NSG/541 Week 6: Recommendations From the Data, sample paper

Cover the Bathroom Calls at Shift Change, Stop Canceling at the Desk, Fix the Clock: Recommendations for Care, Data Capture and a Quality Initiative

[Student Name]

University of Phoenix

NSG/541: Data Analysis and Management

Week 6 Assignment

[Instructor Name]

[Date]

The hospital, the unit and all data are a composite written for a model paper.

The analysis found that typical response time met the unit's target but bathroom calls were answered promptly only 61% of the time, one call in seven was silenced from the station, the longest waits clustered at shift change and five of eleven falls followed a call left waiting more than five minutes. This paper makes recommendations for care, for data capture and for a quality initiative that will test whether the changes help.

Principle: Recommend Only What the Data Support

The analysis supports targeting bathroom calls, shift change and desk cancellations. It does not support claiming that faster responses will prevent all falls, since several falls happened to patients who never pressed a button. A recommendation that overreaches the data invites a disappointing result and a lost chance to learn what does work.

Recommendations for Care

Recommendation 1: protected call coverage at shift change. From 0645 to 0730 and 1845 to 1930, one nursing assistant and the charge nurse will not take handoff duties and will answer all calls, starting with bathroom calls. Finding: the slowest responses and the lowest prompt bathroom response, 38%, occur at these times.

Recommendation 2: bathroom call escalation. Bathroom pull-cord calls will ring on the assigned nurse's and assistant's phones and, if not answered within 2 minutes, on every phone on the unit. Finding: bathroom calls are answered within 3 minutes only 61% of the time, and elimination-related falls are both common and more likely to cause injury (Hitcho et al., 2004).

Recommendation 3: proactive toileting before shift change. Assistants will offer toileting to patients at high fall risk between 0600 and 0630 and 1800 and 1830. Finding: shift change is when bathroom calls wait longest, and meeting the need before it arises reduces calls at the busiest time.

Recommendation 4: a separate approach for patients who do not call. Finding: a third of the falls happened to patients who never pressed a button. These patients, often with confusion, need different prevention, such as bed alarms, closer observation or scheduled rounding, which the falls committee will review separately.

Recommendations for Data Capture

Recommendation 5: synchronize the nurse call server's clock with the hospital network time source, so that the four-minute correction is no longer needed and future links are exact. Owner: facilities.

Recommendation 6: limit desk cancellation. Staff will be educated that calls should be canceled at the bedside unless the need was resolved over the phone, and the system will be configured to require a reason when a call is canceled at the station. Finding: roughly one call in seven was silenced from the station, and observation showed that most of those silences were not followed by a visit.

Recommendation 7: capture the reason for calls. Staff responding with badges will select the reason, such as bathroom, pain or equipment, a feature already installed and never switched on. This will let future analysis identify bathroom needs even when patients use the bed button.

Recommendation 8: record bed-level origin for shared bathrooms, as the vendor reports is possible, so shared-bathroom calls can be linked to a patient.

Recommendation 9: add a fall report field for whether a call light was on and require fall time to the nearest five minutes.

Weiskopf and Weng (2013) note that data collected for care are often reused for purposes they were not designed for, which is why improving data at the source is part of any sustained analysis.

The Quality Initiative

The care recommendations will be implemented as a three-month quality initiative using plan-do-study-act cycles, starting with shift change coverage and bathroom escalation in month 1 and adding proactive toileting in month 2.

Measures, as defined in Week 3: prompt response to bathroom calls, with a target of 80%; median and 90th percentile bedside response time by hour, with a target 90th percentile under 8 minutes at shift change; desk cancellation rate, with a target under 5%; fall rate per 1,000 patient days and injurious fall rate; and falls preceded by a waiting call.

Balancing measures: handoff duration and handoff errors reported, since protected coverage takes staff away from handoff; and staff reports of phone alert burden from escalation.

Reporting: a monthly dashboard for the unit and the falls committee, with the displays described in Week 5.

Decision rules: if prompt bathroom response does not improve by month 2, the coverage plan will be revised. If handoff errors rise, coverage will be restructured. Because falls are few, a change in fall rate over three months will be interpreted cautiously, and the initiative will continue monitoring for at least a year.

Communicating the Recommendations

The recommendations will be presented first to the unit's staff at huddles, framed around patients rather than blame: most calls are answered quickly, and the problem is concentrated at a predictable time, shift change, when everyone is busy. Staff will be asked for their own ideas about coverage before the plan is finalized, since they know the handoff routine best. The falls committee and the unit's leadership will receive the full analysis, with its limits, and the patient safety office will receive the recommended changes to the fall report.

Risks of the Recommendations

Each change carries a risk. Protected coverage could shorten handoffs, so handoff quality is tracked as a balancing measure. Phone escalation could add to alert burden, so staff will be asked about it at week two. Requiring a reason for desk cancellation could slow staff, so the reason list will be kept to four options.

Cost

The recommendations cost little. Clock synchronization and system configuration require a few hours of facilities and vendor time. Shift change coverage reassigns existing staff for about 45 minutes twice a day. Escalation uses the existing phone system. The main cost is attention: the unit must keep the dashboard and the plan-do-study-act cycles going for long enough to learn whether falls change.

Owners and Timeline

The unit manager owns the care changes, the charge nurses own daily coverage, facilities owns clock synchronization and system configuration, clinical informatics owns the dashboard and the patient safety office owns the fall report change. Clock synchronization and cancellation configuration will be completed before month 1, so that the initiative's data are better than the baseline's.

Evidence Supporting the Approach

The approach is consistent with evidence associating faster call light response with lower fall rates across hospital units (Tzeng et al., 2012), while the unit's own analysis identifies where its responses are slowest. Local data aimed at a specific time and type of call are more likely to produce improvement than a general instruction to answer lights faster.

Conclusion

The analysis supports three kinds of action: covering bathroom calls at shift change and escalating slow ones, cleaning up how calls are canceled and timed, and testing the changes in a measured quality initiative with balancing measures. The recommendations stay within what the data show, and the measures defined in Week 3 will tell the unit whether they worked. That is the full cycle the course describes: data managed well enough to support a decision, and a decision measured well enough to learn from.

References

Hitcho, E. B., Krauss, M. J., Birge, S., Dunagan, W. C., Fischer, I., Johnson, S., Nast, P. A., Costantinou, E., & Fraser, V. J. (2004). Characteristics and circumstances of falls in a hospital setting: A prospective analysis. Journal of General Internal Medicine, 19(7), 732-739. https://doi.org/10.1111/j.1525-1497.2004.30387.x

Tzeng, H.-M., Titler, M. G., Ronis, D. L., & Yin, C.-Y. (2012). The contribution of staff call light response time to fall and injurious fall rates: An exploratory study in four US hospitals using archived hospital data. BMC Health Services Research, 12, Article 84. https://doi.org/10.1186/1472-6963-12-84

Weiskopf, N. G., & Weng, C. (2013). Methods and dimensions of electronic health record data quality assessment: Enabling reuse for clinical research. Journal of the American Medical Informatics Association, 20(1), 144-151. https://doi.org/10.1136/amiajnl-2011-000681