· What is the NDNQI? The National Database of Nursing Quality Indicators (NDNQI®) is the only national nursing database that provides quarterly and annual reporting of structure, process, and outcome indicators to evaluate nursing care at the unit level. Linkages between nurse staffing levels and patient outcomes have already been demonstrated through the use of this database. Currently over 1100 facilities in the United States contribute to this growing database which can now be used to show the economic implications of various levels of nurse staffing. NDNQI data allows staff nurses and nursing leadership to review and evaluate nursing performance in relation to patient outcomes. Hospitals can use the information to establish organizational goals for improvement at the unit level, and mark progress in improving patient care and the work environment. It can also help your facility avoid costly complications. · What are nursing-sensitive quality indicators? Nursing-sensitive indicators identify structures of care and care processes, both of which in turn influence care outcomes. Nursing-sensitive indicators are distinct and specific to nursing, and differ from medical indicators of care quality. For example, one structural nursing indicator is nursing care hours provided per patient day. Nursing outcome indicators are those outcomes most influenced by nursing care. · Which particular quality indicator did you select to address in your tutorial? Medication error · Why is this quality indicator important to monitor? · Be sure to address the impact of this indicator on quality of care and patient safety. Medication safety is an important topic because medication errors (MEs) are a common, serious and expensive type of medical error may cause or lead to inappropriate medication use or patient harm  · Why do new nurses need to be familiar with this particular quality indicator when providing patient care? The nurse’s role in and ability to change patient safety and quality improvement within health care has implications for both safety and quality processes and nursing, patient, and organizational outcomes. The relationships between organizational systems factors, clinical processes, and patient safety and quality outcomes. It is important to focus on improving and widening the assessment of the impact of patient safety and quality improvements on the incidence of the broad array of errors that can and do occur in nurses’ work environments. For example, leaders and clinicians need to understand the association between an organization’s culture of safety and patient outcomes as well as how nurses can influence executives to lead working environment improvements. Hello and welcome to the University Hospital Health Care System. My name is Diane Tate. We are so excited to have you on our nursing team. I am here today to help you better understand how our healthcare system uses Nursing Sensitive Quality Indicators – also known as the NDNQI - to en ...

1. · What is the NDNQI?
The National Database of Nursing Quality Indicators
(NDNQI®) is the only national nursing database that provides
quarterly and annual reporting of structure, process, and
outcome indicators to evaluate nursing care at the unit level.
Linkages between nurse staffing levels and patient outcomes
have already been demonstrated through the use of this
database. Currently over 1100 facilities in the United States
contribute to this growing database which can now be used to
show the economic implications of various levels of nurse
staffing.
NDNQI data allows staff nurses and nursing leadership to
review and evaluate nursing performance in relation to patient
outcomes. Hospitals can use the information to establish
organizational goals for improvement at the unit level, and mark
progress in improving patient care and the work environment. It
can also help your facility avoid costly complications.
· What are nursing-sensitive quality indicators?
Nursing-sensitive indicators identify structures of care and care
processes, both of which in turn influence care outcomes.
Nursing-sensitive indicators are distinct and specific to nursing,
and differ from medical indicators of care quality. For example,
one structural nursing indicator is nursing care hours provided
per patient day. Nursing outcome indicators are those outcomes
most influenced by nursing care.
· Which particular quality indicator did you select to address in
your tutorial?
Medication error
· Why is this quality indicator important to monitor?
· Be sure to address the impact of this indicator on quality of
care and patient safety.
Medication safety is an important topic because medication

2. errors (MEs) are a common, serious and expensive type of
medical error
may cause or lead to inappropriate medication use or patient
harm
· Why do new nurses need to be familiar with this particular
quality indicator when providing patient care?
The nurse’s role in and ability to change patient safety and
quality improvement within health care has implications for
both safety and quality processes and nursing, patient, and
organizational outcomes. The relationships between
organizational systems factors, clinical processes, and patient
safety and quality outcomes. It is important to focus on
improving and widening the assessment of the impact of patient
safety and quality improvements on the incidence of the broad
array of errors that can and do occur in nurses’ work
environments. For example, leaders and clinicians need to
understand the association between an organization’s culture of
safety and patient outcomes as well as how nurses can influence
executives to lead working environment improvements.
Hello and welcome to the University Hospital Health Care
System. My name is Diane Tate. We are so excited to have you
on our nursing team. I am here today to help you better
understand how our healthcare system uses Nursing Sensitive
Quality Indicators – also known as the NDNQI - to enhance
quality care outcomes, improve training procedures, establish
best practices, and improve patient satisfaction. These
indicators also help in workflow and the recruitment and
retention of quality staff. You play an important part of this.
You are our eyes and ears when it comes to safe evidence-based
practice and reporting data to help evaluate our Nursing
Sensitive Quality Indicators.
We are very fortunate to be one of the 1100 facilities in the
United States providing the data to NDNQI to fulfill nursing's
commitment to advancing our knowledge base to evaluate and

