Implementation Guide for the Nursing Management Minimum Data Set: NMMDS

Transcription

1 1 Implementation Guide for the Nursing Management Minimum Data Set: NMMDS Sponsored by: Center for Nursing Informatics School of Nursing University of Minnesota

2 2 Content INTRODUCTION... 3 Background... 3 Purpose... 4 Audience... 4 Contributors... 5 Scope... 6 Use Case Scenario... 6 SPECIFICATION OVERVIEW... 8 Organization of this Specification... 8 Convention used in this Implementation Guide... 9 Use of Vocabulary Standards NURSING MANAGEMENT MINIMUM DATA SET NMMDS Environment Nurse Resources COMPONENT - ENVIRONMENT Facility Unique Identifiers Type of Nursing Delivery Unit/Service Patient/Client Population Volume of Nursing Delivery Unit/Service Care Delivery Structure and Outcomes Patient/Client Accessibility Accreditation/Certification/Licensure COMPONENT - NURSE RESOURCES Staffing Satisfaction Nurse Demographics per Unit or Service Clinical Mental work Environmental Conditions Electronic Health Record (EHR) Implementation Stages REFERENCES APPENDIX A The Nursing Management Minimum Data Set Survey APPENDIX B - Publications - NMMDS Articles Published... 99

3 3 INTRODUCTION Background The Nursing Management Minimum Data Set (NMMDS) is a minimum collection of core variables needed by nurse managers to make decisions and compare nursing practice across institutions and geographical areas 1. The NMMDS is a profession-specific data set, developed through grounded theory, expert review panels, national Delphi surveys, focus groups, crosssectional descriptive surveys, and a national consensus working conference 2. It identifies common elements to represent nursing care delivery or the context of nursing care at the unit level or service line in any setting. The NMMDS provides managers and administrators standardized data that be compared within and across settings to understand how the context of care can influence patient and staff outcomes. These common elements can be measured to demonstrate the nursing component alone or as a part of broader care outcomes. Data elements reflect nursing practice and were selected to represent the essence of nursing. The context of care describes the overall setting or experience in which care takes place, such as home, acute care, long term care, and ambulatory or alternative care sites. The NMMDS Implementation Guide (IG) is a technical specification intended to guide the collection of data related to the context and support of direct health care delivery. NMMDS IG provides specifications regarding the precision in capturing, storing, and subsequently describing, analyzing, and comparing effects of patient care management and administrative interventions on complex health care outcomes. The NMMDS IG is based upon the NMMDS survey updates. It is a researchbased data set originally developed in 1989 to identify, define, and test the core variables needed to quantify at the unit or service line level within which health care is delivered 2. Initially, a focus group composed by nursing management and administration experts developed a list of management variables. After a pilot survey, a national Delphi survey was completed to determine necessity, clarity, and collectability of these variables within the acute care delivery system at the University of Iowa 2. The NMMDS research was extended, subsequently, to long term care, ambulatory care, home health care, and occupational health settings. The research included a partnership between The University of Iowa and the American Organization of Nurse Executives (AONE) in 1996 in order to disseminate and further refine those variables.

4 The NMMDS IG is expressed as a collection of data elements coded with the Logical Observation Identifiers Names and Codes (LOINC) standards. LOINC applies universal code names and identifiers to health terms related to laboratory and other clinical observations. Several standards organizations, such as Integrating the Healthcare Enterprise (IHE) or Health Level Seven (HL7), use LOINC to electronically transfer results from different reporting systems to the appropriate healthcare networks. A variety of information systems are involved when mapping the NMMDS variables using the LOINC codes. These include human resource systems, scheduling, acuity, and electronic health records. For instance, human resource systems include many of the variables about staffing Purpose The purpose of this NMMDS IG is to serve as a measure to nurses and health information technology (HIT) staff in implementing the collection of the data elements of the Nursing Management Minimum Data Set (NMMDS) in compliance with the LOINC terminology. The specification contains NMMDS elements with their specific LOINC mapping codes organized by sections according to the NMMDS hierarchy. Sections in the NMMDS IG contain NMMDS categories, data elements within the categories, conceptual and operational definition of each data element, recommendations for use where appropriate, and instructions about integration into information systems. These information systems may include electronic health records (EHRs), scheduling and / or human resource systems. Although the NMMDS has its own coding system, to support interoperability, the LOINC coding system should be integrated into electronic information systems. LOINC coding is provided in this document. Audience The primary audiences for this specification are nurse leaders, nurse informaticists, and HIT staff involved in implementing information systems and creating discrete measurement and analyses of the nursing component of health care. This audience will want to ensure that this specification adequately addresses the implementation of the NMMDS and their specific LOINC codes to support the national standards for interoperability. Secondary users of this specification include nurses working in any context of clinical practice, researchers and educators. This audience is responsible for adopting this guide into clinical practice, incorporating the data elements into research designs, and disseminating the 4

5 5 NMMDS IG to students and novice nurses for advanced learning and expertise. Researchers and educators are key experts in advancing and adopting this specification, to ensure that NMMDS information is consistent with the best nursing practices and nursing data exchange across settings. Contributors This specification was developed under the sponsorship of the Center for Nursing Informatics, School of Nursing, University of Minnesota under the leadership of Connie W. Delaney, PhD, RN, FAAN, FACMI who is one of the two original developers of the NMMDS (along with Diane Huber, PhD, RN, FAAN) and Co-director for the Center. Content expertise, project management, technical insights, and workflow knowledge was provided by Bonnie L. Westra, PhD, RN, FAAN, FACMI, Director for the Center for Nursing Informatics. Additional guidance was provided by Susan A. Matney, PhD, RN, FAAN, chair of the LOINC nursing subcommittee nursing special interest group. Description of the other contributors: Role Name Contact Author Connie Delaney Co-Author/Editor Initial Developers Bonnie L. Westra Lisiane Pruinelli Diane Huber Connie Delaney Project Manager Lisiane Pruinelli Project team members Jung In Park Colleen Hart Lynn Choromanski Mary Jo Swanson Tylor Wagner Amar Subramanian Dorcas Kunkel Mary Jo Swanson

6 6 Vocabulary Facilitator Susan Matney Project Sponsor Connie Delaney Subject Matter Expert Amy Garcia Subject Matter Expert Barbara Caspers Scope The scope of this specification is limited to implementing LOINC encoded NMMDS data. The specification is intended for use in the United States, but may be useful internationally. The NMMDS elements were mapped to LOINC database and encoded with LOINC identifiers. The associated answers are also mapped in the LOINC database and are encoded with LOINC Answer (LA) identifiers. The in-scope data elements are specified in the NMMDS update. The resultant March 2015 version of the NMMDS data elements, served as the foundation for the IG. Details for guiding the implementation and use of the NMMDS data includes environment and nurse resource categories. Financial elements, listed in Appendix A, are part of the NMMDS 2007 version, but to date have not been updated. Thus, the 2007 Financial category and data elements are out of the scope of this specification. The scope of this specification covers requirements that support standardized workforce nursing data. The specification complies with the National Database for Nursing Quality Indicators (NDNQI). This specification facilitates operation analysis, research and education. Use Case Scenario The Use Case covered by this specification is the integration of the NMMDS data elements into information systems and the extraction and use of the data for quality improvement, clinical operations improvement, NDNQI benchmarking or to meet Magnet Status recognition, and for research. Informaticians/ HIT staff use the NMMDS definitions and LOINC codes for coding data in information systems, extraction, and aggregation of the NMMDS data elements (see Fig. 1).

7 7 Informaticians code NMMDS data elements using the NMMDS definitions and LOINC codes. They also create data extracts or reports from the data. Nursing Managers and Administrators use aggregate data represented by NMMDS to: o Make decisions for nursing and the health system that improve the health of populations and clinical processes o Meet some NDNQI data reporting o Support data needed for Magnet Status Researchers use NMMDS data (alone or in combination with other data) to address research questions such as the influence of nursing models or staff variables on patient outcomes i.e. prevention of falls. Figure 1: Use Case for the integration of the NMMDS data elements into information system

8 8 SPECIFICATION OVERVIEW Organization of this Specification The data elements in this specification are grouped according to two high level categories: Environment and Nurse Resources. Each high level category contains NMMDS data elements with their associated number, name, definition, and specific LOINC mapping codes. Instructions about integration into information systems are included. The overall hierarchy of these data elements covered by this specification is illustrated in the flowchart below (Fig. 2). Figure 2: Hierarchy of the NMMDS data elements by high level categories

9 9 Convention used in this Implementation Guide This implementation guide follows formatting conventional. 1. The document is divided in Environment and Nurse Resources high level categories. 2. Each category has its own heading with its components. The original NMMDS code number is presented after each subheading in parenthesis. Heading and subheadings are in Bold. 3. Each component has one or more data elements. 4. Each data element has a code number expressing the original coding present in the data set and as the hierarchy inside the terminology. When the NMMDS was updated, some data elements were discontinued, others added. Therefore, numbers may not be sequential. 5. Each data element code is followed by its name. Some of these data elements have definitions, others not. When data elements have definitions, they are present after the name. 6. Each data element code and associated name is presented in Italics. 7. Each data element definition is in regular font formatting. 8. When there is a need to emphasize some context, the word or sentence is in Underlined. 9. Some data elements may use external resources, such as websites. When these resources are present, the hyperlink is present. 10. A data element may have specific types of coding that can be combined with other data elements coding. These specific types of coding are under a title with bottom and top borders, and in Bold. 11. Data elements may be require (R), optional (O) or conditional (C) 12. The LOINC code for each data element is listed after each data element description. 13. The LOINC concept codes and LOINC answers are listed in tables with the associated NMMDS specific code. 14. The type of answer for LOINC is listed in the last column for LOINC and labeled Ex. UCUM Units (Example Unified Code for Units of Measurement). 15. References for each element follow American Medical Association (AMA) guideline and are presented in the end of this implementation guide.

10 10 Use of Vocabulary Standards LOINC is a laboratory and clinical terminology system focused on observation information. LOINC was developed by Regenstrief Institute and the LOINC committee in 1994 and has historically focused on facilitating the exchange of laboratory information (chemistry, hematology, serology, microbiology, toxicology, cell counts, antibiotic susceptibilities, etc.). Subsequently, it was expanded to other clinical information class domains - vital signs, hemodynamics, intake/output, EKG, procedures, survey instruments, and other clinical observations and other assessments (Omaha System survey instruments, Patient Health Questionnaire set, HHS survey, MFS survey, etc.), management data (Nursing Management Minimum Data Set), and document types/attachments (ambulance reports, clinical reports, medication reports, laboratory reports, occupational therapy attachments, medical social work attachment, etc.). The LOINC standardized coding system was chosen to map and distribute the NMMDS because the question-answer format of LOINC matched the format for the NMMDS. That is, each NMMDS data element and sub-element is a question with different types of answers. For instance, one NMMDS data element (19.02) asks for the percent of nurses on a unit or for a service line by gender. The answers are the percent for females, males, or unknown. LOINC also provides an open source distribution of the LOINC coded NMMDS ( The LOINC coding for the NMMDS is available in this implementation guide, as well as on the LOINC website and through LOINC s downloadable software program called RELMA (Regenstrief LOINC Mapping Assistant).

