10 ANA quality indicators for acute care settings
State nursing associations (SNAs) in California, Arizona, Minnesota, North Dakota, Texas, and Virginia are currently compiling data and conducting field-testing of nursing-sensitive quality indicators.
As more research is gathered and the indicators continue to be tested, they may be modified or changed. To date, the following represent the SNA findings and comprise Washington, DC-based American Nurses Association’s 10 nursing-sensitive quality indicators:
1. Mix of RNs, LPNs, and unlicensed staff caring for patients in acute care settings — Recommended definition: The percent of registered nursing care hours as a total of all nursing care hours. This measure would include only those staff on acute care units. A secondary measure would be the percent of RN contracted hours of total nursing care hours.
2. Total nursing care hours provided per patient day — Recommended definition: Total number of productive hours worked by nursing staff with direct patient care responsibilities on acute care units per patient day. Secondary measures would be RN contracted hours, total contracted hours, and RN nursing care hours per 1,000 patient days.
3. Pressure ulcers — Recommended definition: This measure would be defined and calculated as number of patients with NPUAP-AHCPR stage I, II, III, or IV ulcers (divided by) number of patients in a prevalence study.
A secondary measure should explore the relationship between nursing assessments using a standardized tool and the development of pressure ulcers. The secondary measure would be collected on a "look-back" basis by auditing the charts of patients. Use of the Braden or Norton scales is required. (These can be obtained at a local health services library.)
4. Patient falls — Recommended definition: The rate per 1,000 patient days at which patients experience an unplanned descent to the floor during the course of their hospital stay. The measure would be computed as total number of patient falls leading to injury x 1,000 and multiplied by the total number of patient days.
A secondary measure should explore the relationship between nursing assessments performed and falls. The measure would be defined, for those patients who fell, as the number of patients who had nursing fall assessments as compared to the total number of patients who fell. This secondary measure would be collected on a "look-back" basis by auditing the charts of patients.
5. Patient satisfaction with pain management — Recommended definition: patient opinion of how well nursing staff managed their pain as determined by scaled responses to a uniform series of questions designed to elicit patient views regarding specific aspects of pain management. The questions would be administered to a sample of all patients admitted to the hospital for acute care services.
6. Patient satisfaction with educational information — A measure of patient perception of the hospital experience related to satisfaction with patient education.
Recommended definition: Patient opinion of nursing staff efforts to educate them regarding their conditions and care requirements as determined by scaled responses to a uniform series of questions designed to elicit patient views regarding specific aspects of patient education activities. The questions would be administered to a sample of all patients admitted to the hospital for acute care services.
7. Patient satisfaction with overall care — A measure of patient perception of the hospital experience related to satisfaction with overall care.
Recommended definition: Patient opinion of the care received during the hospital stay as determined by scaled responses to a uniform series of questions designed to elicit patient views regarding global aspects of care. The questions would be administered to a sample of all patients admitted to the hospital for acute care services.
8. Patient satisfaction with nursing care — A measure of patient perception of the hospital experience related to satisfaction with nursing care.
Recommended definition: Patient opinion of care received from nursing staff during the hospital stay as determined by scaled responses to a uniform series of questions designed to elicit patient views regarding satisfaction with key elements of nursing care services. The questions would be administered to a sample of all patients admitted to the hospital for acute care services.
9. Nosocomial infection rate — Recommended definition: This measure would be defined and calculated as number of laboratory confirmed bacteremia associated with sites of central lines divided by 1,000 patient days per unit.
(This indicator is under investigation for its usefulness. For purposes of this effort, infection would be defined according to parameters established by the Centers for Disease Control and Prevention.)
10. Nurse staff satisfaction — Recommended definition: Job satisfaction expressed by nurses working in hospital settings as determined by scaled responses to a uniform series of questions designed to elicit nursing staff attitudes toward specific aspects of their employment situation. The questions would be administered to all RNs in direct patient care or middle management roles at the institution. The six SNAs funded to implement the indicators are using either the Kramer & Schmalenberg or Stamps & Piedmont tools. (These can be obtained at a local health services library.)
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