3. improve patient care. The NDNQI is a national nursing database
evaluating nursing care that provides annual and quarterly
reporting of three major indicators which evaluate nursing care.
In 2018, the authors Griggs, Wiechula & Cusack described
those indicators as structure (staff/skill competency), process
(patient assessment, nursing intervention, and job satisfaction)
and outcome of patient care related to the quantity or quality
nursing care. NDNQI is managed by a company named Press
Ganey. Press Ganey sends us surveys for the data needed and
then provides participating facility research driven reports with
statistics and data themes. Multiple authors including Smith
(writing in 2018) and Griggs, Wiechula & Cusack point out that
this data allows us to understand what we are doing well in our
facility and what we need to improve on, in comparison to
national data, to enhance patient safety, patient care outcomes,
and organizational performance reports.
Now I’d like to share an example, Our Chief Nursing Officer
used the NDNQI ratios and acuity data on staffing to validate
the need various levels of nurse staffing. Authors Mangold and
Pearson, writing 2017, identify how this type of data can
contribute to significant changes to our staffing matrix and
ratios because of the data produced by nurses like you. Our
nurses are better able to provide quality care as a result of this
information and our patient satisfaction scores have almost
doubled over that past 6 months.
Imagine a small snowball made of 5 pieces of snow, then
imagine one made of 100 pieces of snow, and one made of 1100
pieces of snow…the greater the number the bigger the impact. If
you were in the snowball fight, do you want the snowball made
with five snowflakes or the one made with 1100 snowflakes?
The same is true of the data in the NDNQI, when one facility
implements a change the data from the change is shared with
everyone through NDNQI so the dissemination of information is
relatively quick and provides real time evaluation data.
For another example, over the past few months, we have
experienced a dramatic rise in catheter-acquired urinary tract

4. infections also known as CAUTIs and Hospital Acquired
Conditions throughout the facility. This has dramatically
affected the quality of patient care and ultimately our Press
Ganey patient satisfaction surveys. Our rate of CAUTIs and
Hospital Acquired Conditions have also impacted our rate of
Medicare reimbursement. We have experienced a 1 percent
reduction in reimbursement related to this CAUTI and
associated HAC increase. Porter (2018) estimates CAUTI costs
to be over $10,000. To give this number a little more impact,
the Robert Wood Johnson Foundation Interdisciplinary Nursing
Quality Research Initiative reported in 2015 that there was a
total of $330 million dollars lost in Hospital Acquired
Conditions penalties across 721 facilities.
Our nurses have identified CAUTI in their patients with
indwelling catheters as a concern as well as other Hospital
Acquired Conditions. Recognizing that they are the first line of
defense for patient safety, our nurses are participating in a
hospital wide Acquired Condition Reduction Program modeled
after the Centers for Medicare and Medicaid services (n.d). Our
initiative looks at all infections acquired during treatment in
this facility. I encourage you to look at this website. As a nurse
you are the leader of healthcare quality, we depend upon you as
the expert in patient care. YOU are extremely powerful in
contributing to patient care in not only preventing CAUTIs but
in providing a timely reporting of needed data in the Press
Ganey surveys so that our data is contributed to NDNQI.
You May Ask… How Can I Help?
Nurses have an essential role within the interdisciplinary
healthcare team. They are responsible for collecting and
reporting data for the NDNQI. The data collected will
contribute to improved outcomes, improved patient safety, and
an overall improved patient experience. In our facility we
provide the data using online surveys received from Press
Ganey, all members of the interdisciplinary healthcare team
receive the surveys. In a personal communication, our Chief
Nursing Officer, Dr. Smith, underscored that the current facility

5. best practice is to check your hospital email every day you work
and complete any surveys sent to you. The data is very easy to
enter into the survey. Dr. Smith stated that in the beginning
there was a lot of lag time between data entry by the
interdisciplinary team and the time the survey was sent out but
that has improved. We have a quality team at the hospital
responsible for supplying the general data related to CAUTIs.
Other data provided to Press Ganey includes incident reports,
patient admission dates, length or stay, readmission data,
number of patients with catheters vs patients with CAUTIs
diagnosed in facility vs after discharge. To learn more about
Press Ganey please go to their website.
Your job as a nurse is to provide care according to the current
practice policies, complete all required documentation which
includes all popups on CAUTIs and then to enter data when
emailed a survey from Press Ganey. Your role is incredibly
powerful in this initiative because as you know we have a huge
amount of responsibility in placing, caring for and assessing
indwelling catheters and straight caths. Imagine if your work in
completing all required documentation and some quick online
surveys prevents future CAUTIs, the impact would be huge!
I would now like to discuss what we do WITH THE DATA
The data you provide, and which is found in the patient records
provides insights into how the nursing care and interventions we
provide influence patient outcomes. The data found within the
NDNQI gives healthcare leaders an understand of what actions
influence quality and patient safety. Within the NDNQI the data
is trended and the themes and or statistical information is pulled
out to help guide safety and quality initiatives.
Within this organization we have quality improvement teams on
each unit where data from NDNQI and plans for improving
quality are shared. We use the data for guiding us in creating
quality improvement plans and ensuring patient safety. Quality
improvement teams on your unit will share updates with the
NDNQI data and how we plan to use the data.
As we wrap up I’d like to share some ideas about how your