11 11 NURSING MANAGEMENT MINIMUM DATA SET NMMDS The NMMDS document is a collection of data elements divided into two categories: Environment and Nurse Resources. Each of this category includes six unique data elements. Environment The environment is the community and life-style aspects of health that influence client and family need and resources, and their relationship to health care 3. The Environment category is composed of six data elements: Unit/Service Unique Identifier, Type of Nursing Delivery Unit/Service, Patient/Client Population, Volume of Nursing Structure and Outcomes, Patient/Client Accessibility, and Accreditation/Certification/Licensure. Nurse Resources The Nurse Resources category is at the leadership level (management/administration), where nurses in executive nursing practice identify commonalities, as well as differences, of personnel and conditions that are associated with care and care delivery. This category provides elements to measure the care and resource inputs within each setting and across two or more settings 3. Nurse Resources component has six data elements: Staffing, Satisfaction, Nurse Demographics per Unit or Service, Clinical Mental Work, Environmental Conditions, and Electronic Health Records (EHR) Implementation Stages.

12 12 COMPONENT - ENVIRONMENT 01 Facility Unique Identifiers A facility is the highest level of an organization for data aggregation for which unit level data are reported. In some cases, a facility is the same as a unit if there is only one unit Federal Provider Number Facility The National Provide Identifier (NPI) is a unique identification number for health care providers specified by HIPAA. For the NMMDS, the NPI for organizations will be used to indicate the place that sends the bill. (Heart association, Catholic Charities) Facility Name Legal name of the facility Geographic location State or Territory of the facility where the service was provided or originated as defined by the United States Postal Service ( Postal Location (zip code) zip code of the facility where service was provided or originated as defined by the United States Postal Service use a nine digit if possible ( Place of Service Place of service is the location, as indicated on health care professional claims forms, where the service was provided or originated. It is represented by two-digit codes as defined by Centers for Medicare & Medicaid Services (CMS). ( The NMMDS uses the CMS list plus additional codes that end with an x. 1X Stores these may include grocery, pharmacy, department or other stores where retail goods and merchandise are sold 2X Voluntary Health or Charitable Agencies - (e.g., National Cancer Society) Reporting period Starting through end date for the period of time in which LOINC Coding events occurred not when the data are collected or reported Start Date/Time End Date/Time

13 13 LOINC Code NMMDS Component Data Type NMMDS Code NMMDS panel Facility Answer List Facility unique identifier panel Panel Federal provider number Facility Enumerated (See Link) Federal provider name Facility Text State, district or territory federal Enumerated (See abbreviation Facility Link) ZIP code Facility Enumerated (See Link) Place of service Enumerated (See Link) Survey reporting period start date Date Facility Survey reporting period end date Facility Date Type of Nursing Delivery Unit/Service The unique name, identifier, and type of nursing unit or service for each component of the facility Unique Unit Cost Center An identifier given to a cost center by the facility for a unit which only has meaning within the facility; this is the first level of data aggregation beyond the individual patient or care provider Unique Unit Name The name assigned to a unit by the facility, which only has meaning within the facility Type of Nursing Delivery Unit or Service Select all categories that most accurately describe the unit type or specialty (This is the NDNQI List In Appendix D Adult Critical Care Unit Adult Burn Critical Care Unit Adult Cardiothoracic Critical Care Unit Adult Coronary Critical Care Unit Adult Medical Critical Care Unit Adult Neurology Critical Care Unit

14 Adult Pulmonary Critical Care Unit Adult Surgical Critical Care Unit Adult Trauma Critical Care Unit Adult Step-down Unit Adult Med-Surg Step-down Unit Adult Medical Step-down Unit Adult Surgical Step-down Unit Adult Medical Unit Adult Bone Marrow Transplant Medical Unit Adult Cardiac Medical Unit Adult Gastrointestinal Medical Unit Adult Infectious Disease Medical Unit Adult Neurology Medical Unit Adult Oncology Medical Unit Adult Renal Medical Unit Adult Respiratory Medical Unit Adult Surgical Unit Adult Bariatric Surgical Unit Adult Cardiothoracic Surgical Unit Adult Gynecology Surgical Unit Adult Neurosurgery Surgical Unit Adult Orthopedic Surgical Unit Adult Plastics Surgical Unit Adult Transplant Surgical Unit Adult Trauma Surgical Unit Adult Med-Surg Combination Unit Adult Cardiac Med-Surg Combination Unit Adult Neuro/Neurosurgery Med-Surg Combination Unit

15 Adult Oncology Med-Surg Combination Unit Adult Obstetrics Unit Adult Obstetrics Ante-Partum Unit Adult Obstetrics Labor & Delivery Unit Adult Obstetrics Mother/Baby Combined Unit Adult Obstetrics Post-Partum Unit Other Adult Skilled Nursing Unit Other Adult Mixed Acuity Unit Neonatal Level I Neonate-Continuing Care Unit Neonatal Level II Neonate-Intermediate Care Unit Neonatal Level III/IV Neonatal Critical Care Unit Neonatal Well Baby Nursery Unit Neonatal Mixed Acuity Unit Adult Rehabilitation Unit Adult Brain Injury/Spinal Cord Injury Rehabilitation Unit Adult Cardiopulmonary Rehabilitation Unit Adult Neurology/Stroke Rehabilitation Unit Adult Orthopedic/Amputee Rehabilitation Unit Pediatric Rehabilitation Unit Mixed Acuity Rehabilitation Unit Pediatric Critical Care Unit Pediatric Burn Critical Care Unit Pediatric Cardiothoracic Critical Care Unit Pediatric Coronary Critical Care Unit Pediatric Medical Critical Care Unit Pediatric Neurology Critical Care Unit Pediatric Pulmonary Critical Care Unit Pediatric Surgical Critical Care Unit

16 Pediatric Trauma Critical Care Unit Pediatric Step Down Unit Pediatric Med-Surg Step-down Unit Pediatric Medical Step-down Unit Pediatric Surgical Step-down Unit Pediatric Medical Unit Pediatric Bone Marrow Transplant Medical Unit Pediatric Cardiac Medical Unit Pediatric Gastrointestinal Medical Unit Pediatric Infectious Disease Medical Unit Pediatric Neurology Medical Unit Pediatric Oncology Medical Unit Pediatric Renal Medical Unit Pediatric Respiratory Medical Unit Pediatric Surgical Unit Pediatric Bariatric Surgical Unit Pediatric Cardiothoracic Surgical Unit Pediatric Gynecology Surgical Unit Pediatric Neurosurgery Surgical Unit Pediatric Orthopedic Surgical Unit Pediatric Plastics Surgical Unit Pediatric Transplant Surgical Unit Pediatric Trauma Surgical Unit Pediatric Med-Surg Combination Unit Pediatric Cardiac Med-Surg Combination Unit Pediatric Neurology/Neurosurgery Combination Unit Pediatric Oncology Med-Surg Combination Unit Pediatric Mixed Acuity Unit

17 Adult Psychiatric Inpatient Unit Adult General Psychiatric Inpatient Unit Adult Intensive Psychiatric Inpatient Unit Adult Mixed Acuity Psychiatric Inpatient Unit Adolescent Psychiatric Inpatient Unit Adolescent General Psychiatric Inpatient Unit Adolescent Intensive Psychiatric Inpatient Unit Adolescent Mixed Acuity Psychiatric Inpatient Unit Child Psychiatric Inpatient Unit Child General Psychiatric Inpatient Unit Child Intensive Psychiatric Inpatient Unit Child Mixed Acuity Psychiatric Inpatient Unit Child-Adolescent Psychiatric Inpatient Unit Child-Adolescent General Psychiatric Inpatient Unit Child-Adolescent Intensive Psychiatric Inpatient Unit Child-Adolescent Mixed Acuity Psychiatric Inpatient Unit Geripsych Inpatient Unit Geripsych General Psychiatric Inpatient Unit Geripsych Intensive Psychiatric Inpatient Unit Geripsych Mixed Acuity Psychiatric Inpatient Unit Behavioral Health Inpatient Unit Behavioral Health General Psychiatric Inpatient Unit Behavioral Health Intensive Psychiatric Inpatient Unit Behavioral Health Mixed Acuity Psychiatric Inpatient Unit Specialty Psychiatric Inpatient Unit Specialty Psychiatric General Inpatient Unit Specialty Psychiatric Intensive Inpatient Unit Specialty Psychiatric Mixed Acuity Inpatient Unit

18 Multiple Psychiatric Unit Types Inpatient Unit Multiple Psychiatric Unit Types General Inpatient Unit Multiple Psychiatric Unit Types Intensive Inpatient Unit Multiple Psychiatric Unit Types Mixed Acuity Inpatient Unit Other Psychiatric Inpatient or Outpatient Units Psychiatric Day Hospital Outpatient Psychiatric Clinics Psychiatric Residential Unit (no 24/7 nurse) Emergency Department General Emergency Department Obstetrics Emergency Department Pediatric Emergency Department Urgent Care Emergency Department Peri-operative Unit Post Anesthesia Care Unit Pre-Op Holding Operating Room Same Day/Ambulatory Surgery General Ambulatory Care Cardiac Rehabilitation Clinic Outpatient Clinics Outpatient Rehabilitation Clinic Radiation Therapy Clinic Wound Care Clinic Interventional Unit Bronchoscopy Unit Catheterization Lab Unit Dialysis Unit

19 Gastrointestinal Clinic Infusion Unit Pain Management Unit Radiology Unit Short Stay Unit Other Clinic ou Unit Home Health Clinic Hospice/Palliative Care Clinic Long Term Care Unit Patient Preparation/Education Clinic Work Group Clinic Public Health Clinic School Health Clinic Aerospace Clinic Continence Care Clinic Flight Clinic Genetics/Genetics Counseling Clinic Health Promotion Clinic Infection Control Clinic Nutrition Support Clinic Occupational Health Clinic Ophthalmic Clinic Ostomy Care Clinic Reproductive Endocrinology/Infertility Clinic Women's Health Care, Ambulatory Clinic

20 20 LOINC Coding LOINC Code NMMDS Component Data Type NMMDS Code NMMDS panel Facility Answer ID NMMDS Code NMMDS nursing delivery unit or service 02 panel Facility Nursing unit cost center Text Nursing unit name Text Type of nursing unit or service [NDNQI] LL LOINC Answer List Type of nursing unit or service [NDNQI] Answer Set these are the potential values for Type of nursing unit or service from NORMATIVE ANSWER LIST LL Data can be captured at the higher level which are NMMDS codes that are xx or at more granular level, which are codes that are xx.xx. Sequence # NMMDS Component Answer ID NMMDS Code 1 Adult Critical Care Unit LA Adult Burn Critical Care Unit LA Adult Cardiothoracic Critical Care Unit LA Adult Coronary Critical Care Unit LA Adult Medical Critical Care Unit LA Adult Neurology Critical Care Unit LA Adult Pulmonary Critical Care Unit LA Adult Surgical Critical Care Unit LA Adult Trauma Critical Care Unit LA Adult Step-down Unit LA Adult Med-Surg Step-down Unit LA Adult Medical Step-down Unit LA Adult Surgical Step-down Unit LA Adult Medical Unit LA Adult Bone Marrow Transplant Medical LA Unit 16 Adult Cardiac Medical Unit LA Adult Gastrointestinal Medical Unit LA Adult Infectious Disease Medical Unit LA Adult Neurology Medical Unit LA Adult Oncology Medical Unit LA Adult Renal Medical Unit LA Adult Respiratory Medical Unit LA Adult Surgical Unit LA Adult Bariatric Surgical Unit LA Adult Cardiothoracic Surgical Unit LA

