Nursing-Sensitive Quality Indicator – Patient Falls Without Injury
Hello, my name is Jessica Durkin. Today’s tutorial focuses on nursing-sensitive quality indicators, paying special attention to patient falls without injury. This remains a pivotal area of patient care and safety, and as a member of the Quality Improvement Council, I am honored to help you navigate it.
What Are the National Database of Nursing-Sensitive Quality Indicators?
The American Nurses Association established the National Database of Nursing-Sensitive Quality Indicators or NDNQ back in 1998. NDNQI is a remarkable database and a quality measurement program that can compare nursing quality measures among different hospitals on a national, regional, and state basis. NDNQI thus assures standardized definitions and methods of data collection to identify consistent trends and benchmarking of the quality of nursing care throughout healthcare organizations, as noted by Alshammari and colleagues in their 2023 study.
What Do Nursing-Sensitive Quality Indicators Mean?
Nursing-sensitive quality indicators are specific measures that reflect the structure, process, and outcome of nursing care. In their 2020 research, Oner and colleagues explain that these indicators are related directly to the quantity and quality of nursing care and, therefore, provide a means to evaluate nursing interventions for their effectiveness. Notably, these indicators are categorized into three types: 1) structure indicators related to nursing staff characteristics and care environment, 2) process indicators that measure aspects of nursing care like assessment and intervention, and 3) outcome indicators that reflect patient outcomes determined to be nursing-sensitive.
Let’s Look into an Important Quality Indicator to Monitor
Today, we’ll focus on the process indicator of patient falls without injury, which measures the number of patient falls not resulting in injury per 1,000 patient days.
Why Is This Quality Indicator Important to Monitor?
Patient falls, even those without injury, are a significant concern in healthcare settings. They can lead to fear of falling, reduced mobility, and decreased independence, negatively impacting a patient’s quality of life and recovery. Monitoring falls without injury is crucial because it helps identify potential safety issues before harm occurs, allows proactive implementation of preventive measures, contributes to a culture of safety and continuous improvement, and can lead to cost savings by preventing more serious falls. Lee and colleagues, in their 2024 research, emphasize the importance of fall prevention interventions, particularly those leveraging information and communication technology.
Further, This Quality Indicator Impacts the Quality of Care and Patient Safety.
Cooke and colleagues, in 2022, note that tracking and addressing falls without injury significantly enhances patient safety and overall quality of care. This indicator allows healthcare providers to identify at-risk patients early, implement targeted fall prevention strategies, evaluate the effectiveness of fall prevention programs, and create a safer environment for all patients.
As a new nurse, understanding and actively participating in fall prevention is crucial. Nurses are often the first line of defense in patient safety. Familiarity with this indicator will help you assess patients more effectively for fall risk, implement appropriate preventive measures, respond quickly and appropriately when falls occur, and contribute to your organization’s quality improvement efforts. Besides, Zhao and colleagues, in their 2019 study, highlight the importance of evidence-based fall prevention interventions in acute care settings.
Let’s Now Delve into the Collection and Distribution of Quality Indicator Data
Data Collection Process
Based on interviews with quality improvement professionals and recent research, many organizations track patient falls without injury through various active reporting systems. These include incident reports prepared by employees for all incidents of falls, whether resulting in injury or not. Also, electronic health records (EHR) systems have fields specifically designed for documenting falls and accompanying assessments. Also, quality improvement teams can conduct routine audits of patient charts and incident reports. In addition, patients and families are empowered to report falls and near-falls, contributing to a comprehensive data collection process.
Data Dissemination
The data related to patient falls that result in no injury are usually shared on an aggregate level through several channels. Monthly quality reports are distributed to each nursing unit and further discussed in staff meetings. At the same time, quarterly dashboards depict current performance based on several quality indicators through graphics, while annual performance reviews present unit-specific and hospital-wide data on falls. In quality improvement meetings, interdisciplinary teams review their data and develop plans for improvement.
