Exceeding Benchmarks on Nurse-Sensitive Indicators

Outperforming national benchmarks is one requirement of the journey to achieve Magnet® recognition. Throughout 2020, our nurses exceeded national benchmarks for nurse-sensitive indicators, including for central line-associated bloodstream infections.

As the Magnet® journey of Salinas Valley Memorial Healthcare System generates significant improvements in both care quality and patient experience, it demonstrates why nurses’ use of data is an essential contributor to nursing excellence.

As Mercedes Labindalaua, RN, BSN, CCRN, notes, “Regular postings of data heighten awareness of why nursing care matters. Not only are data a more quantitative view of measures and outcomes but data highlight accomplishments and nursing care’s direct impact on patient outcomes.”

Care Quality Improvements

Access to data has certainly had an impact on the Magnet Recognition Program® requirement that a hospital demonstrates outperformance of national benchmarks in key areas, including nurse-sensitive indicators (NSIs).

In the inpatient setting, the rate of central line-associated bloodstream infection (CLABSI) is a widely used NSI, with the Press Ganey® National Database of Nursing Quality Indicators™ (NDNQI) using the rate of hospital-acquired infections per 1,000 central line days as its CLABSI measure. For the SVMHS Magnet® application, the hospital measured CLABSI across eight quarters through Q2 2020. All 11 eligible units outperformed the national benchmark at least seven of those eight quarters.

In the ambulatory setting, the key measurement was for falls with injury, which NDNQI measures as the rate of falls with injury (minor, moderate, major and death) per 1,000 patient days. At SVMHS, all 10 eligible ambulatory units outperformed the national benchmark at least seven of the eight quarters.

For both measures, SVMHS’s results far exceed the Magnet® minimum of outperforming the national benchmark at least five quarters out of eight. Equally impressive, the Executive Summary Report from The Commission on Magnet® recognized each of these achievements as Exemplars in the Magnet Model component of Exemplary Professional Practice.

The Path to a Data-Driven Culture

Both of these examples are directly linked to nurses embracing data. For one, simply submitting a hospital’s data to NDNQI enables nurses to benchmark their work – an important element of any data-driven organization.

Equally important, Magnet® Clinical Excellence Specialist Rebecca Rodriguez, BSN, RN, CEN, and Quality Council representatives create and regularly update color-coded dashboards that display benchmarked, unit-level data metrics. Clinical teams post these metrics on unit huddle boards and, during huddles, staff members discuss these data and nurse-driven improvement strategies. The process ensures all nurses are informed and working toward the same unit-level goals for improving specific clinical outcomes.

Utilizing data to monitor performance in national benchmarks allows nurses to work toward targeted goals.

“When we started this journey, it was instinctive for clinical staff to focus on process and structure-related changes,” says Abigail Acosta, MSN, RN, CPAN, CAPA. “Now, with awareness of data, we are learning to consider clinical outcomes when implementing initiatives and in our everyday practice. It makes it easier to convince and guide each other on the validity of certain interventions and initiatives.”

For CLABSI, the posting of data led to unit nursing teams devising innovative workflow changes that led to the impressive improvements. For falls in the ambulatory setting, the data displays have helped to maintain an already established level of excellence.

“Evaluating data has prompted changes or modifications to my nursing practice,” says Anna Paz Mercado, BSN, RN, ONC. “It allows me to explain and speak about data to my colleagues, and for falls, when conducting rounding, I make sure to pay extra attention to ensuring bed alarms are activated, high-risk-for-fall strategies are followed and to educate patients to call when they need assistance.”

Improving the Patient Experience

Patient experience (PX) is another important component of nursing excellence; meeting Magnet® criteria in at least four out of nine domains demonstrates excellence. However, says Rodriguez, “We had discovered that we were not meeting Magnet® criteria for ambulatory patient experience in any domain.”

In response, nurse leaders did a deep dive into the PX results, and then:

  • The CNO engaged executive leaders and incorporated ambulatory targets into organizational annual goals.
  • Rodriguez provided a list of focus questions to each respective Unit Practice Council (UPC) and leader to guide improvement efforts.
  • The PX Director worked closely with each ambulatory nurse leader to develop project plans.
  • Nurse leaders shared the focus questions and improvement strategies at huddles and staff meetings.
  • UPCs included the focus questions on unit data displays and discussed specific nurse-driven improvement strategies with peers.

By July 2020, SVMHS nurses were meeting and, often, exceeding the Magnet® criteria in the domains of patient education, responsiveness, pain and careful listening.

“Data has a critical role to play, but improvements don’t occur without the nurses on the units also using their professionalism and shared governance model to devise effective strategies for change,” Rodriguez says. “It’s the combination that raises the level of nursing care.”

Patient Experience Teams infographic

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