21 21 26 Adult Gynecology Surgical Unit LA Adult Neurosurgery Surgical Unit LA Adult Orthopedic Surgical Unit LA Adult Plastics Surgical Unit LA Adult Transplant Surgical Unit LA Adult Trauma Surgical Unit LA Adult Med-Surg Combination Unit LA Adult Cardiac Med-Surg Combination LA Unit 34 Adult Neuro/Neurosurgery Med-Surg LA Combination Unit 35 Adult Oncology Med-Surg Combination LA Unit 36 Adult Obstetrics Unit LA Adult Obstetrics Ante-Partum Unit LA Adult Obstetrics Labor & Delivery Unit LA Adult Obstetrics Mother/Baby Combined LA Unit 40 Adult Obstetrics Post-Partum Unit LA Other Adult Skilled Nursing Unit LA Other Adult Mixed Acuity Unit LA Neonatal Level I Neonate-Continuing Care LA Unit 44 Neonatal Level II Neonate-Intermediate LA Care Unit 45 Neonatal Level III/IV Neonatal Critical LA Care Unit 46 Neonatal Well Baby Nursery Unit LA Neonatal Mixed Acuity Unit LA Adult Rehabilitation Unit LA Adult Brain Injury/Spinal Cord Injury LA Rehabilitation Unit 50 Adult Cardiopulmonary Rehabilitation LA Unit 51 Adult Neurology/Stroke Rehabilitation LA Unit 52 Adult Orthopedic/Amputee Rehabilitation LA Unit 53 Pediatric Rehabilitation Unit LA Mixed Acuity Rehabilitation Unit LA Pediatric Critical Care Unit LA Pediatric Burn Critical Care Unit LA Pediatric Cardiothoracic Critical Care LA Unit 58 Pediatric Coronary Critical Care Unit LA Pediatric Medical Critical Care Unit LA

22 22 60 Pediatric Neurology Critical Care Unit LA Pediatric Pulmonary Critical Care Unit LA Pediatric Surgical Critical Care Unit LA Pediatric Trauma Critical Care Unit LA Pediatric Step Down Unit LA Pediatric Med-Surg Step-down Unit LA Pediatric Medical Step-down Unit LA Pediatric Surgical Step-down Unit LA Pediatric Medical Unit LA Pediatric Bone Marrow Transplant LA Medical Unit 70 Pediatric Cardiac Medical Unit LA Pediatric Gastrointestinal Medical Unit LA Pediatric Infectious Disease Medical LA Unit 73 Pediatric Neurology Medical Unit LA Pediatric Oncology Medical Unit LA Pediatric Renal Medical Unit LA Pediatric Respiratory Medical Unit LA Pediatric Surgical Unit LA Pediatric Bariatric Surgical Unit LA Pediatric Cardiothoracic Surgical Unit LA Pediatric Gynecology Surgical Unit LA Pediatric Neurosurgery Surgical Unit LA Pediatric Orthopedic Surgical Unit LA Pediatric Plastics Surgical Unit LA Pediatric Transplant Surgical Unit LA Pediatric Trauma Surgical Unit LA Pediatric Med-Surg Combination Unit LA Pediatric Cardiac Med-Surg Combination LA Unit 88 Pediatric Neurology/Neurosurgery LA Combination Unit 89 Pediatric Oncology Med-Surg LA Combination Unit 90 Pediatric Mixed Acuity Unit LA Adult Psychiatric Inpatient Unit LA Adult General Psychiatric Inpatient Unit LA Adult Intensive Psychiatric Inpatient LA Unit 94 Adult Mixed Acuity Psychiatric Inpatient LA Unit 95 Adolescent Psychiatric Inpatient Unit LA Adolescent General Psychiatric Inpatient Unit LA

23 23 97 Adolescent Intensive Psychiatric Inpatient LA Unit 98 Adolescent Mixed Acuity Psychiatric LA Inpatient Unit 99 Child Psychiatric Inpatient Unit LA Child General Psychiatric Inpatient Unit LA Child Intensive Psychiatric Inpatient LA Unit 102 Child Mixed Acuity Psychiatric Inpatient LA Unit 103 Child-Adolescent Psychiatric Inpatient LA Unit 104 Child-Adolescent General Psychiatric LA Inpatient Unit 105 Child-Adolescent Intensive Psychiatric LA Inpatient Unit 106 Child-Adolescent Mixed Acuity LA Psychiatric Inpatient Unit 107 Geripsych Inpatient Unit LA Geripsych General Psychiatric Inpatient LA Unit 109 Geripsych Intensive Psychiatric Inpatient LA Unit 110 Geripsych Mixed Acuity Psychiatric LA Inpatient Unit 111 Behavioral Health Inpatient Unit LA Behavioral Health General Psychiatric LA Inpatient Unit 113 Behavioral Health Intensive Psychiatric LA Inpatient Unit 114 Behavioral Health Mixed Acuity LA Psychiatric Inpatient Unit 115 Specialty Psychiatric Inpatient Unit LA Specialty Psychiatric General Inpatient LA Unit 117 Specialty Psychiatric Intensive Inpatient LA Unit 118 Specialty Psychiatric Mixed Acuity LA Inpatient Unit 119 Multiple Psychiatric Unit Types Inpatient LA Unit 120 Multiple Psychiatric Unit Types General LA Inpatient Unit 121 Multiple Psychiatric Unit Types Intensive Inpatient Unit LA

24 Multiple Psychiatric Unit Types Mixed LA Acuity Inpatient Unit 123 Other Psychiatric Inpatient or Outpatient LA Units 124 Psychiatric Day Hospital LA Outpatient Psychiatric Clinics LA Psychiatric Residential Unit (no 24/7 LA nurse) 127 Emergency Department LA General Emergency Department LA Obstetrics Emergency Department LA Pediatric Emergency Department LA Urgent Care Emergency Department LA Peri-operative Unit LA Post Anesthesia Care Unit LA Pre-Op Holding LA Operating room LA Same Day/Ambulatory Surgery LA General Ambulatory Care LA Cardiac Rehabilitation Clinic LA Outpatient Clinics LA Outpatient Rehabilitation Clinic LA Radiation Therapy Clinic LA Wound Care Clinic LA Interventional Unit LA Bronchoscopy Unit LA Catheterization Lab Unit LA Dialysis unit LA Gastrointestinal Clinic LA Infusion Unit LA Pain Management Unit LA Radiology Unit LA Short Stay Unit LA Other Unit or Clinic LA Home Health Clinic LA Hospice/Palliative Care Unit LA Long Term Care Unit LA Patient Preparation/Education Clinic LA Work Group Clinic LA Public Health Clinic LA School Health Clinic LA Aerospace Clinic LA Continence Care Clinic LA Flight Clinic LA Genetics/Genetics Counseling Clinic LA

25 Health Promotion Clinic LA Infection Control Clinic LA Nutrition Support Clinic LA Occupational Health Clinic LA Ophthalmic Clinic LA Ostomy Care Clinic LA Reproductive Endocrinology/Infertility LA Clinic 171 Women's Health Care, Ambulatory Clinic LA Patient/Client Population Characteristics of the population served by nursing delivery unit or service. Identify all categories that best describe the actual patient/client population served by the nursing delivery unit/service Chronological age Percent of the population during the reporting period of the appropriate age served on the nursing delivery unit or service (this is a modification of age categories listed at Fetal days (neonatal) days - 1 year years years years years years years years years years years

26 years years years years years years years years Catchment Area This is an estimate of the percent of patients served by this nursing delivery unit or service by geographical area. Select the smallest geographical unit that best fits the population served Neighborhood City or Town District catchment area County catchment area Parish catchment area State catchment area Region catchment area Nation catchment area World catchment area Aerospace catchment area Nautical catchment area Total Patient Population a count of the patient population during the reporting LOINC Coding period. LOINC Code LOINC component Data Type NMMDS Code Patient/Client Population Population distribution panel (chronological age) % for each age group 03.02

27 Catchment area panel population % for each catchment group Total patient population # # LOINC Answer List Population distribution panel (chronological age) [NMMDS] use answers below Sequence # NMMDS Component Answer Type NMMDS Code Population distribution panel (chronological age) Total population of fetal age population % Total population of age birth to 28 days % population Total population of age 29 days to 1 year % population Total population of age 1-4 years population % Total population of age 5-9 years population % Total population of age years population % Total population of age years population % Total population of age years population % Total population of age years population % Total population of age years population % Total population of age years population % Total population of age years population % Total population of age years population % Total population of age years population % Total population of age years population % Total population of age years population % Total population of age years population % Total population of age years population % Total population of age years population % Total population of age GE 85 years population % Catchment area panel population [NMMDS] use answers below Sequence# NMMDS Component Answer Type NMMDS Code Catchment area panel population Neighborhood catchment area population % [Estimated] City or town catchment area population % [Estimated] District catchment area population [Estimated] % County catchment area population [Estimated] % Parish catchment area population [Estimated] %

28 State catchment area population [Estimated] % Region catchment area population [Estimated] % Nation catchment area population [Estimated] % World catchment area population [Estimated] % Aerospace catchment area population % [Estimated] Nautical catchment area population [Estimated] % Volume of Nursing Delivery Unit/Service The number of nursing encounters with related hours for direct and indirect activities that can be associated with the provision of care to a client for a unit or service during a reporting period. The volume of nursing care is determined by combining a type of encounter with a type of nursing provider with a type of client and then either the designated number of hours per encounter, maximum number of encounters possible or actual number of encounters on a unit for a reporting period. An encounter is an interaction between a provider and a client for the direct provision of health care service(s) 4, Type of Nursing Provider - A designation for nursing personnel based on educational preparation, licensure, or certification Certified Advanced Practice Nurse (APN) Registered Nurse, not APN Licensed Practical/ Vocational Nurse (LPN/ LVN) Unlicensed Assistive Personnel (UAP) i.e. nursing assistant or home health aide Total nursing personnel that includes APN, registered nurse, LPN/ LVN, and UAP Type of Client Individual Client- An individual who can be uniquely identified 6,7 and is the recipient of health care or health related services Family - Two or more individuals affiliated by marriage, birth, adoption, biologic, legal ties, social relationships, significant or close other as identified by the patient or client as family 7-10.

29 Population A group of individuals living in a specific geographic area (e.g., a neighborhood, community, city, or county) or associated with a particular group (e.g. race, ethnicity, age) who experience or are at risk for common health related issues (e.g., exposures, health care resources, outcomes, etc.) Type of Encounter Patient Days - the patient census for a unit or service in a 24 hour period Method 1: Patient Days: Midnight Census The daily number should be summed for every day in the month 12(p1) Method 2: Patient Days: Midnight Census plus Actual Hours for Short Stay Patients - The short stay days should be reported separately from midnight census and will be summed by NDNQI to obtain patient days. The total daily hours for short stay patients should be summed for the month and divided by 24 12(p1) Method 3: Patient Days: Midnight Census plus Average Hours for Short Stay Patients - The short stay average is to be obtained from a special study documenting the time spent by short stay patients on specific unit types. Average short stay days should be reported separately and are added with midnight census to obtain patient days. The average daily hours should be multiplied by the number of days in the month and the product divided by 24 to produce average short stay days 12(p2) Method 4: Patient Days: Actual Hours - Sum actual hours for all patients, whether in-patient or short stay, and divide by 24 12(p2) Method 5: Patient Days from multiple Census Reports - A sum of the daily average censuses can be calculated to determine patient days for the month on the unit 12(p2) Visits - A provider-patient interaction either in person or via telehealth or other face-face technologies.

