National Database of Nursing Quality Indicators (NDNQI)

Total Nursing Hours per Patient Day

If the percentage of hours supplied by RNs is not adequate, less skilled staff may have to perform tasks for which they are not trained, increasing the risk of adverse patient outcomes.

The purposes of this indicator are to measure the total nursing hours and examine their relationship between skill mix, processes and outcomes of patient care. Nursing can identify opportunities for improvement in care delivery, patient outcomes as well as provide evidence base for determining the most effective mixture of staffing.

Percent of Total Patient Falls

A patient fall is a sudden, unintentional descent that results in the patient coming to rest on the floor.

The purposes of this indicator are to determine the rate at which patients have a fall and explore the relationship between nursing assessments performed, interventions used and falls.

Lower rates are better.

Percent of Patient Falls with Injury

A patient fall that results in injury.

The purposes of this indicator are to determine the frequency with which patient falls result in injury and explore the relationship between nursing assessments performed, interventions used and falls.

Lower rates are better.

Percent of Surveyed Patients with Hospital Acquired Pressure Ulcers

A pressure ulcer is a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear.

The purposes of this indicator are to determine the rate of hospital acquired pressure ulcer occurrence and explore the relationship between nursing assessments performed, interventions used and pressure ulcer development.

Lower rates are better

Percent of Surveyed Patients with Hospital Acquired Pressure Ulcers: Stage II and Above

Pressure ulcers are staged (classified) to reflect the level of tissue injury or damage. Stage II reflects partial thickness loss of the dermis.

Stage III reflects full thickness tissue loss. The purposes of this indicator are to determine the rate of Stage II and III hospital acquired pressure ulcer occurrence and explore the relationship between nursing assessments performed, interventions used and pressure ulcer development.

Lower rates are better

Percent of Patients with Physical Restraints

Physical restraint (e.g., limb or vest) is any manual method, physical or mechanical device, material or equipment that immobilizes or reduces the ability of a patient to move his arms, legs body or head freely.

The purposes of this indicator are to determine the prevalence of physical restraint use in hospitalized patients and to explore the relationship between nurse staffing and physical restraint use.

Lower rates are better

Percent of Peripheral Intravenous (PIV) Infiltrations

An IV infiltration is the unplanned administration of a non-vesicant solution or medication into the surrounding tissue occurring when the device pulls out of or pierces the vein. An IV extravasation is the unplanned administration of a vesicant solution into the surrounding tissue.

The purposes of this indicator are to determine the prevalence of PIVs in hospitalized pediatric and neonatal populations and to explore the relationship between nurse staffing and PIVs

Lower is better

Percent of Pediatric Pain Assessment/ Intervention/Reassessment (AIR) Cycles

Pain assessment is a comprehensive evaluation of pain location, characteristics, onset, duration, frequency, intensity and precipitating factors.
Pain intervention is the selection and implementation of a variety of measures to facilitate pain relief. Pain reassessment is the subsequent evaluation of the effectiveness of pain relief measures following the intervention(s).

The purposes of this indicator are to determine the prevalence of complete pain AIR cycles in hospitalized pediatric and neonatal populations, determine the average number of pain assessments per patient initiated in 24 hours and explore the relationship between the documented pain AIR cycle and nursing hours worked.

Higher rates are better

Percent of Patients Who Developed a Central Line Associated Blood Stream Infections (CLABSI)

A bloodstream infection can occur when microorganisms (e.g., bacteria, fungi) travel around or through the central line, attach and multiply on the tubing or in fluid administered through the tubing and then enter the blood.

A central line is a tube that is placed into a patient’s large vein, usually in the neck, chest, arm or groin. The purposes of this indicator are to determine the rate of healthcare-associated CLABSI in hospitalized patients and to explore the relationship between nurse staffing and rates of CLABSI.

High rates may suggest the need to examine the clinical and organizational processes related to the care of patients with central lines including adherence to recommended guidelines.

Lower rates are better

Percent of Patients Who Developed a Catheter Associated Urinary Tract Infection (CAUTI)

A urinary tract infection can occur when microorganisms that travel around the indwelling catheter, attach and multiply. An indwelling catheter is a drainage tube that is inserted into the urinary bladder through the urethra to drain urine during hospitalization. The purposes of this indicator are to determine the rate of healthcare-associated CAUTI of hospitalized patients and to explore the relationship between nurse staffing and rates of CAUTI.

High rates may suggest the need to examine the clinical and organizational processes related to the care of patients with indwelling catheters including adherence to recommended guidelines.

Lower rates are better

Percent of Patients Who Developed a Ventilator Associated Pneumonia (VAP)

VAPs are an airway infection that develops more than 48 hours after a patient has been intubated Intubation is the process of inserting a breathing tube through the mouth and then into the airway.

The tube is then connected to a ventilator, which pushes air into the lungs. The purposes of this indicator are to determine the rate of healthcare-associated VAP in hospitalized patients and to explore the relationship between nurse staffing and rates of VAP. High rates may suggest the need to examine the clinical and organizational processes related to the care of patients with breathing tubes including adherence to recommended guidelines.

Lower rates are better