1 trauma center in Houston, Texas, experienced similar challenges at the start of the COVID-19 pandemic. Approach: An interdisciplinary team of nurses, infection preventionists, and hospital educators combined and adapted existing evidence-based practices in a novel way to create a nursing-led toolkit for quality improvement tracking, improving, and sustaining HAI improvements. Outcomes: CLABSI and CAUTI rates were reduced over time following the introduction of the Nurse-Sensitive Indicator Quality Improvement (NSIQI) Toolkit. The CLABSI standardized infection ratio (SIR) decreased by 19%, and the CAUTI SIR decreased by 19.4%. Conclusions: The novel NSIQI Toolkit is a scalable tool for improving and sustaining CLABSI and CAUTI rates, which may have the potential for other nurse-sensitive quality indicators.

Best practices for implementation of Kamishibai cards in the healthcare setting to improve nursing‐sensitive indicator associated outcomes: An integrative review

“…An error should be discussed immediately after the round; it is almost never necessary to interrupt the nurse providing care unless there is an overt safety risk. This is the only time an auditor may intervene, and all should be trained to handle this potentiality (Gould et al., 2018; Joseph et al., 2021; McVey et al., 2022; Salinas, 2022; Salinas et al., 2021; Stewart, 2021). This non‐punitive approach to rounding heralds from the theory of just culture, where punishment of an individual responsible for an error does little to reduce the likelihood of error recurring (Boyson, 2013) and may also lead to a reluctance to report errors in the future (Paradiso & Sweeney, 2019).…”

“…Prior to the roll out of K‐card rounding, education is required for participating staff. The necessary education is twofold: (1) staff need teaching around the K‐card tool itself and (2) they need teaching around the bundle of care the tool is being used to monitor (Gould et al., 2018; Joseph et al., 2021; Kamity et al., 2021; McVey et al., 2022; Salinas et al., 2021; Stewart, 2021). A purposeful education plan should be developed and implemented, as a lack of understanding prevents staff from knowing and adhering to desired standards (Salinas et al., 2021).…”

“…Compared to self‐reporting or chart audits, direct observation prevents accidental falsification of practice standards and ensures the process evaluates real compliance as opposed to perceived or documented compliance (Gould et al., 2018; Joseph et al., 2021; Ormsby et al., 2020; Salinas, 2022; Salinas et al., 2021; Stewart, 2021). First‐hand practice observation allows auditors to provide real‐time feedback and education and facilitates discussion around barriers to compliance (Gauntt et al., 2022; Gould et al., 2018; Joseph et al., 2021; Kamity et al., 2021; McVey et al., 2022; Ormsby et al., 2020; Salinas, 2022; Salinas et al., 2021; Shea et al., 2019; Stewart, 2021).…”

Establishing Standardized Nursing Quality Sensitive Indicators

“…• Nurse-Sensitive Indicator Quality Improvement Toolkit [58] [64] Outcomes: CLABSI and CAUTI rates were reduced over time following the introduction of the Nurse-Sensitive Indicator Quality Improvement (NSIQI) Toolkit. The CLABSI standardized infection ratio (SIR) decreased by 19%, and the CAUTI SIR decreased by 19.4%.…”

COVID-19, burnout, and healthcare-associated infections: a focus on wellness as a top safety priority

“…Staffing shortages played a role in increasing HAIs rates secondary to staff fatigue and burnout, resulting in greater reliance on third-party agency staffing. 17,18 Agency nurses may be less knowledgeable of institution-specific safety culture awareness and hospital-specific HAI prevention techniques. 19,20 Individual and organizational wellness and the path toward resiliency…”