30 Consults An interaction with a client for whom the nurse is not the primary care provider and was requested to see the client for advice, share information, or exchange views Contacts - An interaction with a client that is not otherwise counted in other categories. Examples might be phone calls, mailing, ing or other methods of connecting with a patient Programs - A focal area of health for groups, communities or populations for which various activities can be associated. Typically this is used in public health such as for TB management and includes interventions such as program planning, management, and evaluation; case finding; education; advocacy; outreach; coalition building; etc. If an activity is included under program, do not include it under other categories such as classes Classes - Two or more patients with a common learning need for which knowledge, skills or attitudes are addressed Number of Hours Designated per Encounter - Estimate of direct and indirect hours of nursing care that are client related including nursing activities that occur away from the [client] (e.g., care coordination, documentation time, travel time, treatment planning) 14. This category does not include all paid hours when activities cannot be directly attributable to the care of a specific client (e.g., sick time, vacation, education leave or orientation) 14. Designated hours of nursing care include hours worked by employees or contract nursing staff, i.e., APN, RN, LPN/LVN, unlicensed assistive personnel (UAP) Encounter Capacity estimate of the number of encounters during a reporting period that could be provided for a unit or service. The estimate is derived from budgeted care on a unit or service for the reporting period Actual Encounters the actual number of encounters during the reporting period by type of encounter selected for a unit or service. LOINC Coding LOINC Code NMMDS Component Data Type NMMDS Code

31 Volume of nursing delivery unit or 04 service panel Type of nursing provider [NMMDS] LL Type of client [NMMDS] LL Type of encounter [NMMDS] LL Hours designated [Estimate] h Care capacity # [Estimate] {#} Care provided # {#} LOINC Answer List Type of nursing provider [NMMDS] - Normative answer list (LL767-5) Sequence # NMMDS Component Answer ID NMMDS Code 1 APN LA RN LA LPN/ LVN LA UAP LA Total nursing personnel LA Type of client [NMMDS] - Normative answer list (LL768-3) Sequence # NMMDS Component Answer ID NMMDS Code 1 Individual LA Family LA Population LA Type of encounter [NMMDS] - Normative answer list (LL769-1) Sequence # NMMDS Component Answer ID NMMDS Code 1 Patient days method 1 LA Patient days method 2 LA Patient days method 3 LA Patient days method 4 LA Patient days method 5 LA Visits LA Consults LA Contacts LA Programs LA Classes LA RECOMMENDED CODING

32 32 Coding includes combining NMMDS data element, type of nurse provider, type of client, type of encounter, and information about the encounter. NMMDS Data element Type of nursing provider Type of client Type of encounter Encounter Details APN 02 RN 03 LPN/ LVN 04 UAP 05 Total nursing personnel 01 Individual 02 Family 03 Population 01 Patient Days Method 1 02 Patient Days Method 2 03 Patient Days Method 3 04 Patient Days Method 4 05 Patient Days Method 5 06 Visits 07 Consults 08 Contacts 09 Programs 10 Classes 01 Hours/ encounter 02 Encounter Capacity 03 Actual Encounters RECOMMENDATIONS FOR EACH TYPE OF NURSE PROVIDER There are some combinations type of encounter and type of client that are not logical. The following are the recommended types of clients and encounter types for each type of nurse provider. For each combination, the reporting unit/ service would always report three numbers: hours/ encounter, encounter capacity, and actual encounters. Certified Advanced Practice Nurse (APN) Individual Family Population Patient Days Method 1 Patient Days Method 2 Patient Days Method 3 Patient Days Method 4 Patient Days Method 5 X X X X X Visits X X X Consults X X X Contacts X X X

33 33 Programs X X Classes X X Registered Nurse, not APN Individual Family Population Patient Days Method 1 Patient Days Method 2 Patient Days Method 3 Patient Days Method 4 Patient Days Method 5 X X X X X Visits X X X Consults X X X Contacts X X X Programs X X Classes X X Licensed Practical/ Vocational Nurse (LPN/ LVN) Individual Family Population Patient Days Method 1 Patient Days Method 2 Patient Days Method 3 Patient Days Method 4 Patient Days Method 5 X X X X X Visits X X X Contacts X X X Programs X X

34 34 Classes X X Unlicensed Assistive Personnel (UAP) i.e. nursing assistant or home health aide Individual Family Population Patient Days Method 1 Patient Days Method 2 Patient Days Method 3 Patient Days Method 4 Patient Days Method 5 X X X X X Visits X X X Contacts X X X Programs X X Classes X X Total Nursing Personnel Individual Family Population Patient Days Method 1 Patient Days Method 2 Patient Days Method 3 Patient Days Method 4 Patient Days Method 5 X X X X X Visits X X X Consults X X X Contacts X X X Programs X X Classes X X

35 35 05 Care Delivery Structure and Outcomes The ways in which nursing work is organized for a unit or service. Methods differ and are delineated by nursing responsibilities and accountability for how work is planned, delivered, resources allocated, and care coordinated 16, Functional - Nursing care organized and delineated by the specific tasks and technical aspects provided to a group of patients/clients Team - Nursing care organized by a registered nurse who has the authority and accountability for planning, coordinating, and evaluating nursing care for a group of patients/clients and for directing a team of professional and non-professional providers and assistants Total Patient Care - Nursing care organized by registered nurse who has the authority and accountability for assessing, planning, coordinating, delivering, and evaluating nursing care for one or more patients/clients for a work shift 17,19, Primary Nursing - Nursing care organized by a registered nurse who has the authority and accountability for assessing, planning, coordinating, delivering and evaluating nursing care for a group of patients/ clients throughout their length of stay. When not present to provide care, the primary nurse s (RN s) responsibility is delegated to associate nursing personnel who implement care according to the care plan devised by the primary nurse 17-19, Case Management - Nursing care organized by a registered nurse who has the authority and accountability for advocating, assessing, planning, implementing, coordinating, monitoring and evaluating options and services in order to meet client needs to promote care across the continuum, decrease fragmentation and duplication of care, and to enhance quality and cost-effectiveness of care 17,22, Managed Care - A broad continuum of entities, from the simple requirement of prior authorization for a service in an indemnity health insurance plan to the assumption of all legal, financial, and organizational risks, for the provision of a set of comprehensive benefits to a defined population. Also, the management of

36 healthcare clinical services supplied by groups of providers with the aims of cost effectiveness, quality, and accessibility 24(p29) Advanced Practice Nursing - A model of nursing practice that is provided and/ or LOINC Coding directed by an advanced practice nurse with advanced education and national certification such as a certified registered nurse anesthetist (CRNA), certified nurse-midwife (CNM), clinical nurse specialist (CNS), and certified nurse practitioner (CNP) for a specialty population i.e. family/individual across the lifespan, adult-gerontology, pediatrics, neonatal, women s health/gender-related or psych/mental health. (p.6, Accessed 4 April 2009, from Regulation.aspx) 25. LOINC Code NMMDS Component Answer ID NMMDS Code Method of care delivery LL LOINC Answer List Method of care delivery [NMMDS] - Normative answer list for LL Sequence # NMMDS Component Answer ID NMMDS Code 1 Functional LA Team LA Total patient care LA Primary nursing LA Case management LA Managed care LA Advanced practice nursing LA Patient/Client Accessibility The time, distance and method to connect the nurse/provider and client for an encounter and includes the information, supplies, equipment and personnel required for the encounter. Glossary of Terms in Revised NMMDS Element 6: Method - The way of connecting for a provider-client encounter (e.g., walking, driving, telephone, , etc.) or types of procedures/processes used to connect with clients (e.g., synchronous or asynchronous communications).

37 37 Encounter - An interaction between a provider and a client for the direct provision of health care service(s). Essential Resources - Information, supplies, equipment and personnel resources needed for a client encounter. Information - Facts, opinions, or algorithms that are capable of being transmitted or reproduced and reduce uncertainty Supplies - Consumable items used for health related interventions. These may be located on a care unit or may require delivery (e.g. blood, durable medical equipment). Equipment - Devices that can be used repeatedly for a health related purpose (e.g., blood pressure cuff, oxygen delivery system, bed, etc.). Personnel - Nursing personnel who provide direct or indirect services that support provision of care during a client encounter. Personnel now are defined as nursing personnel but in the future this could include other personnel (e.g. physicians, nurses, occupational therapists, transport personnel, unit secretaries, etc.). * Note, previous measures were discontinued for this NMMDS data element Average time (in minutes) to access the client per encounter Average distance required to travel for an encounter Method used to connect with client for an encounter (select all that apply) walking motorized vehicle nonmotorized vehicle (i.e. bicycle) asynchronous electronic communication e.g., or blogging synchronous communication e.g., telephone, telehealth video visit monitoring the client from the nurses station e.g., remote camera monitoring monitoring the client observing in client(s) room e.g., sitting in client room Average time (in minutes) required to gather essential resources for an encounter

38 Average distance (in meters) required to gather essential resources for an LOINC Coding encounter. LOINC Code NMMDS Component Data Type NMMDS Code Client accessibility panel [NMMDS] Time to access a patient [NMMDS] min Time to access all patients in a Report Period min [NMMDS] Total number of patient encounters in a {#} reporting period [NMMDS] Average time to access a patient in a Report min Period [NMMDS] Distance to access a patient [NMMDS] m Distance to access all patients in a Report m Period [NMMDS] Average distance to access a patient in a m Report Period [NMMDS] Method used to connect with a patient [NMMDS] Time required to gather essential resources min for a patient encounter [NMMDS] Time required to gather essential resources min for all patient encounters in a Report Period [NMMDS] Average time required to gather essential min resources for a patient encounter in a Report Period [NMMDS] Distance required to gather essential m resources for a patient encounter [NMMDS] Distance required to gather essential m resources for all patient encounters in a Report Period [NMMDS] Average distance required to gather essential resources for a patient encounter in a Report Period [NMMDS] m LOINC Answer List Method used to connect with a patient [NMMDS] - Normative answer list for LL Sequence # NMMDS Component Answer ID NMMDS Code 1 Walking LA

39 39 2 Motorized vehicle LA Nonmotorized vehicle (e.g. bicycle) LA Asynchronous electronic communication LA (e.g., , blogging) 5 Synchronous communication (e.g., telephone, LA telehealth video visit) 6 Monitoring from the nurses station (e.g., LA remote camera monitoring) 7 Monitoring in the client(s) room (e.g., sitting in client room) LA Accreditation/Certification/Licensure Indicate quality assurance organizations of the nursing delivery unit/service by 3 different quality measure categories. Use all that apply. Accreditation - Accreditation is a seal of approval given by private, nationally recognized groups that check on the quality of care at health care facilities and organizations. Health care organizations must meet certain quality standards in order to be accredited 26. Certification- Certification is the formal recognition of the knowledge, skills, and experience demonstrated by the achievement of standards that are identified by the profession (ANA, 2009) 27. Licensure - Licensure is the granting of authority to practice (ANA, 2009) 27. State agencies determine the requirements for licensure and examine the competency necessary to meet quality standards Accreditation The Joint Commission Accreditation Accreditation Association for Ambulatory Health Care (AAAHC) Accreditation Commission for Health Care, Inc. (ACHC) American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) American Osteopathic Association (AOA) Accreditation Program Healthcare Facilities Accreditation Program (HFAP) Community Health Accreditation Program (CHAP) DNV Healthcare (DNVHC) Accreditation Program 35

