Creating Change in Nursing

As the healthcare industry changes, hospitals and the healthcare community at large are facing increased challenges.

Understanding these difficulties, the American Nursing Association (ANA) is committed to the continued growth of the National Database of Nursing Quality Indicators (NDNQI), a tool that collects and evaluates nurse-sensitive data on structures and processes and outcomes from acute care hospitals.

“With an increased emphasis on accountability measures, transparent public reporting and pay for quality programs, hospitals and their clinical teams are challenged as never before to use clinical tools and data from NDNQI,” said Maureen Dailey PhD, RN, CWOCN, senior policy fellow, Nursing Practice and Policy, ANA.

“The data collected is particularly important today and is an effective tool to provide quality outcomes,” she added.

Through this program over 2,000 participating facilities are able to utilize data collected from their own units while learning from other hospitals to ensure patients receive the best possible care.


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What is NDNQI?

NDNQI, which began accepting data from hospitals in 1998, is the largest nursing sensitive data registry/database in the world and a key quality resource for hospitals and their staff.

“NDNQI is a precise tool to turn quality data from hospitals into quality solutions,” noted Dailey. “With a major focus on safety outcomes, such as infections, falls, and pressure ulcers, NDNQI is important for patients, clinical teams, hospitals and the nation to meet goal targets to improve the health of patients while preventing harm and reducing costs.

“The program tracks nursing sensitive quality measures, which capture data on the practice of interprofessional teams and specifically the contribution of nursing to quality outcomes,” she added.

Utilizing the Data

NDNQI defines nursing sensitive measures as “measures that are strongly influenced by the care that nurses provide or directly measure nursing as reflected by the structure, process and outcomes of nursing care.”

Measures collected through NDNQI, include, but are not limited to: ANA’s National Quality Forum (NQF) -endorsed skill mix, nurse turnover, patients falls/injury falls measures, as well as other key NQF-endorsed safety measures including hospital/unit-acquired pressure ulcers, and hospital-acquired infections (HAIs).

ANA and NDNQI works closely with the NQF, a not-for-profit organization that “reviews, endorses, and recommends use of standardized healthcare quality performance measures to the US Department of Health and Human Services (HHS).”

ANA’s CEO, Dr. Marla Weston PhD, RN, FAAN, participates on multiple NQF-convened quality groups including the National Priorities Partnership (NPP) and the Measure Application Partnership (MAP).

The majority of the measures collected by NDNQI are endorsed by NQF, according to Dailey. “The data collected from these measures provide actual insights based on the all-important three ingredients: structures of care, processes of care and the outcomes achieved,” she explained.

Participating hospitals have a variety of data and tools at their disposal, but how do they make the most of it?

“It really comes down to driving the data to the team level,” emphasized Dailey. “By making sure teams have access to structures, processes, and outcomes, they can connect the dots.”

“For example, if the unit has an increase of falls they can look at all three of those data points,” she added. “There may be an issue with staffing or with the evidence-based care bundles, which is why it is really important for hospitals to drill that data down right to the individuals who can use that data to improve outcomes of care.”

NDNQI’s new dashboard makes this a seamless process. “It offers a very clear way for interprofessional teams and, in particular, nurses to view the data in a simple, customizable dashboard that is easy to view, understand, and share at the team level.”

“The dashboard, which provides benchmarking against hospitals and improves on outcomes and safety, compares data not only to like hospitals, but also data to similar units, which is very important in performance improvement,” she stressed.

In addition to collecting data on nurse sensitive measures, NDNQI has an annual survey, which allows nurse leaders, including managers of units, to see what the key issues trending to the top, according to Dailey.

“It is a survey that provides insights into staffing issues, behaviors and attitudes,” she noted. “It can help in anticipating nursing turnover and staffing needs in the future and it can help in retaining nurses and improving the culture at the team level.”


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United for Quality

On top of its work with participating facilities, NDNQI has joined forces with other quality programs to improve outcomes across the healthcare continuum.

“ANA is very proud that NDNQI provides national comparison data for several national safety initiatives, including the Partnership for Patients, which is part of the Center for Medicare and Medicaid Services Innovation Center.”

The Partnership for Patients, which includes over 80% of hospitals in the U.S., has two goals, according to Dailey. “The goals are to reduce hospitals acquired conditions by 40% and readmissions by 20%,” she explained. “NDNQI’s data supports this campaign as well as others.”

In addition, the data on infection measures collected by NDNQI are reported to hospitals as well as the Center for Disease Control and Prevention (CDC) and the National Health Care Safety Network (NHSN). ANA is working directly with CDCs’ NHSN team.Reflecting its continued commitment to quality measures, ANA is hosting its annual National Quality Conference, Feb. 5-7 in Phoenix.

“The most important quality conference of the year is the ANA Quality Conference,” said Dailey. “It is where key nurse leaders and clinical staff unite with NDNQI scientists to share best practices and increase the knowledge, skill, and abilities of nurses who are intimately involved in working with the data.”

“The most important quality conference of the year is the ANA Quality Conference,” said Dailey. “It is where key nurse leaders and NDNQI scientists unite to share best practices and increase the knowledge, skill, and abilities of nurses who are intimately involved in working with the data.”


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Looking Forward

ANA, NDNQI, and the facilities it supports are constantly looking to the future of continued quality improvement and positive outcomes.

“NDNQI is moving into a very exciting new area – developing measures for the ambulatory care setting,” said Dailey. “So, we are having an ambulatory care summit this month in Washington D.C., which will include leading clinicians, researchers, hospitals, safety leaders and our partners in the federal government.”

“Together we will look at what are the most important measures to improve care coordination as well as safety,” she said. “We need to improve the safety of transitional care from hospitals to other settings, which is a critical subset area of care coordination work by nurses.”

And the Summit couldn’t come at a more opportune time.

The Magnet Recognition Program “will require ambulatory care quality measurements in 2014, so it is very important that we get hospitals and other key stakeholders input in these new measures,” Dailey concluded. “Quality measures need to be meaningful to the clinicians that are held accountable in reporting and improving quality outcomes, but also it is important that these measures are high impact. They actually have to improve outcomes, particularly those important to patients and families, that will actually move the national quality dial.”

Catlin Nalley is on staff at ADVANCE. Contact:

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