The Center for Nursing Research & Innovation

R01Grant Overview

AHRQ Study: Impact of Unit Level Nurse Workload on Patient Safety

Supported by AHRQ Grant R01 # HS11954
Nancy E. Donaldson RN, PhD., FAAN, Principal Investigator

Description

This project was supported by grant number RO1 HS11954 from the Agency for Healthcare Research and Quality (AHRQ). AHRQ is involved in the effect of working conditions on the quality of care. Select R01 slide show to view an overview of this present study.

The aims of this two-year descriptive correlational study built on the established integrity and capacity of the Collaborative Alliance of Nursing Outcomes (CALNOC) to engage California acute care hospitals in voluntarily using American Nursing Association (ANA) nursing quality indicators for reporting standardized nurse staffing, patient safety and quality indicators in a collaborative repository development and benchmarking project.

CALNOC, one of the first six ANA state-based nursing quality research and development projects, was created to advance improvements in patient care quality and safety through development of a statewide nursing quality database, and to conduct studies examining the effects of nurse staffing on the outcomes of patient care, contributing new knowledge to health services decision support and public policy. CALNOC is the largest ongoing statewide prospective nursing quality measurement research and development project in the nation, and a major contributor of data to the American Nurses Association’s National Database for Nursing Quality Indicators (NDNQI).

This study capitalizes on the existing CALNOC quality measurement, reporting and benchmarking infrastructure. Drawing from CALNOC’s statewide sample of medical-surgical acute care units, this study will break new ground in tracing unit-level, daily, direct care nurse staffing in 100 units over a two (2) month period, examine the association between the structure of direct care daily staffing and workload intensity (patient admissions, discharges, & transfers) and key nurse sensitive patient safety outcomes. This study will also explore the unique contribution of unit level variation in staffing and workload on outcomes.

Primary Aims

The primary aims of the study were:

Test associations, on adult acute care medical surgical units, between measures of unit level daily staffing including, hours of care per patient day (HPPD), ratio of required to actual HPPD, caregiver skill mix, use of contract workers, RN years of experience, and key indicators of patient safety, including the incidence of patient falls, prevalence of hospital acquired pressure ulcers, restraint use and significant clinical events, including sentinel events, clinical errors/omissions and patient self-discharge against medical advice, captured in hospital unusual occurrence reports.

Test associations, on adult acute care medical surgical units, between unit level daily workload intensity (Admissions, Discharges, and Transfers Index) and key indicators of patient safety, including the incidence of patient falls, prevalence of hospital acquired pressure ulcers, restraint use and significant clinical events including sentinel events, clinical errors/omissions and patient self-discharge against medical advice, captured in hospital unusual occurrence reports.

Test associations, on adult acute care medical surgical units, of daily variation in measures of unit level staffing and workload intensity (patient admissions, discharges, & transfers) with key indicators of patient safety, including the incidence of patient falls, prevalence of hospital acquired pressure ulcers, restraint use and significant clinical events including sentinel events, clinical errors/omissions and patient self-discharge against medical advice, captured in hospital unusual occurrence reports.

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