40 Certification The Joint Commission Certification DNV (Det Norske Veritas) Healthcare Accreditation Program Medicare Certification Licensure LOINC Coding State Licensure LOINC Code NMMDS Component Answer ID NMMDS Code NMMDS accreditation, certification, and 10 licensure panel Applicable accrediting agency for unit LL Accreditation received LL Applicable certification agency for unit Certification received Applicable licensing agency for unit LL Licensing received LL LOINC Answer List Applicable accrediting agency for unit [NMMDS] - Normative answer list for LL Accreditation received [NMMDS] - Normative answer list for LL Sequence # NMMDS Component Answer ID NMMDS Code 1 The Joint Commission Accreditation LA Accreditation Association for Ambulatory LA Health Care 3 Accreditation Commission for Health Care, Inc. LA American Association for Accreditation of LA Ambulatory Surgery Facilities (AAAASF) 5 American Osteopathic Association (AOA) LA Accreditation Program 6 Healthcare Facilities Accreditation Program LA (HFAP) 7 Community Health Accreditation Program LA (CHAP) 8 DNV Healthcare (DNVHC) Accreditation Program

41 Applicable certification agency for unit [NMMDS] - Normative answer list for LL Certification received [NMMDS] - Normative answer list for LL3062-8: Sequence # NMMDS Component Answer ID NMMDS Code 1 The Joint Commission Certification LA DNV (Det Norske Veritas) Healthcare LA Certification 2 Medicare Certification LA Applicable licensing agency for unit [NMMDS] - Normative answer list for LL Licensing received [NMMDS] - Normative answer list for LL Sequence # NMMDS Component Answer ID NMMDS Code 1 State Licensure LA COMPONENT - NURSE RESOURCES 13 Staffing The quantity, turnover and retention of nurse staffing by direct care and management position on a nursing delivery unit/service for a reporting period (dd/mm/yy). For this survey, New Nursing Staff is any nurse that starts a new job position Nursing Staff Job Positions - The nursing staff position on a unit or service during the reporting period Direct Care Staff: The direct care staff positions on a unit or service during the reporting period (dd/mm/yy) Advanced Practice Nurses Registered Nurses reporting to department of nursing Licensed Practical Nurses/Licensed Vocational Nurses reporting to department of Nursing Nurse Aids or Equivalent extenders Nursing Students Agency/Travelers Staff Independent Contractors/ Sub-contractors

42 Management, Administrative, Support Staff: The management, administrative, or support staff on a unit or service during the reporting period Case Manager Nurse Manager Staff Development/ Educators Researchers Nursing Quality Improvement (QI) Staff Support Staff (e.g. unit clerks, environmental aids, techs) Nursing Staff Quantity - The number of staff, number of full time equivalents (FTE) hours, and average daily productive staff by position Number of Actual Staff - The number of total staff actually working by position during the reporting period (dd/mm/yy) FTEs of Actual Staff - The number of full time equivalent (FTE) hours of total staff actually working by position during the reporting period (dd/mm/yy). An FTE is equivalent 2080 hours per year which includes any paid time, for example - hours working, vacation, sick time, leave of absence or other paid activity Number of Budgeted Staff - The number of total staff budgeted by position during the reporting period (dd/mm/yy) FTEs of Budgeted Staff -The number of full time equivalent (FTE) hours of total staff budgeted by position during the reporting period (dd/mm/yy). An FTE is equivalent 2080 hours per year which includes any paid time, for example - hours working, vacation, sick time, leave of absence or other paid activity Productive staff - All staff available for care/service provision, excluding e.g.: vacation, disability, or any other type of paid time off Number of New Nurses by Job position - the number of new nursing staff by job position hired during the reporting period

43 Number of New Nurses by Job Position who remained the number of new nurses hired during the reporting period who remained at the end of the reporting period Number of New Nurses by Job Position who left - the number of new nurses hired during the reporting period who left by the end of the reporting period Number of Nursing Staff by Position at Beginning of reporting period Nursing staff by job position at the beginning of the reporting period these are considered preexisting staff and does not include newly hired staff during the reporting period Number of Nursing Staff at Beginning of the reporting by Position who remained (preexisting staff) Number of Nursing Staff at Beginning of the reporting period by Position who left (preexisting staff) Number of Nursing Staff by Position who left. It includes both voluntary and involuntary turnover for newly hired and preexisting staff by job position. ( ) Average Number of Nursing Staff by Position in a Unit or Service. It is obtained by adding the nurses by position at the beginning and end of the period (dd/mm/yy) and dividing by two Number of Nursing Staff Positions that are unfilled Nursing Staff Turnover - Turnover is the percent of nurses by position who are leaving a unit or service either voluntarily or involuntarily Voluntary Turnover 36 - The percent of nurses by position assigned to a unit or service during the reporting period (dd/mm/yy) who self-report a personal choice to transfer or terminate. It includes both full and part time nurses. It excludes terminations due to death, illness, or turnover due to organizational reasons rather than individual reasons.

44 Transfer Voluntary Turnover - The percent of nurses by position assigned to a unit or service during the reporting period (dd/mm/yy) who self-report choosing to transfer Terminate Voluntary Turnover - The percent of nurses by position assigned to a unit or service during the reporting period (dd/mm/yy) who self-report choosing to terminate Involuntary Turnover - The percent of nursing staff by type of job position who leave from a unit or service due to illness, death, or organizational decisions including promotions, layoffs, transfers, dismissals, or involuntary retirements. It includes both full and part time nurses Turnover rate 37 - The percent of nursing staff by position who left the unit or service during a reporting period (dd/mm/yy). The number of staff who left includes both voluntary and involuntary turnover. The calculation is based on the number of staff assigned to the unit during the reporting period. Number of Nurses by Position who left ( ) Average Number of Nurses by Position in a Unit or Service ( ) Vacancy rate - The percent of positions that are unfilled by nursing staff job position divided by the total number of positions budgeted during the reporting period (dd/mm/yy). Number of Nurse Positions that are unfilled ( ) Average Number of Nurses by Position in a Unit or Service ( ) Number of Budgeted Positions Filled Nursing Staff Retention Accession Rate 37 - The percent (%) of new nursing staff by job position who stayed during a specified period of time. It is the number of new nursing staff by job position added during the reporting period (dd/mm/yy) divided by the average number of nurses by position in a unit or service.

45 45 Number of New Nurses by Position ( ) Average Number of Nurses by Position in a Unit or Servive ( ) Stability Rate 37 - The percent (%) of nursing staff employed by position at the beginning of the period (dd/mm/yy) and who still stayed at the end of the period (dd/mm/yy). It is calculated by dividing the number of beginning nurses remaining by position during the reporting period (dd/mm/yy) by the total number of nurses by position at the start of the period (dd/mm/yy). Number of Beginning Nurses by Position who remained ( ) Number of Nurses by Position at Beginning ( ) Instability Rate 37 - The percent (%) of nursing staff employed by position at the beginning of the period (dd/mm/yy) but who left at the end of the period of time (dd/mm/yy). It is calculated by the number of new nursing staff by job position leaving during the reporting period (dd/mm/yy) by the number of new nursing staff by job position at the start of the reporting period (dd/mm/yy). Number of Beginning Nurses by Position who left ( ) Number of Nurses by Position at Beginning ( ) Survival Rate 37 - The percent (%) of newly hired nurses who remained during a reporting period (dd/mm/yy). It is calculated by dividing the number of new nursing staff by job position remaining during the reporting period (dd/mm/yy) divided by the number of new nurses by position. Number of New Nurses by Position who remained ( ) Number of New Nurses by Position ( ) Wastage Rate 37 - The percent (%) of newly hired nurses who left during a specified period of time (dd/mm/yy). It is calculated by dividing the number of new nurses by position leaving by the number of new nurses by position. Number of New Nurses by Position who left ( ) Number of New Nurses by Position ( ) 100

46 46 LOINC Coding LOINC Code NMMDS Component Data Type NMMDS Code Nursing staff job positions, quantity, turnover, 13 and retention panel [NMMDS] Nursing staff job positions panel [NMMDS] Direct care staff [NMMDS] Management, administrative, AndOr support staff [NMMDS] Nursing staff quantity panel [NMMDS] Number of actual nursing staff by job position {#} in a reporting period [NMMDS] Full time equivalent hours of actual nursing h staff [NMMDS] Number of budgeted nursing staff by job {#} position in a reporting period [NMMDS] Full time equivalent hours of budgeted h nursing staff [NMMDS] Number of productive staff in a reporting {#} period [NMMDS] Number of new nursing staff by job position {#} in a reporting period [NMMDS] Number of new nursing staff by job position {#} who remained in a reporting period [NMMDS] Number of new nursing staff by job position {#} who left in a reporting period [NMMDS] Number of nursing staff by job position at {#} beginning of a reporting period [NMMDS] Number of nursing staff by job position at {#} beginning of a reporting period who remained [NMMDS] Number of nursing staff by job position at {#} beginning of a reporting period who left [NMMDS] Number of nursing staff by job position who {#} left in a reporting period [NMMDS] Average number of nursing staff by job {#} position in a reporting period [NMMDS] Number of unfilled nursing staff job positions {#} in a reporting period [NMMDS] Nursing staff turnover panel [NMMDS] Nursing staff.voluntary turnover/nursing staff % [NMMDS] Nursing staff.voluntary turnover.transfer/ Nursing staff [NMMDS] %

47 Nursing staff.voluntary turnover.terminate/ % Nursing staff [NMMDS] Nursing staff.involuntary turnover/nursing % staff [NMMDS] Turnover rate [NMMDS] % Vacancy rate [NMMDS] % Number of budgeted nursing staff job {#} positions filled in a reporting period [NMMDS] Nursing staff retention panel [NMMDS] Accession rate [NMMDS] % Stability rate [NMMDS] % Instability rate [NMMDS] % Survival rate [NMMDS] % Wastage rate [NMMDS] % LOINC Answer List Direct care staff [NMMDS] - Normative list for LL Sequence # NMMDS Component Answer ID NMMDS Code 1 Advanced Practice Nurses LA Registered Nurses reporting to department of LA nursing 3 Licensed Practical Nurses/Licensed Vocational LA Nurses reporting to department of nursing 4 Nurse Aids or Equivalent extenders LA Nursing Students LA Agency/Travelers Staff LA Independent Contractors/ Sub-contractors LA Management, administrative, AndOr support staff [NMMDS] Normative answer list for LL390-8 Sequence # NMMDS Component Answer ID NMMDS Code 1 Case Manager LA Nurse Manager LA Staff Development/ Educators LA Researchers LA Nursing Quality Improvement (QI) Staff LA Support Staff (e.g. unit clerks, environmental aids, techs) LA

48 48 14 Satisfaction Reporting period - dates satisfaction survey completed are within the reporting period (dd/mm/yy) (See NMMDS 1) Facility this is the highest level of aggregation of reporting in which one or many units may report to a facility (See NMMDS 1) Unit this is the level of analysis used in the NMMDS (See NMMDS) Nursing job class: 1. Direct Care Staff 2. Management 3. Administrative 4. Support Staff Job satisfaction survey if the facility has a job satisfaction survey, questions should be mapped to these 10 items. If not, then it is suggested using this survey. The job satisfaction variable is captured in the facility data base indicating that the survey was mapped or added as a record to a staff person during the reporting period (dd/mm/yy). Satisfaction survey questions this would include each of the 10 questions in the survey and the answer to the question ranging from 1 5. The satisfaction items were adapted from Hackman and Oldham s General Job Satisfaction measures from the Job Diagnostic Survey (JDS) 38,39. Scale: 1=strongly disagree; 2=disagree; 3=neutral; 4=agree; 5=strongly agree Generally speaking, I am very satisfied with this job I rarely think of quitting this job I am generally satisfied with the kind of work I do in this job Most nursing staff on this job are very satisfied with the job Nursing staff on this job rarely think of quitting Generally speaking, I am very satisfied with nursing management Generally speaking, I am very satisfied with nursing administration Generally speaking, I am very satisfied with interactions with physicians.

