QI Guide on Improved Nursing Care

My Quality Improvement (MyQI)

The goal is to deliver safe, high-quality health care to patients in all clinical settings. You can use the information in this guide to help improve quality of care across settings and at multiple levels.

Resources and links provide information on these topics: 

Patient Centered Care

Falls and Injuries

Falls can lead to moderate to severe injuries, such as hip fractures and head trauma, and can even increase the risk of early death. Fortunately, falls are a public health problem that is largely preventable.

learn more iconCDC fact sheet on falls among older adults

learn more iconCDC fact sheet on falls in nursing homes

learn more iconFall and Injury Prevention from the Evidence-Based Handbook for Nursesi ( PDF file PDF version - 612.02 KB )

Toolkit IconFalls toolkit from the National Center for Patient Safety

Toolkit Icon The Falls Management Program - tool to improve fall care processes and outcomes

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Pressure Ulcers

Each year, more than 2.5 million people in the United States develop pressure ulcers.ii Prevention requires an organizational culture and operational practices that promote teamwork and communication, as well as individual expertise.

Toolkit IconAHRQ toolkit to prevent pressure ulcers in hospitals

learn more icon Preventing and Managing Pressure Ulcers from the Evidence-Based Handbook for Nursesiii ( PDF file PDF version - 198.79 KB )

learn more iconPressure Ulcer Training from the National Database of Nursing Quality Indicators

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Ventilator Associated Pneumonia (VAP)

VAP is the leading cause of death amongst hospital-acquired infections. Reducing mortality due to VAP requires an organized process that guarantees early recognition of pneumonia and consistent application of the best evidence-based practices.

learn more iconLearn strategies to prevent VAP in hospitals

Toolkit IconIHI Ventilator Bundle - series of interventions to prevent VAP

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Intravascular Catheter-Related Infections

In the United States, about 15 million central vascular catheter (CVC) days occur in intensive care units (ICUs) each year.iv

learn more iconCDC guidelines for the prevention of intravascular catheter related infections

Toolkit IconIHI Central Line Bundle - a series of interventions to prevent infections related to CVCs

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Urinary Catheter-Related Infections

Urinary tract infections (UTIs) account for about 40% of all hospital acquired infections. More than 80% of those infections are associated with catheters. Nursing staff can be instrumental in preventing urinary catheter-related infections.v

Video IconCDC overview video on catheter associated UTIs

learn more iconPrevention and management guidelines for catheter associated UTIs

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Preventing Other Healthcare Associated Infections

Healthcare-associated infections (HAIs) lead to 99,000 deaths annually.vi There are more than 75,000 bloodstream infections a year among hospital patients, and as many as 25% of infected patients die .vii Nurses are on the frontlines of preventing these infections, and by implementing certain evidence-based recommendations these infections can be dramatically reduced.

learn more icon Evidence-based strategies for nurses on controlling the spread of HAIsviii ( PDF file PDF version - 173.15 KB )

Toolkit IconNursing infection control checklistix

learn more iconCDC recommendations to prevent infections

learn more iconCDC guide to infection prevention for outpatient settings

Toolkit IconVarious CDC toolkits for preventing healthcare associated infections

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Opportunities for Patient Safety and Quality Improvement

Reducing Medication Errors

Each year, about 7,000 people die because of medication errors in hospitals.x Nurses play a critical role in preventing medication errors and facilitating better medication management.

learn more iconGeneral information from the FDA regarding medication errors

learn more iconStudy showing the relationship between task interruptions and medication errors by nurses

learn more iconLearn about the nurse's role in preventing medication errors

learn more iconLearn about the medication safety in relation to nursing xi ( PDF file PDF version - 348.82 KB )

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Handoffs

The transfer of essential information and the responsibility for care of the patient from one health care provider to another is an integral component of communication in health care. Ineffective handoffs can lead to adverse events and patient safety risks.

