1.
D R . A N J A L A T C H I M I T H U K U M A R A N
V I C E P R I N C I P A L
E R A C O L L E G E O F N U R S I N G
E R A U N I V E R S I T Y , L U C K N O W - 2 2 6 0 0 3
QUALITY INDICATOR IN
NURSING

2.
INTRODUCTION
 Quality indicators are the means to judge the real
performance of certain clinical as well as managerial
parameters selected for monitoring and evaluation.
 The Quality Indicators (QIs) are measures of health
care quality that make use of readily available
hospital inpatient administrative data.

3.
Meaning of quality indicator in nursing
Quality Indicators (QIs) are standardized, evidence-
based measures of health care quality that can be used
with readily available hospital inpatient administrative
data to measure and track clinical performance and
outcomes.

4.
Meaning of quality indicators in NABH
 Quality Indicators are the backbone on which
quality assurance program of a hospital
relies.
 NABH ( National Accreditation Board for Hospitals
& Healthcare Providers) accreditation expects
hospitals to calculate several quality indicators and
use it for monitoring the quality of care.
 Checklist for quality indicator as per NABH

5.
SUMMARY OF STANDARDS
 NQI.1 There is a structured quality improvement and
continuous monitoring program for nursing service.
 NQI.2 The organization identifies key indicators to
monitor the structures, processes and outcomes,
which are used as tools for continual improvement
for nursing services.

6.
STANDARD CONTINUED
 NQI.3 The nursing quality improvement program is
supported by the management
 NQI.4 There is an established system for nursing
audit
 NQI.5 Incidents, complaints and feedback from
nursing professionals are collected and analyzed to
ensure continual quality improvement.

7.
NQI.1
STRUCTURED QUALITY IMPROVEMENT AND
CONTINUOUS MONITORING PROGRAMME
 Objective
 The quality improvement program is developed,
implemented and maintained by a committee with a
representative from nursing personnel
 Elements Interpretation
 There is need for a formal controlled documentation.
This will be aligned with the organizations quality
improvement program
 Remarks
 At minimum, a “nursing manual” shall be established.

8.
CONTINUED
Objective
There is a designated individual for coordinating and
implementing the nursing quality improvement
program.
Elements Interpretation
 Self explanatory
Remarks
 This individual shall necessarily be a senior and
experienced nursing professional preferably with
exposure to NABH and quality standards

9.
CONTINUED
 Objective
 The quality improvement program shall be reviewed
at periodic intervals.
 Elements Interpretation
 Self explanatory
 Remarks
 It should be reviewed and updated at least once
every year.

10.
NQI 2
IDENTIFICATION OF KEY INDICATORS
 Objective
 The patient falls are monitored and the incident of
patient falls is documented by the appropriate nursing
professionals.
 Elements Interpretation
 The factors responsible for patient fall can be classified
as under
 1) Nursing related
 2) Patient related unbalanced or unsteady gait,
incorrect use of equipment.
 3) Falls requiring medical intervention.
 Remarks
 Self explanatory

11.
CONTINUED
 Objective
 The hospital acquired decubitus/pressure ulcers in
various departments are monitored and recorded as
per laid down protocols by the HCO
 Elements Interpretation
 Self explanatory
 Remarks
 Self explanatory

12.
CONTINUED
Objective
 The medication errors during provisioning of care
are monitored and recorded on occurrence by the
concerned nursing staff in forms as laid down by the
HCO
Elements Interpretation
 Self explanatory
Remarks
 Self explanatory

13.
CONTINUED
Objective
 Monitoring of accidental declining ( If applicable)
Elements Interpretation
 Self explanatory
Remarks
 Self explanatory

14.
CONTINUED
Objective
 All needle stick injuries are documented and
monitored as per the policy laid down by the HCO
that should be in consonance with the national and
international guidelines.
Elements Interpretation
 Self explanatory
Remarks
 Self explanatory

15.
CONTINUED
Objective
 All extravasations are recorded and monitored as per
the laid down protocols.
Elements Interpretation
 Self explanatory
Remarks
 Self explanatory

16.
CONTINUED
Objective
 The hand hygiene compliance is monitored and
recorded by the nursing professional responsible for
the same.
Elements Interpretation
 Self explanatory.
Remarks
 The monitoring should be as per the criteria
identified by the WHO guidelines on hand hygiene.
 Self explanatory

17.
CONTINUED
Objective
 All restraint related incidents are monitored and
documented
Elements Interpretation
 Self explanatory
Remarks
 Self explanatory

18.
CONTINUED
Objective
 The compliance with pain assessment and
management is monitored by the senior nursing
professional while undertaking their professional
rounds and the same is documented.
Elements Interpretation
 Self explanatory
Remarks
 Self explanatory

19.
CONTINUED
Objective
 The satisfaction of patients with the nursing care is
monitored by the senior nursing professionals and
the same is documented.
Elements Interpretation
 Self explanatory
Remarks
 Self explanatory

20.
NQI 3
NURSING QUALITY IMPROVEMENT PROGRAMME
Objective
 The management makes available adequate
resources required for quality improvement
program.
Elements Interpretation
 This shall include the men, material, machine,
money and method.
Remarks
 These should be in steady supply so as to ensure that
the program functions smoothly

21.
CONTINUED
Objective
 The management supports and implements use of
appropriate quality improvement, statistical and
management tools in its quality improvement program.
Elements Interpretation
 Self explanatory
Remarks
 For example, Root Cause Analysis, FMEA, Project
Evaluation and Review Technique (PERT), Critical Path
Method(CPM) control charts, etc.