49 Generally speaking, I am very satisfied with interactions with nonphysician health care team members Generally speaking, I am very satisfied with my own level of autonomy Total number staff taking survey LOINC Coding LOINC Code NMMDS Component Answer ID NMMDS code NMMDS job satisfaction panel Panel Nursing job class [NMMDS] Panel Generally speaking, I am very satisfied with LL this job I rarely think of quitting this job LL I am generally satisfied with the kind of work I LL do in this job Most nursing staff on this job are very satisfied LL with the job Nursing staff on this job rarely think of quitting LL Generally speaking, I am very satisfied with LL nursing management Generally speaking, I am very satisfied with LL nursing administration Generally speaking, I am very satisfied with LL interactions with physicians Generally speaking, I am very satisfied with LL interactions with non-physician health care team members Generally speaking, I am very satisfied with my LL own level of autonomy Total number of staff completing the job satisfaction survey LL LOINC Answer List NMMDS job satisfaction panel - Normative answer list for LL Sequence # NMMDS Component Answer ID NMMDS Code 1 Strongly disagree LA Disagree LA Neutral LA Agree LA Strongly agree LA

50 50 Instructions The normative answer list is used for all satisfaction questions. The percent of staff for each of the satisfaction questions can be calculated by either all staff assigned to a unit or by job class for a specified reporting period (dd/mm/yy). The denominator is the total number of staff assigned to a unit during the reporting period or the total number of staff by job class. The numerator is the number of staff by each satisfaction question either for the total unit or by job class. 19 Nurse Demographics per Unit or Service NMMDS 19 includes the demographics and profiles of the nursing personnel on a unit or in a place of service. NMMDS 19 replaces the previous NMMDS 11 and NMMDS Employment position 41,42 - Percent of staff on a nursing unit or service line with primary job title with assigned responsibilities Advanced Practice Registered Nurse (APRN) - A registered nurse (RN) who has a graduate degree and advanced knowledge including nurses with masters or doctoral degrees Advanced Practice Nurse (APN) An RN who has a graduate degree with a specific specialty (Nurse Practitioner, Certified Registered Nurse Anesthetist, Certified Nurse-Midwife and Clinical Nurse Specialist, or other graduate specialties) and may be licensed and or certified to practice nursing at an advanced level with substantial autonomy and independence and a high level of accountability Nurse Consultant (NC) - An RN who provides advice or expertise in the field of nursing regarding such issues as nursing education, nurse staffing, nurse policy, etc Nurse Researcher (NR) - An RN who conducts research in the field of nursing Nurse Executive (NE) - An RN involved with management and administration concerns.

51 Nurse Manager (NM) - A nurse who has line management position with 24-hour accountability for a designated patient care services which may include operational responsibility for patient care delivery, fiscal and quality outcomes Nurse Faculty (NF) - A RN employed by a school of nursing or other type of nursing education program; nurse faculty are generally involved in teaching, research and service Staff Nurse (SN) - A nurse in direct patient care who is responsible for the treatment and well-being of patients Gender 43 - The behavioral, cultural, or psychological traits typically associated with one sex. Percent of licensed staff on a nursing unit or service line by gender (see for license type) Female Male Unknown Race/Ethnicity 44 A class or kind of people unified by shared interests, habits, or characteristics or a category of humankind that shares certain distinctive physical traits. Percent of licenses staff on a nursing unit or service line by race/ ethnicity (see for license type) American Indian/Alaska Native Asian Black/African American Native Hawaiian/Other Pacific Islander White/Caucasian Hispanic/Latino Age of Staff - Age by five-year increments of staff member at the start of the reporting period (See NMMDS for reporting period) Percent of licenses staff on a nursing unit or service line by age (see for license type) years old

52 years old years old years old years old years old years old years old years old years old years old years old years old Entry Level Nursing Degree - The degree a nurse first completes to enter into nursing practice Licensed Practical /Licensed Vocational degree- Nursing Associate degree- Nursing Diploma- Nursing Baccalaureate degree- Nursing Master's degree- Nursing Doctoral degree- Nursing Practice (DNP) Doctoral degree- Nursing (PhD) Doctoral degree- Nursing, Other Highest Level of Education in a Nursing Degree - The highest level of education in a nursing degree Licensed Practical Licensed Vocational degree- Nursing Associate degree- Nursing Diploma- Nursing Baccalaureate degree- Nursing

53 Master's degree- Nursing Doctoral degree- Nursing Practice (DNP) Doctoral degree- Nursing (PhD) Doctoral degree- Nursing, Other Highest Level of Education in Non-Nursing Degree - The highest level of education in non-nursing degree obtained by a nurse in a non-nursing field Associate degree - Non-Nursing Baccalaureate degree - Non-Nursing Master's degree- Non-Nursing Doctoral degree- Non-Nursing Nursing License Type Licensed Practical Nurse or Licensed Vocational Nurse (LPN/LVN) -An individual who holds a current license to practice as a practical or vocational nurse in at least one state with jurisdiction of the United States Registered Nurse (RN) - An individual who holds a current license to practice within the scope of professional nursing in at least one jurisdiction of the United States Advanced Practice RN - Includes all advanced license statuses for your state Nursing Certification A process of verifying that an RN, who through a formal post-basic education program has developed expertise within a specialty area of nursing practice. Certification is conducted by an independent and unbiased credentialing testing center Acute Care NP Adult NP Adult Psychiatric-Mental Health NP Adult-Gerontology Acute Care NP Adult-Gerontology Primary Care NP

54 Diabetes Management- Advanced Family NP Family Psychiatric- Mental Health NP Gerontological NP Pediatric NP School NP Adult- Gerontology CNS Adult Health CNS Adult Psychiatric- Mental Health CNS Child/ Adolescent Psychiatric- Mental Health CNS Gerontological CNS Home Health CNS Pediatric CNS Public/ Community Health CNS Ambulatory Care Nursing Cardiac Rehabilitation Nursing Cardiac- Vascular Nursing Certified Vascular Nurse College Health Nurse Community Health Nursing General Nursing Practice Gerontological Nursing High- Risk Perinatal Nursing Home Health Nursing Informatics Nursing Medical- Surgical Nursing Nurse Executive Nurse Executive, Advanced

55 Nursing Case Management Nursing Professional Development Pain Management Nursing Pediatric Nursing Perinatal Nursing Psychiatric- Mental Health Nursing Public Health Nursing- Advanced School Nursing CWOCN CWCN CWON CCCN COCN Certified Nurse-Midwives (CNMs) Employment Specialty Acute care/critical Care - Nurses in this specialty provide care to patients with acute conditions. They also provide care to pre- and postoperative patients Anesthesia - Nurses in this specialty provide care to patients receiving anesthesia during operative procedures Geriatric/Gerontology - Nurses in this specialty provide the special care needed in rehabilitating and maintaining the mental and physical health of the elderly Home Health - Nurses in this specialty provide care for people in their homes, such as those recovering from illness, an accident, or childbirth Informatics 48 - Nurses in this specialty integrate computer science, information science, and nursing science and information to provide support of patients, nurses, and providers to provide knowledge, data integration, information processing, and technology communication.

56 Maternal-Child Health - Nurses in this specialty provide medical and surgical treatment to pregnant women and to mother and baby following delivery Medical/Surgical - Nurses in this specialty provide diagnostic and therapeutic services to acutely ill patients for a variety of medical conditions, both surgical and non-surgical Occupational Health - Nurses in this specialty provide on-the-job health care for the nation's workforce, striving to ensure workers' health, safety, and productivity Oncology - Nurses in this specialty provide care and support for patients diagnosed with cancer Palliative Care - Nurses in this specialty provide sensitive care and pain relief to patients in the final stages of life Pediatrics/Neonatal - Nurses in this specialty provide care and treatment to young patients ranging in age from infancy to late teens; provide care and support for very sick or premature newborn babies Public Health - Nurses in this specialty provide population-based community services Psychiatric/Mental Health/Substance Abuse - Nurses in this specialty aid and support the mental health of patients with acute or chronic psychiatric needs; pain management nurses who help regulate medications and provide care Rehabilitation - Nurses in this specialty provide physical and emotional support to patients and the families of patients with illnesses or disabilities that affect their ability to function normally and that may alter their lifestyle School Health - Nurses in this specialty are dedicated to promoting the health and well-being of children of all ages in an academic environment

57 Trauma - Nurses in this specialty provide emergency care to patients of all ages. These nurses work to maintain vital signs and prevent complications and death Women's Health - Nurses in this specialty provided care for women across the life cycle with emphasis on conditions that are particular to women NPI (National Provider unit level) 49 - This number will provide a unique national provider number to every Medicare health care provider Yes No LOINC Coding LOINC Code NMMDS Component Answer ID NMMDS Code Licensed nurse demographics per unit or service panel Panel Employment position panel [NMMDS] Panel Nurse employment position Provider [NMMDS] LL Licensed nursing personnel # Licensed nursing personnel.employment position [NMMDS] # Licensed nursing personnel.employment position/ Licensed nursing personnel.nursing unit % Licensed nursing personnel and sex panel [NMMDS] Panel Sex of Provider [NMMDS] LL Licensed nursing personnel [NMMDS] # Licensed nursing personnel.sex[nmmds] # Licensed nursing personnel.sex/ Licensed nursing personnel.nursing unit [NMMDS] % Race or ethnicity panel [NMMDS] Panel Race or ethnicity of Provider [NMMDS] LL Licensed nursing personnel # [NMMDS] # Licensed nursing personel.race or ethnicity # [NMMDS] #

58 58 Licensed nursing personel.race or ethnicity/ Licensed nursing personnel.nursing unit [NMMDS] % Age category panel [NMMDS] Panel Nurse age range Provider [NMMDS] LL Licensed nursing personnel # [NMMDS] # Licensed nursing personnel.age range # [NMMDS] # Licensed nursing personnel.age range/ Licensed nursing personnel.nursing unit [NMMD] % Entry level nursing degree panel [NMMDS] Panel Entry level nursing degree Provider [NMMDS] LL Licensed nursing personnel # [NMMDS] # Licensed nursing personnel.entry level nursing degree # [NMMDS] # Licensed nursing personnel.entry level nursing degree/ Licensed nursing personnel.n % Highest level of education in a nursing degree panel [NMMDS] Panel Highest level of education in a nursing degree Provider [NMMDS] LL Licensed nursing personnel # [NMMDS] {#} # Licensed nursing personnel.highest level of education in a nursing degree # [NMMDS] # Licensed nursing personnel.highest level of education in a nursing degree/ Licensed % Highest level of education in non-nursing degree panel [NMMDS] Panel Highest level of education in a non-nursing degree Provider [NMMDS] LL Licensed nursing personnel # [NMMDS] # Licensed nursing personnel.highest level of education in a non-nursing degree # [NMMDS] # Licensed nursing personnel.highest level of education in a non-nursing degree/ Licensed.nursing unit [NMMDS] % Nursing license type panel [NMMDS] Panel Primary nursing license type Provider [NMMDS] LL Licensed nursing personnel # [NMMDS] # Licensed nursing personnel.primary nursing license type # [NMMDS] #