Toolkit IconRecommended strategies to improve the handoff process in the hospital

Toolkit IconToolkit to guide handoff communication in perioperative practice

learn more iconLearn how to improve communication during handoffs

learn more iconLearn how nurses can improve the handoff processxii ( PDF file PDF version - 358.65 KB )

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Working Conditions and Work Environment for Nurses

Nurse Fatigue and Stress

The increased demands on nurses have set the stage for increased nurse fatigue and stress, compromising patient safety and negatively impacting the health and well-being of nurses.

learn more iconLearn how working conditions contribute to work stress and burnout among nurses ( PDF file PDF version - 171.73 KB )

Slide Show IconPresentation on nurse fatigue and patient safety

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Nursing Turnover

Nursing turnover has been reported to range from 15 percent to 36 percent per year.xiii High nurse turnover rates negatively affect the ability of hospitals to meet patient needs and provide quality care.

learn more iconLearn how to decrease nurse turnover rates ( PDF file PDF version - 101.34 KB ) by creating a safe and high quality work environmentxiv

Toolkit IconTools to calculate total nursing turnover expenses

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Teamwork

Safe health care depends on highly trained individuals with disparate roles and responsibilities acting together in the best interests of the patient.

learn more iconStudy showing the relationship between teamwork among nurses and job satisfaction

learn more iconStudy describing an intervention to enhance nursing staff teamwork and engagement

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Nursing Workload and Patient Safety

Nurses are experiencing higher workloads than ever before. Research has shown that heavy nursing workloads adversely affect patient safety.

learn more iconNEJM study on the association of nurse workload and increased inpatient mortality

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General Resources on Nursing and Quality of Care

The following general resources provide key information on the role of nurses in improving quality of care.

learn more iconIOM report examining the future of the nursing workforce

learn more iconImplementation guide for nursing sensitive care measures

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i Patient Safety and Quality: An Evidence-Based Handbook for Nurses. AHRQ Publication No. 08-0043, April 2008. Agency for Healthcare Research and Quality, Rockville, MD.
ii Preventing Pressure Ulcers in Hospitals: A Toolkit for Improving Quality of Care. AHRQ Publication No. 11-0053-EF, April 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/long-term-care/resources/pressure-ulcers/pressureulcertoolkit/index.html
iii Patient Safety and Quality: An Evidence-Based Handbook for Nurses. AHRQ Publication No. 08-0043, April 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/clinicians-providers/resources/nursing/resources/nurseshdbk/index.html
iv Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011. CDC Publication, April 2011. Centers for Disease Control and Prevention, Healthcare Infection Control Practices Advisory Committee (HICPAC). http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf.
v Prevention and Management of Catheter-Associated UTIs. Infectious Disease Special Edition, September 2010. http://www.idse.net/download/UTI_IDSE10_WM.pdf
vi AHRQ's Efforts to Prevent and Reduce Healthcare-Associated Infections. Fact Sheet. AHRQ Publication No. 09-P013, September 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/factsheets/errors-safety/haiflyer/index.html
vii CDC. Vital Signs: Central Line - Associated Bloodstream Infections-United States 2001, 2008, and 2009. MMWR 2011; 60(08);243-248.
viii Patient Safety and Quality: An Evidence-Based Handbook for Nurses. AHRQ Publication No. 08-0043, April 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/clinicians-providers/resources/nursing/resources/nurseshdbk/index.html
ix Infection Control Checklist - Nursing Department. Best Practices, October 2000. Texas Health Care Association. http://www.txhca.org/BestPractices/InfectionControl/nursing.pdf
x Interdisciplinary Nursing Quality Research Initiative. Nurses' Role in Preventing Medication Errors. http://www.inqri.org/uploads/ResearchSynthesisMedicationErrors.pdf
xi Patient Safety and Quality: An Evidence-Based Handbook for Nurses. AHRQ Publication No. 08-0043, April 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/clinicians-providers/resources/nursing/resources/nurseshdbk/index.html
xii Ibid.
xiii Hayes LJ, O'Brien-Pallas L, Duffield C, et al. Nurse turnover: a literature review. Int J Nurs Stud 2006;43:237-63.
xiv Patient Safety and Quality: An Evidence-Based Handbook for Nurses. AHRQ Publication No. 08-0043, April 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/clinicians-providers/resources/nursing/resources/nurseshdbk/index.html
xv Ibid.

Page last reviewed January 2015
Internet Citation: QI Guide on Improved Nursing Care: My Quality Improvement (MyQI). January 2015. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/monahrq/myqi/nursing.html