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Nursing-Sensitive Quality Indicators

The National Database of Nursing-sensitive Quality Indicators (NDNQI) is a repository created as part of a safety and quality initiative. The NDNQI was made following pilot studies that tested nursing-sensitive indicators after changes within the workforce established that it was essential to assess associations between nurses and the quality of patient care. According to Merkley et al. (2018), the NDNQI is the sole national database that provides regular reporting of structure, outcome indicators, and processes to evaluate nursing care at a unit level. The NDNQI is tasked with two main goals; to provide participant hospitals with unit-level data for use in quality improvement initiatives and to develop national data concerning the associations between nurses and patient outcomes. Consequently, all hospitals from all the states volunteer their membership and information to help achieve NDNQI’s objectives. Moreover, the NDNQI program includes various hospitals, including teaching, non-teaching, pediatric, and general.

Nursing sensitive indicators are relevant patient outcomes based on the nurses’ area and domain of practice, and nursing interventions or inputs determine that. According to Ju et al. (2018), nursing-sensitive indicators are the basis for changes in a patient’s health status or outcomes that can be directly determined by nursing care. In addition, nursing-sensitive indicators provide a foundation for monitoring and evaluating the quality of nursing care. For example, they can assist in developing a common ground for nursing care standards to improve patient outcomes. Nonetheless, there are several nursing-sensitive indicators such as falls, nursing care hours per patient, and pressure ulcer prevalence, among many more. However, all nursing-sensitive indicators are equally important because they help determine whether nursing care impacts patients significantly.

The selected nursing-sensitive indicator for this tutorial is patient falls with injury. It is necessary to address this indicator because patient falls are harmful to patient safety and are commonly recorded in healthcare institutions. Besides, patient falls are among the leading contributors to increased morbidity and mortality in healthcare systems and hospitals. In recent research, Chen et al. (2022) established that approximately thirty percent of falls result in patient injury. As a result, patient falls must be addressed and prevented because of their negative impacts. For instance, patient falls contribute to increased lengths of stay in hospitals, poorer health outcomes, and increased utilization of resources. Also, some falls with injury may cause harm to soft tissues or fractures, leading to significant pain, distress, and functional impairment among fall victims. Furthermore, many risk factors associated with patient falls are essential to address. For example, DiGerolamo & Chen-Lim, (2021) indicates that functional impairment, previous falls, and lower extremity weaknesses are some of the most critical risk factors for patient falls.

Consequently, experienced and new nurses must be aware of patient falls as a nursing-sensitive quality indicator. However, it is more important for new nurses to be mindful of this nursing-sensitive indicator to familiarize themselves with their nursing roles in preventing patient falls. As a result, new nurses can practice fall prevention strategies and interventions to improve patient safety. In a recent study about patient fall, Dykes et al. (2018) asserts that adequate knowledge about patient falls and their impacts are positively associated with better attitude and practice of fall prevention activities among nurses. Therefore, new nurses must understand their roles in preventing patient falls, including monitoring patients’ conditions, supervising nurse aids, and documenting patient fall risk assessments. Furthermore, nurses are tasked with offering patient education concerning falls and how to prevent them.

Collection and Distribution of Quality Indicator Data

Based on the interview concerning patient falls, the organization utilizes a data collection spreadsheet to record falls that result in injury and those that do not. In detail, the spreadsheets are continuously filled as patient falls occur. However, the information recorded in spreadsheets is based on observations and interviews with patients and caregivers present during the fall. For instance, patients or caregivers current at the time of the fall is interviewed about the cause and associated injuries. In addition, physical exams are done to establish the impacts of the fall before filling out the spreadsheet. Consequently, the information is scanned and manually entered into the organization’s electronic records system. This data collection and storage process reduces errors and promotes easier data sharing. According to Baumann et al. (2018), storing patient information in electronic health records eases accessing, sharing, and analyzing data. However, other health organizations have customized data collection sheets to collect data concerning patient falls for history, measurement, and analysis purposes.

