ANA hails release of new evidence on proven safety practices

Connecticut Nursing News, Sep-Nov 2001

AHRQ award of $7.5 million in funding for further research on the relationship between work environment and quality-of-care issues cited as `particularly encouraging'

WASHINGTON, DC-The American Nurses Association (ANA) applauded the Agency for Healthcare Research and Quality (AHRQ) for its release yesterday of new evidence on practices that could improve patient safety throughout the nation's health care system, and for AHRQ's willingness ' to commit $50 million in funding in fiscal year 2001 for further research on patient safety.

"ANA commends the AHRQ for its work in developing effective patient safety initiatives, in particular its commitment to devote funding for further research in the area of work environment and quality of patient care, including nurse staffing," said ANA President Mary Foley, MS, RN.

Foley's response came in reaction to AHR.Q's announcement of plans to allocate $7.5 million in funding for further research that focuses on the relationship between the health care workforce, working conditions and safety, and quality of care. "We are especially interested in seeing more research devoted to the relationship between nurse fatigue and patient safety so that best practices related to hours of work can be defined," said Foley.

The AHRQ report, Making Health Care Safer: A Critical Analysis of Patient Safety Practices, reviewed the evidence pertaining to 79 patient safety practices. Of those practices, 73 are listed as likely to improve patient safety, and 11 are considered highly proven to work, -but are not performed routinely in the nation's hospitals and nursing homes. In addition, a surprising finding is that "more than a dozen practices long considered important by patient safety experts"-including changes in nurse staffing ratios -- have not been sufficiently studied and thus did not make the top 11 list, AHRQ said.

"Even though many of these practices are clearly valuable in improving patient safety, the report shows there needs to be more research so that we know more about which practices are most effective and how complex or costly they would be to put in place,- said AHRQ Director John M. Eisenberg, MD.

While agreeing with Eisenberg, Foley also pointed out that ANA's Nursing-Sensitive Quality Indicators, which correlate sufficient staffing and quality nursing care with improved patient outcomes, already serve as an innovative, evidence-- based initiative that may be used to assess and improve patient safety within the nation's health care system. The indicators include the mix of registered nurses, licensed practical nurses and unlicensed staff caring for patients in acute care settings; total nursing care hours provided per patient day; and patient satisfaction with pain management, educational information, overall care and nursing care. These indicators have been used as tools in data collection for the National Database of Nursing Quality Indicators, an ANA initiative that allows the profession to examine further the links between nursing interventions and staffing and patient outcomes.

In addition, ANA's Nurse Staffing and Patient Outcomes in the Inpatient Hospital Setting study, released in March 2000, has documented that hospitalized patients have better outcomes in hospitals with higher staffing levels and higher ratios of RNs in the staffing mix. Specifically, the study tracked five adverse outcome measures that can be mitigated if adequate nursing care is given. Those measures include length of stay in the hospital, pneumonia contracted while in the hospital, postoperative infection, pressure ulcers (bed sores) and urinary tract infections contracted while in the hospital.

"These various studies and indicators all confirm that patients fare better when RNs play a significant role in their care," Foley said. "But, as the AHRQ evidence-based report clearly indicates, the picture is still far from complete, and much research still needs to be done in this area, particularly where patient safety is concerned."

The American Nurses Association is the only full-- service professional organization representing the nation's 2.7 million Registered 'Nurses through its constituent member state nurses associations. The ANA advances the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public.