Learning Objective #1: Describe the process of developing and pilot testing of two pediatric indicators for national benchmarking

Learning Objective #2: Describe the results of the pilot testing and data collection tool refinement

---

The American Nurses Association through the National Database of Nursing Quality Indicators has been collecting nurse sensitive patient outcomes with adult populations since 1998 using the patient unit as the level of analysis. NDNQI has collected quarterly data on patient falls, pressure ulcers and staffing measures including hours per patient day and skill mix. There are over 500 participating sites accounting for over 4700 patient care units. Through this effort data indicate most unit types with a higher number of nursing hours worked had statistically better patient fall rates than those where fewer nurses were present.

ANA, in collaboration with personnel from NDNQI determined a need for the development and testing of pediatric indicators for participating sites. Criteria for indicators included: 1) sensitive to nursing care 2) scalable across pediatric sites (e.g. age of patient, size of unit) and 3) feasible - causing no undue burden for data collectors. After a review of the literature, consultation with pediatric nurse scientists and clinical and administrative leaders in pediatric care two indicators were chosen for pilot testing; the pain assessment-intervention-reassessment cycle and intravenous infiltration.

Information about the selected indicators, proposed data collection sheets, operational definitions and accompanying instructions were placed on the NDNQI website for comment. There was high level of support for the indicators in regards to sensitivity, scalability and feasibility.

Twenty-six general, intensive care and neonatal units participated in the pilot study. Evaluations were obtained by survey and phone conferences held with site coordinators for final modifications to all documents. Full implementation of the pediatric indicators is underway.

This work helps establish comparison benchmarks for pediatric patients and supports evidence of nursing's impact on quality outcomes. These new indicators will 1) protect our most vulnerable patients and 2) further scientific study between outcomes and staffing.