The organization has several approaches to disseminate aggregate data related to nursing-sensitive indicators such as patient falls. For instance, the organization spreads information about issues like patient falls in the facility for internal staff. That is, the organization publishes brochures handed out to all the departments within the facility. Also, team meetings are organized to disseminate information to individual staff and encourage in-depth discussions concerning patient falls and best practice interventions. Besides, Chapman et al. (2020) state that active dissemination of knowledge in healthcare is more effective because it involves diligent effort to pass information to patients and other healthcare workers. However, the organization also utilizes local media to sensitize the masses concerning the state of medical challenges such as patient fall and measure that can be taken by people who visit hospitals.

While patient falls as a nursing-sensitive quality indicator are commonly reported, nurses have numerous roles in preventing patient falls, supporting accurate reporting of patient falls, and promoting high-quality patient outcomes. For example, nurses should complete and document patient fall risk assessment and screening and make it available for other caregivers. Also, a nurse’s role is to write patient-specific fall prevention practices. According to Leland et al. (2022), recording patient-specific fall prevention strategies increases accuracy and decreases the risks of patient falls. However, in the event of a patient fall, a nurse’s responsibility is to report the fall to a physician for documentation and decision-making concerning possible injuries.

Furthermore, nurses should obtain essential supplies such as canes and walkers for their patients. Besides, nurses should supervise nurse aids to prevent falls caused by neglect. Consequently, nurses who thoroughly execute their duties increase accuracy in reporting and improve quality care and patient outcome. Accurately entering data concerning nurse interventions is crucial to ensure quality and safe patient care. For instance, it is not always possible for nurses to remember in detail the best practices or interventions they used earlier on a patient. Therefore, clear and accurate records for each patient are necessary to prevent errors. According to Asmirajanti et al. (2019), precise nursing documentations are essential for effective clinical communication. Also, they provide an accurate reflection of nursing assessments, care provided, and patient information to facilitate quality and safe care delivery.


Asmirajanti, M., Hamid, A. Y. S., & Hariyati, Rr. T. S. (2019). Nursing care activities based on documentation. BMC Nursing18(S1).

Baumann, L. A., Baker, J., & Elshaug, A. G. (2018). The impact of electronic health record systems on clinical documentation times: A systematic review. Health Policy122(8), 827–836.

Chapman, E., Haby, M. M., Toma, T. S., de Bortoli, M. C., Illanes, E., Oliveros, M. J., & Barreto, J. O. M. (2020). Knowledge translation strategies for dissemination with a focus on healthcare recipients: an overview of systematic reviews. Implementation Science15(1).

Chen, L.-C., Shen, Y.-C., Ho, L.-H., & Shih, W.-M. (2022). The Fall Risk Screening Scale Is Suitable for Evaluating Adult Patient Fall. Healthcare10(3), 510.

DiGerolamo, K. A., & Chen-Lim, M. L. (2021). An Educational Intervention to Improve Staff Collaboration and Enhance Knowledge of Fall Risk Factors and Prevention Guidelines. Journal of Pediatric Nursing57, 43–49.

Dykes, P. C., Bogaisky, M., Carter, E. J., Duckworth, M., Hurley, A. C., Jackson, E. M., Khasnabish, S., Lindros, M. E., Lipsitz, S. R., Scanlan, M., Yu, S. P., Bates, D. W., & Adelman, J. S. (2018). Development and Validation of a Fall Prevention Knowledge Test. Journal of the American Geriatrics Society67(1), 133–138.

Ju, Q.-Y., Huang, L.-H., Zhao, X.-H., Xing, M.-Y., Shao, L.-W., Zhang, M.-Y., & Shao, R.-Y. (2018). Development of evidence-based nursing-sensitive quality indicators for emergency nursing: A Delphi study. Journal of Clinical Nursing27(15-16), 3008–3019.

Leland, N. E., Lekovitch, C., Martínez, J., Rouch, S., Harding, P., & Wong, C. (2022). Optimizing Post-Acute Care Patient Safety: A Scoping Review of Multifactorial Fall Prevention Interventions for Older Adults. Journal of Applied Gerontology, 073346482211043.

Merkley, J., Amaral, N., Sinno, M., Jivraj, T., Mundle, W., & Jeffs, L. (2018). Developing a Nursing Scorecard Using the National Database of Nursing Quality Indicators®: A Canadian Hospital’s Experience. Canadian Journal of Nursing Leadership31(4), 82–91.


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