Measuring How Nurses Contribute to Patient Safety and Health Care Quality

Update from RWJF on the Joint Commission's Work

In 2007 and 2008, the Joint Commission tested specifications for 15 "nursing sensitive" performance measures in 49 acute-care hospitals across the United States. The goal was to determine the reliability and feasibility of these measures for assessing and improving the ways nurses contribute to patient safety and health care quality.

Key Findings

• All 15 performance measures, individually and as a set, were effective in improving patient care, and hospitals could feasibly collect data on them all.
• Specifications for some of the measures needed further refinement and clarification. For example, hospitals are not consistent in the way they classify injuries from falls or how they measure the onset of infection.

Key Recommendations

• Performance measures can be strengthened and greater uniformity achieved across hospitals by clarifying the definitions of what is being assessed, refining data-collection approaches and collaborating with others to align terminology.

Funding

The Robert Wood Johnson Foundation (RWJF) supported this unsolicited project from January 2007 to December 2008 with a grant of $299,490.

(c) RWJF, 2009

INQRI's Work on the NQF-15

In INQRI's first year, our call for proposals focused on measurement, with special attention paid to the 15 nursing sensitive measures endorsed by the National Quality Forum. Several INQRI teams have examined these measures.

• Developing and Testing Nursing Quality Measures with Consumers and Patients
  Baruch College
  Led by scholars in health policy, public policy and nursing, the goal of this project was to develop nursing-sensitive quality measures that patients and other decision-makers will find important and useful. In addition to checking out, with recent patients, how they respond to existing nursing quality measures, the project also worked on new measures in an area that both patients and professionals often point to as critical: the coordination of their care. The Baruch team recently held a briefing in Washington, DC to discuss their findings. Click here for more information.

• Quality Care on Acute Inpatient Units
  The University of California, San Francisco
  The goal of this project led by a nurse scholar was to test the power of the National Quality Forum-endorsed measures to advance quality nursing research and design, test other measures as potential indicators of nursing quality, and determine the impact of nurse staffing on these indicators in specific types of patient care units.

• Validating NQF Nursing-Sensitive Performance Measures
  University of Pennsylvania
  Led by a nurse scholar, the goal of this team was to analyze and validate measures from the National Quality Forum nursing-sensitive measure set using data collected from approximately 600 acute care hospitals in three states, as well as Medicare hospital performance measures, in 2005-2006.

• Lessons Learned from State Roll-Out of the NQF Nursing Sensitive Measures
  Massachusetts Hospital Research and Education Association, Inc.
  Led by a team of health services researchers, the goal of this team was to evaluate two statewide implementations of the NQF Nursing-Sensitive Measures created to provide hospitals and the public with comparative measures of nursing quality. The two statewide implementations are a voluntary effort in Massachusetts hospitals and a government mandated effort in Maine hospitals.

• Improving the NQF Failure to Rescue Metric
  Mayo Clinic
  Led by scholars in nursing and health services research and informatics, the goal of this team was to refine one of the most controversial measures of nursing-sensitive quality of care: failure to rescue.