AIGNA Conference 2018 Care Metrics Older Person

1. Development of a National
Suite of Older Person
Quality Care-Metrics
using Consensus
Methodology
Mary Nolan
Quality Care-Metrics Project Officer
Nursing & Midwifery Planning & Development, HSE, Midlands
mary.nolan13@hse.ie

2. What are
Quality Care-Metrics (QCM)?
A measure of the nursing and midwifery clinical
care processes in healthcare settings in Ireland,
aligned to evidence based standards and agreed
through national consensus. (HSE, 2015)

3. QCM is an ongoing
quality improvement
process that is driven by
the monthly data
collections

4. Donabedian’s Conceptual
Model of Care (1966)
Structure
How care is organised. The
stable elements of
organisation and
infrastructure that comprise
a health delivery system.
Outcome
The end-results of care
Process
What is done – the
actions that are taken
and how they are
carried out. Includes the
interaction between
patient and providers.

5. Test Your Care
www.testyourcarehse.com

6. Example of Metric

7. Quality Care-Metrics Report

9. Validation of the QCM in use &
development of new OP metrics
Project Aim to identify a final suite of
nursing quality care process metrics and
associated indicators.
Led by Prof Fiona Murphy and team at
University of Limerick in collaboration
with OP nurses nationally and NMPDs
Study Design four phase process –
• Systematic literature review
• EDelphi (online surveys) x 2 phases
• consensus meetings

10. Four Phase Study Design
• Phase 1: A systematic literature review to identify
metrics that have been used in the respective fields
and the indicators for same
• Phase 2: A two-round online Delphi survey to develop
consensus on ‘what’ metrics to measure
• Phase 3: A two-round online Delphi survey to develop
consensus on indicators for prioritised metrics. ‘How’
to measure the prioritised metrics
• Phase 4: A face-to-face consensus meeting with
representative group to review the findings and build
consensus on metrics and indicators

11. Delphi Study
Multi-phase process
designed to combine
opinion into group
consensus
• SURVEY
• CONSENSUS
MEETING

12. Sample for Delphi Surveys
•Nurses
working in the
OP services
•Needed to be
accessible
electronically
•Sample size-
approx 300
Staff nurse
19%
CNM1
6%
CNM2
25%
CNM3
2%
CNS
7%
Director of
Nursing
13%
Assistant Dire
ctor of
Nursing
18%
Educator
2%
Other
8%
GRADE (%)
404 OP Nurses nationally

13. Face-to-face
consensus meeting
Prioritised metrics & associated
indicators discussed to build
consensus on final suite of
metrics and respective indicators.
- Working Group and invited Older
Person Nursing experts

14. Results following
Consensus Meeting
• 19 Older Person Process Metrics
• 80 associated indicators
To enable measurement of the quality of
Older Person Nursing processes

15. New Metrics Suite for
Older Persons Nursing
• Comprehensive geriatric
assessment
• Person centred care planning
• Falls risk
• Fall prevention
• Optimizing nutrition and
hydration
• Assessment and management
of pressure ulcers
• Continence assessment,
promotion and management
• Pain assessment and
management
• Activities (physical, social,
recreational and sensory)
• Skin Integrity
• Medicines Administration
• Medicines Prescribing
• Medicines storage and custody
• MDA Medicines
• Responsive behaviour support
• Safeguarding vulnerable adults
• End of life and palliative care
• Infection Control
• Person experience

16. Older Persons Quality Care Metrics Working Group
Ms Anne Donnellan Age Action Ireland
Ms Anne Harris, Patient engagement, HSE
Ms Deirdre Lang, DoN National Clinical Programme for OP
Ms. Georgina Basset. DoN - Irish Association of Directors of Nursing & Midwifery
Ms Kathleen Doherty, St Joseph's Hospital Stranorlar, Co. Donegal - CHO 1
Ms Rosalind Allen / Ms Sandhya Joy St Anne’s CNU., Clifden , Co Galway – CHO 2
Ms Mary Marks / Ms Dhivya Plakkal, St. Camillus Hospital, Limerick - CHO 3
Ms Cathy Sheehan, Castletownbere Community Hospital, Co Kerry - CHO 4
Ms Eilis Geraghty / Ms Elaine Flanagan, Sacred Heart Hospital, Carlow – CHO 5
Ms Florence Hogan, Leopardstown Park Hospital, Dublin - CHO 6
Ms Joan Guinan-Menton, Peamount Healthcare, Dublin - CHO 7
Ms Paula Phelan, St Vincent’s, Mountmellick Co Laois. / Ms Marie Butler, St Oliver’s Hospital, Dundalk -
CHO 8
Ms Patricia Greville, St Joseph’s CNU, Trim, Co Meath - CHO 8
Ms Fiona Dunne, St Mary’s ,Phoenix Park, Dublin /Ms Bridget Gray, Cappagh Hospital, Dublin - CHO 9
Ms Mary J Foley St Finbarr’s Hospital, Cork - ANP
Ms Maura Gillen, Buncrana Community Hospital, Donegal . - Practice Development
Ms Mary B Lucas Ennistymon Community Hospital, Co Clare- CNSp

17. Thank you to all who contributed to
this work for Older People and Older
People Nursing