Collection and use of national nursing data standards (NNDS)
Since April 2016, nursing leaders from across Canada have gathered annually in Toronto to discuss the collection and use of nursing data standards in Canada. The NNDS symposiums have been sponsored by CNA, the Canadian Institute for Health Information and Canada Health Infoway and held with the support of the Canadian Nursing Informatics Association and the University of Toronto’s Lawrence S. Bloomberg faculty of nursing. The symposiums focus on the area of nursing/clinical data standards in clinical practice, administration, nursing education, research and policy.
- Recorded proceedings, with presentation materials:
- Written proceedings:
The overall goal of this work is to realize the collection of standardized data that is captured once and used for multiple purposes.
The NNDS initiative supports the implementation of the Canadian Health Outcomes for Better Information and Care (C-HOBIC). C-HOBIC is introducing structured, evidence-based standardized questions for admission and discharge assessments. The information that is collected all have a concept definition, a valid and reliable measure, and empirical evidence linking them to nursing inputs or interventions. This is important to people receiving care within the health-care system.
The C-HOBIC concepts are:
- functional status (e.g., continence)
- symptoms (e.g., pain, nausea, fatigue, dyspnea)
- safety (e.g., falls, pressure ulcers)
- therapeutic self-care (e.g., readiness for discharge)
These concepts are items that all nurses routinely assess in health-care settings. By introducing a standardized approach for assessments, nurses and other health-care clinicians will be able to use this information to examine practice and improve health outcomes within settings and across the continuum of care. The use of data standards allows for abstraction to relevant, secure jurisdictional data repositories (or databases) in preparation for entry into provincial electronic health records (EHRs).
Instruments from the interRAI consortium are used to help nurses standardize data collection and avoid documentation burden. This approach supports examining patient outcomes across the health-care system because interRAI measures are used in long-term care, home care and community care across Canada. A numeric rating scale is used to collect information about the intensity of pain for acute care. Therapeutic self-care (i.e., patients’ self-care ability related to the disease/medical condition and its treatment) is assessed with an instrument developed by Sidani and Doran.1
The C-HOBIC items have been mapped to the International Classification for Nursing Practice and to SNOMED CT.
Benefits of standardized data
- The use of standardized questions in admission and discharge assessments helps nurses access real-time information to examine the effect of nursing practice and quality improvement initiatives.
- It can provide valuable information to facilitate discharge planning and improve the sharing of clinical information with the health-care team across the continuum of care.
- It provides health-care executives with real-time reports they can use to make staffing and financial decision and compare with other data (such as length of stay and readmissions). This helps them evaluate their unit/organization’s ability to improve clinical outcomes (such as pain management and preparing patients for discharge).
- Standardized information is important to patients and their families within the health-care system — so they can, for example, compare data to determine if they are maintaining or improving functional status, or if self-care capacity is adequate.
- At a broader level, standardized information will be useful to researchers and policy-makers to examine how well the system is meeting the health-care needs of people.
Vision for C-HOBIC data
- Facilitates communication and helps identify safety risks
- Encourages and informs proactive care
- Helps determine discharge readiness
- Improves communication within the team through use of standardized data
- Enhances satisfaction by revealing measurable results
- Identifies how clinical practice leads to improved outcomes
- Shifts from task-focused care to outcomes-focused care
- Improves clinical accountability.
- Health-care executives:
- Provides standardized information for comparative analysis within and between organizations (benchmarking)
- Provides information to evaluate operational decisions and allocate resources effectively
- Provides information to identify areas for quality improvement
- Provides information to support accreditation surveys — required organizational practices (ROPs)
- Provides information to support continuity of care across the continuum
- Health-care system:
- Provides standardized information to support results-driven, patient-focused care
- Ensures results can be measured and reported publicly
- Health system:
- Provides timely, standardized information to help answer research questions that will inform management of clinical programs
Phase I (2007 to 2009) of the C-HOBIC project introduced the collection of standardized patient outcome data related to nursing. This information was made available to clinicians at the point of care. An evaluation showed that C-HOBIC data reports were beneficial in examining the impact of nursing care. Read the Phase 1 final report [PDF, 745.2 KB].
Phase II (2012 to 2015) introduced the development and implementation of a synoptic report to support patient care transitions. The synoptic reports display normalized admission and discharge scores from the C-HOBIC data set. By comparing these clinical outcomes between admission and discharge, health-care providers can plan the appropriate care and resources to manage ongoing care to optimize health outcomes. Read the Phase 2 final report [PDF, 1.5 MB].
Phase III (2015-2018) demonstrated the feasibility of sending C-HOBIC data from the information systems (electronic health records) in acute care facilities to the Discharge Abstract Database (DAD) at the Canadian Institute for Health Information (CIHI). Including the C-HOBIC data set in DAD will provide standardized patient-centred outcomes data to support aggregation and analysis of clinical outcomes, health-system use and performance reporting. Read the Phase 3 final report [PDF, 1.2 MB].
1Irvine Doran, D., Sidani, S., Keatings, M., & Doidge, D. An empirical test of the nursing role effectiveness model. Journal of Advanced Nursing, 38(1): 29-39.