Implementation of the National Nursing Quality Report Initiative in Canada: Insights From Pilot Participants.

A qualitative study was undertaken to explore the perceptions and experiences of nurse leaders associated with their participation in the pilot testing of a national nursing database. Interviews with 18 participants were conducted and analyzed using a direct content analysis approach. Three themes emerged including selecting, accessing, and uploading indicators; using indicators and monitoring tools for improvement; and perceiving involvement as a catalyst. Study findings may inform quality improvement efforts in health care organizations.

Setting a new standard of care in nursing homes.

The Winnipeg Regional Health Authority's introduction of a full-time nurse practitioner in a 116-bed non-profit nursing home provided an opportunity to explore a collaborative relationship between an NP acting as the primary care provider and a single physician serving as the consultant for complex care and after-hours care. The outcomes were measured in terms of resident and family satisfaction, quality of care indicators and cost effectiveness. Data were collected from pre-existing quality indicators, including a resident/family satisfaction survey, transfers to acute care, and medication use statistics. Unstructured interviews were also conducted with nursing staff and members of the interdisciplinary team. Dramatic improvements in medication use were observed, including a 17 per cent reduction in overall drug costs, a 55 per cent decrease in polypharmacy rates and a 63 per cent reduction in antipsychotic drug use. Transfers to emergency decreased by 20 per cent. Family satisfaction with the quality of health care provided to residents increased by 24 per cent. The collaborative practice of an NP with physician consultation is an effective way of delivering quality care to nursing home residents.