The Role of the Nurses to Make Reporting Accurate to facilitate Quality Outcomes
Nurses play a significant role in the completeness and accuracy of fall data. As a nurse, you can make a difference by ensuring timely and accurate documentation of falls or near-falls on EHR and incident reports. It’s crucial to perform and document fall-risk assessments on all patients upon admission, routinely throughout their stay, and when changes to conditions occur. Instituting appropriate fall prevention interventions according to the results of fall risk assessments and documenting them is also essential.
It’s important not to ignore near-misses. Reporting a near-miss may identify potential problems before an actual fall occurs. Participating in discussions of fall data in staff meetings or quality improvement efforts is also valuable. Educating patients and their families regarding fall risk and prevention strategies and promoting reporting of falls or near-falls contributes to a culture of safety. Moreover, the accuracy of the quality data depends entirely upon the nurses updating the reports and their documentation. Even a fall without injury contributes valuable information that will help prevent future falls and promote patients’ safety. Besides, in their 2020 research, Oner and colleagues emphasize the importance of nursing-sensitive indicators in evaluating the quality of nursing care.
In Conclusion,
Nursing-sensitive quality indicators play a crucial role in improving patient care and safety, including patient falls without injury. In this regard, the responsibilities of new nurses include accurate reporting and the prevention of falls. By understanding the importance of this indicator and participating with active engagement in data collection and fall prevention efforts, you foster improved outcomes for patients and the organization as a whole. Engagement in the nursing-sensitive quality indicators, such as patient falls without injury, ensures quality is maintained and patients are safe. This will be a good reminder to you that each report you make about an incident and each preventive measure you put into place provides service to the healthcare environment and improves the outcomes of patients. If, after reviewing this tutorial, you have any questions regarding nursing-sensitive quality indicators or preventing falls, please contact your supervisor or the Quality Improvement team. Together, we will be able to create a much safer environment for our patients and realize the highest quality of care.
References
Alshammari, S. M. K., Aldabbagh, H. A., Anazi, G. H. A., Bukhari, A. M., Mahmoud, M. A. S., & Mostafa, W. S. E. M. (2023). Establishing standardized nursing quality sensitive indicators. Open Journal of Nursing, 13(8), 551–582. https://doi.org/10.4236/ojn.2023.138037
Cooke, M., Fuente, M., Stringfield, C., Sullivan, K., Brassil, R., Thompson, J., Allen, D. H., Granger, B. B., & Reynolds, S. S. (2022). The impact of nurse staffing on falls performance within a health care system: A descriptive study. Journal of Nursing Management, 30(3), 750–757. https://doi.org/10.1111/jonm.13555
Lee, K., Yi, J., & Lee, S.-H. (2024). Effects of community-based fall prevention interventions for older adults using information and communication technology: A systematic review and meta-analysis. Health Informatics Journal, 30(2). https://doi.org/10.1177/14604582241259324
Oner, B., Zengul, F. D., Oner, N., Ivankova, N. V., Karadag, A., & Patrician, P. A. (2020). Nursing‐sensitive indicators for nursing care: A systematic review (1997–2017). Nursing Open, 8(3), 1005–1022. https://doi.org/10.1002/nop2.654
Zhao, Y. (Lucy), Bott, M., He, J., Kim, H., Park, S. H., & Dunton, N. (2019). Evidence on fall and injurious fall prevention interventions in acute care hospitals. JONA: The Journal of Nursing Administration, 49(2), 86–92. https://doi.org/10.1097/nna.0000000000000715
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Question 
Prepare an 8–10 minute audio training tutorial (video is optional) for new nurses on the importance of nursing-sensitive quality indicators.