59 59 Licensed nursing personnel.primary nursing license type/licensed nursing personnel.nursing unit % Nursing certification panel [NMMDS] Panel Nursing certification Provider [NMMDS] LL Licensed nursing personnel # [NMMDS] {#} # Licensed nursing personnel.nursing certification # [NMMDS] # Licensed nursing personnel.nursing certification/ Licensed nursing personnel.nursing unit [NMMDS] % Employment specialty panel [NMMDS] Panel Nurse employment specialty Provider [NMMDS] LL Licensed nursing personnel # [NMMDS] # Licensed nursing personnel.employment specialty # [NMMDS] # Licensed nursing personnel [NMMDS] % National provider indentifier panel [NMMDS] Panel Provider has a national provider ID LL Registered nurse personnel # [NMMDS] # Registered nurse personnel.national provider ID # [NMMDS] # Registered nurse personnel.national provider ID/ Registered nurse personnel.nursing unit [NMMDS] % 20 Clinical Mental work The level of knowledge and decision-making required to perform role appropriate and acceptable work on a nursing unit/service by type of nurse provider; and the Mental Workload associated with the clinical work 50. Type of Nursing Provider - A designation for nursing personnel based on educational preparation, licensure, or certification APN 2. Registered Nurse, not APN 3. Licensed Practical/ Vocational Nurse (LPN/ LVN) 4. Unlicensed Assistive Personnel (UAP) i.e. nursing assistant or home health aide. 5. Total nursing personnel

60 Knowledge Required - The level of knowledge required by nursing personnel to perform work on the unit or service. Estimate the % distribution of Knowledge required for the Unit/Service by nursing personnel Knowledge required Level 1 - Knowledge of simple routine or repetitive tasks or operations that require little or no previous training or experience Knowledge required Level Knowledge of basic or commonly used rules, procedures, or operations that requires some previous training or experience Knowledge required Level Knowledge of basic or commonly used nursing procedures which are reflected in licensure followed by training as a practical nurse or vocational nurse Knowledge required Level Knowledge of a body of standardized rules, procedures, or operations that require considerable training and experience to perform the full range of standard nursing assignments and resolve recurring problems Knowledge required Level Knowledge reflected in licensure followed by training as a practical or vocational nurse and sufficient work experience to demonstrate skill sufficient to perform moderately difficult range of practical nursing care Knowledge required Level 4-1- Knowledge of a wide variety of interrelated or nonstandard assignments reflected in licensure as a practical or vocational nurse and a broad work experience that demonstrated skill sufficient to resolve a range of problems with responsibility for carrying assignments to completion.

61 Knowledge required Level A knowledge of nursing comparable to that acquired through completion of a two year college level program in nursing Knowledge required Level 5 - A basic knowledge of professional nursing concepts, principles and practices comparable to that acquired in the 3 year diploma or 4 year baccalaureate program Knowledge required Level 6 - Professional knowledge of established concepts, principles and practices to perform professional nursing assignments of moderate difficulty requiring training equivalent to an educational program leading to a bachelor's degree and additional training or experience Knowledge required Level 7 - Professional knowledge of a wide range of nursing concepts, principles, and practices to perform highly specialized nursing assignments of advanced nature and considerable difficulty requiring extended specialized training and experience Knowledge required Level 8 - Mastery of nursing to apply experimental theories and new developments to the solution of complex health care problems not susceptible to treatment by accepted methods; or to make decisions or recommendations significantly changing, or developing, important public policies or programs; or equivalent knowledge Knowledge required Level 9 - Mastery of the profession of nursing to generate new hypotheses and develop new theories; or equivalent knowledge Decision-Making Required - The nature and extent of choice identifying/selecting that a worker must conduct to do acceptable work. Estimate the percentage of nursing personnel working on the unit or service by decision-making level Decision-making required level 1 - Decisions require little or no choice as: work consists of a few, simple, clear-cut, directly related and quickly learned actions.

62 Decision-making required level 2 - Decisions that involve various choices that require the employee to recognize the existence of and differences among a few easily recognizable situations Decision-making required level 3 - Decisions that depend upon the analysis of the subject phase, or issues involved in each assignment, and the chosen course of action may have to be selected from many alternatives Decision-making required level 4 - Decisions regarding what needs to be done include the assessment of unusual circumstances, variations in approach, and incomplete and conflicting data Decision-making required level 5 - Decisions regarding what needs to be done include major areas of uncertain issues and elements as the work requires originating new techniques, establishing criteria, or developing new information Decision-making required level 6 - Decisions regarding what needs to be done include largely undefined issues and elements and require extensive probing and analysis to determine the nature and the scope of the problems as the work requires continuing efforts to establish concepts, theories, or programs, or to resolve unyielding problems Mental Work load - Time Load, Mental Effort Load and Psychological Stress Load experienced by nursing personnel while working on a unit/service. Estimate the percent distribution of Time Load, Mental Effort Load and Psychological Stress Load experience by nursing personnel on the unit/service Time Load - The total amount of time available to nursing personnel on a unit/service to accomplish a task as well as overlap of tasks or parts of tasks Time load level 1 - Often have spare time. Interruptions or overlap among activities occur infrequently or not at all Time load level 2 - Occasionally have spare time. Interruptions or overlap among activities occur frequently.

63 63 LOINC Coding Time load level 3 - Almost never have spare time. Interruptions or overlap among activities are frequent or occur all the time Mental Effort - The amount of attention or concentration that is required to perform a task Mental effort load level 1 - Very little conscious mental effort or concentration required. Activity is almost automatic, requiring little or no attention Mental effort load level 2 - Moderate conscious mental effort or concentration required. Complexity of activity is moderately high due to uncertainty, unpredictability, or unfamiliarity. Considerable attention required Mental effort load level 3 - Extensive mental effort and concentration are necessary. Very complex activity requiring total attention Psychological Stress Load - The presence of confusion, frustration, and/or anxiety associated with task performance Psychological stress load level 1 - Little confusion, risk, frustration, or anxiety exists and can be easily accommodated Psychological stress load level 2 - Moderate stress due to confusion, frustration, or anxiety noticeably adds to workload. Significant compensation is required to maintain adequate performance Psychological stress load level 3 - High to very intense stress due to confusion, frustration, or anxiety. High to extreme determination and self-control required. LOINC Code NMMDS Component Data Type NMMDS Code Clinical knowledge, decision making, and 20 mental workload panel [NMMDS]

64 Type of nursing provider [NMMDS] Knowledge required level [NMMDS] Nursing staff.knowledge required level/ % Nursing staff [NMMDS] Decision making required level [NMMDS] Nursing staff.decision making required % level/nursing staff [NMMDS] Workload dimensions panel [NMMDS] Time load level [NMMDS] Nursing staff.time load level/nursing staff % [NMMDS] Mental effort load level [NMMDS] Nursing staff.mental effort load level/ % Nursing staff [NMMDS] Psychological stress load level [NMMDS] Nursing staff.psychological stress load level/ Nursing staff [NMMDS] % LOINC Answer List Type of nursing provider [NMMDS] Normative List LL767-5 Sequence # NMMDS Component Answer ID NMMDS Code 1 APN LA RN LA LPN/ LVN LA UAP LA Total nursing personnel LA Knowledge required level [NMMDS] Normative list LL Sequence # NMMDS Component Answer ID NMMDS Code 1 Knowledge required Level 1 LA Knowledge required Level 2-1 LA Knowledge required Level 2-2 LA Knowledge required Level 3-1 LA Knowledge required Level 3-2 LA Knowledge required Level 4-1 LA Knowledge required Level 4-2 LA Knowledge required Level 5 LA Knowledge required Level 6 LA Knowledge required Level 7 LA Knowledge required Level 8 LA Knowledge required Level 9 LA

65 Decision making required level [NMMDS] Normative list LL Sequence # NMMDS Component Answer ID NMMDS Code 1 Decision-making required level 1 LA Decision-making required level 2 LA Decision-making required level 3 LA Decision-making required level 4 LA Decision-making required level 5 LA Decision-making required level 6 LA Time load level [NMMDS] Normative list LL Sequence # NMMDS Component Answer ID NMMDS Code 1 Time load level 1 LA Time load level 2 LA Time load level 3 LA Mental effort load level [NMMDS] Normative list LL Sequence # NMMDS Component Answer ID NMMDS Code 1 Mental effort load level 1 LA Mental effort load level 2 LA Mental effort load level 3 LA Psychological stress load level [NMMDS] Normative list LL Sequence # NMMDS Component Answer ID NMMDS Code 1 Psychological stress load level 1 LA Psychological stress load level 2 LA Psychological stress load level 3 LA Environmental Conditions Environmental condition is an external condition of having many diverse interrelated and interdependent components linked through many interconnections. Environmental factors include cultural, psychosocial, and physical factors which impact the immediate work environment. To address environmental conditions, a survey should be created for nursing staff on the unit to rate the perceived amount of cultural, psychosocial, and physical factors within the nursing delivery unit/service

66 LOINC Coding Cultural Factors - Cultural factors are factors that create an atmosphere that is non-collegial and non-professional. Examples are decreased loyalty to the institution by coworkers, decreased unit cohesiveness, lack of trust and respect, the presence of time clocks, and the lack of perquisites equal to physicians, such as a nurses lounge Cultural Factors Frequency Psychosocial Factors - Episodes in which nurses have experienced verbal assaults, physical violence, and/or feelings of conflict or friction with coworkers, particularly physicians Psychosocial Factors Frequency Physical Factors - Actual physical surroundings in which nurses work. Examples are the multiple stimuli that affect concentration, or the lack of any space that is quiet, or the lack of room to do the work small tight spaces with many people Physical Factors Frequency LOINC Code NMMDS Component Answer ID NMMDS Code NMMDS environmental condition panel Total number of staff completing the # environmental conditions survey [NMMDS] To what extent do you agree or disagree with LL cultural factors contributing to the phenomenon of complexity? Within the last month, how often have you LL experienced cultural factors? To what extent do you agree or disagree with LL psychosocial factors contributing to the phenomenon of complexity? Within the last month, how often have you LL experienced psychosocial factors? To what extent do you agree or disagree with LL physical factors contributing to the phenomenon of complexity? Within the last month, how often have you experienced physical factors? LL

67 67 LOINC Answer List Normative answer list LL2995-0, LL Sequence # NMMDS Component Answer ID NMMDS Code 1 Strongly disagree LA Disagree LA Somewhat disagree LA Somewhat agree LA Agree LA Strongly agree LA Normative answer list LL Sequence # NMMDS Component Answer ID NMMDS Code 1 Rarely/Never LA Sometimes LA Often LA Almost always/always LA Electronic Health Record (EHR) Implementation Stages Stage representing the highest level of implementation of an EHR for the nursing unit or service 58. The information to answer this question would be collected by talking with the health IT staff in the organization. The NMMDS is unit or service line information. It may be that a single solution applied to an entire facility or it may be that the answer varies by unit or service line. Complete the information for a unit or service line by selecting the highest stage of EHR implementation Stage 0 - All three ancillaries not installed (laboratory, pharmacy, and radiology) Stage 1 - Ancillaries - Lab, Rad, and Pharmacy - all installed Stage 2 - Clinical Data Repository (CDR), Controlled Medical Vocabulary, Clinical Decision Support (CDS), may have Document Imaging; Health Information Exchange (HIE) capable Stage 3 - Nursing/clinical documentation (flow sheets), CDSS (error checking), Picture Archive and Communication Systems (PACS) available outside Radiology

