ANA awards five hospitals for nursing quality

Poudre Valley gets fourth consecutive award

According to Craig Luzinski, MSN, RN, NEA-BC, FACHE, chief nursing officer at Poudre Valley Hospital in Fort Collins, CO, the hospital received the American Nurses Association (ANA) NDNQI (National Database of Nursing Quality Indicators) Award for Outstanding Nursing Quality for the fourth consecutive year. "We were the first hospital to receive the award in 2007, and that year, NDNQI gave out just one award. So, at that time, they didn't fragment it by facility type like they do now," he says. Since then, the hospital has won three consecutive awards in the teaching hospital category.

What sets Poudre Valley Hospital (PVH) apart? "I think part of it is that PVH has been an organization that has embraced the Magnet model. And then, we've also been immersed in the Malcolm Baldrige quality model. And so, by merging those two things, the organization as a whole has a focus on outcomes. And that can be outcomes related to quality, finances, customer satisfaction, HR metrics," he says. By knowing current baselines for all major indicators and setting goals, the vision for top-class care is set, Luzinski says.

"What we do is we establish a process or an issue such as patient falls, or urinary tract infections. We measure to find out what our baseline is. We then go outside of our hospital to benchmark against other facilities trying to look at that top 10%. And, the nice thing about NDNQI is, a couple of years ago, they started reporting back to us the top decile. It used to be just the top quartile. And so they segmented it out a little more bit for us," he says.

So what does one do with all the data? He says the hospital has had a system of balanced scorecards for several years in which it identifies key measures to keep track of, the goals, and then measuring how it's doing on those goals. "Specifically for nursing, we have a pretty robust nursing quality dashboard, which includes many of the nursing-sensitive indicators that NDNQI has on their database," he says.

The key to the nursing quality dashboard "is involving staff identifying and developing action plans to improve our current status," he says. "And, I think that's where we have made a lot of progress — using benchmarking, using dashboards, and then making them very transparent so that everyone gets to see everyone else's data. And then, expecting action plans to be developed if we're not at the level that we would like to have."

Some of those the hospital has prioritized are patient falls, pressure ulcers, and hospital-acquired infections. The measures are unit-specific. So, for example, patient falls wouldn't be an issue in the neonatal unit. And in the med/surg floors, you wouldn't be concerned with ventilator-associated pneumonia, he says. But in the ICU, VAPs and catheter-associated urinary tract infections would be important indicators.

"We do measure, from a financial and productivity standard, our nursing productivity measures, which are usually measured in hours-per-patient data; it's sort of a standard benchmarkable number. We look at our nurses' education levels. So, the percentage of two-year degree nurses, bachelor's degree, masters-prepared, and then doctorate or PhD. We look at and monitor the number of nurses who are certified — have national certifications — and that can be clinical certifications in their area of specialty or administrative certifications like in my job," he says.

He says Poudre has nurses in roles outside direct patient care. For instance, the director of the quality resource department is a nurse, and under him is a group of nurses who work through the "data manipulation and collection process," he says. "And they also work with the physicians, too, on their data to help organize it and then help us understand how we can better use the data rather than just reacting to things when numbers go up and down. You know, understanding control charts, and variability, and common cause..."

For its work on pressure ulcers, the hospital emphasizes a physical assessment every day so staff can be proactive in identifying redness or bony areas, as well as getting patients walking to promote circulation. The hospital has a clinical nurse specialist focused on skin integrity. Beyond other responsibilities, she works in the wound care clinic. "She's a resource so that if we find a patient that either has a pressure ulcer or looks like it's developing, we have the ability to call her up as a consult and she can come up and help nurses walk through the variety of therapy options," he says.

Falls are another priority for staff. "We've got a pretty robust program of doing an assessment of an individual and then placing them into a risk division or category, and it's based on a variety of different observed assessments or what people tell us," he says. If a patient is labeled a high risk for falls, the electronic health record system helps remind and alert staff to initiatives to reduce the likelihood of a fall. If an at-risk patient tries to get out of his or her bed or chair, an alarm goes off. High-risk patients are also escorted by staff to the bathroom. Staff "try to educate the patients and the family members as to why we're there; we're there for their safety. And we try to educate them that the bathroom is a very dangerous place if they try to get up, and they get dizzy, and they'll fall. And, so we try to say that it's not to embarrass them, but it's to keep them from hurting themselves," he says.

In the neuro unit, a video monitor technician sits at a desk to monitor everyone. The staff also have started something he says has been helpful for other hospitals — hourly rounding. Either a nursing assistant or RN is responsible for checking on patients each hour. "What you check are the three Ps: potty, positioning, and pain. And so, when you check every hour, you say, 'Do you have to use the restroom?' 'Are you positioned appropriately?', which is going to help with pressure ulcers and just general comfort. And then, 'Are you having pain that we need to address?'" he says.

(The ANA also awarded: University of Kansas Hospital, Kansas City, KS/Academic Medical Center; Medical Center of the Rockies, Loveland, CO/Community Hospital; Children's Hospital & Medical Center, Omaha, NE/Pediatric Hospital; Craig Hospital, Englewood, CO/Rehabilitation Hospital.)