22.
CONTINUED
Objective
 The senior nursing professionals as delineated by the
HCO also monitor the nursing satisfaction based on
pre determined criteria in consultation with human
resource department of the HCO
Elements Interpretation
 Self explanatory
Remarks
 Self explanatory

23.
CONTINUED
Objective
 The attrition rate and frequency of attrition of the
nursing professional is monitored and documented
by the head of the nursing in consultation with the
human resource department of the HCO
Elements Interpretation
 Self explanatory
Remarks
 Self explanatory

24.
NQI 4
ESTABLISHED SYSTEM FOR NURSING
AUDIT
Objective
 The parameters to be audited are defined by the organization As
these audits are retrospective/ concurrent in nature. It is imperative
that this be done using predefined parameters so that there is no
bias.
Elements Interpretation
 The parameters could be disease based, nursing protocol based,
nursing documentation based, cost based, community based or
based on morbidity ( length of stay) It shall lay down the objectives,
the parameters that are going to be captured, develop a checklist
where required, sampling and data collection guidelines and
preparation of report.
Remarks
 The audit shall encompass all aspects of care including clinical and
nursing

25.
CONTINUED
Objective
 Patient and staff anonymity is maintained. This means
that the names of the patients and the hospital staff who
may figure in the audit documents must not be disclosed
or any reference be made to them in public discussion/
conferences.
Elements Interpretation
 This is at the stage of report preparation and
dissemination.
Remarks
 The staff participating in the audit shall maintain patient
and staff anonymity and not reveal names

26.
CONTINUED
Objective
 All audits are recorded and reviewed
Elements Interpretation
 Self explanatory
Remarks
 The organization could use a checklist with the
predefined parameters and the audit findings could
be recorded on this sheet.

27.
CONTINUED
Objective
 Implementation is recorded and reviewed.
Elements Interpretation
 All remedial measures as ascertained should be
documented and implemented and improvements
there of recorded to complete the audit cycle.
Remarks
 This should preferably be done based on root cause
analysis.

28.
NQI.5
COLLECTION & ANALYSIS OF INCIDENTS,
COMPLAINTS AND FEEDBACK
Objective
The organization has an incident reporting system The
incident reporting system includes :-
Elements Interpretation
 a) Identification
 b) Reporting
 c) Review
 d) Action on incidents.
Remarks
 These could be members of the core committee/ nursing
quality assurance committee, etc.

29.
CONTINUED
Objective
 Corrective and preventive action are taken based on
the findings of such analysis.
Elements Interpretation
 The objective of this is to continually improve the
quality of patient-care services.
Remarks
 All such action shall be documented.

30.
CONTINUED
Objective
 The organization has a process to collect feedback
and receive complaints
Elements Interpretation
 Self explanatory
REMARKS
 This shall be communicated to the patients using
displays or brochures

31.
CONTINUED
Objective
 The organization has established processes for
analysis of incidents, feedbacks and complaints.
Elements Interpretation
 The quality improvement committee shall be
responsible for this activity
Remarks
 This could preferably be done by identifying the root
cause where possible; it is preferable that patients be
included in analyzing the feedback and complaint.

32.
NQI.5
COLLECTION & ANALYSIS OF INCIDENTS, COMPLAINTS AND
FEEDBACK
Objective
 Feedback about care and service is communicated to
staff.
elements Interpretation
 At a minimum, patient satisfaction levels shall be
communicated on a monthly basis.
Remarks
 This could be done using internal communication. It
is equally important that positive feedback about
care and services is communicated to staff.

33.
Examples of Hospital Quality Measures
for Consumers
 Patient safety measure
 Effectiveness measure
 Patient center measure
 Timelines measure
 Efficiency measure
 Equity measure

34.
SUMMARY
 Till now we have discussed about quality indicators
of nursing and its significance in nursing care like
introduction, meaning, checklist for NABH, standard
of NQI 1-5 , example of quality measure etc. I hope
you all understand the quality indicator of nursing
measure. If you all get chance to work quality
standard will you able to apply this knowledge
confidently.

35.
CONCLUSION
 System for monitoring and measurement of nursing
quality standards shall be established
 Statistical review and analysis of trends shall be
reviewed by the organization.
 These act as tools for excellence in nursing care
delivery and satisfaction with nursing care amongst
patients.
 Contributes to overall improvement in quality of care

36.
References
 NABH standard 5th edition from QCI , India.
 NABH standard 4th edition from QCI , India
 Licenses ,documents for establishment hospital
 Quality indicator of hospital measure