68 Stage 4 - Computerized Practitioner Order Entry (CPOE), Clinical Decision Support (clinical protocols) Stage 5 - The closed loop medication administration with bar coded unit dose medications environment is fully implemented Stage 6 - Physician documentation (structured templates), full CDSS (variance & compliance), full Radiology-PACS Stage 7 - Complete EMR; CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP LOINC Coding LOINC Code NMMDS Component Answer ID NMMDS Code Electronic health record implementation stage Panel 22 panel Electronic health record implementation stage Electronic Health Record (EHR) Implementation Stage [NMMDS] - LOINC Answer List Normative answer list LL Sequence # NMMDS Component Answer ID NMMDS code 1 Stage 0 - All three ancillaries not installed LA (laboratory, pharmacy, and radiology) 3 2 Stage 1 - Ancillaries - Lab, Rad, Pharmacy - all LA installed 1 3 Stage 2 - Clinical Data Repository (CDR), Controlled Medical Vocabulary, Clinical Decision Support (CDS), may have Document Imaging; Health Information Exchange (HIE) capable LA Stage 3 - Nursing/clinical documentation (flow sheets), CDSS (error checking), Picture Archive and Communication Systems (PACS) available outside Radiology 5 Stage 4 - Computerized Practitioner Order Entry (CPOE), Clinical Decision Support (clinical protocols) 6 Stage 5 - The closed loop medication administration with bar coded unit dose medications environment is fully implemented LA LA LA

69 69 7 Stage 6 - Physician documentation (structured templates), full CDSS (variance & compliance), full Radiology-PACS 8 Stage 7 - Complete EMR; CCD transactions to share data; Data warehousing; Data continuity with ED, ambulatory, OP LA LA

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75 75 APPENDIX A The Nursing Management Minimum Data Set Survey THE NURSING MANAGEMENT MINIMUM DATA SET SURVEY DHuber & CDelaney2005 FINANCIAL RESOURCES These NMMDS data elements were not updated with the updates. 15 Payer Type 15.1 Total Health System (if applicable) Refer to Volume of Nursing Delivery Unit/Service (Item 03). Calculate the percentage of total service effort by each of the following payer types for each encounter type identified for the total health system. Payer Type Hours Days Visits Procedures Consults Contacts Programs Classes Enrollees Government Medicare Medicaid Public Health Service (PHS) PHS-Indian

76 Military Health System (TRICARE) Dept. of Justice State Employer State Health Service Non-government Health Maintenance Organization (HMO) Preferred Provider Organization (PPO) Discount Fee-for- Service Commercial Insurance Workers Compensation

77 Industrial Trust Accounts Self Pay Indigent Charity Multi-Method Non-patient Revenue Generation 15.14

78 Total Organization Refer to Volume of Nursing Delivery Unit/Service (Item 03). Calculate the percentage of total service effort by each of the following payer types for each encounter type identified for the total organization. Payer Type Hours Days Visits Procedures Consults Contacts Programs Classes Enrollees Government Medicare Medicaid Public Health Service (PHS) PHS-Indian Military Health System (TRICARE) Dept. of Justice State Employer State Health Service

79 79 Non-government Health Maintenance Organization (HMO) Preferred Provider Organization (PPO) Discount Fee-for- Service Commercial Insurance Workers Compensation Industrial Trust Accounts Self Pay Indigent Charity

80 Multi-Method Non-patient Revenue Generation 15.24

81 Total Nursing Department Refer to Volume of Nursing Delivery Unit/Service (Item 03). Calculate the percentage of total service effort by each of the following payer types for each encounter type identified for the total nursing department. Payer Type Hours Days Visits Procedures Consults Contacts Programs Classes Enrollees Government Medicare Medicaid Public Health Service (PHS) PHS-Indian Military Health System (TRICARE) Dept. of Justice State Employer State Health Service

82 Non-government Health Maintenance Organization (HMO) Preferred Provider Organization (PPO) Discount Fee-for- Service Commercial Insurance Workers Compensation Industrial Trust Accounts Self Pay Indigent

83 83 Charity Multi-Method Non-patient Revenue Generation 15.34

84 Nursing Delivery Unit/Service Refer to Volume of Nursing Delivery Unit/Service (Item 03). Calculate the percentage of total service effort by each of the following payer types for each encounter type identified for the nursing delivery unit/service. Payer Type Hours Days Visits Procedures Consults Contacts Programs Classes Enrollees Government Medicare Medicaid Public Health Service (PHS) PHS-Indian Military Health System (TRICARE) Dept. of Justice State Employer State Health Service

85 Non-government Health Maintenance Organization (HMO) Preferred Provider Organization (PPO) Discount Fee-for- Service Commercial Insurance Workers Compensation Industrial Trust Accounts Self Pay Indigent

86 86 Charity Multi-Method Non-patient Revenue Generation 15.44

87 87 16 Reimbursement 16.1 Total Health System (if applicable) Identify the percentage distribution of reimbursement received for the total health system. Payment Basis % Services Delivered % Revenue Fee for service Discounted fee for service Per diem Diagnosis Related Group (DRG) All Payer Group (APG) Per visit Per member/month Total Organization Identify the percentage distribution of reimbursement received for the total organization.

88 88 Payment Basis % Services Delivered % Revenue Fee for service Discounted fee for service Per diem Diagnosis Related Group (DRG) All Payer Group (APG) Per visit Per member/month 16.27

89 Total Nursing Department Identify the percentage distribution of reimbursement received for the total nursing department. Payment Basis % Services Delivered % Revenue Fee for service Discounted fee for service Per diem Diagnosis Related Group (DRG) All Payer Group (APG) Per visit Per member/month Nursing Delivery Unit/Service Identify the percentage distribution of reimbursement received for the nursing delivery unit/service.

90 90 Payment Basis % Services Delivered % Revenue Fee for service Discounted fee for service Per diem Diagnosis Related Group (DRG) All Payer Group (APG) Per visit Per member/month 16.47

91 91 17 Nursing Delivery Unit/Service Budget 17.1 Costs Organization - Health System (if applicable) Identify the planned and actual organizational budget figures as a percentage of the health system s annual itemized budget. Organization Costs Wages (hours) Salaries per year Benefits Depreciation Supplies Other operating expenses System s Planned Budget System s Actual Budget

92 Nursing Department - Organization Identify the planned and actual nursing department budget figures as a percentage of the organization s annual itemized budget. Nursing Department Costs Wages (hours) Salaries per year Benefits Depreciation Supplies Other operating expenses Organization s Planned Budget Organization s Actual Budget

93 Nursing Delivery Unit/Service - Nursing Department Identify the planned and actual nursing delivery unit/service budget figures as a percentage of the nursing department s annual itemized budget. Nursing Delivery Unit/Service Costs Wages Salaries Benefits Depreciation Supplies Other operating expenses Nursing Department s Planned Budget Nursing Department s Actual Budget

94 Revenues Organization - Health System (if applicable) Identify the planned and actual organizational revenue as a percentage of the health system s annual revenues. Organization Revenue Revenue System s Planned Budget System s Actual Budget Nursing Department - Organization Identify the planned and actual nursing department revenue as a percentage of the organization s annual revenues. Nursing Department Revenue Revenue Organization s Planned Budget Organization s Actual Budget Nursing Delivery Unit/Service - Nursing Department

95 95 Identify the planned and actual nursing delivery unit/service revenue as a percentage of the nursing department s annual revenues. Nursing Delivery Unit/Service Revenue Revenue Nursing Department s Planned Budget Nursing Department s Actual Budget

96 96 18 Expenses 18.1 Organization Health System (if applicable) Identify the following expenses of the total organization as a percentage of the health system s total expenses for the reporting year. Measures Percent of total expenses Direct: Sum of labor costs directly attributable to a unit of service including wages, benefits, travel, recruitment, education per year Direct material: Sum of material costs, including patient/client supplies used to provide the unit of service per year Indirect: Capital; equipment; an expense depreciated over time; administration; labor expenses shared by more than one nursing unit/service; clinical program development; expenses for future development per year Nursing Department - Organization

97 97 Identify the following expenses of the total nursing department as a percentage of the organization s total expenses for the reporting year. Measures Percent of total expenses Direct: Sum of labor costs directly attributable to a unit of service including wages, benefits, travel, recruitment, education per year Direct material: Sum of material costs, including patient/client supplies used to provide the unit of service per year Indirect: Capital; equipment; an expense depreciated over time; administration; labor expenses shared by more than one nursing unit/service; clinical program development; expenses for future development per year

98 Nursing Delivery Unit/Service - Nursing Department Identify the following expenses of the nursing delivery unit/service as a percentage of the nursing department s total expenses for the reporting year. Measures Percent of total expenses Direct: Sum of labor costs directly attributable to a unit of service including wages, benefits, travel, recruitment, education per year Direct material: Sum of material costs, including patient/client supplies used to provide the unit of service per year Indirect: Capital; equipment; an expense depreciated over time; administration; labor expenses shared by more than one nursing unit/service; clinical program development; expenses for future development per year

99 99 APPENDIX B - Publications - NMMDS Articles Published Delaney CW, Huber D, (eds.). A Nursing Management Minimum. Data Set (NMMDS): A Report of an Invitational Conference. Chicago, IL: The American Organization of Nurse, Delaney C, Reed D, and Clarke, M. (2000). Describing patient problems & nursing treatment patterns using nursing minimum data sets (NMDS & NMMDS) & UHDDS repositories. Proceedings of AMIA - Annual Symposium. AMIA Symposium 2000; pp Delaney C. Significance of the nursing minimum dataset for decision support in acute care. In: Mills MEC, Romano CA, Heller BR, editors. Information management in nursing and health care. Springhouse, PA: Springhouse; 1996; pp Huber D, and Delaney CW. The Nursing Management Minimum Data Set (NMMDS): Data Elements. Unpublished manuscript, Huber D, Schumacher L, and Delaney C. Nursing Management Minimum Data Set (NMMDS). Journal of Nursing Administration 1997: 27(4): Huber D, Delaney C. The American Organization of Nurse Executives (AONE) research column. The Nursing Management Minimum Data Set. Appl Nurs Res 1997: 10(3): Jones J, Newsom ET, and Delaney C. Use of nursing management minimum data set (nmmds) for a focused information retrieval. San Diego: CA ed., Kunkel DE, Westra BL, Hart CM, Subramanian A, Kenny S, and Delaney CW. Updating and normalization of the nursing management minimum data set element 6: Patient/client accessibility. CIN - Computers Informatics Nursing 2012: 30(3), Subramanian A, Westra BL, Matney SA, Wilson PS, Delaney C, Huff SM, and Huber DL. Integrating the nursing management minimum data set into the Logical Observation Identifier Names and Codes system. Proceedings of AMIA - Annual Symposium. AMIA Symposium 2008; pp Westra B, Subramanian A, Hart C, Matney S, Wilson P, Huff S, et al. Achieving "Meaningful Use" of Electronic Health Records Through the Integration of the Nursing Management Minimum Data Set. Journal of Nursing Administration 2010: 40(7/8):