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Table 3 LMIC relevant Nursing sensitive indicators aligned with International Patient Safety Goals

From: Developing metrics for nursing quality of care for low- and middle-income countries: a scoping review linked to stakeholder engagement

International patient safety goals domain

Indicator definition

Source of indicator

Measurement approach

Identify patients correctly

  
 

Proportion of patients with name tags

Literature (IPSG)

Structure

Improve effective communication

  
 

Proportion of patients who have a complete assessment (history, head to toe examination, vital signs, weight/height, plan of care) at admission

Literature

Process

 

Proportion of patients who have discharge instructions (follow-up care, education, return date)

Literature

Process

 

Proportion of patients with appropriate vital signs monitoring as per patient acuity documented

Literature

Process

 

Proportion of patients who received at least one session of counselling or communication in 24 hours

Literature

Process

 

Proportion of patients with assessment and planning of care done at least once in 24hours

Literature

Process

 

Proportion of patients with ward round recommendations documented in the cardex

Stakeholders

Process

 

Proportion of patients with surgeons’ instructions transferred to the cardex and with completely filled postoperative forms

Stakeholders

Process

 

Availability of basic nursing forms/charts

Stakeholders (HFA)

Structure

 

Adverse effects reporting system in place to reporting

Stakeholders (HFA)

Structure

Improve the safety of high-alert medications

  
 

Record of daily stock monitoring/handover and safety of drugs classified under the Dangerous Drugs Act

Stakeholders

Structure

 

Proportion of blood transfusions monitored as per blood transfusion guidelines

Literature

Process

 

Proportion of documented blood transfusions reactions

Literature

Outcome

 

Proportion of patients on anti-coagulation therapy with dose, drug and food interactions, and appropriate nursing care documented

Literature (NPSG)

Process

 

Proportion of patients on drugs with a narrow therapeutic range that are flagged

Literature (NPSG)

Process

Ensure correct site, procedure, patient for surgery

  
 

Proportion of patients scheduled for surgery with correctly and completely filled preoperative forms/checklist

Stakeholders

Process

 

Proportion of patients with the status of the patient, surgical procedure and surgical site, documented in the cardex

Literature (IPSG)

Process

 

Proportion of patients with filed consent form before surgery

Stakeholders

Process

 

Proportion of patient identifiers before surgery (name tags/other identifying measures)

Literature (IPSG)

Process

 

Proportion of patients with pre-marked sites for procedures that require marking of the incision or insertion site.

Literature (IPSG)

Process

Reduce risk of HCA infections

  
 

Proportion of surgical patients with post-operative surgical wound infection

Literature

Outcome

 

Proportion of patients on intravenous fluids/treatment whose cannula site was checked and documented (state of cannula site- swollen, SSI, soiled)

Literature

Outcome

 

Proportion of patients on intravenous fluids/treatment whose cannula site was checked and documented vascular access infiltration

Literature

Outcome

 

Proportion of patients requiring wound cleaning with wound cleaned and wound dehiscence (wound characterization-burst wound, septic, granulating, necrotic), exudate and pain documented

Literature

Process

 

Proportion of newborns aged <5 days and born within the hospital who develop septic cords

Stakeholders

Outcome

 

Proportion of newborns on phototherapy with documentation of eyecare done, eyes checked for damages and eye pad changed once in 24 hours

Stakeholders

Process

 

Proportion of patients with UTI in non-genito urinary infection with documentation for input-output monitoring

Literature

Outcome

 

Proportion of patients who develop pressure ulcers while in the ward

Literature

Outcome

 

Proportion of patients with basic activities of daily living (ADL) done.

Literature

Process

 

Compliance with hand hygiene guidelines based on established goals

Literature

Process

 

Patient education on infection prevention practices

Stakeholders

Process

 

Availability of hand hygiene guidelines/training/reminders

Stakeholders (HFA)

Structure

 

Availability and easily accessible clean toilets

Stakeholders

Structure

 

Availability of Waste segregation (3 bins and sharp boxes)

Stakeholders (HFA)

Structure

 

Needle, sharp box more than 3/4 full, or any used needles/sharps outside the box

Stakeholders (HFA)

Structure

 

Bandages/infectious waste lying uncovered

Stakeholders (HFA)

Structure

 

Clean running water (piped, bucket with tap, or pour pitcher)

Stakeholders (HFA)

Structure

 

Functioning hand hygiene stations (that is, alcohol-based hand rub solution or soap and water with a basin/pan and clean single-use towels)

Stakeholders (HFA)

Structure

 

Storage space for sterile and high-level disinfected items (either a room with limited access or a cabinet that can be closed)

Stakeholders (HFA)

Structure

Reduce risk of patient harms resulting from falls

  
 

Proportion of patients with risk of falling who have harm reduction measures

Literature

Process

 

Use of physical restraint

Literature

Process

 

Proportion of patient falls with injuries

Literature

Process

Additional indicators that don’t fall in the IPSG criteria

  

Other safety related indicator

  
 

Proportion of patients at risk of DVT (immobile, obese, on total nursing care etc) who are assessed for DVT at least once in 24 hours

Literature

Process

 

Proportion of diabetic and critically patients with blood sugar monitoring

Stakeholders

Process

 

Proportion of diabetic patients with the following documented: type of feed, medication, frequency, intervention, sugar levels, time of last feed to help interpret the result)

Stakeholders

Process

Structure indicators

  
 

Patient to nurse ratio

Literature

Structure

 

Nurse skill mix (by education level)

Literature

Structure

 

Staff wearing name tags and on uniform

Stakeholders (HFA)

Structure

Outcome indicators

  
 

Patient satisfaction with overall care

Literature

Outcome

 

Patient satisfaction with nursing care

Literature

Outcome

 

Proportion of patients who died

Literature

Outcome

 

Average length of stay (by illness acute vs chronic)

Literature

Outcome

  1. Literature - Indicator identified from the systematic adopted for LMIC/Kenyan context; Stakeholder - Indicator not defined in literature but stakeholders felt this was a priority/important area to measure; IPSG/NPSG - Indicator has been defined under either of these criteria; Stakeholder (HFA) - indicator already exists in the Joint Health Facility Assessment (HFA) indicator set developed through a stakeholder process
  2. UTI Urinary tract infection, DVT Deep venous thrombosis, HCA Health care acquired