Nursing-Sensitive Quality Indicator – Patient Falls Without Injury
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Introduction
The focus of Assessment 4 is on how informatics support monitoring of nursing-sensitive quality indicator data. You will develop an 8–10 minute audio (or video) training module to orient new nurses in a workplace to a single nursing-sensitive quality indicator critical to the organization. Your recording will address how data are collected and disseminated across the organization along with the nurses’ role in supporting accurate reporting and high quality results.
Professional Context
The American Nursing Association (ANA) established the National Database of Nursing Quality Indicators (NDNQI®) in 1998 to track and report on quality indicators heavily influenced by nursing action.
NDNQI® was established as a standardized approach to evaluating nursing performance in relation to patient outcomes. It provides a database and quality measurement program to track clinical performance and to compare nursing quality measures against other hospital data at the national, regional, and state levels. Nursing-sensitive quality indicators help establish evidence-based practice guidelines in the inpatient and outpatient settings to enhance quality care outcomes and initiate quality improvement educational programs, outreach, and protocol development.
The quality indicators the NDNQI® monitors are organized into three categories: structure, process, and outcome. Theorist Avedis Donabedian first identified these categories. Donabedian’s theory of quality health care focused on the links between quality outcomes and the structures and processes of care (Grove et al., 2018).
Nurses must be knowledgeable about the indicators their workplaces monitor. Some nurses deliver direct patient care that leads to a monitored outcome. Other nurses may be involved in data collection and analysis. In addition, monitoring organizations, including managed care entities, exist to gather data from individual organizations to analyze overall industry quality. All of these roles are important to advance quality and safety outcomes.
Reference
Grove, S. K., Gray, J. R., Jay, G. W., Jay, H. M., & Burns, N. (2018). Understanding nursing research: Building an evidence-based practice (7th ed.). Elsevier.
Preparation
As you begin to prepare this assessment you are encouraged to complete the Conabedian Quality Assessment Framework activity. Quality health care delivery requires systematic action. Completion of this will help you succeed with the assessment as you consider how the triad of structure (such as the hospital, clinic, provider qualifications/organizational characteristics) and process (such as the delivery/coordination/education/protocols/practice style or standard of care) may be modified to achieve quality outcomes.
This assessment requires you to prepare an 8–10 minute audio training tutorial (with optional video) for new nurses on the importance of nursing-sensitive quality indicators. To successfully prepare for your assessment, you will need to complete the following preparatory activities:
Review the nursing-sensitive quality indicators presented in the Assessment 04 Supplement: Informatics and Nursing Sensitive quality Indicators [PDF] Download Assessment 04 Supplement: Informatics and Nursing Sensitive quality Indicators [PDF]resource and select one nursing-sensitive quality indicator to use as the focus for this assessment.
Conduct independent research on the most current information about the selected nursing-sensitive quality indicator.
Interview a professional colleague or contact who is familiar with quality monitoring and how technology can help to collect and report quality indicator data. You do not need to submit the transcript of your conversation, but do integrate what you learned from the interview into the audio tutorial. Consider these questions for your interview:
What is your experience with collecting data and entering it into a database?
What challenges have you experienced?
How does your organization share with the nursing staff and other members of the health care system the quality improvement monitoring results?
What role do bedside nurses and other frontline staff have in entering the data? For example, do staff members enter the information into an electronic medical record for extraction? Or do they enter it into another system? How effective is this process?
Watch the Informatics and Nursing-Sensitive Quality Indicators Video Exemplar.
Recording Your Presentation
To prepare to record the audio for your presentation, complete the following:
Set up and test your microphone or headset using the installation instructions provided by the manufacturer. You only need to use the headset if your audio is not clear and high quality when captured by the microphone.
Practice using the equipment to ensure the audio quality is sufficient.
Review Using Kaltura for Kaltura to record your presentation.
View Creating a Presentation: A Guide to Writing and Speaking. This video addresses the primary areas involved in creating effective audiovisual presentations. You can return to this resource throughout the process of creating your presentation to view the tutorial appropriate for you at each stage.
