Nursing Quality and Informatics Framework: A Lean Six Sigma Approach to Achieving Zero Harm Nurse Sensitive Indicators

Hospitalized adults often face common events such as falls, pressure injuries, and hospital-acquired infections (HAIs), leading to adverse outcomes for both patients and hospitals. The Center for Medicare and Medicaid (CMS) has designated various nurse sensitive indicators as "never events," pressuring hospital leaders to achieve zero falls, pressure injuries, and HAIs. Direct patient care nurses play a crucial role in contributing to these zero-harm goals. However, intense messaging from hospital administration can lead to nurses developing fears related to patients at risk, resulting in disengagement and unintended consequences on patient care.

To address these challenges, a comprehensive nursing quality improvement and informatics initiative was launched, utilizing lean six sigma methodology, high-reliability and zero-harm principles integrated with core principles and practices of clinical informatics. This initiative aimed to reframe efforts to improve nurse sensitive indicators, fostering deep engagement among multidisciplinary care teams. As a result, zero-harm indicators have shown significant improvement, with operational costs attributed to falls reduced by 35% in the current year compared to the prior year's estimated cost of over 1 million US dollars. Additionally, the system is on track for 20% fewer falls and 20% lower cost per fall compared to the previous year. Falls prevention and mobility enhancement practices will be highlighted.

Moreover, through the application of lean six sigma methodology and clinical informatics workflow analysis, the initiative identified the prevalence and contributing factors of pressure injuries, leading to a positive return on investment. This allowed for the implementation of two full-time equivalent certified wound, ostomy, and continence nurses (CWOCNs) and skin champions unit RN coverage for all acute care medical surgical and critical care units.

The nursing quality and informatics framework also tackled the issue of HAIs through identification and root cause analysis, securing external national grant funding and achieving over 500 days since the last catheter-associated urinary tract infection (CAUTI) or central line-associated bloodstream infection (CLABSI). This framework demonstrated how lean six sigma practices and clearly defined clinical informatics processes enhance nursing care teams' performance with standardized reporting, consistent case reviews, and clinical workflows, ultimately empowering the direct care nursing team.

This presentation will present a nursing quality and informatics framework, supported by lean six sigma methodology, high-reliability principles, and effective clinical informatics for three demonstration cases falls, pressure injury and c-difficile to illustrate the effective pathway to zero-harm nurse-sensitive indicators, reduced operational costs, and increased patient safety. This approach serves as a model for other healthcare systems aiming to achieve excellence in patient care outcomes and nurse engagement through tightly integrated clinical informatics principles with high-reliability methodology.