A New Guide for Implementing Nursing-Sensitive Performance Measures
From October 2004 to December 2005, the Joint Commission on Accreditation of Healthcare Organizations (now known as the Joint Commission) created, tested and disseminated specifications for implementing 15 "nursing-sensitive" performance measures.
The measures, endorsed by the National Quality Forum, provide a framework for evaluating the ways nurses in acute-care hospitals contribute to patient safety, health care quality and a professional work environment.
- Project staff produced the Implementation Guide for the National Quality Forum (NQF) Endorsed Nursing-Sensitive Care Performance Measures. The guide provides standardized specifications for hospitals and other health care organizations to use in collecting and analyzing data on the measures.
- Project staff conducted several evaluations of the implementation guide with potential users and revised it based on the results.
- The Joint Commission added the specifications to its list of standards from which hospitals can choose to gain accreditation.
The Robert Wood Johnson Foundation (RWJF) supported the project with an unsolicited grant of $154,687.
In 2004, the National Quality Forum — a nonprofit organization created to develop and implement a strategy for reporting health care quality — identified and endorsed 15 measures of the ways nurses in acute-care hospitals contribute to patient safety, health care quality and a professional work environment.
These measures, known as "national voluntary consensus standards for nursing-sensitive care," include:
- Prevalence of pressure ulcers.
- Prevalence of falls with injury. Smoking cessation counseling for heart failure.
- Death among surgical patients with treatable serious complications.
RWJF and the U.S. Department of Veterans Affairs co-funded development of the measures (see Grant Results on ID# 047479). RWJF then commissioned articles exploring the steps required to implement them (see Grant Results on ID# 056621). The articles appeared in Medical Care Research and Review, 64(2); abstracts are available online.
A lack of standardized specifications for implementing the measures limited their use by multiple stakeholders.
America's health care system long overlooked the central role that nursing plays in providing high-quality health care. Without a set of nursing measures to capture nurses' contribution to quality, it will remain difficult to convince funders and researchers to allocate resources to the nursing field. Nursing-quality measurement has been an untapped strategy for improving health care.
With RWJF support, in 2004, the National Quality Forum endorsed national voluntary consensus standards for nursing-sensitive care. The consensus standards enable assessment of the extent to which nurses in acute care hospitals contribute to health care quality, patient safety and a professional and safe work environment. The project team also identified priority areas for research.
As a result, the National Quality Forum's 15 national voluntary consensus standards for nursing-sensitive care (on patient outcomes, nursing interventions and system-level measures) became the first national, standardized and consensus-based performance measures for nursing care. The consensus standards enable consumers to assess the quality of nursing care in hospitals and allow providers to identify critical outcomes and processes of care for continuous improvement. Purchasers can use the consensus standards to reward hospitals for better performance. See Grant Results on ID# 047479.
More than half (54 percent) of all health care providers in the United States are nurses, but there has been little rigorous research that demonstrates the impact of nurses' care on patient outcomes. The Interdisciplinary Nursing Quality Research Initiative, a five-year program that RWJF started in 2006, aims to identify causal linkages between nursing and health outcomes for patients. RWJF funded nine teams of nurse scholars and scholars from other disciplines to conduct two-year research projects to examine the link between nurses' contributions and the safety and quality of patient care.
From October 2004 to December 2005, the Joint Commission on Accreditation of Healthcare Organizations (now known as the Joint Commission) created, tested and disseminated standardized specifications for implementing 15 "nursing-sensitive" performance measures endorsed by the National Quality Forum.
The Joint Commission is an independent, not-for-profit organization that accredits and certifies more than 15,000 health care organizations and programs in the United States.
Project staff convened a 16-member Technical Advisory Panel to oversee the development of the specifications.
Project staff reported the following results in reports to RWJF:
- Joint Commission staff and the Technical Advisory Panel produced the Implementation Guide for the National Quality Forum (NQF) Endorsed Nursing-Sensitive Care Performance Measures. The guide provides standardized specifications for hospitals and other health care organizations to use in collecting and analyzing data on the measures. (For more details, see the Bibliography.)
- Project staff conducted several evaluations of the specifications and of the guide with potential users and based revisions on the findings:
- Thirty diverse acute-care hospitals across the country collected sample performance data following the guide and completed a detailed questionnaire on its utility. Through telephone follow-up at several hospitals and site visits to two, project staff discussed the guide with hospital staff working in patient care, information management and performance measurement.
- Two organizations that were approved by the Joint Commission as vendors to offer their performance measurement systems to hospitals seeking accreditation evaluated the guide against those systems.
- Five vendors of electronic medical records reviewed the guide and recommended ways to incorporate performance data into such records during health care delivery, rather than as a separate exercise.
- The Joint Commission added the measures and specifications to its list of standards from which hospitals can choose to gain accreditation.
To encourage use of the measures, project staff posted the implementation guide on the Joint Commission's Web site and publicized it through the Joint Commission's listserv and Nursing Advisory Council. The National Qualify Forum also publicized the guide.
AFTER THE GRANT
In January 2007, the Joint Commission received a two-year grant from RWJF (ID# 059409) to conduct a full pilot test of the performance specifications and implementation guide at 50 sites to determine their reliability across different kinds of health care organizations.
GRANT DETAILS & CONTACT INFORMATION
Developing Standardized Technical Specifications for Nursing-Sensitive Performance Measures
Joint Commission on Accreditation of Healthcare Organizations (Oakbrook Terrace, IL)
Dates: October 2004 to September 2005
Technical Advisory Panel for the Implementation Guide
Linda Burnes Bolton, Dr.P.H., R.N., F.A.A.N.
Cedars-Sinai Health System
Los Angeles, Calif.
Marilyn P. Chow, R.N., D.N.Sc., F.A.A.N.
Nancy E. Donaldson, R.N., D.N.Sc., F.A.A.N.
UCSF School of Nursing
San Francisco, Calif.
Sandra R. Edwardson, Ph.D., R.N., F.A.A.N.
Agency for Healthcare Research & Quality
Agency for Healthcare Research and Quality
Diane Feeney, R.N., M.Sc.
National Quality Forum
Lillee S. Gelinas, R.N., M.S.N.
Robert Wood Johnson Foundation
Michael Grove, R.N., Med., C.H.E., N.H.A.
Department of Veterans Affairs
Trent Haywood, M.D., J.D.
Centers for Medicare & Medicaid Services
Teresa Horan, M.P.H.
Centers for Disease Control and Prevention
Ellen Kurtzman, R.N., M.P.H.
National Quality Forum
Eileen Lake, Ph.D., R.N.
University of Pennsylvania School of Nursing
Jerod Loeb, Ph.D.
The Joint Commission
Oakbrook Terrace, Ill.
Jack Needleman, Ph.D.
UCLA School of Public Health
Los Angeles, Calif.
Mary Jean Schumann, M.S.N., R.N., M.B.A.
American Nurses Association
Silver Spring, Md.
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Implementation Guide for the National Quality Forum (NQF) Endorsed Nursing-Sensitive Care Performance Measures. Oakbrook Terrace, Ill.: Joint Commission on Accreditation of Healthcare Organizations, 2005. Available online.
"Nursing-Sensitive Care Performance Measures Draft Technical Information Guide Pilot Site Field Review," Oakbrook Terrace, Ill.: Joint Commission on Accreditation of Healthcare Organizations, fielded 2005.
Report prepared by: Nina Berlin
Reviewed by: Sandra Hackman
Reviewed by: Marian Bass
Program Officer: Rosemary Gibson