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Measurement of quality of nursing practice in congenital cardiac care

The impact of nursing care on patient outcomes has been globally demonstrated. However, limited attention has been given to standardized measurement of pediatric nursing care. To address this gap, C4-MNP conducted a qualitative descriptive study to understand the current state of pediatric cardiovascular nursing quality measurement in freestanding children’s hospitals across the country. 

Two encompassing patterns facilitated communication of data: 

1.   structure and process of health care delivery
2.   structure and process of evaluation of care

Interviews with nurse leaders from 20 sites revealed seven topic areas for measurement that address both structure and process of nursing care:

 

An integral part of each interview was the nurse leader’s review of the local, regional, and national external and internal pressures that influence the quality of care. The following quotes highlight specific areas of concern:

We had a major restructuring of the entire nursing department, which really did
increase our turnover significantly. And I do think that has an effect on quality.

There is a challenge…to hire only bachelor level nurses. [We] have been able to hire
at the new graduate level, but have not done as well at the experienced-nurse level.

The more leadership becomes engaged with the bedside, the better things seem
to move. If the communication is better, the understanding becomes better.

The mentor program has increased the quality of care. [Nurses] who have 20+
years [of experience]… all those critical thinking skills and techniques…is worth a lot.

For more information about this process, please review our C4-MNP Phase I publication.

Use of a pediatric cardiovascular nursing consortium for development and evaluation of quality measures

Building on this initial work, C4-MNP utilized a consensus-based method to develop quality measures within working groups dedicated to each topic area. Working groups drafted 28 measures that were presented to the consortium and later evaluated by C4-MNP members based on National Quality Forum (NQF) criteria. Results from this evaluation revealed 10 measures that met criteria for pilot testing. The final 10 measures were independently reviewed and critiqued by an external nursing quality measurement committee, and were also made available to the national parent support group, Mended Little Hearts, for feedback:

For more information about this process, please review our C4-MNP Phase II publication.

State of nursing practice assessments

C4-MNP is also committed to conducting a series of nursing practice assessments in order to establish the current state of practice, identify variation in practice, and develop recommendations to standardize practice.

Our initial State of Nursing Practice Assessment Survey evaluated care related to clinical deterioration, patient/family centered care, adult congenital heart defect (CHD), pressure ulcers, work environment, and nutrition. Seventeen of 28 C4-MNP sites participated for a response rate of 60.7 percent. Results indicated that C4-MNP may consider standardizing the Health of the Work Environment Survey across participating sites, as well as the extent to which families are present for their child’s care and receive adequate levels of support. For detailed results from this assessment, please review the aggregate State of Nursing Practice Assessment Aggregate Report.

An additional State of Nursing Practice Assessment was conducted to understand and describe the management of opioid and sedative weaning in pediatric CHD patients. Twelve of 27 C4-MNP sites participated for a response rate of 44.4 percent. Results indicated substantial practice variation, including which provider is primarily responsible for weaning decisions, how medications are weaned, what education materials are provided to families, and what type of follow-up occurred after discharge. The results from this assessment have been accepted for publication in Dimensions of Critical Care Nursing, and are published in the March/April 2017 issue.