Table 2 The preliminary and the initial list of nursing-sensitive quality indicators
QI number | Preliminary list of QIs identified from a literature review | Initial list of nursing-sensitive QIs after the project group decisiona | Description/definition of the QIs in the initial listb |
|---|---|---|---|
1 | Incidence of cognitive impairment | Rejected | |
2 | Prevalence of symptoms of depression | Accepted/modified Proportion of residents with symptoms of depression in past three days with and without treatment | Examples of symptoms of depression: 1) The resident has little interest or pleasure in things he/she usually enjoys; 2) The resident is anxious or restless; 3) The resident is sad, depressed, or thinks everything is hopeless |
3 | Prevalence of symptoms of depression without antidepressant therapy | Included in the forementioned QI | |
4 | Prevalence of behavioral symptoms affecting others | Accepted/modified Proportion of residents with behavioral symptoms in past three days affecting others | Examples of behavioral symptoms: 1) Walking around without seeing their own needs or security: 2) Verbally aggressive; 3) Physically aggressive; 4) Socially deviant behavior; 5) Sexually deviant behavior or undressing in public; 6) Opposes care |
5 | Prevalence of little or no social activity | Accepted/modified Proportion of residents with a certain degree of participation in social activities | Examples of social activities: 1) An activity the resident has been interested in for a long time; 2) Visit from an old friend or family; 3) Telephone or email contact with an old friend or family |
6 | Prevalence of little or no activity | Accepted/modified Proportion of residents with a certain degree of participation in activities of interest for them | Examples of activities: Cards/toys/puzzles; PC activities; talking on the phone; needlework; dancing, discussions, or conversations; exercising; gardening activities; helping others; music; pets; reading; writing; crossword puzzles; spiritual or religious activity; traveling or shopping; walking or driving a wheelchair outdoors; watching TV or listening to the radio |
7 | Incidence of decline in ADL | Accepted/modified Proportion of residents with worse ADL status compared to 90 days ago | ADL means ‘Activities of Daily Living’ Examples of ADL activities: Bathing; personal hygiene; dressing and undressing; walking; moving; using the toilet; mobility in bed; and how the resident eats and drinks |
8 | Prevalence of physical restraints | Accepted/modified Proportion of residents with the use of aids that inhibit freedom of movement | Use of aids that inhibit freedom of movement means involuntary use of coercive devices that inhibit normal movement. Involuntary use means without consent from the resident Examples of aids that inhibit freedom of movement: 1) Bed rails that are completely up on all open sides of the bed; 2) Fixation of the resident in the chair with harness or belt; 3) Obstacles leading to the resident being unable to get up from the chair |
9 | Prevalence of falls | Accepted/modified Proportion of residents with falls in past 30 days | No further description/definition |
10 | Prevalence of bedfast residents | Accepted/modified Proportion of bedfast residents | A bedfast resident is defined as one who lies in bed or sits in an armchair/recliner for 22 of the 24 h of the day |
11 | Prevalence of pressure ulcers | Accepted/modified Proportion of residents with pressure ulcers | Pressure ulcers are caused by prolonged pressure on a skin area over a bone prominence Pressure ulcers can be graded in severity: 1) Area of skin redness; 2) Partial loss of skin layer; 3) Deep skin craters; 4) Full thickness skin loss exposing muscle and/or bone; 5) Necrotic tissue dominates |
12 | Prevalence of bladder/bowel incontinence | Accepted/modified Proportion of residents with bladder and bowel incontinence | Bladder and bowel incontinence means loss of urine and bowel function |
13 | Prevalence of fecal impaction | Accepted/modified Proportion of residents with fecal impaction | Fecal impaction means no stools within three days or problems with hard stools |
14 | Prevalence of toilet assistance program | Accepted/modified Proportion of residents with established toilet routines | Established toilet routines can be planned toilet visits where employees accompany residents to the toilet at set times |
15 | Prevalence of indwelling catheters | Accepted/modified Proportion of residents with an indwelling urinary catheter | A urinary catheter is a hollow and thin flexible tube inserted through the urethra into the bladder. An indwelling catheter refers to a catheter that is left in the bladder all the time |
16 | Prevalence of urinary tract infection | Accepted/modified Proportion of residents with urinary tract infection in past 30 days | Urinary tract infection means bacterial infection in the lower or upper urinary tract (bladder and renal pelvis) |
17 | Prevalence of pain | Accepted/modified Proportion of residents with pain without adequate pain treatment | No further description/definition |
18 | Prevalence of weight loss | Accepted/modified Proportion of residents with weight loss | Weight loss is defined as a weight loss of 5% or more in the past 30 days, or a weight loss of 10% or more in the past 180 days Example 1: A weight loss of 4 kg in the past 30 days from 65 to 61 kg means a weight loss of approximately 6% Example 2: A weight loss of 7 kg in the past 180 days from 65 to 58 kg means a weight loss of approximately 11% |
19 | Prevalence of tube feeding | Rejected | |
20 | Prevalence of dehydration | Accepted/modified Proportion of residents with dehydration | Dehydration can be defined as: 1) Insufficient fluid intake, less than 1000 ml per day; 2) Fluid loss greater than fluid intake |
21 | Prevalence of oral and dental health problem | Accepted/modified Proportion of residents with dental and/or oral problems | Dental or oral problems are assessed based on whether the resident has: 1) Dentures and/or removable bridge; 2) Not intact natural teeth; 3) Pain/discomfort in mouth or face; 4) Dry mouth; 5) Ingestion problems; 6) Inflamed or bleeding gums |
22 | Prevalence of use of 9 or more different medications | Rejected | |
23 | Prevalence of antipsychotic use in the absence of psychotic and related conditions | Rejected | |
24 | Prevalence of antianxiety/hypnotic use | Rejected | |
New | Suggestion from the project group Proportion of residents with hearing loss without the use of hearing aidsc | No further description/definition | |
New | Suggestion from the project group Proportion of residents who have had a systematic medication review in past year or when neededd | A medication review is a systematic procedure to ensure the quality of the resident’s drug use. The medication review can be carried out in an interdisciplinary team consisting of a physician, a registered nurse, and/or a pharmacistd |