The Center for Nursing Research & Innovation
Current Projects Overview
Introduction The Collaborative Alliance for Nursing Outcomes (CALNOC; formerly known as the California Nursing Outcomes Coalition) was launched in 1996 as the nation’s first ongoing nursing quality database. CALNOC has a current membership of 225 hospitals from California, Washington, Oregon, Arizona, Nevada, and Hawaii. Self-funded by participant annual data management fees, contracts and grants, CALNOC is a joint venture between the Association of California Nurse Leaders and the California state affiliate of the American Nurses Association, ANA\California. CALNOC was established as one of six initial American Nurses Association Nursing Quality Indicator Report Card research and development pilot projects. Once enrolled, hospital participant attrition has been low, with less than 5% of member hospitals withdrawing since 1998. The demographic characteristics of CALNOC participating hospitals are presented in Table 1 and demonstrate the diversity of its member institutions. CALNOC website
2. 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.
Project Aim
The aim of this 2 year study is 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.
3. 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, are working 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 has designed a study that uses 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 attend an 8 hour workshop to maximize data collection reliability. During the course of the study, nurses will observe 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 is being 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.
4. 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.
5. Building Capacity for Clinical Inquiry and Evidence-Based Practice
Ongoing active consultations with the following Bay Area hospitals:
|
Printer-friendly
page