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First national nursing outcome measures revealed

England’s first set of national outcome indicators specifically related to nursing care will measure performance on pressure ulcers, falls and urinary tract infections, Nursing Times has learned.

The results will allow teams to compare their outcomes with others across the country and highlight those whose performance is poor.

The first three indicators were agreed by the chief nursing officer for England Dame Christine Beasley and the strategic health authority chief nurses in recent weeks. They have been submitted to be included in the NHS list of Measures for Quality Improvement, which will mean trusts’ results are routinely published for nurses and trusts, and potentially for the public.

In 2008 Dame Christine committed to defining indicators, known in the past as nursing metrics, so nurses can measure and demonstrate how they are improving care - contributing to the quality agenda set out in former health minister Lord Darzi’s review of the NHS.

Nurse leaders will be able to use the results to show how performance is often linked to staffing levels.

Documents seen by Nursing Times say the indicators will “support improving quality in NHS provided care – in both the NHS and social care settings – and apply to anyone wanting to measure and demonstrate continued improvement regarding nursing care”.

Each of the three is linked to one of the Department of Health’s high impact actions for improving quality and productivity, launched last year, and could be used to monitor how well they are being followed.

DH programme director for quality in nursing Gerry Bolger, who has coordinated agreement of the indicators, said having a standard approach for all trusts and settings would allow more benchmarking and lead to improvement.

He said they would continue to be refined and added to. He told Nursing Times: “This is a way for nurses to assure themselves, patients and commissioners that they are giving good care.”

Peter Griffiths, director of the National Nursing Research Unit at King’s College London, who has led research on developing nursing outcome indicators, said getting official approval was a significant step.

He said: “Step one is to get them out there. There will now be a lot of work to do to really make sense of them and to make them more prominent.”

Professor Griffiths said the indicators would challenge the ability of nurses and nurse leaders to improve against them, and they would need support to do so.

He said: “Very little will happen unless there is the capacity and will to respond and improve rates.”

Professor Griffiths said the measures could highlight problems but warned results could also be misinterpreted - for example if trusts with high rates are assumed to be providing poor quality care. “There needs to be a more sophisticated understanding across the system of what we can and can’t learn [from the indicators]. Sitting on top [with the highest rates] doesn’t necessarily mean you have got a problem.”

Heart of England Foundation Trust nurse director Mandie Sunderland has developed a system to measure the quality of nursing practice – rather than outcomes – in areas including pressure area care, infection control and falls prevention.

She said the outcome indicators would boost the “profile of the importance of nursing care with people like commissioners and regulators”, but would not on their own help nurses improve standards.

Ms Sunderland said: “My rate of falls might be high but that doesn’t actually tell me what I’m doing wrong. What I’m trying to do to is measure best practice in the process of nursing care.

“To me as a jobbing nursing director, to be assured about standards I need more detail around what is actually going on.”

The indicators are:

  • The number of falls resulting in physical injury per 1,000 bed days, adjusted for the age of patients.
  • The number of patients who have developed one or more new pressure ulcers during the previous month. For hospital care this is per 1,000 bed days, for out of hospital care per 10,000 population of the primary care organisation.
  • The number of patients with an indwelling (continuous) urinary catheter per 1,000 bed days or per 10,000 population. The indicator is intended to help reduce the rate of urinary tract infections.

Readers' comments (4)

  • Marjorie Lloyd

    Not sure this will identify or improve nursing care and is in danger of becoming another tickbox / checklist exercise. We also need much more qualitative evidence of good nursing practice

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  • Having indicators ia all very well to ensure the correct care is being given. The best way to ensure patient safety in these areas is to educate staff at ward level on the use of catheter care bundles, on monitoring patient's skin condition on a daily basis and the measures to be put in place to prevent sores developing. Staff should also be updated on the prevention of falls and managers should ensure areas at high risk of falls are effectively staffed to reduce the risk to patients. All of these systems should be monitored to ensure compliance by the appropriate lead. This way incidencs of these issues would reduce and it would not just be a tick box exercise

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  • if we didn't have to keep bloody doing all these tick boxes we might actually be able to give the patients quality time in order to prevent pressure sores, regularly toilet them and be able to keep an eye on the high risk fallers. i came into nursing to give patients good basic care. i feel now patients are no longer patients but a bay number!

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  • We need a wide range of measures to improve patient care including education, adequate resources etc, but data such as the new indicators also have a place as they will demonstrate areas that provide high quality care in addition to identifying areas in need of improvement. They will be useful in highlighting the need for adequate resources and for business cases, calculating staffing levels etc.

    It is unlikely that the indicators will prevent nurses from providing direct care as stated above as most trusts already collect this kind of data, particularly around pressure ulcers. It is people such as myself (Tissue Viability Nurses etc.) who will be required to change the way we work. We already collect the required data but will need to report this in the new format ie per 1,000 bed days - anybody out there have a simple formula for working this out??!!

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