6. actions IMPACT HEALTH CARE IN GENERAL
Your involvement in accurate charting and completing surveys
provides data used for the greater science of nursing. This
information helps the nursing profession to identify nurse-
sensitive indicators of quality to use for improvement in our
patient care. Our nursing leaders use the NDNQI data to
determine the best practices for their unit and facility to
improve both quality care outcomes and workplace safety,
including nurse patient staffing ratios.
Our facility models itself after the 2015 Robert Wood Johnson
Foundation Interdisciplinary Nursing Quality Research
Initiative Policy Brief for not only quality and safety
improvement, but to achieve higher outcome-based hospital
payments. Our Value Based Purchasing program provides acute
care facilities incentive money when the facility has good
performance on quality measurements and makes improvements
in the facilities quality and safety of care. There is also an
overlap of the Value Based Purchasing program and the
Medicare reimbursement program so facilities are able to
potentially have double the financial benefit because the nurse
sensitive outcomes influence the requirements for full
reimbursement from Medicare. John Hopkin’s hospital has been
a leader in using the NDNQI data to make improvements in
safety and quality with a 41% reduction in CAUTIs with the use
of national data on nursing interventions from NDNQI. Nursing
leaders need to work to ensure they use the data from the
nursing sensitive outcomes to make improvements in care
within individual facilities and units.
In CONCLUSION
Our involvement in NDNQI is a wonderful and positive
influence on the profession of nursing and patient care. Your
responsibility is to ensure you have accurate and complete
documentation and to complete any Press Ganey surveys you
receive. Our role as a facility is to provide all additional data to
NDNQI and to support you in your work while focusing on
quality improvement and sharing data with you from NDNQI

7. and our quality improvement work. The success of NDNQI is
relying on our commitment to provide data in a timely manner
and then to use the national data to make improvements at the
facility. Nurses are at the front line of quality improvement and
evidence-based practice. We can all make a huge improvement
in patient care. You are a valuable asset to our team!
Thank you!
Resources:
· AHRQ(2019). High reliability. Retrieved from
https://psnet.ahrq.gov/primers/primer/31.
· CFAR, Inc., Tomasik, J., Fleming, C. (2015). Promising
interprofessional collaboration. Retrieved from
https://www.rwjf.org/en/library/research/2015/03/lessons-from-
the-field.html
· Clarke, J.R.(2013)The use of collaboration to implement
evidence-based safe practices Journal of Public Health
Research:2:(e26)
· Deloitte(2017). Transforming into a high reliability
organization in health care. Retrieved from
https://edit.modernhealthcare.com/assets/pdf/CH111283727.PD
F
· Donnelly, P., & Kirk, P. (2015). Using the PDSA model for
effective change management. Education for Primary Care,
26(4), 279–281.
· Institute for Healthcare Improvement. (2018). Plan-do-study-
act (PDSA) worksheet. Retrieved from
http://www.ihi.org/resources/Pages/Tools/PlanDoStudyActWork
sheet.aspx
Assessment 4 Instructions: Informatics and Nursing Sensitive
Quality Indicators
Top of Form
Bottom of Form
Content
· Print

8. · Prepare an 8-10 minute audio training tutorial (video is
optional) for new nurses on the importance of nursing-sensitive
quality indicators.
As you begin to prepare this assessment you are encouraged to
complete the Conabedian Quality Assessment Framework
activity. Quality healthcare 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.
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, Gray, Jay, Jay, & Burns, 2015).
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

9. 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.
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.
Reference
Grove, S. K., Gray, J. R., Jay, G.W., Jay, H. M., & Burns, N.
(2015). Understanding nursing research: Building an evidence-
based practice (6th ed.). St. Louis, MO: Elsevier.
Demonstration of Proficiency
By successfully completing this assessment, you will
demonstrate your proficiency in the course competencies
through the following assessment 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

10. 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 and 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.
Preparation
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:
· Select a single nursing-sensitive quality indicator that you see
as important to a selected type of health care system.
· 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

11. do they enter it into another system? How effective is this
process?
· Watch the Informatics and Nursing-Sensitive Quality
Indicators Video Examplar.
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 the 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 [email protected] to request accommodations.
Instructions
For this assessment, 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

12. 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 NDNQI®?
· 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 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

13. 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.
· 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 APA Style and Format page on
Campus.
Portfolio Prompt: Save your presentation to your ePortfolio.
Submissions to the ePortfolio will be part of your final
Capstone course.
·
Scoring Guide
Use the scoring guide to understand how your assessment will
be evaluated.
View Scoring Guide