Performance Manager
Survey of Nursing Practice (ED)
  Demographics of Unit
  Unit: ED  
  MR #
   
  1.) NURSE SENSITIVE PATIENT OUTCOMES: confusion and delirium as important variables in patient falls.  
  Information Source: Nursing Notes, Patient  
  Question: Are nurses using appropriate confusion assessment variables?  
  Audit: Written Documentation  
 
Is the patient consistently alert and oriented?
Yes No
 
If "yes," proceed to the next section of survey.
 
 
If patient is not alert and oriented, is this their baseline?
Yes No Uncertain
 
Is altered LOC noted?
Yes No
 
Is there suspicion or history of substance abuse?
Yes No
 
Is presence of confusion documentated?
Yes No N/A
 
Is presence of fluctuating confusion documented?
Yes No N/A
 
Is acute onset of mental status changes notes?
Yes No N/A
 
If "yes," was an MD notified?
Yes No
   
  2.) PAIN  
  Information Source: Nursing note, Patient  
  Basic Measurements of Pain Intensity:  
  • Patient’s self report (numeric, simple descriptive, visual analogue, faces scales)  
  • Behaviors (e.g. facial expressions, body measurements, agitation, crying, vocalizations)  
  • Proxy pain report (report of pain from individual close to patient e.g. parent, spouse, family, caregiver)  
  • Physiologic measures (e.g. changes in BP, pulse, RR)  
  Question: Does staff utilize a variety of pain assessment tools/strategies for patients that are at particular risk for under-treatment of pain?  
  Audit: Written Documentation  
 
For those patients ABLE to provide a self-report of pain, proceed to next section of survey.
 
 
For those patients unable to provide a self-report of pain (r/t confusion, sedation, unconsciousness, or cognitive deficit) is pain assessed using other/multiple methods?
Yes No N/A
 
For those patients unable to provide self-report of pain, is the assessment method documented?
Yes No
 
Is the assessment method (e.g. presence of pain behaviors) used to reassess pain post-pharmacologic intervention?
Yes No
   
  3.) INFECTION  
  3a.) PERIPHERAL INTRAVENOUS ACCESS  
  Information Source: Nursing notes, observations  
  Question: Is there appropriate assessment, management, and documentation of peripheral IVs?  
  Audit: Written Documentation  
 
If this patient does not have a peripheral IV, skip to question 3b.
 
 
Are peripheral and central sites date, time and location documentation present?
Yes No
  Observation  
 
Does the patient’s peripheral or central IV dressing have date of insertion written on the dressing?
Yes No N/A
   
  3b.) FOLEY CATHETERS  
  Information Source: Nursing notes, observations  
  Indications for Foley catheters:  
  • Post-op requirement/surgical pathway  
  • Acute urinary retention/obstruction  
  • Patient requires close urine output monitoring  
  • Patient requires chronic catheterization/neurogenic bladder  
  • Urinary incontinence with open sacral/perineal wounds  
  • End of life/comfort care  
  Question: Is the indication, placement, and discontinuation of Foley catheters documented appropriately?  
  Observation  
 
Does this patient currently have a Foley catheter?
Yes No
 
If no, skip to question #4.
 
  Audit: Written Documentation  
 
Is there an indication for Foley catheter?
Yes No
 
Is there an order for insertion of Foley catheter?
Yes No
 
Is the insertion date of the Foley catheter documented?
Yes No
 
Was a urine sample sent for patients when catheter was placed?
Yes No
 
For patients arriving with a foley was a urine sent?
Yes No
   
  4.) NURSE SENSITIVE PATIENT OUTCOMES: Skin and Wound  
  Information Source: Nursing notes, observations  
  Question: Are specific wound care interventions documented?  
  Observation  
 
Is the patient undressed and in a hospital gown?
Yes No N/A
 
Excess sheets and clothing removed from ambulance transfer?
Yes No
  Audit: Written Documentation  
 
If patient has potential or impaired skin integrity is this documented in nursing record and appropriate interventions are taken.
Yes No N/A
 
Are adult diapers being used on this patient?
Yes No Pt arrived with diaper
   
  6.) PATIENT EDUCATION  
  Information Source: Nursing notes  
  Question: Does documentation of patient education include assessment of patient learning needs, teaching content/method, and patient response to teaching?  
  Audit: Written Documentation  
 
Is assessment of patient learning needs identified?
Yes No
 
The individual receiving education was identified (e.g. patient, family, or other)?
Yes No
 
Was the teaching method was identified?
Yes No
 
Was the teaching content identified?
Yes No
 
Was patient comprehension of teaching assessed?
Yes No
   
  7.) CARE COORDINATION  
  Information Source: nursing note, whiteboard, Patient  
  Question: Is there documentation of communication with multi-disciplinary care team members?  
  Audit: Written Documentation  
 
Is there documentation regarding plan of care?
Yes No
 
Is patient or family able to articulate basic plan of care?
Yes No N/A
 
Where is the nursing plan of care documented?
 
 
Nursing Note
Yes No
 
Patient Whiteboard
Yes No
 
ED Dashboard
Yes No
          



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