The Center for Nursing Research & Innovation
Completed Projects Overview
Study Purpose -
To understand whether more sensitive measures of staffing and workload
have an impact on patient safety when variance in these factors
exceeds a unit-specific margin of safety. This study will break
new ground in tracing daily staffing in approximately 100 medical
surgical patient care units over a two (2) month period.
Study Aims -
To examine associations between the structure of staffing and patient
safety and outcome indicators such as falls, pressure ulcers, restraint
prevalence and significant clinical events.
To examine the effect of a new nurse workload indicator (patient
turnover) and nurse staffing.
Read the final report for this grant.
- Develop/Present a 1 unit Venous Access Device Patient Safety
interdisciplinary, web-based, academic graduate course;
- Translate the academic course into a CE version for practicing
- Evaluate the content, processes and impact of instructional
processes on clinician learning and patient safety;
- Disseminate findings and courseware.
The CalNOC Partners TRIP to Reduce Patient Falls Project built
on the infrastructure of the California Nursing Outcomes Coalition
(CalNOC) Database Project, a joint venture of ANA\California &
the Association of California Nurse Leaders (ACNL).
The primary aim of the CalNOC Partners for Quality TRIP To Reduce
Patient Falls Project, a four-year quality improvement demonstration
Project, is to use evidence from the reported literature and the
California Nursing Outcomes Coalition statewide repository to reduce
the incidence of patient falls and severity of fall-related injury
in California Hospitals. The Project builds on the established infrastructure
and capacity of the California Nursing Outcomes Coalition (CalNOC).
CalNOC engages California acute care hospitals in voluntarily reporting
standardized nurse staffing, patient falls, and fall-related injuries,
as well as other quality indicators, in a collaborative repository
development and benchmarking Project using American Nurses Association's
2008 Donaldson NE, Rutledge DN, Geiser K. The Role of the Coach in Advancing Research Translation. In: Henricksen K, Battles JB, Keyes MA, Grady ML, eds. Advances in Patient Safety: New Directions and Alternative Approaches. Vol 1. Washington, D.C.: AHRQ; 2008:285-302.
Read the final report for this grant.
Moore Foundation Nursing Initiative—CALNOC Baseline Outcomes
The Center for Nursing Research and Innovation and CALNOC was fortunate to receive funding from the Gordon and Betty Moore Foundation from 2004-2007. During that time, CALNOC expanded to include almost 40 of the acute care hospitals in the 5 Bay Area Counties, enhanced the CALNOC website to improve data submittal and site specific reporting, and supported the testing of new nursing sensitive indicators. Because of the investment in new nursing sensitive indicators CALNOC was able to test 3 nursing measures: Pain Management and Assessment, Catheter Associated Blood Stream Infections in Peripherally Inserted Central Lines (CABSI-PICC), and Medication Administration Accuracy. In July 2006 CALNOC launched the CABSI-PICC and Medication Administration Accuracy. The Center continues to work with the Foundation to provide an annual report regarding Bay Area hospital engagement in CALNOC.
The University of California San Francisco
School of Nursing Center for Nursing Research and Innovation partnered with the Gordon
and Betty Moore Foundation in late 2003. The Gordon and Betty
Moore Foundation announced their intention to invest in the profession
of nursing and safe patient care practices. The Foundation committed
$110M over 10 years to address the shortage of nurses and improvement
in nursing–related patient care quality in 5 Bay Area Counties,
including Marin, San Francisco, Alameda, San Mateo and Santa Clara
counties. The UCSF Center for Nursing Research and Innovation, has been
conducting research and demonstration projects examine and improving
nursing practice safety, quality and outcomes since 1999. Leveraging
the existing resources and expertise of the Center, the partnership
with the Gordon and Betty Moore Foundation expedited expansion
of a key project with the California Nursing Outcomes Coalition Project
(CalNOC). CalNOC methods, measures and infrastructure were tapped
and expanded to provide the acute care clinical evaluation of GBMF
initiatives planned for the 50 acute care hospitals in the target
five Bay Area counties.
