Table 3.
LMIC relevant Nursing sensitive indicators aligned with International Patient Safety Goals
| 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 | |
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
UTI Urinary tract infection, DVT Deep venous thrombosis, HCA Health care acquired