382 / Expert standards in nursing

GERMANY
Classification of the PSP
Type of Patient Safety Practice Not Evaluated
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Other
There is no specified text here There is no specified text here
Topic of the reported practice
Clinical guidelines or pathways
Aim and the benefit of the Patient Safety Practice
 
Expert standards are professionally determined according to the level of performance that match the needs of the population served and implies criteria for its evaluation. They give direction to complex professional interventions, provide margins and alternatives for professional action and decision-making and are suited for nursing care problems that require considerable attention and assessment and are characterised by a highly interactive nature. The purpose of national expert standards is to raise the level of quality of care in health and social care facilities for users and their relatives significantly. There is an agreement within the international discourse on quality of nursing care that standards of best practice developed by expert panels (National Expert Standards) should be implemented in practice beside the standards and procedures developed on an institutional and local level.
Description of the Patient Safety Practice
 
In Germany, the German Network for Quality Development in Nursing (DNQP) in close cooperation with the German Nursing Council (DPR) and with financial support from the German Ministry of Health is working since 1999 on the complex development of evidence-based expert standards in nursing that give direction to professional nursing care. Until 2009 a series of seven national expert standards has been developed, consented and implemented. These standards cover the following areas of nursing practice: Prevention of pressure ulcers; Discharge management; Pain management; Fall prevention; Promotion of urinary continence; Nursing care for people with chronic wounds; Nutrition management for ensuring and promoting oral nutrition. Expert standards are instruments for defining, implementing, and evaluating the quality of performance. They provide information about the professional liability towards people in need of nursing care, legal requirements and society as a whole. The core functions of expert standards are: Definition of professional functions and accountabilities; Initiation and promotion of innovation; Promotion of an evidence-based professional practice, identity and mobility; Basis for a constructive dialogue on quality of care with other professions. In summary, expert standards are professionally determined according to the levels of performance that match the needs of the population served and implies criteria for its evaluation. Expert standards give direction to complex professional interventions, provide margins and alternatives for professional action and decision-making and are suited for nursing care problems that require considerable attention and assessment and are characterised by a highly interactive nature.

Methodological approach of the DNQP
The methodological approach used by the DNQP for the development, consensus-building, implementation and updating of expert standards is outlined in detail in a method paper (German only) that is updated on a regular basis. The core principles of the methodological approach are summarised below. They have been also addressed by Schiemann and Moers in an english journal article (Schiemann, D./Moers, M. (2007): Expert standards in nursing as an instrument for evidence-based nursing practice. Journal of Nursing Care Quality 22 (2): 172-179). In its approach for the development and consensus-building of expert standards, the DNQP drew upon models from the European Network for Quality Development in Nursing (EuroQUAN). For the implementation of the standards it had to develop its own approach, because there had not been any international approaches – neither in nursing nor in other health care professsions – suitable for this purpose. The selection of themes for expert standards is made by the DNQP steering group and is based on epidemiological considerations. Pressure sores and other chronic wounds, incontinence, falls, pain and malnutrition are some of the main problems in nursing care in our time. Besides that, effective quality improvements of nursing care practice can be expected in these areas. Therefore, these issues are also of relevance due to economic considerations. The theme of another expert standard is also true for discharge management in hospital. The themes covered so far have gained high levels of approval in the German nursing community. Their relevance is confirmed by all practice settings. In 2005, the DNQP received explicit support by the German Advisory Council on the Assessment of Developments in the Health Care System. In its report, the Council stressed the significance of expert standards for the further development of nursing care quality in institutional as well as home and community based settings and called for the development of additional expert standards.

The methodological approach of the DNQP embraces the following steps:

Convening of an independent expert panel
For the development of each expert standard, an independent expert panel – consisting of 8 to 12 experts from nursing practice and science – is convened. In addition, a representative from patient or consumer groups is asked to participate. For the acceptance of the expert standards within and outside the nursing community the proof of independence of the members’ expertise and transparency about the development process is of high importance. The members of the expert panel are required to declare potential conflict of interests. The procedure for convening the expert panel has been outlined in detail by the DNQP steering group in a guidance document.

Developing evidence-based expert standards
To ensure that the expert standards reflect the current best research evidence, they are based on a comprehensive review of the national and international literature. The principles of evidence-based practice are taken into account during the development process. The evidence is built upon the analysis and appraisal of the existing research and, in case of no sufficient research results available, the experts’ assessment.