Notes:
You may use other tools to record your tutorial. You will, however, need to consult Using Kaltura for instructions on how to upload your audio-recorded tutorial into the courseroom, or you must provide a working link your instructor can easily access.
You may also choose to create a video of your tutorial, but this is not required.
If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact DisabilityServices@Capella.edu to request accommodations.
Instructions
For this assessment, first review the nursing-sensitive quality indicators presented in the Assessment 04 Supplement: Informatics and Nursing Sensitive quality Indicators [PDF] Download Assessment 04 Supplement: Informatics and Nursing Sensitive quality Indicators [PDF]resource and select one nursing-sensitive quality indicator to use as the focus for this assessment.
Next, imagine you are a member of a Quality Improvement Council at any type of health care system, whether acute, ambulatory, home health, managed care, et cetera. Your Council has identified that newly hired nurses would benefit from comprehensive training on the importance of nursing-sensitive quality indicators. The Council would like the training to address how this information is collected and disseminated across the organization. It would also like the training to describe the role nurses have in accurate reporting and high-quality results.
The Council indicates a recording is preferable to a written fact sheet due to the popularity of audio blogs. In this way, new hires can listen to the tutorial on their own time using their phone or other device.
As a result of this need, you offer to create an audio tutorial orienting new hires to these topics. You know that you will need a script to guide your audio recording. You also plan to incorporate into your script the insights you learned from conducting an interview with an authority on quality monitoring and the use of technology to collect and report quality indicator data.
You determine that you will cover the following topics in your audio tutorial script:
Introduction: Nursing-Sensitive Quality Indicator
What is the National Database of Nursing-Sensitive Quality Indicators?
What are nursing-sensitive quality indicators?
Which particular quality indicator did you select to address in your tutorial?
Why is this quality indicator important to monitor?
Be sure to address the impact of this indicator on the quality of care and patient safety.
Why do new nurses need to be familiar with this particular quality indicator when providing patient care?
Collection and Distribution of Quality Indicator Data
According to your interview and other resources, how does your organization collect data on this quality indicator?
How does the organization disseminate aggregate data?
What role do nurses play in supporting accurate reporting and high-quality results?
As an example, consider the importance of accurately entering data regarding nursing interventions.
After completing your script, practice delivering your tutorial several times before recording it.
Additional Requirements
Audio communication: Deliver a professional, effective audio tutorial on a selected quality indicator that engages new nurses and motivates them to accurately report quality data in a timely fashion.
Length: 8–10 minute audio recording. Use Kaltura to upload your recording to the courseroom, or provide a working link your instructor can access.
Script: A separate document with the script or speaker’s notes is required. Important: Submissions that do not include the script or speaker’s notes will be returned as a non-performance.
References: Cite a minimum of three scholarly and/or authoritative sources.
APA: Submit, along with the recording, a separate reference page that follows APA style and formatting guidelines. For an APA refresher, consult the Evidence and APA page on Campus.
Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:
Competency 1: Describe nurses’ and the interdisciplinary team’s role in informatics with a focus on electronic health information and patient care technology to support decision making.
Describe the interdisciplinary team’s role in collecting and reporting quality indicator data to enhance patient safety, patient care outcomes, and organizational performance reports.
Competency 3: Evaluate the impact of patient care technologies on desired outcomes.
Explain how a health care organization uses nursing-sensitive quality indicators to enhance patient safety, patient care outcomes, and organizational performance reports.
Competency 4: Recommend the use of a technology to enhance quality and safety standards for patients.
Justify how a nursing-sensitive quality indicator establishes evidence-based practice guidelines for nurses to follow when using patient care technologies to enhance patient safety, satisfaction, and outcomes.
Competency 5: Apply professional, scholarly communication to facilitate use of health information and patient care technologies.
Deliver a professional, effective audio tutorial on a selected quality indicator that engages new nurses and motivates them to accurately report quality data in a timely fashion.
Follow APA style and formatting guidelines for citations and references.