Currently in the U.S., 60% of all adult, non-obstetric hospital admissions are age 65 years or older. As compared to other age cohorts, older hospitalized patients are more severely ill, consume more health care resources, suffer more adverse events, and have longer lengths of stay. NCQI is a joint initiative between two New York based health care systems, Mount Sinai NYU Health and the North Shore-Long Island Jewish Health System; ten hospitals are participating in phase one.
Objective: NCQI is based on the national demonstration project, Nurses Improving Care to the Hospitalized Elderly (NICHE), one of the exemplars in evidence-based practice in nursing. The purpose of NCQI is to expand the Geriatric Resource Nurse model (NICHE) with the national model of Family-Centered Care to improve the standard of nursing care to hospitalized older adults and their families. Staff nurses receive formal education on functional assessment; continuing sessions on common geriatric syndromes, family/caregiver involvement, and discharge planning; and, nurse-nurse consultation rounds with geriatric advanced practice nurses. The specific aims of the research are to determine whether the initiation of the NCQI that focuses on improving the knowledge and expertise of nurses in the care of older patients and their families can improve hospital quality indicators of: patient falls, pressure ulcers, and use of physical restraints.
Design: This is a pre-test post-test design. Quality indicators of nursing care were examined to determine the effect of NCQI. Pre-NCQI measures and post-NCQI (after 12 months of NCQI training of the nurses on the study units) measures were obtained.
Population, Sample, Setting, Years: The study was conducted from September 2000 through December 2001 in 18 patient care units in 10 hospitals in the NY metropolitan area. Two to four nurses per patient care unit were part of the training program; these nurses were responsible for disseminating the geriatric nursing and family centered care content to other staff on their patient units. The unit-based outcome variables were assessed to determine the effectiveness of this new model of nursing care.
Variables: The intervention consisted of one year of intensive training of selected nurses on each of the study units. Outcome variables included quality indicators of patient falls, pressure ulcers and use of physical restraints.
Methods: The pre-NCQI measures of quality indicators were obtained from various hospital data bases. In one of the 2 health systems there was a consistent method of data collection for the targeted quality indicators. Within the other health system, new definitions of quality indicators were introduced. Units were compared to themselves from time one measurement to time two measurement.
Findings: There were significant changes in unit-based quality outcome indicators of patient falls, pressure ulcers, and use of physical restraints from time one to time two. As part of the NCQI Project, consistent definitions of quality indicators were introduced throughout the systems.
Conclusions: NCQI was effective in demonstrating changes in nurse sensitive quality indicators of patient care.
Implications: There are two immediate implications for nursing: the need to enhance the education of nurses regarding care of geriatric patients and their families and the need to develop consistent definitions of nurse sensitive outcome variables.
Funding Source: Mount Sinai NYU Health and North Shore-Long Island Jewish Health System, New York Health Alliance
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