Ways to stay focused on your patients, not your EHR. Moreover, the NQF has not endorsed any additional nurse-sensitive structure, process, or outcome measures since 2004. Performance measures must be selected with thoughtful intention. There is no doubt that minority nurses experience slights which are related to race from unconscious bias which permeates our culture. In contrast to frameworks based on the medical model of care (Donabedian, 2003), patient outcome categories proposed in nursing quality frameworks are typically more closely aligned with nursing’s social mandate. (2010). Outcome statement must be patient centered, specific, and measurable. Despite the proliferation of national and regional nursing databases, participation is voluntary and no available databases contain information on all of the 15 nurse-sensitive measures endorsed by the NQF (Kurtzman, Dawson, & Johnson, 2008; Kurtzman & Jennnings, 2008; VanFosson, Jones, & Yoder, 2015). His now-famous quote about making quality improvement measureable says, Some is not a number; soon is not a time. Value-Based Purchasing Measures Used by CMS in 2016.a. Quality assessment initiatives are hindered by the paucity of available data related to nursing processes and patient outcomes across these three domains of practice. More emphasis is needed on establishing clinically meaningful relationships between specific nurse process measures and patient outcomes that reflect the full spectrum included in the nursing profession’s social mandate. Responses to the documentation burden include extending work hours to complete documentation, diverting time away from patient care to complete documentation, or leaving documentation incomplete. Bodrock, J. Kane, R. L., Shamliyan, T. A., Mueller, C., Duval, S., & Wilt, T. J. Nursing exists for the sole purpose of serving the public good; therefore, the public owns the discipline. d=Veteran’s Administration Nursing Outcomes Database (Veteran’s Health Affairs (VHA), 2009). In response to declining reimbursement and escalating quality and safety problems, stakeholders in the healthcare industry now challenge traditional assumptions across the delivery system and seek empirical evidence to guide system redesign. Nurse leaders and scholars have long recognized the need to measure the outcomes of nursing care and have attempted to address the associated challenges at various times throughout history. An evolving science. Measurable. Matney, S. A., Maddox, L. J., & Staggers, N. (2014). The current state of nursing performance measurement, public reporting, and value-based purchasing. Specific and measurable: tracking data to monitor outcomes is practical and timely. doi:11.1177/1077558707299260, Outland, B., Newman, M. M., & William, M. J. (2010). However, neither has been widely adopted in the United States. Crossing the quality chasm: A new health system for the 21st Century. Lewin-VHI. x[�R#��m:�8��ظ�s(-��5D�����9" Doran (Ed), Nursing Outcomes State of the Science (2nd ed, 487-508). 141 0 obj <> endobj c=Military Nursing Outcomes Database (Patrician, Loan, McCarthy, Brosch, & Davey, 2010) Silver Spring, MD: Nursebooks.org. symptom management), these types of outcomes remain underdeveloped and ignored. Sudbury, MA: Jones & Bartlett: Learning, Krueger, L., Funk, C., Green, J., 7 Kuznar, K. (2013). One overall goal is determined for each nursing diagnosis. Reliable and valid nurse process measures require accurate and complete documentation of nursing care and patient responses to that care. American Nurses Association (ANA). Enhancing nursing practice by utilizing voice recognition for direct documentation. Journal of Obstetrics and Gynecology Nursing, 43, 132-133. doi:10.1111/1552-6909.12276. Western Journal of Nursing Research, 35(6), 760-794. doi:10.1177/01939549137476577, Burston, S., Chaboyer, W., & Gillespie, B. (2001). Note: outcomes generally begin with a verb like increase, expand, or improve. The current documentation burden in nursing is high and is a major source of job dissatisfaction among direct care nurses (Hakes & Whittington, 2008). Bigbee, J. L., & Issel, L. M. (2012). Rather, surveillance involves a series of interdependent activities to include the gathering of multiple pieces of information from multiple sources; analyzing the collected information for meaningful patterns; identifying the need for further intervention(s); and initiating appropriate action(s) (Fasolino & Verdin, 2015; Jones, 2011). Quality measures are considered important to the extent that they address priority quality issues such as the IOM (2001) six aims and, in the case of nursing, the social mandate. However, outcomes offer no guidance for quality improvement unless they are related to modifiable antecedents (e.g., structures and processes of care). Writing outcome statements "Outcomes - are specific, measurable statements that let you know when you have reached your goals. Western Journal of Emergency Medicine, 15(4), 541-547. doi:10.5811/westjem.2014.3.19658. Can electronic medical records really improve quality? EHR technology can accommodate an almost infinite number of data fields and this may increase the opportunity to develop more nurse process measures. Instead, specific quality measures must be derived from domain and/or problem specific frameworks. }ҋ;��n��Y�=��3uG�cJ7r��_��&7qRl���/�d\K��v���`�’9��nYuo��O���+?L�J�4�q|6x�+�P�2p�{����>��3~�Ox+��>6zQ?y�߅��a$�>���fU�JٺS1�%��%\̠J���c�zS��.tn=��Y���LK��5�� Forward, C. (2013). When performance on an outcome influences provider reimbursement, the increased attention is often accompanied by a reallocation of resources to correct the problem. endstream endobj 142 0 obj <>/Metadata 13 0 R/Pages 139 0 R/StructTreeRoot 23 0 R/Type/Catalog>> endobj 143 0 obj <>/MediaBox[0 0 612 792]/Parent 139 0 R/Resources<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 144 0 obj <>stream The terms goal, outcome, and expected outcome are oftentimes used interchangeably. Measures based on data collection methodologies intrinsic to care processes and captured by existing data systems are highly desirable. Quality and performance measurement: National efforts to improve quality of care through measurement development. Measurement also consumes human and material resources review process outcomes remain underdeveloped and ignored specifications. 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