Consensus building involving the nursing community
After the expert panel has drafted a new expert standard, a consensus-conference is held to present and discuss the draft in a moderated and structured way. Over the years, participation rates have continuously increased, for example the numbers have risen from 440 to approximately 650 participants in the latest conferences. The results of the conferences will be taken into consideration for the final version of the expert standard. Approximately three months after the conference, the expert standard is made available for nurses, health care facilities and the public. Each standard consists of a preamble, the standard itself including structure, process and outcome criteria, comments on each standard criterion and the literature study on which the expert standard is based. The preamble and the standard itself are available for download from the DNQP website. The printed publication with the comments and the literature study can be purchased via the DNQP office. The publication of a new standard is announced and reported about broadly in the professional media.

Exemplary implementation of the expert standard
After the consensus-conference, the expert standards are implemented in model projects in appr. 25 hospitals and institutional as well as home care facilities over a period of six months. The implementation is accompanied and supported by the scientific team of the DNQP. The purpose of the implementation is to gain insight into the acceptance and feasibility of the expert standards in practice. The DNQP developed a standardised audit-instrument for the implementation process. During the implementation of the existing standards, 1,300 to 3,100 participants were involved. The results of the implementation projects are analysed and published by the DNQP. Feedback from individual nurses and various practice settings indicate that the expert standards are highly accepted and perceived as an appreciation of their work by nurses.

Dissemination of the expert standards
There is a high demand for the expert standards of the DNQP from all German speaking countries. More than 150.000 copies of the expert standards on pressure prevention, discharge management, pain management, fall prevention, promotion of urinary continence, care for people with chronic wounds and nutrition management have been ordered from the DNQP office. Because of this, the DNQP is in a position to work on the development of new standards and update existing ones independently from third party grants. The publication of user-friendly versions of expert standards is expected to cause an increase of interest in the standards. The national consumer organisation has developed user-versions of the first five expert standards that are published in a guidebook called „Good nursing care in nursing homes and at home“.
Attachment of relevant written information and/or photos, as appropriate
There is no specified text here
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Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, partly
Level of implementation of reported practice
Institution level
Specific and measurable outcome for the reported practice were defined
Not known
A baseline measurement before implementation of the reported practice was obtained
No
A measurement after full implementation of the reported practice was obtained
No
Evaluation of a "positive" effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
There is no specified text here
Enclosure of a reference or attachment in case of published evaluation's results
Wolke, R.; Hennings, D.; Scheu, P. (2007): Gesundheitsökonomische Evaluation in der Pflege. Analyse von Kosten und Nutzen der Einführung des Nationalen Expertenstandards Dekubitusprophylaxe in der Pflege in einer Stationären (Langzeit-)Pflegeeinrichtung. Zeitschrift für Gerontologie und Geriatrie 40(3):158-177
Wolke, R. (2009): Umsetzung der gesundheitsökonomischen Evaluation in der Pflege. Analyse von Kosten und Nutzen der Einführung des Nationalen Expertenstandards „Förderung der Harnkontinenz in der Pflege“. Lage: Jacobs Verlag
Wolke, R.; Allgeier, C. (2012): Expertenstandard Ernährungsmangagement - Nur Kosten oder auch Nutzen? Gesundheitsökonomische Analysen zum Nationalen Expertenstandard „Ernährungsmanagement zur Sicherstellung und Förderung der oralen Ernährung in der Pflege“. Lage: Jacobs Verlag

There is no specified text here
Health care context where the Patient Safety Practices was implemented
 
Nursing facility
Hospital
Home care
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
No
Specification of implementation in another health care setting(s)
There is no specified text here
Successful implementation's level  of this Patient Safety Practice across settings
There is no specified text here
Involved health care staff
 
Nurses
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
No
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
There is no specified text here
Point of time in which service user or their reprasentatives' involvement takes place
There is no specified text here
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
There is no specified text here
Short description of the service users' level of involvement
There is no specified text here
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
Yes
List of sources where public information is accessible
www.dnqp.de

Gute Pflege im Heim und zu Hause
Hrsg.: Verbraucherzentrale Bundesverband e. V.
2. Auflage 2012; 168 Seiten
ISBN: 978-3-936350-67-8
Bestellnummer: GP42

Several publications about the expert-standards:
http://www.wiso.hs-osnabrueck.de/fileadmin/groups/607/Literaturliste__-_Veroeffentlichungen_zu_Expertenstandards.pdf
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
Yes
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
Lack of knowledge on implementation strategies
No management support
No motivation among staff
Not sufficient financial resources available
Not sufficient human resources available
Specially trained staff not available
Staff or management did not recognise the need for change
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
There is no specified text here
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
Yes
Description of used incentives, if any.
The institutions offered training for involved nursing staff.
Evaluation and Audit with detailed Feed-back for involved staff.
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
There is no specified text here
Contact information
 
Name: Petra Blumenberg
Country: GERMANY
Organisation: German Network for Quality Development in Healthcare
E-mail: p.blumenberg@hs-osnabrueck.de
Phone: 0049-541-9693147
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