The Betty Moore CalNOC Nurse-Related Outcomes Project Year One
goals, supported by $1.4 Million in grant funds, focused on expansion
of CalNOC infrastructure and data capture methods; integrated its
advisory and governance stakeholder involvement in the development
of new indicators; engaged national experts in the development
and pilot testing of new nursing quality/safety indicators and conducted baseline evaluation analyses. It was expected that the outcomes of
the Year One Project would serve as the basis for ongoing evaluation
of the impacts of emerging GBMF Nursing Initiative activities and
interventions. Mary Foley RN, MS, FAAN served as Project Director
for this project.
The Robert Wood Johnson Foundation launched an ambitious initiative that provides support to nine
health care systems/associations to establish learning networks
to assist and accelerate the efforts of their member hospitals to
implement and evaluate the impact of rapid response team
interventions with the aim of improving patient outcomes and the
work environment of nurses. The literature suggests that rapid response teams mobilize
clinical expert responders to manage emergent changes in patient
condition which are potentially life threatening and may be related
to clinician or system errors and omissions.
In Press Donaldson, NE, S E, Shapiro, et al. (2009 (In Press)). "Leading successful rapid response teams, A multisite implementation evaluation." JONA 39(4).
Read the final report for this grant.
6. CALNOC Interdisciplinary Nursing Quality Research Initiative (INQRI) Project Impact of Medical Surgical Acute Care Microsystem Nurse Characteristics and Practices on Patient Outcomes
Support for this study was provided by a grant through the Interdisciplinary Nursing Quality Research Initiative, a national program of the Robert Wood Johnson Foundation.
The aim of this 2 year study was to develop a model examining the effects of unit level nurse workload, workforce characteristics and selected care processes on nurse sensitive outcomes in acute care medical-surgical units. The CALNOC outcomes studied are (1) incidence of falls and fall related injuries, (2) prevalence of hospital acquired pressure ulcers (HAPU), (3) prevalence of medication administration errors (4) prevalence of peripherally inserted central catheter (PICC) associated blood stream infections, and (5) Stage 3 and 4 Pressure Ulcer Incidence. Integrating HAPU incidence, a publicly reported indicator, into the CalNOC dataset will enable study of the association between HAPU prevalence and incidence, as well as the sensitivity of both HAPU measures to variation in nurse workload, and the predictive power of early stage prevalence for HAPU late stage incidence.
7. LPCH Medication Accuracy Study
Nurses and others at Lucile Packard Children’s Hospital (LPCH), under the direction of Annette Nasr RN, PhD, Nurse Scientist and Project Principal Investigator, worked with Nancy Donaldson, to examine the effects of a computerized physician order entry (CPOE) and computerized nursing documentation on medication administration accuracy in the pediatric population. Medication errors pose significant threats to this vulnerable population, and there is limited research available related to the epidemiology and prevention of medication errors in the pediatric population, although there is emergency evidence on the effects of CPOE on medication accuracy.
Under Nancy Donaldson’s direction, the team designed a study that used the CalNOC Medication Administration Accuracy Measure to systematically observe direct care staff nurses prepare, administer and document medications. This measure involves a naïve nurse observing the medication process, then conducting a medical record review after the observation in order compare what was administered with what was ordered. If any errors have occurred, the observer notes the type, number, and frequency of the error. The nurse-observers attended an 8 hour workshop to maximize data collection reliability. During the course of the study, nurses observed 100 medication passes before and 100 medication passes after the introduction of CPOE and electronic nursing documentation on three acute care units and two critical care pediatric units.
The results of this study will demonstrate the impact of this new technology on the accuracy of medication administration. This study will also be the first time the CalNOC Medication Administration Accuracy Measure is used in pediatrics.
This study was supported by a $35,000 grant from the LPCH Pediatric Research Fund, indicating a strong commitment on the part of LPCH to building capacity for research and making it integral to patient care excellence.
8. CALNOC Best Practices Study
At the request of member hospitals, CALNOC is exploring factors associated with best performing hospitals in regards to preventing falls and pressure ulcers. Phase I of the study, conducted in 2007, involved identifying hospitals in the lowest (best performing) quartile and the highest (worst performing) quartile from those in our 2006 database. Using qualitative methods, CALNOC investigators interviewed principals in some of each category to identify structures and processes that may be critical to achieving best performance. The results of those interviews were used to develop a survey designed to validate these findings. Selected CALNOC member hospitals have been asked to participate in this second phase, begun in May 2009. The results of this study may help identify best practices suitable for spread to other member hospitals. Preliminary results are expected in July, 2009.