About The Database
The National Database of Nursing Quality Indicators (NDNQI)Ž, a repository for nursing-sensitive indicators, is a program of NCNQŽ. NDNQIŽ is the only database containing data collected at the nursing unit level. As you peruse this site, you will be able to obtain information on its history, a menu of NDNQIŽ nursing-sensitive indicators, NDNQIŽ enrollment procedures, samples of quarterly reports to participating facilities, and examples from facility nurse liaisons of how NDNQIŽ reports have been used to improve care.
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| NDNQIŽ is a dynamic program. New nursing-sensitive indicators are added to the database; new projects are initiated; and new facilities join regularly. The guiding forces behind NDNQIŽ are constantly trying to determine how this program can be enhanced to better serve the participating facilities and the nursing profession better, therefore, the dynamic nature of the project.
NDNQIŽ History
In 1994, the American Nurses Association (ANA) launched the Safety & Quality Initiative to explore and identify the empirical linkages between nursing care and patient outcomes. The Nursing Care Report Card for Acute Care (ANA, 1995) proposed 21 measures of hospital performance with an established or theoretical link to the availability and quality of nursing services in acute care settings. In 1997, ANA issued a call for organizations to submit proposals to develop and maintain the National Database of Nursing Quality Indicators. Midwest Research Institute (MRI) and the University of Kansas School of Nursing (KUSON) were selected by ANA to take on this task because of their expertise in database programming and outcomes research. The database eventually moved from MRI to KU in 2001. From 1997 - 2000, a series of pilot studies were funded by ANA to test selected indicators: definitions, data collection methodology and instrument development. Selected state nursing associations (Arizona, ANA/California, Minnesota, North Dakota, Ohio, Texas, and Virginia) were involved in the pilot projects. The following publications were created as a result of this work:
- Nursing Quality Indicators: Definitions and Implications (ANA,1996);
- Implementing Nursing's Report Card: A Study of RN Staffing, Length of Stay and Patient Outcomes, (ANA, 1997);
- Nursing Quality Indicators: Guide for Implementation 2nd Edition (ANA, 1999);
- Nursing Quality Indicators Beyond Acute Care: Literature Review (ANA, 2000);
- Nursing Quality Indicators Beyond Acute Care: Measurement Instruments (ANA, 2000);
- Nurse Staffing and Patient Outcomes (ANA, 2000)
- Nursing Quality Measurement: A Review of Nursing Studies 1995-2000 (Rantz, Bostick & Riggs, 2002)
Additional publications (Resources, 2005) are available for review and were also generated as part of this work. NDNQIŽ has grown both in terms of the number of participating hospitals and in the number of indicators. NDNQIŽ began accepting data from hospitals in 1998 and to charge for the process of data submission and comparison reports in 2001. |
Nursing-Sensitive Indicators
Defined
Nursing-sensitive indicators reflect the structure, process and outcomes of nursing care. The structure of nursing care is indicated by the supply of nursing staff, the skill level of the nursing staff, and the education/certification of nursing staff. Process indicators measure aspects of nursing care such as assessment, intervention, and RN job satisfaction. Patient outcomes that are determined to be nursing sensitive are those that improve if there is a greater quantity or quality of nursing care (e.g., pressure ulcers, falls, and intravenous infiltrations). Some patient outcomes are more highly related to other aspects of institutional care, such as medical decisions and institutional policies (e.g., frequency of primary C-sections, cardiac failure) and are not considered "nursing-sensitive".
Development
Development of new indicators occurs when no acceptable existing indicator represents nursings contributions to patient care. The commitment in indicator development is that all NDNQIŽ indicators will be based on empirically-based research; therefore, all development efforts begin with the implementation of an in-depth literature review. Indicators with empirical support are identified for review by a panel of nurse experts. The panel determines the validity of said indicators to nursing practice. With the list of nursing-sensitive indicators, NDNQIŽ then talks with participating hospitals to determine the burden on the hospitals of collecting the data for the indicator. For those indicators which seem to be nursing-sensitive, are clinically meaningful and do not place undue burden upon the participating facilities, the next step is a full pilot test in a number of willing facilities. Those indicators which are deemed to provide the most value for the effort are added to the menu of NDNQIŽ nursing-sensitive indicators.
The process for developing an indicator includes the following steps:
1. Review of the peer-reviewed literature to determine which indicators have been shown to be nursing sensitive and if there have been reliability studies.
2. Discussions with topic experts to identify measurement issues and additional information that should be collected to support hospital reports or analysis, for example, patient risk level.
3. Develop a plan for data collection and reports.
4. Solicit comments from participating facilities on the feasibility of proposed data collection plan and the utility of the indicators.
5. Conduct pilot studies with volunteer hospitals to test the data collection guidelines and forms.
6. Revise plan for data collection and reports.
7. Develop the web data collection system, including administrative sections of the database, data entry screens, and tutorial.
8. Announce the availability of the new indicator to member hospitals so that staff may take the tutorial, begin data collection and submission.
9. Conduct data analysis and development of quarterly reports.
Indicator List
Over the last 3-5 years, NDNQIŽ has submitted nursing-sensitive quality indicator definitions to the National comparison data for the indicators are grouped based on patient (Adult/Pediatric) and unit type: Critical Care, Step-Down, Medical, Surgical, Combined Med-Surg, Rehab, Psychiatric and Staffed Bed Size. Teaching and Magnet Status is identified as it relates to participating hospitals. The quarterly reports provide the national comparison along with unit performance data trended over 8 quarters. The benefits to participating in NDNQI are many, and hospitals have found the reports assist them in quality improvement efforts, RN retention efforts and recruitment, patient recruitment, research, staff education, nursing administration and to satisfy reporting requirements for regulatory agencies or magnet designation.
How to Join NDNQIŽ
Joining the National Database for Nursing Quality Indicators (NDNQI)Ž is a step-by-step process. NDNQIŽ is housed and operated out of The University of Kansas School of Nursing, on behalf of ANA. Hospital liaisons are available to guide you through the process. There are 3 documents that are required for submission to enroll. Membership can begin in any quarter.
- NDNQIŽ Database Agreement
This is a contract which spells out NDNQI responsibilities and those of the participating hospital.
- NDNQIŽ Site Coordinator Contact Information
This form provides contact information for someone at your facility who will serve as the liaison between NDNQI and your facility, to ensure your data is submitted accurately.
- Fee Payment
Each participating facility pays a membership fee.
Following completion of the contracting process, data collectors at the hospital will be required to successfully complete a web-based tutorial on collecting indicator data according to NDNQIŽ specifications.
After successful completion of the tutorials, data collection and submission can be initiated. Quarterly reports are provided 6 weeks after the closing of the data collection period.
Once a year each hospital has the option to participate in the RN Satisfaction survey. Participation in this survey will require your hospital to decide what month it wishes to survey the nursing staff and then sign up. Participation during particular months is on a first-come-first-served basis.
It is the goal of NDNQIŽ to make the process of enrollment in NDNQIŽ as uncomplicated a process as possible. We hope you will join the many leaders in nursing quality who already participate in NDNQIŽ. To obtain the documents for membership enrollment and additional information please visit NDNQIs Web site.
). ANA collaborated with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) via a grant they received from the Robert Wood Johnson Foundation (RWJF) to develop the micro specifications of the NQF nursing measures.
